Aphasia Institute – Life Participation Approach to Aphasia: A Statement of Values for the Future (Part 3)

The Origins Of LPAA

Functional and Pragmatic Approaches

LPAA draws on ideas underlying functional and pragmatic approaches to aphasia nad shares some common values with those who take a broad approach to functional communication treatment by focusing on life participation goals and social relationships. In our view, however, the term “functional” does not do justice to the breadth of this work. In addition, the term is often used narrowly to mean “functional independence in getting a message across”. Although LPAA recognizes the value of this type of impairment-level work, it should form part of a bigger picture where ultimate goal for intervention is re-engagement into everyday society.

Human Rights Issues and Consumers’ Goals

LPAA is a means of addressing unmet needs and rights of individuals with aphasia and those in their environment. Indeed, the Americans with Disabilities Act (ADA), signed into law on July 26, 1990, requires that physical and communication access be provided for individuals with aphasia and other disabilities and allows them legal recourse if they are blocked from accessing employment, programs, and services in the public and private sectors.

In 1992, ASHA provided guidelines for a “communication bill of rights” (National Joint Committee for the Communicative Needs of Persons with Severe Disabilities). Its preface states that “all persons, regardless of the extent or severity of their disabilities, have a basic right to affect, through communication, the conditions of their own existence”. Communication is defined as “a basic need and basic right of all human beings”. ASHA thus views communication as an integral part of life participation.

Emphasis on Competence and Inclusion

LPAA philosophy embraces a view of treatment that emphasizes competence and inclusion in daily life, focusing as much on the consequences of chronic disorders as on the language difficulty caused by the aphasia. Along with other movements in education and health care, LPAA shifts from a focus on deficits and remediation to one of inclusion and life participation. Such international changes in focus point to the need to address the personal experience of disability and promote optimal life inclusion and reintegration into society.

Changes in Reimbursement and Service Delivery

Health care and reimbursement in America have undergone an unprecedented overhaul. Financial exigencies have led to an emphasis on medically essential treatments and others seen as likely to save on future health care costs. Many of the incentives in this model result in the provision of efficient short-term minimal care, rather than the longer term, fuller care supported in the past.

LPAA represents a fundamental shift in how we view service delivery for people confronting aphasia. Since LPAA focuses on broader life-related processes and outcomes form the onset of treatment, service delivery and its reimbursement will require novel means that stand outside most current practices. We are confident that cost-sensitive and therapeutically effective models are possible. Our purpose in this introductory article is to prompt a discussion with providers and consumers as to whether life participation principles and values should play a more central role in the delivery and reimbursement of future service delivery for all those affected by aphasia.

Norma