Aphasia specialists at universities in Ohio, Pennsylvania, and Nebraska have collaborated on an article that reevaluates the role of Augmentative and Alternative Communication (AAC) in aphasia rehabilitation. The authors present their conclusions about how SLP clinicians working in aphasia rehabilitation should revise their views regarding how AAC tools, materials, methods, and applications can expand rehabilitation opportunities for persons with acquired aphasia and related disorders.
The article purposefully draws on multiple sources, of disparate types, to reframe understandings that may have been inherited from earlier times – e.g., that aphasia rehabilitation focuses on restorative therapeutic interventions, provided by SLPs working in outpatient settings, delivering services over the months following onset, typically with little or no incorporation of AAC. Recent years have shown these views to be too limiting. Broader understandings of the scope and nature of aphasia rehabilitation, coupled with new organizations involved in aphasia rehabilitation activities, and armed with new and more powerful technologies, have greatly altered the landscape. This article succinctly highlights important impacts of these changes.
The authors focus on four particular topics in their discussions. First, they discuss recent trends in AAC use in aphasia. They note that – in the approach of earlier decades – when AAC was employed, it was: (a) often focused on expressing basic needs; (b) limited to persons with the most severe impairments; (c) resorted to as a last resort. The observe, however, that “(r)ecent developments highlight the need for AAC to be better integrated into aphasia rehabilitation plans”. Second, they discuss the importance of more recent, holistic conceptual frameworks for thinking about aphasia rehabilitation. Living with Aphasia: a Framework for Outcome Measurement (A-FROM), for example, displays a Venn Diagram of overlapping circles representing: (a) language improvements; (b) participation in life situations; (c) environmental adaptations; and (d) personal identity and perceptions, with the goal being to make the adjustments that maximize benefits at the center, where the circles overlap. The Life Participation Approach to Aphasia (LPAA), in turn, works to identify, promulgate, and implement concrete steps that can help improve the lives PWA in practice. Third, the authors point to the new roles that advanced communication and rehabilitation technologies can play in these processes, improving therapy outcomes, to promoting self-cueing of speech, to supporting remote, multimodal communicative interactions. Finally, the authors argue that that AAC should be not only better integrated into aphasia rehabilitation, but also introduced earlier in the rehabilitation processes.
The authors have contributed a useful update. As they show, the old, limiting assumptions about AAC in aphasia rehabilitation have not disappeared entirely, but the shapes of their replacements are already taking the field.
For further reading: Aimee Dietz, Sarah E. Wallace, & Kristy Weissling. Revisiting the Role of Augmentative and Alternative Communication in Aphasia Rehabilitation. American Journal of Speech-Language Pathology. Vol. 29, No. 2, pp. 909-913. May 2020. https://doi.org/10.1044/2019_AJSLP-19-00041