Communication in context: A qualitative study of the experiences of individuals with multiple sclerosis

The purpose of this study was to examine an insider's perspective on commun ication in multiple sclerosis (MS), a disease of the central nervous system in which scattered lesions or plaques produce varying combinations of moto r, sensory, and/or cognitive impairments. Qualitative research methods were used because they are designed to provide a systematic way of exploring co mplex issues, such as communication, that cannot be separated from the cont ext in which they occur. Seven participants, all of whom had mild communica tion impairments, described their everyday experiences of communication and the impact of MS on these experiences. Themes derived via inductive analys is of verbatim transcripts included: watching the communication changes, it 's about participating in my life, and communicating is unpredictable. Usin g the World Health Organization model of disablement, the participants' com munication impairments were mild. However, participants reported major life style changes characterized by important limitations in communicative parti cipation. Whereas some of the limitations were attributed to changes in spe ech and language, others were thought to be the result of changes in cognit ion, vision, mobility, and susceptibility to fatigue. Clinical implications include the need to develop assessment protocols and outcome measures that capture issues related to communicative participation in natural contexts and participation in society.