Intersections of literal and metaphorical voices in aphasia

Background: oVoiceo in the aphasia literature has come to include metaphorical meanings associated with social identity and inclusion. Concepts of metaphorical voice acknowledge communication as a primarily social act through which we construct our identities, prompting attention to how social practices can impact those identities, either supporting or silencing metaphorical voice. The impact of aphasia on literal voice, (i.e., the physical production of spoken language) is also acknowledged in the research literature, but the intersections of metaphorical and literal voice in aphasia have rarely been explicitly addressed. Aims: The aim of this paper is to foreground these intersections through a case study involving a novel application of the software program SentenceShaper (R), which can be used to facilitate construction of messages recorded in one's own voice. Methods Procedures: This qualitative case study describes a project involving a man with nonfluent aphasia and apraxia who worked with a graduate student clinician over several months using SentenceShaper (R) to record a specific text for a specific purpose. Interpretative description is used to analyse the process and product of their interactions, set within the philosophical framework of a social intervention model. Data sources include the recording itself, field notes, and written reflections on interaction. Outcomes Results: Findings show how literal voice is linked to identity, creating an authentic link between person and message. They also highlight ways in which a social approach to therapeutic interaction can support both literal and metaphorical voice. Finally, they illustrate the creativity with which a person with aphasia integrates components of a therapeutic process into a repertoire of tools to support communication. Conclusions: Literal and metaphorical voice are inextricably linked. Considering voice in both senses has the potential for identifying goals that might otherwise be overlooked.