PSYU3344 Week 8 Aphasia PDF

PSYU3344: Aphasia and acquired communication disorders ASSOCIATE PROF. SCOTT BARNES (PHD, MSPAA, CPSP) PSYU3344 Week 8 APHASIA AND ACQUIRED COMMUNICATION DISORDERS 1. What is aphasia? 2. Aphasia syndromes...

PSYU3344: Aphasia and acquired communication disorders ASSOCIATE PROF. SCOTT BARNES (PHD, MSPAA, CPSP) PSYU3344 Week 8 APHASIA AND ACQUIRED COMMUNICATION DISORDERS 1. What is aphasia? 2. Aphasia syndromes 3. Stages of recovery and aligned speech pathology practice 4. Constraints and influences on practice FMHHS | DEPARTMENT OF LINGUISTICS 2 What is aphasia? FACTS AND FIGURES What is aphasia? DEFINITION AND TERMS Aphasia is an acquired, selective impairment of language processing caused by brain damage, resulting in a multimodal communication disability affecting everyday life A variety of terms have been used for this condition over the course of its modern history dysphasia apraxia aphemia anarthria Aphasia dysarthria dyspraxia apoplexy ‘Aphasia’ is now the most commonly accepted in research and practice You may still sometimes hear ‘dysphasia’, but it is a little dated McNeil and Pratt (2001); Worrall et al. (2016) FMHHS | DEPARTMENT OF LINGUISTICS 4 What is aphasia? DEFINITION AND TERMS Aphasia is an acquired, selective impairment of language processing caused by brain damage, resulting in a multimodal communication disability affecting everyday life Why might “aphasic” (n.) be problematic? Why is having a consensus term important? McNeil and Pratt (2001); Worrall et al. (2016) FMHHS | DEPARTMENT OF LINGUISTICS 5 What is aphasia? DEFINITION AND TERMS Aphasia is an acquired, selective impairment of language processing caused by brain damage, resulting in a multimodal communication disability affecting everyday life The way you define aphasia speaks to what you consider to be important about it Brain injury vs. language disorder Health condition vs. communication disability Professional practice requires a command of multiple perspectives on aphasia This is because of the range of contexts via which speech pathology services are delivered, and the evolving nature of its effects on people with aphasia and their life-worlds McNeil and Pratt (2001); Worrall et al. (2016) FMHHS | DEPARTMENT OF LINGUISTICS 6 What is aphasia? DIFFERENTIAL DIAGNOSIS Diagnostic process Practice parameters Aetiology Practice scope Clinical purpose Service Expertise Presentation context FMHHS | DEPARTMENT OF LINGUISTICS 7 What is aphasia? DIFFERENTIAL DIAGNOSIS Onset Impacts Context Persisting Speech Community Progressive Language Hospital Sudden Cognition Long-term Communication residential FMHHS | DEPARTMENT OF LINGUISTICS 8 What is aphasia? DIFFERENTIAL DIAGNOSIS Proximal Distal O, I, C explanations explanations Persisting DLD ADHD Language Autism Ment. health Communication Cult. diff. cond. Community Demo. diff. FMHHS | DEPARTMENT OF LINGUISTICS 9 What is aphasia? DIFFERENTIAL DIAGNOSIS Proximal Distal O, I, C explanations explanations Progressive Dementia Depression Speech Primary Schizophrenia Language Progressive Abuse disorder Cognition Aphasia Communication Motor Neurone Disease Community Parkinsons Disease FMHHS | DEPARTMENT OF LINGUISTICS 10 What is aphasia? DIFFERENTIAL DIAGNOSIS Proximal Distal O, I, C explanations explanations Sudden Aphasia Agnosia Speech Dysarthria Amnesia Language Apraxia of Psychiatric Cognition speech condition Communication Cognitive Hospital comm. disorder FMHHS | DEPARTMENT OF LINGUISTICS 11 What is aphasia? DIFFERENTIAL DIAGNOSIS Diagnostic process Focus questions Aetiology Presentation Expertise Aetiology Stroke Orientation Aphasia TBI Intelligibility Dysarthria Affected brain Understandability Apraxia of speech structures Relevance RH Disorder LH vs. RH Appropriateness TBI Cog. Comm. Comorbidity Affect Co-occurrence Condition outside scope of practice Expertise Presentation FMHHS | DEPARTMENT OF LINGUISTICS 12 What is aphasia? DIFFERENTIAL DIAGNOSIS We’ll watch some videos here! FMHHS | DEPARTMENT OF LINGUISTICS 13 What is aphasia? DIFFERENTIAL DIAGNOSIS Diagnostic process Focus questions Aetiology Presentation Expertise Aetiology Stroke Orientation Aphasia TBI Comprehension Dysarthria Affected brain Intelligibility Apraxia of speech structures Understandability RH Disorder LH vs. RH Relevance TBI Cog. Comm. Comorbidity Appropriateness Co-occurrence Affect Condition outside scope of practice Expertise Presentation FMHHS | DEPARTMENT OF LINGUISTICS 14 What is aphasia? PREVALENCE AND INCIDENCE Around a third of people who experience a stroke will develop aphasia May be as low as 25% or as high as 40% Aphasia is associated with increased mortality, higher rehabilitation costs, more frequent depression, and poorer functional outcomes Aphasia severity decreases over time for most people Put another way, aphasia is most severe at onset (following stroke) Aphasia will persist for 50-60% of people who present with it at onset On the other hand, the remainder will see substantial recovery Some studies suggest that fewer than 25% will see complete recovery Pederson et al. (2004); Flowers et al., (2016) FMHHS | DEPARTMENT OF LINGUISTICS 15 What is aphasia? PREVALENCE AND INCIDENCE There are around 50,000 new strokes in Australia per year The complexities of stroke and aphasia (together and separately) make precise prevalence numbers difficult to compile Aphasia advocacy groups have estimated there are around 80,000 people with aphasia in Australia Equivalent groups have estimated there are 1,000,000 people with aphasia in the US An ageing population and improved survival rates for stroke are likely to see these numbers rise Code and Petheram (2011) FMHHS | DEPARTMENT OF LINGUISTICS 16 What is aphasia? AETIOLOGY AND COMORBIDITY Aphasia is caused by damage to the areas of the brain supporting language processing Strongly lateralised to the left hemisphere of the cerebral cortex in almost all people Left-handers are more likely to have right-lateralised or more bilaterally-represented language, but still very uncommon Stroke is the most common cause of aphasia because it disrupts the blood supply to cells in the brain Ischaemic vs. haemorrhagic Aphasia can also be caused by traumatic injuries, tumours, infections, and degenerative conditions Some terms to keep in mind: thrombus, embolus, infarction, ischaemic penumbra, perilesional areas, diaschisis, hemiplegia, hemiparesis, hemianopia, perisylvian regions FMHHS | DEPARTMENT OF LINGUISTICS 17 Source: Friederici (2011) 18 Source: Friederici (2011) 19 Source: Federenko et al. (2024) 20 Source: Federenko et al. (2024) 21 Blue = phonology; Red = semantics; Green= syntax Source: Vigneau et al. (2006) 22 What is aphasia? AETIOLOGY AND COMORBIDITY Haemorrhagic strokes are more likely to cause death than ischaemic strokes Those who survive tend to have better outcomes than survivors of ischaemic strokes Haemorrhages caused by AVMs often affect younger, otherwise healthy people The majority (i.e., more than 50%) of people with aphasia will experience milder symptoms Around 20% will be younger than 65 Motor impairments are likely to occur alongside aphasia This is particularly the case for ischaemic strokes generating expressive aphasia symptoms; it is less likely when aphasia symptoms are more receptive and lesions are more posterior Around 60% of people experiencing stroke will present with aphasia, dysarthria, and/or dysphagia Dysarthria and dysphagia are both more common following stroke than aphasia, and often co-occur A small number of people (i.e., around 10%) will have all three conditions 20-30% of people with communication impairments following stroke will experience both aphasia and dysarthria This is more common than aphasia alone and dysarthria alone People with this profile often present with significant aphasia and dysarthria Mitchell et al. (2020); Flowers et al. (2013); Law et al. (2009); Croquelois and Bogousslavsky (2011) FMHHS | DEPARTMENT OF LINGUISTICS 23 What is aphasia? RECOVERY Tissue re-profusion is the primary mechanism for recovery in the days and weeks post-onset This is accomplished via brain-internal processes and facilitative medical intervention Spontaneous recovery (i.e., natural improvement in aphasia symptoms without intervention) may persist for many months post- onset (e.g., 3-6 months) but seems to be greatest around 1 month. The strongest predictors of recovery from aphasia are lesion volume and integrity of perilesional areas Factors including age, gender, handedness, stroke type, and aphasia type have not been comprehensively demonstrated to influence the degree of recovery Successful recruitment of right hemisphere homologue regions may be important for recovery, particularly in the subacute phase The interaction between brain-internal processes and behavioural intervention is not well understood It requires continued exploration via the systematic application of the principles of neuroplasticity, functional neuroimaging, and non-invasive brain stimulation At later stages of recovery, improvements in aphasia as a result of intervention tend to be more modest, but there is clear evidence that people with chronic aphasia can improve language functioning Hillis and Heidler (2002); Stockert et al. (2016); Brady et al. (2020) FMHHS | DEPARTMENT OF LINGUISTICS 24 What is aphasia? HILLIS AND HEIDLER (2002) FMHHS | DEPARTMENT OF LINGUISTICS 25 What is aphasia? LIFELONG EFFECTS Aphasia has pervasive and multifaceted impacts on life, including identity, overall health, personal relationships, and participation in society People with aphasia are much more likely to experience depression following stroke Depression can also have a substantial impact on the success of rehabilitation, multiplying the effects of aphasia People with aphasia of working age are less likely to return to paid employment 28% of people with aphasia return to work vs. 45% of those with stroke in the absence of aphasia If they do return, it tends to be in a modified capacity, or in a different role altogether People with aphasia have fewer social contacts and reduced social networks, placing them at risk for isolation Aphasia can transform the relationships between people with aphasia and their significant others, introducing forms of dependency that were not present prior to the stroke There is some evidence that aphasia is among the health conditions that have the largest negative impact on quality of life Lam and Wodchis (2010) explored health-related quality of life for people residing in long-term high needs care Aphasia was more impactful than cancer, dementia, and conditions severely affecting motor functioning Worrall et al. (2016); Kauhanen et al. (2000); Dalemans et al. (2008); Ross Graham et al. (2011); Shadden (2005); Lam and Wodchis (2010); Northcott et al. (2016) FMHHS | DEPARTMENT OF LINGUISTICS 26 What is aphasia? KAUHANEN ET AL. (2000) FMHHS | DEPARTMENT OF LINGUISTICS 27 What is aphasia? PUBLIC KNOWLEDGE AND ADVOCACY There are a similar number of people with aphasia as there are people with Parkinson’s Disease Public awareness and knowledge of aphasia is poor in general, and compared to Parkinson’s Disease When removing health professionals from the sample, knowledge of aphasia is effectively absent Robust and effective service provision requires substantial resourcing which is, ultimately, determined by political processes If public knowledge and awareness is poor to non-existent, this fundamentally undermines efforts to advocate for aphasia services that are commensurate with its impacts on the lives of people with aphasia and their significant others. Code and Petheram (2011); McCann et al. (2012); Worrall et al. (2016) FMHHS | DEPARTMENT OF LINGUISTICS 28 Activity APHASIA AND ASSOCIATED CONDITIONS AND OUTCOMES Best case Worst case What would be a good outcome for a person with What would be a poor outcome for a person with aphasia, and how likely is it? aphasia, and how likely is it? What percentage of people will present with aphasia What percentage of people will not have a complete following stroke, but then recover? recovery from aphasia? What percentage of people will have aphasia only What percentage of people will have aphasia, following stroke? dysarthria, and dysphagia? What percentage of people with aphasia under 65 What percentage of people with aphasia under 65 years will return to work? years will NOT return to work? What percentage of people with aphasia will NOT What percentage of people with aphasia will experience depression at 12 months post-onset? experience depression at 12 months post-onset? FMHHS | DEPARTMENT OF LINGUISTICS 29 Aphasia syndromes WHAT’S THE DEAL WITH THEM? Aphasia syndromes WHAT’S THE DEAL WITH THEM? The roots of current aphasia syndromes are evident in the earliest stages of modern aphasiology Particularly the Wernicke-Lichtheim “classical connectionist model” This way of classifying aphasia fell out of favour, but was revived in the 1960s by Norman Geschwind His work effectively commenced the “Boston School”, which resulted in the development of the Boston Diagnostic Aphasia Examination (BDAE) This approach was also used by Andrew Kertesz in developing the Western Aphasia Battery (WAB) In this approach to aphasia, clusters of signs are grouped together to form a variety of aphasia types Clusters of signs form the syndromes, i.e., recurrent patterns of aphasia Syndromes are linked with lesion locations, which are inferable based on the nature and distribution of signs Many speech pathologists and other health professionals have a strong attachment to this approach to aphasia classification; so much so that it is rarely explicitly questioned Tesak and Code (2008); Ardila (2010) FMHHS | DEPARTMENT OF LINGUISTICS 31 Aphasia syndromes WHAT’S THE DEAL WITH THEM? Non-fluent types Global, Mixed Transcortical (Isolation), Broca’s, Transcortical Motor, Fluent types Wernicke’s, Transcortical Sensory, Conduction, Anomic Key ideas Non-fluent types result from anterior lesions, and motor impairments are more likely Fluent types result from posterior lesions, and motor impairments are less likely Transcortical types are characterised by (relatively) intact repetition Principally focused on cortical lesions and their effects Key terms Anomia = problems with word production Paraphasia = distortions of a targeted word; may be phonemic (“literal”) and semantic (“verbal”) Neologism = production of non-words; may fill much of a person’s utterances, i.e., “jargon” Agrammatism = morphosyntactic problems associated with non-fluent aphasia Paragrammatism = morphosyntactic problems associated with fluent aphasia Automatic speech = well-learned language patterns, e.g., counting, idioms, responsive talk FMHHS | DEPARTMENT OF LINGUISTICS 32 Aphasia syndromes SHEPPARD AND SEBASTIAN (2021) FMHHS | DEPARTMENT OF LINGUISTICS 33 Aphasia syndromes BDAE-3 AND WAB-R FMHHS | DEPARTMENT OF LINGUISTICS 34 Aphasia syndromes WHAT’S THE DEAL WITH THEM? There are a variety of critiques and criticisms that have been directed at the syndrome approach Syndromes and associated assessment procedures have little basis in theories of language processing In this approach, surface signs of aphasia that have different underlying causes are not differentiated Predictions about lesion location are inconsistent, at best It does not deal well with the heterogeneity and variability of aphasia People who receive the same classification may have quite different clinical presentations The fluency dimension has been resistant to systematic measurement Classification does not offer specific direction for intervention, and has a marginal influence on sound clinical assessment Marshall (2010); Clough and Gordon (2020); Sheppard and Sebastian (2021) FMHHS | DEPARTMENT OF LINGUISTICS 35 Aphasia syndromes THE BOTTOM LINE Aphasia syndromes have a long history in aphasiology and speech pathology practice They can be a useful shorthand / heuristic for characterising people with aphasia, and some people may fit the syndrome characteristics well This can facilitate communication between professionals familiar with aphasia Classification has political value and prestige, particularly in medical settings The syndrome categories are not particularly informative outcomes of assessment, and provide limited specific direction for intervention Some of the underlying premises of the system – particularly the relationship between lesion location and language abilities – are questionable, and are a fierce source of debate FMHHS | DEPARTMENT OF LINGUISTICS 36 Blue = phonology; Red = semantics; Green= syntax Source: Vigneau et al. (2006) 37 Current speech pathology practice WHAT IS DONE AT DIFFERENT STAGES OF RECOVERY? Concepts for practice: ICF OLD FAITHFUL FMHHS | DEPARTMENT OF LINGUISTICS 39 Concepts for practice: A-FROM LIVING WITH APHASIA: A FRAMEWORK FOR OUTCOME MEASUREMENT FMHHS | DEPARTMENT OF LINGUISTICS 40 Stages of recovery from aphasia HILLIS AND HEIDLER (2002) FMHHS | DEPARTMENT OF LINGUISTICS 41 Current speech pathology practice STAGES OF RECOVERY FROM APHASIA Acute Rehabilitation Community Speech pathologists: Speech pathologists: Speech pathologists: work alongside medical teams diagnose and describe aphasia assess aphasia and its effects on screen for and monitor aphasia provide intervention for aphasia communication and life diagnose aphasia assess and support provide or facilitate intervention for assess and support communication needs for aphasia communication needs for hospital discharge provide or facilitate training for counsel and educate people with counsel and educate people with routine communication partners aphasia and their significant aphasia and their significant provide or facilitate counselling others others people with aphasia and their educate and inform team contribute to case management significant others members about aphasia; as part of a team carry out case management advocate for people with aphasia discharge and refer to other support self-management services discharge and refer to other services FMHHS | DEPARTMENT OF LINGUISTICS 42 Current speech pathology practice ACUTE A medical approach to aphasia management predominates for all professionals at this stage Direct assessment activities tend to be more individualised (i.e., informal) With regard to language assessment, speech pathologists tend to use flexible assessment strategies that drawn on clinical expertise to make preliminary judgements about diagnosis, severity, and communicative efficacy There are also structured (i.e., formal) assessment strategies available, but they are used sparingly There are a variety of consultative activities that speech pathologists undertake in this setting People with aphasia receive counselling and information about their condition Team members may receive information and training about individuals or people with aphasia in general These activities may shade into, or actually become, advocacy for people with aphasia Establishing robust communication for people with aphasia – often using AAC – is also a priority This supports them to have important conversations with significant others and participate in medical care Substantial direct aphasia intervention is infrequent, even for those who are medically stable Rose et al. (2014); Foster et al. (2013); Foster et al. (2016) FMHHS | DEPARTMENT OF LINGUISTICS 43 Current speech pathology practice REHABILITATION A medical approach to aphasia management remains, but the prospect of leaving hospital looms Direct assessment activities tend to draw on structured strategies (i.e., formal; diagnostic and analytic) Language assessment is more extensive at this stage, supporting diagnosis and description of aphasia, monitoring of change, and goal-setting for impairment-focused intervention Communication assessment is directed towards activities of daily living and communicative effectiveness, particularly with a view to discharge from hospital to home or another context of care (e.g., further in-patient rehab, a nursing home) Team-based management is highly important for this setting (i.e., people with aphasia are likely to have multiple needs) Speech pathologists will routinely work with medical doctors, occupational therapists, physiotherapists, neuropsychologists, dieticians, and social workers People with aphasia and their families also have a stronger voice in this setting, with goal-setting increasingly personalised Family-based case conferences are a routine part of care Impairment-focused intervention is a high priority, as are interventions focused on discrete activities of daily living (ADLs) ADL-focused interventions are a key point for collaboration with other professionals When aphasia is the only or primary impairment resulting from stroke, there is often pressure to move people through this stage of care quickly, discharge them from hospital, return them home (where possible), and follow-up with them as an outpatient. Rose et al. (2014); Worrall & Sherratt (2017) (Ch6) FMHHS | DEPARTMENT OF LINGUISTICS 44 Current speech pathology practice COMMUNITY The focus shifts away from a medical model care to a more socially-oriented model of care Direct assessment mixes structured (i.e., formal) and individualised (i.e., informal) strategies Diagnostic and analytic language assessment is still employed to evaluate aphasia with a view to monitoring change and setting impairment focused goals, particularly if the person with aphasia is less than or around a year post-onset Assessment of communication and experiences begins to take precedence, with language assessment providing valuable context Speech pathologists often become a primary source of healthcare for people with aphasia This means that speech pathologists are often assisting people with aphasia with troubleshooting a variety of life needs, facilitating their access to other services, and advocating for their needs Communication partner training across a variety of contexts may can become prominent The intervention approaches employed are increasingly heterogenous in order to meet the life-demands and characteristics of different people with aphasia At this stage, speech pathologists are also seeking to support self-management of aphasia, reflecting its lifelong nature Although they feature at every stage of care, speech pathologist- and community-led aphasia groups are an important tool at this stage of recovery. Rose et al. (2014); Worrall & Sherratt (2017) (Ch6); Wray et al. (2020); Attard et al. (2018) FMHHS | DEPARTMENT OF LINGUISTICS 45 Current speech pathology practice WHAT DO PEOPLE WITH APHASIA WANT? People with aphasia express a strong desire for speech pathology services that foster hope In the earlier stages of recovery, people with aphasia report that active engagement in rehabilitation, positivity, accepting the need for adaptation, and support from family and friends are important mediators of successful living At later stages of recovery, similar themes are present, with an emphasis on engagement in meaningful social activities and communication People with aphasia tend to frame their objectives for rehabilitation in terms of specific aspects of their lives and social activity, i.e., in ICF terms, Activity This does not mean that all speech pathology goals need to be aligned with Activity; just that we need to have a strong understanding of the practical outcomes that will be meaningful for clients with aphasia People with aphasia have also expressed a desire to return to their pre-injury lifestyle and activities, to engage in a broader range of communicative activities, to gain more information about their condition, and to help others Worrall et al. (2011); Brown et al. (2012); Grohn et al. (2013) FMHHS | DEPARTMENT OF LINGUISTICS 46 Constraints and influences WHAT ARE THE REALITIES FOR PRACTICE? Caseloads in different practice contexts ROSE ET AL. (2014) FMHHS | DEPARTMENT OF LINGUISTICS 48 Constraints and influences on practice ACUTE The need to provide services to people with (or suspected of having) dysphagia has been recognised as a strong constraint on service provision to people with aphasia in acute care The complexity of the heavily medical acute care context can also make working with people with aphasia challenging This includes the lack of space and privacy, the dynamic and changing nature of work, and the culture and staff churn of the duration of a patient’s stay It is also clear that professionals find aphasia challenging and confronting, and may have negative experiences when attempting to communicate with people with aphasia See the Carragher et al. (2020) study below for some, at times, quite stomach-churning comments from professionals about their interactions with people with aphasia While medically unwell and distressed, people with aphasia may have limited ability to engage with the kinds of tasks that speech pathologists might want to carry out with them, including impairment-focused intervention Rose et al. (2014); Foster et al. (2013); Foster et al. (2016); Carragher et al. (2020); Simmons-Mackie et al. (2007) FMHHS | DEPARTMENT OF LINGUISTICS 49 Constraints and influences on practice ACUTE Some of the initiatives that have been put forward for improvements to aphasia care have limited evidence to support them Two key examples of this are initiatives to support very early intensive impairment-focused intervention and enhanced communicative environments for people with aphasia High quality studies are yet to distinguish benefits of very early intensive impairment- focused intervention from usual case, e.g., Godecke et al. (2021) The cultural changes required for changing communication with patients with aphasia may be difficult to comprehensively implement Early psychosocial support may well offer the best, most applicable approach to improving aphasia care in the acute setting This is because these activities are already a routine part of speech pathology practice, and is consistent with the needs of people with aphasia (see here for a description of just such an intervention). Rose et al. (2014); Foster et al. (2013); Foster et al. (2016); Carragher et al. (2020); Simmons-Mackie et al. (2007) FMHHS | DEPARTMENT OF LINGUISTICS 50 Constraints and influences on practice REHABILITATION The characteristics of aphasia can make it challenging to implement multifaceted, high dosage speech pathology intervention Service organisation and resourcing does not support every person with aphasia to receive high dosage speech pathology intervention Speech pathologists are then tasked with making decisions about who should receive services, at which time, and at which dosage and intensity At this stage of recovery, people with aphasia and their families are at a challenging juncture for their lives, and engaging demanding interventions amongst this uncertainty may not be feasible Rose et al. (2014); Worrall & Sherratt (2017) (Ch6) FMHHS | DEPARTMENT OF LINGUISTICS 51 Constraints and influences on practice Carragher et al. (2020): Aphasia disrupts usual care FMHHS | DEPARTMENT OF LINGUISTICS 52 Constraints and influences on practice Carragher et al. (2020): Aphasia disrupts usual care FMHHS | DEPARTMENT OF LINGUISTICS 53 Constraints and influences on practice Carragher et al. (2020): Aphasia disrupts usual care What could an enriched communicative environment involve? What are the principles that are relevant for its accomplishment? Are they necessarily specific to aphasia? FMHHS | DEPARTMENT OF LINGUISTICS 54 Constraints and influences on practice Carragher et al. (2020): Aphasia disrupts usual care What could an enriched communicative environment involve? What are the principles that are relevant for its accomplishment? Are they necessarily specific to aphasia? FMHHS | DEPARTMENT OF LINGUISTICS 55 Constraints and influences on practice COMMUNITY The chronicity and complexity of aphasia is not well recognised by healthcare systems Schemes like NDIS are more sensitive to the lifelong nature of disability, but reasonably few people with aphasia will qualify for it People with aphasia are at strong risk of isolation and disengagement with healthcare and society, which means that their needs in the community are very likely underestimated The multifaceted life-enablement approaches that are often promoted for this stage of recovery are principle- (and rhetoric!) heavy and theory- and evidence-light This constrains their ability to be applied at a service-level There is a need to make society more accessible for people with aphasia Speech pathologists have not traditionally worked with communities, and the means and mechanisms through which effective community-level approaches for aphasia might be implemented are yet to be conceived Rose et al. (2014); Worrall & Sherratt (2017) (Ch6) FMHHS | DEPARTMENT OF LINGUISTICS 56 PSYU3344 Week 8 APHASIA AND ACQUIRED COMMUNICATION DISORDERS 1. What is aphasia? 2. Aphasia syndromes 3. Stages of recovery and aligned speech pathology practice 4. Constraints and influences on practice FMHHS | DEPARTMENT OF LINGUISTICS 57