An aphasia researcher from Chapman University’s Department of Communicative Sciences and Disorders, together with a colleague from Johns Hopkins University’s Department of Physical Medicine and Rehabilitation, have published an article that reviews changes in approaches to diagnosing aphasia over the past several decades, as well as the evolution which has taken place during that time regarding approaches to long-term aphasia management. Rather than presenting the results of original research, the authors draw selectively on published literature and expert opinion, presenting an interpretative synthesis as to how views on aphasia diagnosis and management have evolved, why, and what it may mean for the future.

The authors begin the section on aphasia diagnosis by discussing the classification system developed by Norman Geschwind, Frank Benson, Harold Goodglass, and Edythe Kaplan sixty years ago. That approach incorporated historically named clinical syndromes, such as Broca’s aphasia and Wernicke’s aphasia, and associated them with particular patterns of modality deficits and severities. In 1972, Goodglass and Kaplan published the Boston Diagnostic Aphasia Examination (BDAE), a groundbreaking standardized aphasia assessment instrument for use in assigning individuals to aphasia diagnostic categories on the basis of their impairment profiles. Subsequently published assessment instruments, such as the Western Aphasia Battery (WAB), took similar approaches; and the WAB is today the single most widely used aphasia assessment instrument with application both to research and clinical service delivery. But aphasia specialists know the limitations of narrowly focusing on impairments, and now are striving to develop frameworks for introducing functional use of language, task performance abilities, and prerequisites for life participation into intervention planning and clinical service delivery.

Views on approaches to managing aphasia have broadly paralleled aphasia diagnostic developments. With publication of the BDAE, and its emphasis on impairment, there arose a corresponding focus on developing and applying therapies that would reduce impairments. As various technologies have become available for probing functional communication in aphasia, or self-confidence, or cortical activity, etc., there has been an accompanying interest in interventions that target these dimensions. Yet other clinicians have been investigating adjuvant therapies – including behavioral programs, pharmacological therapies, or transcranial brain stimulation – in research work.

For further reading:   S. M. Sheppard & R. Sebastian. 2021. Diagnosing and managing post-stroke aphasia. Expert Review of Neurotherapeutics, 21(2), 221-234. https://doi.org/10.1080/14737175.2020.1855976

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