The World Report on Disability: An impetus to reconceptualize services for people with communication disability

Challenges to the conceptualization and delivery of services for people with communication disabilities (PWCD) have been described in the lead article in this issue, which was itself a response to the World Report on Disability. A number of commentaries followed the lead article, where authors from around the world responded to the lead article (Wylie, McAllister, Davidson & Marshall, 2013), and the World Report on Disability. This paper synthesizes the issues, ideas, and challenges raised in the preceding commentaries. This has been done by addressing each of the four key issues posed in the lead article. A number of proposals for better responding to the needs of PWCD are outlined. These include: engaging with the collection of epidemiological data, consideration of which PWCD are under-served and how this may be changed, the use of documentation, adoption of new roles and strategies for speech-language pathologists, the challenges of communitydirected vs individually-focused approaches, and the suggestion of public health communication disability workers and mid-tier workers, who could work alongside more traditional speech-language pathologists

What people with aphasia want: Their goals according to the ICF

Background: The goals of people with aphasia should guide service delivery. Services are increasingly influenced by the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001), but little is yet known about whether the goals of people with aphasia span the full spectrum of the ICF. Aims: The purpose of this study was to describe the goals of people with aphasia and to code the goals according to the ICF. Methods Procedures: A qualitative descriptive research approach was used involving semi-structured in-depth interviews with 50 participants with aphasia post-stroke. Interviews were videotaped and transcribed verbatim and then analysed using qualitative content analysis. The goals of a 30% consecutive subsample were then coded using the ICF. Outcomes Results: Nine broad categories of goals were identified. Participants with aphasia wanted to return to their pre-stroke life and to communicate not only their basic needs but also their opinions. They also wanted information about aphasia, stroke, and available services; more speech therapy; greater autonomy; and dignity and respect. They identified the importance of engagement in social, leisure, and work activities as well as regaining their physical health. Interestingly, their goals included wanting to help others. Goals could be linked to all ICF components within the ICF, with the majority linked to Activities and Participation, followed by Environmental Factors, Body Functions and Structures, and Personal Factors. Conclusions: People with aphasia in this study were able to articulate a wide range of goals post-stroke that encompassed all of the ICF components but had a particular focus on the Activity and Participation components