Aphasia Management: The Speech Pathologist's Role

When working with patients who suffer neuropathologies of speech or language, one quickly learns that there is as much variability within a disorder as among disorders. The same is probably true about the different disciplines represented in this Seminar. There is probably as much variability in the management of aphasia within the discipline of Speech Pathology as there is in the fields of Neurology, Rehabilitation Medicine, Neurolinguistics, and so on. Thus , the reader must remember that the following is written by a speech pathologist, not the speech pathologist. Where my approach differs from that of other speech pathologists who manage aphasic patients, I will point out that difference. As with any art or science, the management of aphasia is enjoyed most by people who know something about it. Patient management is actually a complicated form of human play, and the reader has to become one of the players in order to enjoy the art or the science fully. This paper attempts to explain what happens when speech pathologists and aphasic patients meet, so that, after reading, the interested reader might participate. An interesting exchange of views regarding aphasia has been taking place during the past few years, and this will be the basis for some of the discussion in this paper. In 1977, Rubens, a neurologist, and La Pointe, a speech pathologist, exchanged views on what each discipline expected of the other when it came to managing aphasic patients. Results of a survey of neurologists conducted by Rubens (1977) indicated that 25 percent never referred aphasic patients to a speech pathologist and another 25 percent did not understand the role of speech pathologists. On announcing these results, Rubens asked speech pathologists to develop an understanding of the neurologist's role in managing aphasic patients, to speak in neurologic terminology, and to document the value of any language therapy administered. La Pointe (1977) responded by asking neurologists to refer aphasic patients to speech pathologists, to provide the medical data necessary for planning rehabilitation, to consult speech pathologists regarding the patient's further treatment, to consider nonmedical models of aphasia classification and management, to provide time for the speech pathologist to demonstrate the efficacy of language treatment, and to grant the speech pathologist the independence to work by consultation, with all its inherent privileges and responsibilities. On the one hand, neurologists were asking us to manage aphasic patients, but to report results in a vocabulary they can understand; on the other hand, speech pathologists were asking neurologists for the opportunity to do what we do best, but recommending that they learn our language, i.e., become bilingual. Both positions seem reasonable.