Types of aphasia therapy

Aphasia rehabilitation should:

	Reference	NHMRC Level of evidence
Be tailored to the needs of the person with aphasia and the nature of their communication difficulty	Plowman, Hentz, & Ellis, 2012; Worrall et al., 2011;	Qual
Address the impact of aphasia on functional everyday activities, participation and quality of life including the impact upon relationships, vocation and leisure as appropriate from post-onset and over time for those chronically affected	Hilari, Needle, & Harrison, 2012	I
Address the needs of family/carers	Howe et al, 2012	Qual
Include information tailored to meet the needs of people with aphasia and their family/carers	Worrall et al., 2011	Qual
Include communication partner training	Simmons-Mackie et al., 2010	I

Rationale: People with aphasia report significantly worse health-related quality of life (QoL) than stroke survivors without aphasia, and worse QoL than healthy controls, particularly in the areas of independence, social relationships, and aspects of access to the environment (Hilari et al., 2012). While people with aphasia report prioritising communication goals in their overall rehabilitation process, they also emphasize social, relationship, leisure, and work goals, and the need for information tailored to their needs (L. Worrall et al., 2011).

Communication partner training was shown to be an effective approach for improving communication activities and/or participation of some communication partners and is probably effective in improving communication activities and/or participation of some persons with chronic aphasia when they are interacting with trained communication partners (Simmons-Mackie et al., 2010).

Communication partner training

STUDY: “Communication partner training in aphasia: A systematic review”. Simmons-Mackie, Raymer, Armstrong, Holland, Cherney (2010)

DETAILS: This systematic review study investigated the effects of communication partner training on persons with aphasia and their communication partners.  A total of 31 studies were included­ for review. While the majority of the studies used low quality study designs, two RCTs were included. 
The review suggests that skilled communication partners can facilitate and support the communication activities and participation of people with aphasia. Further research is required to be able to investigate the impact of partner training on persons with aphasia in the acute stage. Additionally, outcomes of language impairment, psychosocial adjustment and quality of life for both the person with aphasia and their communication partner requires further investigation.

The review provides the following tentative recommendations related to the clinical question of the study:

• Partner training is probably effective for improving communication activities and/or participation for people with chronic aphasia (even when these individuals are not included in the intervention) when communicating with a trained partner; thus, this approach should be considered for this population” (pp1833)
• “For the communication partners of people with aphasia, partner training appears to be an effective method of improving partner skill in supporting communication for people with aphasia” (pp1833)

OVERALL CONCLUSION: Results from this systematic review demonstrated that communication partner training is effective in improving communication participation of persons with chronic aphasia and that of their of trained communication partner.  

RESOURCES:

What resources can I access to assist with communication training?

1. Learn more about the Queensland Ambulance Service communication board
2. Supported Conversation for Adults with Aphasia (SCA) Kagan, A. Black, S. E., Duchan, F. J., Simmons-Mackie, N. & Square, P. (2001).
3. Learn more about Supported Conversation for Adults with Aphasia (SCA)
4. Read about AAC strategies for healthcare settings developed by Scope. This handout provides information on free resources, non-eletronic and electronic AAC devices that can be used in a healthcare setting to support communication. 
5. Download and display UK Connect's Ten Top tips for communicating with people with aphasia poster. 
6. Check out Supporting Partners of People with Aphasia in Relationships & Conversation (SPPARC) Lock, S. Wilkinson, R. & Bryan, K. (2008).  SPPARC is a resource specifically designed to provide clinically effective tools to work with people with aphasia and their communication partners.  The SPPARC manual consists of a manual, CD and DVD and provides practical resources to provide support and conversation training programs, conversation assessment and treatment materials and video extracts of everyday conversations which can be used as a resource.  
7. Keep an eye out for Connect's 'Health Talk' resource - a communication resource pack which is being developed to support conversations between patients and healthcare staff. 

Conversation therapy:

1. Better Conversations with Aphasia is a free e-learning resource to improve access to conversation therapy for speech and language therapists/pathologists (SLTs), and for people with aphasia (PWA) and their families.
   Visit the website to  learn how to do conversation therapy, have access to a complete therapy programme, interactive learning materials, and advice from experienced clinicians. This resource was developed by a project team at University College London. 

References:

1. Plowman, E., Hentz, B., & Ellis, C., Jr. (2012). Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice, 18(3), 689-694. doi: 10.1111/j.1365-2753.2011.01650.x
2. Worrall, L., Sherratt, S., Rogers, P., Howe, T., Hersh, D., Ferguson, A., & Davidson, B. (2011). What people with aphasia want: Their goals according to the ICF. Aphasiology, 25(3), 309-322. doi: 10.1080/02687038.2010.508530
3. Hilari, K., Needle, J. J., & Harrison, K. L. (2012). What are the important factors in health-related quality of life for people with aphasia? A systematic review. Archives of Physical Medicine and Rehabiliation, 93(1 Suppl), S86-95. doi: 10.1016/j.apmr.2011.05.028
4. Howe, T., Davidson, B., Worrall, L., Hersh, D., Ferguson, A., Sherratt, S., & Gilbert, J. (2012). 'You needed to rehab families as well': family members' own goals for aphasia rehabilitation. International Journal of Language & Communication Disorders, 47(5). doi: 10.1111/j.1460-6984.2012.00159.x
5. Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., & Cherney, L., R. (2010). Communication partner training in aphasia: a systematic review. Archives of Physical Medicine and Rehabiliation, 91(12), 1814-1837.