Beyond aphasia: Therapies for living with communication disability

Carole Pound, Susie Parr, Jayne Lindsay & Celia Woolf

Oxon, UK, Winslow Press, LTD, 2000

This book offers an addition to impairment-based therapies in the form of what the authors describe variously as:

"therapies for living with communication disabilities" (p. xiii)

"a 'systemic' approach…one which pays attention to the social networks of which the person with aphasia is a part" (p. 3)

"therapies for living with aphasia" (p. 3)

"real life therapy" (chapter 6, p. 243)

Chapter 1: Developing therapies for living with communication disability. This chapter offers the reader a glimpse at the various world-wide influences on the therapies being developed at an aphasia center in London called Connect: The Communication Disability Network. In particular, they discuss a social model theory of disability coming out of British disability theory. The social model sees the major problem of those with disabilities as being barriers to their social participation. The authors advocate therapies based on their clients' experience of their disability, on eliminating environmental, instructional and attitudinal barriers to their clients' social participation, and on working with clients to establish a new, self-actualized social identity.

The authors offer their "Living with Aphasia" model for intervention depicting the person with aphasia in a social context and how therapies can be associated with the following goals: (1) identifying barriers to social participation; (2) enhancing communication; (3) adaptation of identify and self actualization; (4) health promotion; (5) promoting a healthy psychological state; and (6) promoting autonomy and choice of lifestyle (p. 16, 19-28).

Chapter 2: Partnerships and practicalities: Groupwork, goal setting and evaluation. Small therapy groups are seen as have social and potential for empowerment advantages over individual therapies. The authors describe groups with different goals, facilitated by clinicians or by clients themselves. The emphasis for individual clients as they participate in group activities is on problem-based assessment, goal setting, and intervention.

Chapter 3: Facilitating communication. The authors develop a A total communication approach, one that promotes the simultaneous use of a variety of communication means such drawing, speech, gesture, facial expression, writing and communication devices (e.g. a communication book). The approach is not just one involving practice, but one in which total communication is carried out in everyday life contexts (e.g., "The pub outing, pp. 75-80). Also discussed are Kagan's supported conversation techniques to be used by the conversational partner to foster conversational access for the person with aphasia (Kagan, 1993) and how to conduct conversation groups of individuals with aphasia (pp. 109-125).

Chapter 4: Breaking down the barriers. Therapy projects are discussed-ones that aim to break down social barriers to life participation. Examples are making videos to teach others about aphasia, organizing group outings, producing literature on the center, writing an aphasia-friendly cookbook (p. 129). Also discussed are the use of computers to reduce barriers caused by communication difficulties (pp. 145-158) stress management (pp. 166-173) and assertiveness training (pp. 173-177).

Chapter 5: Developing therapies for developing identities. Included in this chapter are discussions of using those with aphasia experience as role models (p. 183), of how to explain aphasia to those affected by it (pp. 185-196) and of developing personal portfolios and narratives to convey biographical information (201-230) and how to celebrate aphasia through words, poems, music (231-242).

Chapter 6: Aphasia and beyond: Real-life therapy. This chapter contains lively review of the points raised in other chapters of the book, some case examples of how therapy affected individual's life course, discussion of complexities of life circumstances for those involved with aphasia, and a brief discussion of how therapies might be evaluated in light of life change.


Kagan, A. (1993). Functional is not enough: Training conversation partners for aphasic adults. In A. Holland & M. Forbes (Eds.), Aphasia treatment: World perspectives. London: Chapman & Hall.