Self-management strategies

7.1 People with aphasia, their families and carers, and speech pathologists should work together to develop appropriate self-management strategies.

Reference: Nichol et al., 2019: Scoping review of 45 studies (aphasia-focused; 2 RCTs, 15 case study/series, 14 single group/within subjects, 5 experimental vs control group, 4 mixed methods, 2 qualitative); Nichol et al., 2021: Qualitative study; Nichol et al., 2022: Qualitative study; Nichol et al., 2023a: Qualitative study; Nichol et al., 2023b: Qualitative study; Palmer et al., 2019: RCT; Wray et al., 2018: Systematic review of 24 RCTs (not restricted to aphasia)
NHMRC level of Evidence: Qual.

Rationale: The incorporation of self-management techniques for people with aphasia aligns with a person-centred and holistic treatment approach (Nichol et al., 2023a – see also AARP introduction). While there is not currently sufficient evidence to inform the optimal method of incorporating self-management strategies for people with aphasia (Wray et al., 2018), qualitative research demonstrates its importance for successfully living with aphasia (Nichol et al., 2022). 

Self-management plans should be developed collaboratively, be based on individual needs, goals, and resources, and enable and empower the person with aphasia to take responsibility for managing life with aphasia (Nichol et al., 2023b). These plans may include (Nichol et al., 2019; Nichol et al., 2022; Nichol et al., 2023a; Nichol et al., 2023b): 
●       active participation in meaningful social interactions and recreational activities,
●       building communication confidence through encouragement, positivity, and opportunities for
         communication success,
●       establishing emotional and psychosocial supports to enable discussion of frustrations, other
         emotions, and life changes. This may include (access to) psychological therapy (see
         statements 5.19 and 5.20),
●       using technology (including AAC – see statement 5.14) to support communication access,
         social connection, independence, and control,
●       community-based interventions such as peer support and community aphasia groups (see
         statement 5.22), or communication partner training (see statements 2.6, 5.23, 6.1), and
●       self-managed computer-based word finding therapy, to increase frequency/intensity of
         practice (Palmer et al., 2019).

Communication partners, speech pathologists, and technology are key support sources for aphasia self-management (Nichol et al., 2021).

References:

1. Nichol, L., Hill, A. J., Wallace, S. J., Pitt, R., Baker, C., & Rodriguez, A. D. (2019). Self-management of aphasia: a scoping review. Aphasiology, 33(8), 903-942.
2. Nichol, L., Wallace, S. J., Pitt, R., Rodriguez, A. D., & Hill, A. J. (2021). Communication partner perspectives of aphasia self-management and the role of technology: an in-depth qualitative exploration. Disability and Rehabilitation, 1-18.
3. Nichol, L., Wallace, S. J., Pitt, R., Rodriguez, A. D., Diong, Z. Z., & Hill, A. J. (2022). People with aphasia share their views on self-management and the role of technology to support self-management of aphasia. Disability and Rehabilitation, 44(24), 7399–7412. https://doi.org/10.1080/09638288.2021.1989501
4. Nichol, L., Rodriguez, A. D., Pitt, R., Wallace, S. J., & Hill, A. J. (2023a). "Self-management has to be the way of the future": Exploring the perspectives of speech-language pathologists who work with people with aphasia. International Journal of Speech Language Pathology, 25(2), 327–341. https://doi.org/10.1080/17549507.2022.2055144 
5. Nichol, L., Pitt, R., Wallace, S. J., Rodriguez, A. D., & Hill, A. J. (2023b). "There are endless areas that they can use it for": speech-language pathologist perspectives of technology support for aphasia self-management. Disability and Rehabilitation: Assistive Technology, 18:8, 1473-1488, DOI: 10.1080/17483107.2022.2037758
6. Palmer, R., Dimairo, M., Cooper, C., Enderby, P., Brady, M., Bowen, A., Latimer, N., Julious, S., Cross, E., Alshreef, A., Harrison, M., Bradley, E., Witts, H. & Chater, T. (2019). Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. The Lancet Neurology, 18(9), 821-833. DOI: 10.1016/S1474-4422(19)30192-9
7. Wray, F., Clarke, D., & Forster, A. (2018). Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia. Disability and rehabilitation, 40(11), 1237-1251.