Speech pathology services for primary progressive aphasia: Exploring an emerging area of practice

Background: Primary progressive aphasia (PPA) is a clinical dementia syndrome characterised by the gradual dissolution of language without impairment of other cognitive domains for at least the first 2 years of illness (Mesulam, 2001). In recent years the authors had observed an increase in the number of referrals of individuals with a queried diagnosis of PPA to their speech pathology service. However, they perceived a lack of information on the best management path for these individuals. Aims: The aim of this study was to collate information about current service provision for clients with PPA living in the Australian state of New South Wales (NSW) and their caregivers. This information would identify current referral rates and speech pathology management of this population. This information, when combined with a review of the literature and an examination of overseas service provision, would be used to develop a framework for future speech pathology service provision for progressive aphasia. Method & Procedures: Data relating to individuals with queried or confirmed PPA was collected from speech pathologists via a survey. Speech pathology services with an adult neurological caseload were surveyed in rural and metropolitan regions across NSW. Questions asked for information relating to referral patterns, demographics, and interventions provided. Outcomes & Results: Responses from the survey indicated that only a small number of clients with PPA are referred to speech pathologists state-wide. At facilities where individuals were referred with queried PPA, all respondent speech pathologists provided some form of intervention. All clients were assessed and various intervention types were delivered including individual therapy, group therapy, intermittent review, and client and carer education. Overwhelmingly respondents talked of an emerging field of practice, and the need for more accessible information for clinicians and people with PPA and their carers. Conclusion: PPA appears to be an area of under-referral for speech pathologists in NSW. We would like to see increased referrals to speech pathology services and promotion of the role of the speech pathologist on dementia care teams. There is evidence that speech pathology intervention with this population can be effective. It is recommended that intervention targets both impairment and activity-participation levels but also we stress the importance of education and support that is specifically tailored to those with progressive language disorders.