Global aphasia, the most severe and disabling form of aphasia, has long been overshadowed in both research and rehabilitation efforts. Despite its profound impact on language and communication, global aphasia has often been overlooked. However, Sharon Adjei-Nicol’s groundbreaking book, Working with Global Aphasia: Theory and Practice, seeks to rectify this oversight. This book not only addresses the severe language impairments characteristic of global aphasia but also delves into the coexisting cognitive deficits, providing an invaluable resource for speech and language therapists, researchers, and students alike.
The book encompasses six chapters, which delve into various aspects, providing a nuanced understanding of the challenges associated with global aphasia and offers practical strategies for assessment and intervention. The introductory chapter (Chapter 1) sets the stage by highlighting the heterogeneity within the population of People with Global Aphasia (PwGA). Adjei-Nicol draws attention to the varied functional communication abilities among individuals with global aphasia, using three case studies to exemplify the range of impairments. The absence of recent investigations into the prevalence of global aphasia is noted, emphasizing the need for more attention to this severe form of aphasia. The author discusses findings from an analysis of CT scans, suggesting a correlation between extensive brain damage and persistent, severe language disturbances. Prognosis for recovery is acknowledged as generally poor, and the chapter underscores the importance of targeting real-life communication in therapy to achieve meaningful gains.
Moving to the theoretical underpinnings (Chapter 2), the book explores the role of cognition in the context of global aphasia. Adjei-Nicol provides an in-depth overview of the five elements of cognition: attention, perception, memory, executive functions, and language. Attention is highlighted as a fundamental cognitive process, with failure to attend linked to information processing failure. The chapter stresses the coexistence of aphasia with impairments in any cognitive domain. The significance of perception in day-to-day activities is discussed, and the author introduces practical methods, such as picture categorization tasks, to identify central semantic deficits in speech and language therapy.
Chapter 3 emphasizes the crucial role of accurate assessment in treatment planning and tracking changes over time. The assessment process is discussed as essential for capturing both communicative strengths and weaknesses. Adjei-Nicol suggests direct communication with the client’s family or caregivers to gather comprehensive information on social history, communication contexts, and premorbid communication abilities. The chapter emphasizes the importance of understanding task demands when faced with poor performance in assessments, and advocates for a thoughtful consideration of the factors influencing challenges.
The scarcity of research evidence in the context of global aphasia is addressed in Chapter 4. The severe communication difficulties faced by clients limit their ability to provide perspectives and priorities, leading to an evidence base heavily reliant on clinical experience and consensus. The author summarizes intervention research, citing findings from a UK survey on clinical practice. Despite the majority of studies constituting low-quality evidence, the chapter reports on studies suggesting improvements in global aphasia, albeit with a longer recovery trajectory compared to other aphasia types.
Chapter 5 provides a practical guide to intervention approaches for PwGA. The author details direct and indirect methods that have proven successful. Visual attention tasks are highlighted as beneficial for improving a client’s ability to attend to and scan between visual stimuli. The inclusion of indirect therapy approaches, which can complement or replace direct treatment, broadens the therapeutic tool kit. Specific tasks, such as moving objects in the client’s line of vision or practicing gaze-shifting, are introduced as practical strategies.
The final chapter (Chapter 6) focuses on effective management and the importance of multidisciplinary collaboration. Adjei-Nicol emphasizes the collaborative role of speech and language therapists (SaLTs) with other members of the multidisciplinary team (MDT), including occupational therapists, physiotherapists, and psychologists. A UK survey on clinical practice identifies capacity and mood assessments as key collaborative areas. The chapter highlights the value of observing clients in sessions with other disciplines to gain insights into their ability to follow instructions, make choices, recognize objects, and problem-solve in meaningful contexts.
Working with Global Aphasia: Theory and Practice stands as a seminal contribution to the field, addressing the most severe and disabling form of aphasia that has historically received minimal attention in research and rehabilitation. This practical book transcends conventional boundaries by providing a comprehensive understanding of global aphasia, amalgamating clinical observations with existing literature. A notable strength lies in the holistic approach adopted, which not only explores the severe language impairments characteristic of global aphasia but also delves into the often-overlooked co-occurring cognitive deficits that pose additional challenges in therapeutic interventions.
The author skillfully intertwines theoretical underpinnings with practical application throughout the chapters. Real case examples are strategically incorporated, enhancing the clinical relevance of the content and bridging the gap between theory and practice. The first chapter meticulously outlines the heterogeneity within PwGA, shedding light on the varying functional communication abilities through insightful case studies. This sets the stage for subsequent chapters, providing a solid foundation for clinicians and researchers to comprehend the nuanced challenges faced by individuals with global aphasia.
Chapter 2 expands on the theoretical framework, offering a profound overview of cognition and its interplay with communication. Attention is highlighted as a fundamental cognitive process, and the chapter emphasizes the coexistence of aphasia with impairments in various cognitive domains. This theoretical foundation enriches the reader’s understanding of the intricate dynamics involved in global aphasia, preparing them for the subsequent critical analysis of research evidence in Chapter 4. The book conscientiously acknowledges the scarcity of empirical research on global aphasia, urging readers to navigate this challenge with a discerning eye and an appreciation for the role of clinical experience and consensus in shaping interventions.
Practical guidance permeates the book, with Chapters 3, 5, and 6 providing actionable insights for speech and language therapists. Chapter 3 underscores the importance of accurate assessment, emphasizing the need to capture both communicative strengths and weaknesses. The author recommends direct communication with the client’s family or caregivers for a comprehensive understanding, exemplifying the book’s commitment to practical applicability. Chapter 5 introduces a range of direct and indirect intervention approaches, with a focus on visual attention tasks and novel cognitive exercises. The book’s innovative spirit shines through as it encourages therapists to explore new ways of assessment and treatment, considering the impact of cognitive difficulties and adapting strategies for improved outcomes.
Furthermore, the book is accessible to a broad audience, presenting complex concepts in a clear and concise manner. This accessibility ensures that both experienced speech and language therapists and students entering the field can benefit from its wealth of knowledge. As a capstone, Chapter 6 outlines key areas for effective management and underscores the importance of multidisciplinary collaboration. This collaborative approach aligns with findings from a UK survey on clinical practice, further solidifying the book’s practical relevance and potential impact on multidisciplinary teams working with PwGA.
In a nutshell, Working with Global Aphasia: Theory and Practice is an essential addition to the literature on aphasia research and rehabilitation. Sharon Adjei-Nicol’s meticulous exploration of this challenging but highly rewarding population will undoubtedly make a significant contribution to the field. Whether you are an experienced practitioner or a student embarking on your journey in speech and language therapy, this book provides the knowledge, skills, and tools needed to navigate the complexities of global aphasia.
Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
[email protected]