What is the Life Participation Approach to Aphasia?

If you work with people with aphasia, you might have heard the term “LPAA” recently. But what exactly is LPAA? How do you “do it?” How does it differ from traditional aphasia therapy?

LPAA, or the Life Participation Approach to Aphasia, is not strictly a therapeutic technique. It is a service-delivery model and mindset for working with people with aphasia. It broadens the SLP’s clinical practice to focus on life goals rather than solely on traditional communication goals.

In LPAA, the focus is shifted and expanded from a focus on impairments to a focus on a person’s participation in life and community. The approach also incorporates their environments and others in their lives impacted by aphasia. It can still include therapy targeting specific impairments, but always makes sure to address the “why” behind it.

The SLP still picks the appropriate therapeutic technique to address the client’s impairments and communication needs, but also makes sure to look at environmental factors. There are not specific therapy tasks or a framework to follow in order to “do it correctly.”

The best thing about LPAA? You might already be incorporating its ideas without realizing it! If you routinely ask patients what’s important to them, involve their family members in care, and look at their environments, then you’re already on track.

Five Core Values of the Life Participation Approach to Aphasia

  1. The explicit goal is enhancement of life participation. The first value places the emphasis of treatment on the person with aphasia’s participation in life activities. This can include work, family, community and hobbies. For instance, a client’s life participation goal might be to resume golfing with friends. The impact of aphasia on this goal is where the SLP can begin.
  2. All those affected by aphasia are entitled to service. When someone has aphasia, it impacts all those around them – especially close family and friends. LPAA says that everyone involved can receive services. Furthermore, building a strong community around the person with aphasia is critical.
  3. The measures of success include documented life-enhancement changes. While all SLPs love to see improvements on standardized measures, sometimes success looks different. For instance, if someone attended two golf club events instead of zero the month before, that is a documented, measurable improvement in life participation. The LPAA approach looks at the reason to communication as much as the communication itself. Quality of life measures and improved social relationships can also be used to document life enhancement.
  4. Both personal and environmental factors are targets of intervention. When a person in a wheelchair needs to access a building with stairs, the customary approach is to build a ramp. This core value of LPAA says that sometimes it is more appropriate to “build a ramp” than to wait for improved language in order for a person to participate in an activity. For someone with aphasia, this might mean creating an aphasia-friendly cookbook with picture-based recipes and color-coded measuring utensils. This “ramp” could allow someone who loves to cook to resume that activity.
  5. Emphasis is on the availability of services as needed at all stages of aphasia. It is the person with aphasia who should dictate when treatment ends. Sometimes people will end treatment and then request additional services at a later time based on life changes.

LPAA Project Group (In alphabetical order: Chapey, R., Duchan, J., Elman, R., Garcia, L., Kagan, A., Lyon, J., & Simmons-Mackie, N.) (2000). Life participation approach to aphasia: A statement of values for the future. ASHA Leader, 5(3), 4–6.https://doi.org/10.1044/leader.FTR.05032000.4

Incorporating the Life Participation Approach to Aphasia Into Your Practice

Want to incorporate the ideas of LPAA into your clinical practice, but not sure how? A great starting point can be by setting some client-centered goals. Ask your patient questions like:

  • “What life activities do you want to get back to?”
  • “What are you interested in doing?”
  • “With whom would you like to communicate more often?”

These questions can build a conversation about how your client can be more involved in activities that are important to them – and how you can help them get there.

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