‘Joined-up practice’: Optimising recovery for people with aphasia and their family and friends

This issue of International Journal of Speech-Language Pathology (IJSLP) celebrates the remarkable career of Professor Linda Worrall, one that has interwoven an extraordinary number of educational, clinical, and theoretical ideas together, all in pursuit of making a difference to the lives of people with communication disorders and the profession which is tasked with this challenge. Professor Worrall’s career as an educator in speech-language pathology, in developing and delivering curricula, and in supervising new researchers across an array of topics, has contributed to a culture of excellence in our field, and recognition of the importance of sound evidence as the foundation of our practice. Her creativity and intellect, however, has inspired practitioners at all stages of their careers to develop new ways of thinking, new ways of treating, and new ways of collaborating with clients and colleagues alike. While the profession has been influenced by Professor Worrall’s work in so many ways, her greatest legacy has been to enhance the lives of people with communication disorders, in particular, those people with aphasia who found a true advocate and champion for the advancement of science around this complex condition.

Professor Worrall’s influence has been extensive both throughout Australia and globally. As the ambitious co-creator and Director of the NHMRC Centre for Clinical Excellence in Aphasia Rehabilitation in 2009, Professor Worrall raised the profile of aphasia research to a new level, drawing together clinicians from all over the country to bring forward their ideas and their energy to set a new and ambitious research agenda. This initiative was the culmination of a long series of successes in creating opportunities for people with communication difficulties, founding, in 2002, the Australian Aphasia Association, a national consumer-led body that supports and advocates for people with aphasia, their families, and those professionals working in this area. Professor Worrall has also played a substantial role in drawing together the international aphasia community, in identifying common frameworks in which to situate ideas and create common agendas, and in co-founding the international peak body, Aphasia United. Her extensive network, and her extreme generosity in bringing people along with her, are testimony to the ease with which this Special Issue came together.

Professor Worrall’s introductory paper, The Seven Habits of Highly Effective Aphasia Therapists: the perspective of people living with aphasia (Worrall, 2019), leads this special issue and, in many ways, joins all the many aspects of her varied career. When delivered as the keynote presentation at the International Aphasia Rehabilitation Conference in Aveiro, Portugal, in 2018, Professor Worrall received a standing ovation. This paper draws together findings from 48 studies, conducted by teams in which Professor Worrall has lead or worked, into seven key recommendations for speech-language pathology clinicians and researchers on how to be a ‘highly effective’ practitioner. Novel to this paper is that these ‘habits’ emanate from the views of people with aphasia and therefore have the critical ecological validity that should underpin professional behaviour and practice. The Special Issue then comprises a series of papers by colleagues who responded to a call to submit to this opportunity to celebrate the themes that resonate through Professor Worrall’s work.

The first three papers focus on the importance of connectedness and communication between the clinician and client (Berg, Askim, & Rise, 2019; Lawton, Conroy, Sage, & Haddock, 2019) and between family members (Beales, Bates, Cartwright, & Whitworth, 2019). Lawton et al. (2019) draw attention to the critical role of the therapeutic relationship in the process and outcomes of aphasia rehabilitation. They provide first evidence for reliability and validity of patient and clinician versions of the Aphasia and Stroke Therapeutic Alliance Measure (A-STAM). This tool has potential for evaluating the therapeutic relationship to enhance rehabilitation outcomes but also may be useful in developing these skills in student and novice clinicians. Berg et al. (2019) interview speech-language pathologists about their perceptions of what can enhance client participation in rehabilitation. SLPs identified that rehabilitation can be challenging owing to perceptions of vulnerability, mismatched expectations for therapy outcomes, and a limited evidence base to guide collaborative goal setting. Beales et al. (2019) tackle the reduced connectedness and reciprocity of communication that are commonly reported by families living with progressive aphasia and dementia. They use interview methods to explore perspectives and experiences following a treatment for lexical retrieval in functional contexts and unveil two themes: benefits of participating in this type of intervention but a prior lack of access to information about communication difficulties. They stress the importance of education, support, and practical strategies to facilitate communication within families.

O’Halloran et al. (2019) take a different angle on participation and client-centred care and consider an issue of equity. They explore to what degree the perspectives of people with communication disorders were included in research informing development of the Australian Hospital Patient Experience Question Set (AHPEQS), by the Australian Commission on Safety and Quality in Healthcare. This question set is designed to measure quality and safety of hospital care. O’Halloran et al. conclude that the majority of studies provide inadequate information to assess whether the voices of those with communication impairment have been included. Given that effective communication between patients and health professionals is essential to care and safety in the hospital setting, these authors challenge the validity of the AHPEQS and call for better representation of this vulnerable group of people.

The next two papers contribute to the evidence base for client-centred and participation-focused rehabilitation approaches for people with aphasia (Cherney, Braun, Lee, Kocherginsky, & van Vuuren, 2019; Pitt, Theodoros, Hill, & Russell, 2019). Pitt et al. test the efficacy of a 12-week web-based group therapy programme – Telerehabilitation Group Aphasia Intervention and Networking programme (TeleGAIN) with 19 participants. They report positive effects of the programme for people with aphasia, including improved communication-related quality of life, improved engagement in communication activities, and reduction in severity of aphasia symptoms. Cherney, et al. explore how much therapy is needed to generate improvements in conversational participation. With a single 60-minute session of computer-delivered conversational script training, their 20 participants showed improvements in accuracy and speed of script production via the computer, as well as improvements in conversation with the clinician. Importantly, these changes were maintained for up to two weeks showing the potential strength and validity of this intervention approach.

Picking up again on the theme of education, Rose, Wallace, and Leow (2019) surveyed 65 family members’ experiences and preferences for receiving information about aphasia early after stroke onset. Most family members reported receiving little or no information on aphasia and low satisfaction with the information they did receive. The findings support ongoing efforts to improve access to adequate and timely information about aphasia, awareness about aphasia amongst other health professionals, and access to services across the continuum of care. Further exploring the issue of aphasia awareness, Hill, Blevins, and Code (2019) re-executed a community survey exploring changes in awareness over the past 16 years in the UK. While they report that awareness has improved, with about a third of those surveyed now having heard the term ‘aphasia’, only 5% had any knowledge about aphasia. Awareness was significantly lower than for other common disorders of stuttering, dyslexia and autism. They highlight the continued need to raise community awareness and knowledge, with hopes that this may support breaking down social and environmental barriers to societal participation.

These papers reflect the wide range of topics and practices that Professor Worrall has contributed to and influenced over this generous period of her professional career. There will be more. While Professor Worrall is known for her grand initiatives, her passion for her craft, her commitment to educating and supporting others, she is certain to have her eye on the future.