Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Robert Marshall

Second Advisor

Dr. Patrick Kitzman


Background: Aphasia is an acquired language disorder, usually due to stroke, that affects the social functioning and the quality of life of the person with aphasia as well as the quality of life of his or her family and caregivers. Traditional aphasia therapy has tended to focus on decontextualized tasks and discrete elements of language functioning. The Life Participation Approach to Aphasia (LPAA) focuses on the collaborative nature of communication and addresses communication within personally relevant contexts. Joint decision-making is one type of social interaction that occurs frequently between married couples and has received considerable attention in the literature. To date, no study has investigated how married couples affected by aphasia collaboratively make decisions.

Aim: The present study aims to provide foundational information on joint decision-making by married couples affected by aphasia.

Methods and Procedures: Fourteen married couples in which one of the spouses had aphasia volunteered to participate in the study. A variety of assessment measures were administered to the participants with aphasia to characterize their speech and language deficits and all participants were administered a non-verbal reasoning test and a marital quality scale. The primary task of interest in this study involved a joint decision-making activity in which spouses were read two hypothetical ‘survival-type’ scenarios and were given a list of items for each scenario. The spouses were instructed to decide on six items and then rank their selected items in order of importance in terms of their value in helping them survive the scenarios. Participants’ interactions were audio- and video-recorded, and their verbal communication transcribed verbatim. The participants’ communicative interactions were coded for speech functions and analyzed by comparing differences in communication behaviors between the spouses with and without aphasia.

Results: Findings showed that participants with and without aphasia utilized a variety of speech functions but that the participants with aphasia made far fewer attempts to persuade their spouse to agree with them and that the spouses without aphasia tended to dominate the interaction, resulting in an imbalance of power in the decision-making process. Despite the differences in communication behaviors, both groups of spouses were supportive of the ideas suggested by their significant other and conflicts were typically resolved quickly.

Conclusion: Findings from this study revealed potential discrepancies in the balance of power between the spouses with and without aphasia in decision-making communication. Suggestions are provided for tailoring interventions and guiding future research in joint decision-making in couples affected by aphasia.

Digital Object Identifier (DOI)