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Delivering for aphasia

Easy Access Summary

Aphasia is the term for problems people have with communicating, usually as a result of a stroke. They may have trouble speaking, trouble understanding or trouble with both and it can range from mild to very severe. These problems can be very disabling, and effective treatment is needed to avoid the devastating effects aphasia can have on people’s lives.
 
The paper is mainly a tribute to the work of Professor Pam Enderby who has done many studies in this area over more than 30 years. She has looked at: how many people have aphasia; how much treatment they get; how much treatment they need; and how we could make better use of other resources to bridge the gap.
 
We found that average hours of treatment in the developed world ranges between 1 and 5 hours whereas recent research suggests that around 9 hours is the minimum needed to be effective. We also found that the proportion of time therapists spent treating aphasia was actually reducing as other demands on their time increased.
 
It is not all doom and gloom however. Whilst treatment by trained therapists is very expensive they could maximise their impact by using other means to deliver high volumes of treatment under their overall supervision. The most promising of these include using volunteers and also delivering treatment by computers or other electronic devices.
 
We concluded that there is a need to continually monitor the amount of treatment available compared with the latest evidence on the amount of treatment needed to be effective. We argue that this must lead to a rethinking of the role of therapists, and better use of resources such as volunteers and computer technology.

Authors

C. Code; B. Petheram

Abstract

Providing a quality service for people with aphasia is a primary goal of speech-language pathologists working with neurogenic communication disorders. This paper reviews what is known about the incidence and prevalence of aphasia and what services are provided for people with aphasia. On the basis of the stroke data, the incidence of aphasia in the developed world ranges between 0.02–0.06% with prevalence ranging between 0.1–0.4%. Average hours of treatment for aphasic people in the developed world ranges between 1–5 hours per week, with a great deal of variability, although recent research suggests that intense treatment of ∼9 hours per week over a relatively short period is needed in order to be effective. It is concluded that there is a significant gap between what the research suggests is the appropriate amount of treatment and actual provision throughout the English-speaking world.