Therapy should address functional everyday activities

 5.5 Aphasia rehabilitation should address the consequences of aphasia on functional everyday activities, participation, social connectedness, and quality of life. Speech pathologists should consider targeting interventions on the impact of aphasia on relationships, vocation, and leisure in all phases of care.

References:  Ford et al., 2022: Scoping review of 53 qualitative studies; Hilari, 2011: Non-randomised observational study; Hilari et al., 2012: Systematic review of 14 studies (6 cross-sectional, 3 case-control studies, 3 qualitative, 1 cohort study, 1 retrospective study); Worrall et al., 2011: Qualitative study

NHMRC Level of Evidence: Qual.

Rationale: People with aphasia report significantly worse health-related quality of life than stroke survivors without aphasia, and worse quality of life than peers without stroke (Hilari, 2011). Quality of life is particularly impacted in the areas of independence and social relationships, with social networks reported as shrinking, and remaining relationships changing in quality and closeness (Ford, 2022), and aspects of poor access to the environment (Hilari et al., 2012).

While people with aphasia report prioritising communication goals in their overall rehabilitation process, they also emphasise addressing leisure, work, social, and relationship goals, as well as the need for information tailored to their needs (Worrall et al., 2011). People with aphasia want access to flexible, life-relevant services tailored to their personal experience of aphasia that focus on support to find autonomy and purpose post-stroke, and to develop the skills to cope with the negative consequences for interpersonal relationships and roles that unfold over time. 

References:

1. Ford, A., Douglas, J., & O’Halloran, R. (2022). The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. Brain Impairment, 23(3), 231–261. https://doi.org/10.1017/BrImp.2021.12
2. Hilari, K. (2011). The impact of stroke: Are people with aphasia different to those without? Disability and Rehabilitation, 33(3), 211-218. DOI: 10.3109/09638288.2010.508829
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 Rehabilitation, 93(1 Suppl), S86-95. DOI: 10.1016/j.apmr.2011.05.028
4. 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