Seven Habits of Highly Effective Aphasia Therapists: A Review
Have you ever thought to yourself - What do individuals living with aphasia want in a clinician? What makes a successful and collaborative clinical relationship? Maybe even - am I a good speech-language pathologist to treat aphasia? Aphasia therapy needs to be highly individualized to be effective. So, it’s no wonder us SLPs may feel uncomfortable treating this complex disorder! The good news is, we now have research to show what makes an SLP treating aphasia effective. And the best part? It is from the perspective of individuals with aphasia!
A recent study published in September 2019 by Dr. Linda Worrall answers SLPs’ burning questions about our clinical effectiveness regarding aphasia. Worrall and her team have conducted 58 published studies across 16 years to seek out the view of persons living with aphasia, their caregivers, and SLPs. That’s a lot of dedication and information! They have composed their findings into the following themes based on data collected.
1. Effective therapists prioritize relationships with people living with aphasia
This means the clinician invests time and creates a positive relationship with each person with aphasia and their care partners. They also seek feedback from their patients for a collaborative approach. Why? Because when genuine relationships are established, the individual with aphasia tended to indicate their therapy was more effective!
What are some ways you can establish good rapport and relationships right from the beginning? Proven methods include:
Active Listening
Supported communication
Accepting body language & non-verbal cues
Silence
Joking & laughter
Remember, every patient of yours is a person and you should acknowledge important aspects of their life to establish a strong relationship. This sets the groundwork for successful intervention!
2. Effective therapists find their patients a rope team
The term "rope team" comes from the sport of mountain climbing. The rope team will tether themselves together for safety to help prevent falls. By establishing a rope team, you can provide individuals with aphasia a positive atmosphere for participation and communication without fear of judgment. In aphasia rehabilitation, a rope team can consist of other healthcare professionals and caregivers, but, more importantly, others with aphasia.
Groups are a well-researched way to prevent social isolation and disablement. Studies show that those who attend support groups want a group that fits their needs and provides a sense of belonging. Therefore, speech-language pathologists need to consider the structure of their groups and invest time in making the dynamic work for all participants.
If there aren’t aphasia groups in your area and you can’t start one, online support groups such as those run through social media can be an effective means of providing your patients with a rope team. One popular group is the Aphasia Recovery Connection, which has nearly 10,000 participants on their Facebook Group.
3. Effective therapists begin with the end in mind
Most SLPs tend to work in one setting. They are unable to follow their patients with aphasia throughout the continuum of care. SLPs likely do not have the opportunity to see how these individuals recover three months, one year, or ten years from now. Therefore, it is vital to take note of the individual with aphasia's insight regarding what they want to achieve. But, how SLPs supposed to know what their clients want when they may only see them for a short blip on their journey to recovery?
Three research programs listed in the article sought the answer to that question. They determined that these themes are essential for individuals with aphasia to live successfully:
Establishing ways for communication to (re-)establish strong relationships
Self-reporting improvement
Participating in meaningful activities
Positivity and support throughout life
SLPs - take advantage of the thoughts and experiences of those already living with aphasia. Because when you start with the end in mind, life participation becomes a primary driving factor for therapy.
4. Effective therapists use SMARTER therapy
Always make sure the person with aphasia knows what you are working on and why. Did you know that in a survey, some people with aphasia reported not knowing how the goals set by their therapist related to their everyday life? This brings up the importance of collaboration between the patient and SLP when establishing goals.
The use of the SMARTER framework (shared, monitored, accessible, relevant, transparent, evolving, and relationship-centered) is recommended to help clinicians think about the process of goal setting. This acronym is a way for aphasia therapists to remember what people with aphasia actually want out of therapy and how to achieve those results successfully.
Here’s some more detail on what each component of the SMARTER acronym stands for:
SHARED: The clinician, person with aphasia, and/or caregiver share their feelings about meaningful goals. This goes further than just asking - it involves understanding each other’s perspective and expectations throughout therapy.
MONITORED: Regularly discuss improvement and progress towards goals. Continually evaluate for change and effectiveness of therapy during treatment.
ACCESSIBLE: The goal must allow ‘communication access’ by being in an aphasia-friendly format. Use communication strategies to ensure the person with aphasia understands the purpose of the goal and how it will help them achieve functional change.
RELEVANT: Goals and treatment must be relevant to the individual’s life, needs, activities of interest, and environment.
TRANSPARENT: The person with aphasia needs to understand how the goals and therapy tasks relate to their life.
EVOLVING: Goals are ever-changing and should change throughout rehabilitation and as they develop different needs and face new obstacles.
RELATIONSHIP-CENTERED: Use a person-centered approach to goal setting and treatment. Strengthen relationships with the individual and their caregivers to establish rapport and trust.
Have you ever thought about setting goals before completing impairment-based testing? By switching the standard order, it prioritizes the person with aphasia’s life goals to make them more motivated, informed, and respected. Try it during your next evaluation!
5. Effective therapists leave no person behind
Some individuals with aphasia inevitably fall through the cracks along the continuum of care. Whether it is a person with mild aphasia in acute care or an individual in the community that has "plateaued," it is important for SLPs to advocate for their patients to access speech services.
Just because an individual with aphasia leaves the hospital does not mean they don’t need speech therapy. Just because they are no longer experiencing spontaneous recovery does not mean they have plateaued. Depending upon the severity of aphasia, the individual will likely require some degree of speech therapy throughout their life. Speech therapy can be re-established any time an individual with aphasia identifies a new functional need! And it’s part of the aphasia therapist’s job to ensure services for those people.
6. Effective therapists look behind the mask
You cannot assume a person who seems happy, is happy. There is a robust literature base that states 70% of persons living with aphasia will experience depression within the first year following their stroke. Over time, individuals can often mask their depression or anxiety. The SLP is a trusted healthcare provider that can communicate with persons with aphasia where other physicians may fail. Therefore, a competent clinician knows the signs of depression, will routinely screen and refer out to a professional as needed.
Some useful tools to monitor and prevent depression within an SLPs scope of practice include:
Regular depression screenings
Group support activities
Communication partner training
Collaborative goal setting
Self-management workbooks
Psychological health education
7. Effective therapists give people living with aphasia a voice
SLPs have the rewarding opportunity to help their patients regain their communication skills. As a human, communication is a vital component of life - without it, relationships suffer, and isolation occurs. An effective therapist will provide communication supports, caregiver training, help the person living with aphasia meet their life goals, and spread awareness of aphasia to the public.
People with aphasia have expressed goals to give back to others with aphasia and advocate for wide-spread knowledge about their communication disorder. Aphasia therapists can help assist with this goal by helping reveal competence to other healthcare professionals and community members. Strategies such as introducing accessible means for communication within their environment can help those living with aphasia have successful interactions. Help raise awareness about aphasia, but more importantly, help those with aphasia advocate themselves.
SO, WHAT DO YOU THINK?
Do you check these boxes? Are you motivated to improve your clinical skills? I believe all medical SLPs can learn a great deal from this research study as it provides a unique insight straight from the patients we treat daily. My biggest takeaway - life participation and collaboration with your patient is key to the success of therapy. Persons with aphasia should be working on what they find to be essential to their life.
Read the article here.
Worrall, L. (2019): The seven habits of highly effective aphasia therapists: The perspective of people living with aphasia, International Journal of Speech-Language Pathology, DOI: 10.1080/17549507.2019.1660804
ABOUT THE AUTHOR
Katie Brown, MA, CCC-SLP,CBIS
Katie is the owner and founder of Neuro Speech Solutions. She is passionate about providing person-centered treatment to her clients in order to meet their life participation goals. Katie is dedicated to helping other SLPs provide functional therapy through affordable materials and education courses.
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