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Logical alternatives to aphasia therapy when evidence-based research is lacking.

Article Excerpt
Speech-language pathologists should always provide evidence-based therapies for their aphasic patients. Unfortunately, there is not always evidence-based research demonstrating effective treatment approaches for each type of aphasia, modalities of deficits, and individual patient variables related to age, gender, education, etiology, and other diversity issues. This article discusses clinical syllogisms related to intuition, authority, and relative application as methods for evaluating nonscientifically based therapeutic methods and procedures in aphasia. They should only be used when there is no appropriate evidence-based therapeutic research for a particular patient.

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A relatively recent addition to the community of sciences is the discipline of communication sciences and disorders. It aspires as a science because it is an organized body of progressive knowledge that is systematically and objectively studied, largely based on verifiable empirical evidence, and employs hypotheses testing and answering of research questions. Lum (2002) notes that if a discipline is to be a scientific profession, the knowledge would have to be based on scientific principles. In a truly scientific profession, clinicians would use scientific standards in clinical practice and the scientific method to judge the efficacy of all intervention. Unfortunately, there is not always a sufficient amount of scientifically tested therapeutic methods and procedures in the treatment of aphasia. Tanner and Gerstenberger (1996) comment on the dearth of clinically relevant aphasia research in Aphasiology, an international, interdisciplinary journal.

This unfortunate void of research extends to all aspects of clinician-patient interaction including the utilization of workbooks, apraxia and dysarthria drills, word recall assist strategies, techniques for reducing perseveration and bouts of emotional lability, reading and writing rehabilitation, orientation and stimulation and reinforcement techniques. Much of what a practising clinician must do has not been tested empirically. By necessity, therapy is a combination of borrowed teaching strategies from education, psychology, logical inductive and inductive reasoning, commonsense direction and guidance. The limited body of applied research is certainly not desirable, but the practising clinician must perform; he/she does not have the academic luxury to close the lecture with the statement that "all the data are not in." (p. 328)

In an ideal clinical world, speech-language pathologists would select from several scientifically proven therapeutic methods and procedures for every...

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