This issue of Topics in Language Disorders (TLD) addresses the acquired communication disorder of aphasia. Aphasia can accompany a wide and divergent range of neurological disorders, including stroke most commonly, but also brain tumor, cerebral trauma, and degenerative neurological disorders. A dictionary definition of aphasia describes it as a multimodality disturbance of language, resulting from focal damage to portions of the brain that are responsible for language, typically within the left hemisphere. The disorder impairs, in varying degrees, not only the understanding and expression of oral language, but also reading and writing.

Although technically correct, such a definition does not capture the true impact of aphasia on the individual who has aphasia and others around him or her. In a landmark study, the consequences and significance of this acquired language impairment within a social, economic, and political context were explored from the perspectives of 50 people with long-term aphasia (average time postonset was 7.2 years, with a range of 5-15 years; Parr, Byng, Gilpin, & Ireland, 1997). The participants took part in in-depth interviews in which they described the onset of aphasia; its consequences for employment, education, leisure, social life, and personal relationships; their access to information; their experience and evaluation of health and social services; and their perceptions and understanding of disability.

The results of this qualitative study (Parr et al., 1997) indicated that aphasia is experienced as a complex, dynamic process that negatively affects the individual at a number of different levels-as someone who interacts with others, as a member of groups and communities, and as a citizen. The aphasia makes itself felt, not just as an acute and traumatic event but continuously, as life events unfold. In addition, the study detailed the disabling barriers that are faced by people with aphasia. For example, access to educational and employment opportunities is often restricted because of the spoken and written language deficit, and financial difficulties may result. For many people, relationships with others are diminished. These findings are consistent with more recent qualitative studies of aphasia. Those affected by aphasia report social isolation, loneliness, loss of autonomy, restricted activities, role changes, and stigmatization (Brown, Worrall, Davidson, & Howe, 2012; Cruice, Worrall, & Hickson, 2006; Dalemans, de Witte, Wade, & van den Heuvel, 2010; Davidson, Howe, Worrall, Hickson, & Togher, 2008; Hilari, 2011; Howe, Worrall, & Hickson, 2008; Sjoqvist Natterlund, 2010).

Because the impact of aphasia extends far beyond the linguistic problem, it is essential that treatment approaches to the management of aphasia extend to broader areas as well. Indeed, current approaches to aphasia rehabilitation continue to evolve and have taken many different avenues. Consistent with the World Health Organization's International Classification of Functioning, Disability, and Health (ICF), treatment methods have targeted the impairment, communication activity, community participation, and/or the environment. Regardless of the approach, the ultimate goal is to facilitate the process of living successfully with aphasia and improve quality of life.

This issue of TLD represents a sampling of the broad spectrum of recent approaches to the management of aphasia offered by experts who have been at the forefront of their development. The first two articles illustrate interventions that focus on remediating the underlying impairment, with the goal of improving word retrieval. Kendall and Nadeau (2016) present the phonomotor treatment program that, as its name suggests, trains a corpus of phonemes representing the repertoire of phonological sequences within the language. Edmonds (2016) takes a different approach to anomia. Her Verb Network Strengthening Treatment (VNeST) focuses on the lexical-semantic system, using the centrality of the verb to activate a variety of semantic concepts.

Each article highlights the theoretical motivation of the intervention, describes the procedures, and details the accumulating evidence supporting the approach. Importantly, both interventions are concerned with generalization of the treatment effect to untrained words including those in the context of discourse. The authors also illustrate the different phases of inquiry contributing to the evidence base, discuss various methodological problems, stress the importance of careful systematic adherence to the scientific process, and suggest future directions for research.

The third article, by Kaye and Cherney (2016), describes script training, a treatment approach that is consistent with the activity/participation domain of the ICF. Although the article details the current evidence supporting this treatment approach, its major focus is to describe a clinically useful means of developing scripts for participants with aphasia of varying severities, a process that can be time consuming. Kaye and Cherney (2016) describe how components of basic script templates can be modified and provide data illustrating their use with participants who differ in the severity of their aphasia.

Rather than detailing a specific intervention, the final two articles present different service delivery models that are increasing in number both in the United States and worldwide. Elman (2016) describes the concept of the community-based Aphasia Center, which, consistent with the principles of the Life Participation Approach to Aphasia (LPAA Project Group, 2000), offers a choice of programs to foster group interaction and involvement in activities typical of daily life. In addition to providing a historical context for the development of this service model, Elman (2016) provides personal reflections on the important components that should be addressed during the management of aphasia.

Finally, Babbitt, Worrall, and Cherney (2016) focus on the Intensive Comprehensive Aphasia Program (ICAP). The ICAP is unique in that it incorporates both impairment and activity/participation approaches and provides the array of treatments intensively. The ICAP described in this article offers a variety of evidence-based approaches, including the phonomotor, VNeST, script training, and interactive conversation group treatments described previously in this issue. The authors ask the critical question of whether it is possible to identify up front those who may benefit most from a more intensive program.

The number of people with aphasia is increasing worldwide, given that stroke is its major cause and that the absolute number of people who have strokes annually is increasing globally (Mozaffarian et al., 2016). Poststroke aphasia is associated with greater mortality, increased disability, longer lengths of stay, and use of more rehabilitation services compared with stroke patients without aphasia (Bersano, Burgio, Gattinoni, & Candelise, 2009; Dickey et al., 2010; Ellis, Simpson, Bonilha, Mauldin, & Simpson, 2012). Given the increased burden of care associated with this disorder, it is imperative that clinical researchers continue to develop evidence-based treatments to improve the quality of life of persons with aphasia and decrease aphasia's social and economic impacts.

This issue of TLD presents just a few examples of the innovative work that is currently being done in the field of aphasiology. Other research that is ongoing is devoted to understanding and implementing biological treatments including pharmacological therapies, brain stimulation, and even stem cell transplantation. The results of biological interventions such as these are likely to change the face of aphasia treatment in the future. In the meantime, the articles in this issue of TLD highlight behavioral treatments and service delivery models that the practicing clinician can implement immediately. They address the scientific basis and clinical utility of the approaches and should be of interest to clinicians and researchers alike.

-Leora R. Cherney, PhD

Issue Editor

Professor

Physical Medicine & Rehabilitation and

Communication Disorders & Sciences

Northwestern University

Chicago, Illinois

Director

Center for Aphasia Research and Treatment

Rehabilitation Institute of Chicago

Chicago, Illinois

[email protected]

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