June may be aphasia awareness month, but I'm pretty sure that if you're getting this email, you already know too well what aphasia is.

I had planned to round up more resources, but I can't help but feel a bit like I'd be "preaching to the choir". So instead, I'd like to reflect on some things I've learned, or at least been reminded of, lately.

Over the past 5 months, I've been seeing an aphasia client to try my hand at teletherapy and test a consultative model of therapy. We meet for one hour each month, with daily app assignments in between. I'll call this client "Lia", and she's given me permission to share.

Here are some of the take-away lessons:

1. Setting goals together makes treatment easier

When you're treating a person with chronic aphasia, there are SO MANY things you can work on. But as this person is living their life and has come to you for help, it's important to work out what would make the BIGGEST impact, as well as what you think you can reasonably achieve. Setting specific goals that the client is motivated to work on will help you plan therapy and measure what matters.

Lia is a young woman who wants to speak to her son on the phone more independently. We selected 5 questions and phrases from the Apraxia Therapy app for daily practice. She has trouble making sense of the time on digital clocks, so we're working on numbers using Number Therapy. She has trouble getting words started, so we're practicing the words in Naming Therapy in a sound-a-week model, starting with p/b/m lip sounds, moving to t/d/n tongue tip sounds, etc. by customizing the word list.

2. Go for the quick wins

Changing the brain is hard and takes lots of time and repetition. But changing the environment or supports can make an immediate difference. Look for the barriers that stop a person with aphasia from communicating and think about what you can do to reduce them. Just as ramps solve the problem of stairs for a person using a wheelchair, so can a trained partner or assistive device help a person with aphasia.

Lia received an iPad with a full-featured AAC app from a community organization. She wasn't using it very often because she didn't carry the iPad around with her. But she was never without her smartphone. We found a low-cost AAC app for the phone that could be customized for Lia's most used words and phrases. Now she's never without her communication aid, and she uses it a lot more often.

3. Celebrate the little victories

Stroke recovery is slow, so it's good to stop and appreciate the little victories along the way to keep up motivation and reflect on how far you've come. Share these successes on social media or with friends to make a record of progress.

Lia was out for dinner with her parents and ordered a sandwich by pointing at the menu. Then she looked at the server and said, "no tomato!" She shocked everyone at the table, even herself, with this clear and assertive request. Her daily speech practice had bolstered her confidence, and it brought tears of joy to her mother's eyes.

4. Build community - for everyone

Aphasia can be extremely isolating for everyone involved. That's why it's critical to connect people with aphasia and their care partners with communities of people who understand what it's like. Look for local meetings or online groups to make sure nobody feels like they're the only one to go through this.

Lia's mother set the goal of connecting Lia with other young people with aphasia, but Lia was hesitant. So we made it part of therapy to attend an online group at least once. She was scared and didn't want to, but she agreed to try it. I also reached out to the Aphasia Recovery Connection to find other parents of adult children with aphasia for Lia's mom to talk with when she was feeling overwhelmed. Talking with someone in her same position gave her hope for a brighter future.

5. Daily practice yields results

Therapy once a week is slow to produce results, and monthly consultations would be even slower, were it not for one thing: homework. Daily practice using interactive apps that provides cues, feedback, and score reports allows for independent practice and remote monitoring. Practice makes perfect, or at least leads to improvements.

My inbox dings three times each afternoon as Lia's score reports come in. I can see how she's progressing, and even listen to her audio recordings. She feels the words she practices come easier now, and she's ready for more advanced exercises. She's now moving up to use Advanced Language Therapy for written language - critical to support her use of her AAC app and better engage with her world.

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I wish I could end it there, but there's one final lesson that's also important:

6. Aphasia is hard, and recovery is bumpy

No matter how good the therapy, motivation, or support, there are going to be setbacks and bad days. Not all goals are going to be achieved. But that doesn't mean therapy has failed or that all hope is lost. It's just how life works: ups and downs, unfair things happening to good people. Take heart in knowing you've done what you can, and that it's not your fault when things aren't perfect.

Lia has suffered a few seizures since we started working together, and that means new medications and new safety issues at home. Lia's apraxia is persistent, making oral communication frustratingly difficult or non-existent. And fear has blocked a few attempts at joining a community group. But we keep working or we pivot. I'm good at what I do, but I'm not a magician. And that's okay.

Whether you're on the giving end or the receiving end of therapy, I hope something here resonated with you. It's important to keep raising awareness of aphasia outside our circles so that more people are accepting and know what to do when they meet someone with aphasia. But for those of us who know all too well, we also need to be accepting of what we can and can't do so we can get up to fight another day.

Wishing you well,

Megan

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P.S. I'm still saving up those aphasia resources and will send another Resource Round-Up soon! Follow along on Facebook or Instagram for daily aphasia resources and tips all month.

P.P.S. I can't wait to attend the International Aphasia Rehab Conference in person in Philadelphia next week. Let me know if you're going so we can connect! You can also attend IARC'22 virtually - it's not too late to sign up!

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