Australian Aphasia Rehabilitation Pathway
Clinical Centre of Research Excellence in Aphasia Rehabilitation Working Group. (2014).
Brisbane (Australia): University of Queensland, Retrieved August 8, 2016 from http://www.aphasiapathway.com.au/.
These guidelines are part of an effort by the Australian research group Centre for Clinical Research Excellence in Aphasia Rehabilitation, which intended to provide a set of evidence-based practice statements for assessment and treatment of people with aphasia. While the best practice recommendations are intended to assist speech-language pathologists working in Australian healthcare systems, a number of the recommendations are relevant to aphasia rehabilitation in general.
Centre for Clinical Research Excellence in Aphasia Rehabilitation (Australia)
<div>Treatment should be provided for individuals from culturally and linguistically diverse populations in all relevant languages and modalities, if possible. Family and community roles of the person with aphasia should be discussed to help guide the clinician's interactions and management in session (Good Practice Point).</div>
<div>Individuals with aphasia and their families should be provided with information about stroke and aphasia, with supports and modifications consistent with the patient's current communication abilities and patient/family needs and preferences (Level I Evidence).</div>
<p>Assessment with individuals from culturally and linguistically diverse populations should include:</p>
<ul>
<li>collection of comprehensive information about the individual's language history, if he/she reports using more than one language premorbidly; and</li>
<li>use of assessments appropriate to the language/dialect and cultural background of the individual, if possible (Good Practice Point).</li>
</ul>
<div>When the speech pathologist is not proficient in the language of the person with aphasia, an interpreter who is trained, qualified, and knowledgeable about aphasia and speech pathology should be used (Level I Evidence).</div>
<p>During assessment, the following should be considered:</p>
<ul>
<li>continuous re-assessment should be integrated into therapy;</li>
<li>the clinician should explain, in an accessible format, the process of assessment and results to the person with aphasia and his/her family;</li>
<li>the clinician should help the person with aphasia and his/her family understand the links between assessment results and the the choice of therapy tasks and goals; and</li>
<li>assessment should be holistic (Good Practice Point).</li>
</ul>
<div>Individuals with aphasia one month post-onset "should have access to intensive aphasia rehabilitation if they can tolerate it" (Level I Evidence; p. 18, Comprehensive Supplement to the Australian Aphasia Rehabilitation Pathway). The evidence is slightly weaker supporting intensive aphasia rehabilitation for individuals less than one month post onset (Level II Evidence).</div>
<p>The following should be considered when establishing aphasia treatment goals:</p>
<ul>
<li>The goal-setting process should be explained to the person with aphasia/family in an accessible way (Good Practice Point).</li>
<li>Goals should be identified by the person with aphasia, his/her family, and the rehabilitation team (Good Practice Point).</li>
<li>Goals identified by the person with aphasia/family should take priority, while still considering assessment findings (Good Practice Point).</li>
</ul>
<div>Aphasia treatment should "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" (Level I Evidence; p. 19, Comprehensive Supplement to the Australian Aphasia Rehabilitation Pathway).</div>
<p>A number of treatments are recommended for individuals with aphasia, including those that target:</p>
<ul>
<li>aspects of language following cognitive neuropsychology models, especially for reading and writing deficits (Level I Evidence);</li>
<li>constraint-induced language therapy (Level I Evidence);</li>
<li>gesture-based therapy (Level III-2 Evidence);</li>
<li>sentence comprehension and production (Level III-3 Evidence);</li>
<li>discourse treatment (Level IV Evidence);</li>
<li>augmentative and alternative communication (Level IV Evidence);</li>
<li>word retrieval deficits, following cognitive neuropsychology models (Level IV Evidence); and</li>
<li>computer-based treatment (Level II Evidence).</li>
</ul>
<div>The speech pathologist should provide resources for the person with aphasia and his/her family for aphasia groups, support organizations, or connecting with other people with aphasia (Level I Evidence).</div>
<div>Hospital patients with suspected aphasia should be referred to a speech pathologist to ensure adequate ability to communicate healthcare needs (Level IV Evidence).</div>
<div>"People with aphasia and their families/carers should have access to a contact person for any queries post-discharge and know how to self-refer to appropriate speech pathology services after discharge if they feel further rehabilitation is required" (Good Practice Point; p. 37, Comprehensive Supplement to the Australian Aphasia Rehabilitation Pathway).</div>
<p>In addition to individual therapy by speech pathologists, treatment for aphasia may include:</p>
<ul>
<li>group therapy and conversation groups, and trained volunteers (Level I Evidence); and</li>
<li>telerehabilitation (Level IV Evidence).</li>
</ul>
<div>Individuals with suspected aphasia should be referred to a speech pathologist for assessment to determine presence and severity of aphasia, and should be ensured access to such services via appropriate promotion of speech-language pathology to potential referral sources (Good Practice Point).</div>
<div>Speech-language pathologists should provide education and training for other healthcare workers who care for people with aphasia in order to improve communication (Level I Evidence).</div>
<div>The primary communication partners of the person with aphasia should be provided with communication partner training (Level I Evidence).</div>
<div>Individuals with aphasia, including chronic aphasia, should be offered therapy addressing receptive and expressive language to improve communication in their everyday environments (Level I Evidence).</div>
<div>"Language behaviours unique to the bilingual person with aphasia such as translation, language mixing and switching should be considered in both assessment and intervention planning" (Level IV Evidence).</div>
<div>Every individual post-stroke should be screened for aphasia with an instrument that is valid, reliable, and able to detect aphasia (Good Practice Point).</div>
