About the Aphasia CRE

General stroke research has systematically excluded people with aphasia despite the fact that people with aphasia can provide informed consent and adapted outcome measures exist that enable full participation for people with aphasia.

Excluding people with aphasia from research limits the applicability of research findings to the general stroke population and slows the pace of improvements in medical and rehabilitation care for people with aphasia.

Aphasia is a complex condition arising from damage to many areas of the brain. The impact of aphasia varies considerably for people. For some it severely impacts all language functions (e.g. speaking, listening, reading and writing), while for others it impacts only one function (e.g. reading) or may be mild or moderate in severity. This complexity makes it difficult to accurately predict recovery from aphasia.

Predicting recovery accurately would help practitioners to provide appropriate advice about rehabilitation and prognosis to people with aphasia and their families, as well as helping to better manage our limited health care resources through prescribing treatments appropriately.

The hospital and rehabilitation workforce struggles to cope with the communication challenges associated with aphasia and this can limit quality of care. People with aphasia struggle to engage in health care and personal communication while in hospital and this seriously impacts their wellbeing.

Evidence-based solutions to improving healthcare communication with people with aphasia exist but have not been implemented in practice.

Recent research evidence confirms that speech therapy treatments for aphasia are effective. However, we have very limited evidence on patient-related and therapy dose factors that contribute to best immediate outcomes, as well as maintenance of treatment effects.

Existing stroke clinical guidelines provide limited information for aphasia across the continuum of care. Aphasia care in acute stroke is particularly lacking, with speech therapy time dominated by swallowing care. A pathway for acute stroke aphasia care is needed to maximise patient recovery and improve patient experience at a time of great vulnerability and need.

People with aphasia are highly susceptible to mental health problems. For example, up to 44% experience anxiety and up to 56% depression at any one time after stroke. Failure to provide appropriate psychological management of these mental health problems not only causes avoidable suffering and poorer rehabilitation outcomes, it also impacts the Australian healthcare system and economy due to associated increased length of hospital stays and greater use of community-based healthcare.

Stroke Foundation audits of rehabilitation services since 2008 show that the mental health needs of Australian stroke survivors with aphasia are consistently neglected.

Aphasia is a chronic disability with support  and rehabilitation needs long after hospital discharge. However, once discharged from rehabilitation care, people with aphasia find it difficult to access community services that meet their needs. This lack of engagement contributes to further social isolation and carer burden. Offering aphasia-specific supports in various community settings is another key priority for improving long-term health outcomes.

The majority of aphasia care is one-to-one and face-to-face with a healthcare practitioner. This model is unsustainable, expensive and inaccessible to people living outside metropolitan or larger regional centres. Services must change to address the current underservicing of rehabilitation in Australia.

Consumers with aphasia want:

• evidence-based therapy in greater doses
• more support after leaving hospital
• more assistance with maintaining or transforming life roles after their stroke.

Technology is revolutionising healthcare, but aphasia poses barriers to uptake. We need innovative technology-solutions that are tailored to the challenges of aphasia.

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