A Bird's Eye View: The Past and Future of Activity-Focused Treatment.

Throughout her career, Audrey Holland advocated for persons with aphasia, urging clinicians and others to view each person in the context of their needs and desires in navigating daily life. In this article, we acknowledge her ideas about functional treatment, and consider their influence on contemporary, activity-focused aphasia treatment. Three criteria define activity-focused treatment: (1) activity-specific goals, (2) personally relevant targets, and (3) near-real-life practice settings. Elements of treatment design, activities, and outcome measurement described here exemplify Audrey's beliefs in person-centered clinical aphasiology. Operationalizing treatment elements and designing a context as close to real life as possible are clinical actions that support these beliefs. Activity-focused treatment and other life participation approaches have often been relegated to the last phase of treatment; following Audrey's example, we advocate beginning with activity-focused treatment based on a client's communication needs and desires. Activity-focused treatment benefits persons with aphasia, their families, clinicians, and other stakeholders by presenting outcomes that reflect communication change in a real-life context and that are individually relevant. Such outcomes foster an individual's inclusion in their communication environments, respect the WHO platform of functional treatment, and prepare a clinician to present outcome data relevant to that individual.