The merits of a case study approach in communication disorders

Blog post by Louise Cummings, Nottingham Trent University.

The case study has had something of a bad press in recent years. How often do we hear that they provide low-quality evidence of the effectiveness of an intervention in speech and language therapy? The emphasis on evidence-based practice in healthcare has seen the case study relegated to the bottom of the hierarchy of evidence. From this lowly position, the case study is seen to fall of scientific objectivity and rigour which are the hallmarks of other types of investigation, most notably systematic reviews and randomized controlled trials. The result is that researchers, teachers and practitioners in a wide range of disciplines feel almost duty-bound to preface their use of case studies with a health warning – these studies are of limited scientific value and should be treated as such. I have no intention of issuing health warnings or adopting an apologetic approach to the use of case studies. Indeed, I believe they offer immeasurable benefits in instructional and research contexts in communication disorders and elsewhere. These benefits are threefold.

First, case studies are the most effective way of introducing students of communication disorders to the key skill which all clinicians must possess, namely, clinical decision-making. Speech and language therapists must make decisions on a daily basis about how best to assess and treat their clients, when to terminate a course of therapy and refer clients to other medical and health professionals, and how to measure the outcomes of intervention. Of course, it is true that clinicians acquire and refine most of their skills of clinical decision-making ‘on the job’. But it is also possible to get a head start on this process by interrogating the basis of decisions that are taken in the management of actual clients. This is where the case study comes into its own. By exploring the basis of the full gamut of decisions which clinicians must make in relation to a client, students can begin to assimilate the very essence of this most elusive of clinical skills. The case study is not just the most effective, but the only, method by means of which this can be achieved.

Second, case studies provide an invaluable opportunity for students of communication disorders to put their skills of linguistic analysis into practice. The narrative produced by an adult with a traumatic brain injury or the conversational exchange between a client with aphasia and his or her spouse is the richest possible data on which to fine tune these skills. I will not be alone in lamenting the lack of such data in modern research articles in communication disorders, the emphasis of which is on the reporting of largely quantitative results in the shortest space possible. It is something of an irony that as electronic publications have surpassed print publications, in journals at least, the extended extracts of language often seen in older research papers have all but disappeared in more modern articles. If anything, an electronic format should make the inclusion of client narratives and conversational exchanges more, not less, likely to be published. There is simply nowhere for the student of communication disorders to get this practice other than through case studies.

Third, all medical and health professionals are encouraged to see the client first, and their medical condition or other disorder second. This is no less the case for speech and language therapists who must learn that aphasia, dysarthria and other communication disorders sit alongside an array of factors which can influence a client’s adjustment to communication disability. Case studies are the best context in which to appreciate the complex interplay that exists between communication disorders and these factors.

For all these reasons, I have championed a case study approach to communication disorders in my recent book Case Studies in Communication Disorders (Cambridge University Press, 2016). I urge other researchers, teachers and practitioners in speech and language therapy to do likewise.

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