Image use in aphasia rehabilitation: Practices of speech-language pathologists in South Africa and international contexts.

Purpose: The study aimed to explore speech-language pathologists' practices regarding image selection and use in the treatment of people living with aphasia. Images are widely utilised with people living with aphasia, however, supporting their communication optimally remains challenging.

Method: Ninety-two speech-language pathologists from South Africa, Australia, USA, and the UK completed a custom-designed online survey. Descriptive and inferential statistics, with structured-tabular thematic analysis were used.

Result: Sixty-two (82.7%) of the 75 participants who conduct assessments with people living with aphasia mostly use images. Sixty-seven (72.8%) of the total sample include images during treatment. South African respondents reported using black-and-white line drawings (28.1%) less frequently than speech-language pathologists from other countries (9.8%). Coloured images were preferred overall. South African participants significantly reported culture (62.5%) and religious orientation as "always important" (63.3%) compared to their counterparts (34.1%, 12.2%). Respondents use images to support learning and language; and less frequently in discourse with people living with aphasia. The more experienced a respondent was, the more knowledgeable and confident they felt incorporating images. Themes of client considerations and clinical settings for images emerged. Speech-language pathologists' perceived barriers were time, larger caseloads, people living with aphasia's variable responses to images, and lack of resources.

Conclusion: Speech-language pathologists in this sample have a knowledge base of image types and factors that may contribute to image interpretation in people living with aphasia. However, further research globally is needed. A structured approach to image selection is lacking in both low and middle-income, and high-income countries. Considering people living with aphasia's skills, preferences, and communication partner involvement may optimise image use. Development of a framework for systematically organising image features for people living with aphasia is warranted.