Evidence of effective aphasia rehabilitation is emerging, yet intervention and delivery varies widely. This European Stroke Organisation guideline adhered to the guideline development standard procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The resulting multi-disciplinary, evidence-based recommendations support the delivery of high-quality stroke-related aphasia rehabilitation. The working group identified 10 clinically relevant aphasia rehabilitation questions and rated outcomes’ relevance and importance. Following systematic searching, independent reviewers screened title-abstracts and full-texts for randomised controlled trials of speech-language therapy (SLT) for stroke-related aphasia. Results were profiled using PRISMA. Risk-of-bias was evaluated using the Cochrane Risk-of-Bias 1 tool. We prioritised final-value data. Where possible we conducted meta-analyses (RevMan) using random effects and mean, standardised mean differences (functional communication, quality of life, aphasia severity, auditory comprehension and spoken language outcomes) or odds ratios (adverse events). Using GRADE, we judged quality of the evidence (high-to-very low) and ESO recommendation strength (very strong-to-very weak). Where evidence was insufficient to support recommendations, expert opinions were described. Based on low-quality evidence we recommend the provision of higher total SLT dose (⩾20 h) and suggest higher SLT intensity and frequency to improve outcomes in aphasia rehabilitation. Similarly, we suggest the provision of individually-tailored SLT and digital and group therapy delivery models. Very low-level evidence for transcranial direct current stimulation (tDCS) with SLT informed the expert consensus that such interventions should only be provided in the context of high-quality trials. Evidence-based clinical-research priorities to inform SLT aphasia rehabilitation intervention choice and delivery are highlighted.

Dyslexia is a common specific learning difficulty. In higher education two models of disability are prevalent, ‘disorder’ and ‘difference’, which each differentially conceptualise dyslexia and the nature of supports required. A lack of research has been undertaken in Ireland regarding students’ experience of dyslexia, and the move from second to third level education. A greater understanding of the challenges encountered is necessary to inform provision of resources to help students with dyslexia excel in higher education. Semi-structured interviews were completed with four undergraduate students and one postgraduate student with a diagnosis of dyslexia to explore their experiences of transitioning into university. Thematic analysis revealed four common themes: dyslexic identity, self-advocacy, transition experiences, and future advice. Various difficulties were identified regarding lack of appropriate academic resources, inconsistencies between supports provided in secondary and third level education, and low self-confidence which serves as a barrier to success. However, strengths including self-directed learning techniques and communication and self-advocacy skills were also evidenced, supporting a ‘difference’ view of dyslexia. The findings highlight the need to re-evaluate the current academic service provisions, in alignment with a model of dyslexia that allows individualisation and enables students, as opposed to disabling them.

Background: Aphasia services are currently faced by increasing evidence for therapy of greater intensity and comprehensiveness. Intensive Comprehensive Aphasia Programs (ICAPs) combine these elements in an evidence-based, time-limited group program. The incorporation of new service delivery models in routine clinical practice is, however, likely to pose challenges for both the service provider and administering clinicians. This program of research aims to identify these challenges from the perspective of aphasia clinicians from six countries and will seek to trial potential solutions. Continual advancements in global communication technologies suggest that solutions will be easily shared and accessed across multiple countries. Aims: To identify the perceived and experienced barriers and facilitators to the implementation of 1) intensive aphasia services, 2) comprehensive aphasia services, and 3) ICAPs, from aphasia clinicians across six countries. Methods and procedures: A qualitative enquiry approach included data from six focus groups (n = 34 participants) in Australia, New Zealand, Canada, United States of America (USA), United Kingdom (UK), and Ireland. A thematic analysis of focus group data was informed by the Theoretical Domains Framework (TDF). Outcomes and results: Five prominent theoretical domains from the TDF influenced the implementation of all three aphasia service types across participating countries: environmental context and resources, beliefs about consequences, social/professional role and identity, skills, and knowledge. Four overarching themes assisted the identification and explanation of the key barriers and facilitators: 1. Collaboration, joint initiatives and partnerships, 2. Advocacy, the promotion of aphasia services and evidence-based practice, 3. Innovation, the ability to problem solve challenges, and 4. Culture, the influence of underlying values. Conclusions: The results of this study will inform the development of a theoretically informed intervention to improve health services’ adherence to aphasia best practice recommendations.

Introduction: An estimated 1 billion people with disabilities live in low and middle income countries, a population that includes people with communication disabilities (PwCD). PwCD are a heterogenous group with a wide range of abilities who may be underrepresented in research due to the communication demands involved in research participation. Methods: A critical analysis of 145 studies from a previously published systematic review was undertaken with the aim of documenting the opportunities for direct participation of PwCD in research on poverty and disability in low- and middle- income countries. Results: The key finding was the high risk of underrepresentation of PwCD in research on poverty and disability in LMICs, despite low rates of explicit exclusion (n = 8; 5.5%). A total of 366 uses of data collection tools were analysed (255 unique tools). The majority of data collection tools had high communication demands (92.9%), including those measuring disability (88.6%) and those assessing poverty (100%). Only 22 studies (15.2%) specifically included PwCD. A subset of these studies (n = 14) presented disaggregated data in a way that allowed for analysis of outcomes for PwCD, suggesting a clear intersection between poverty and communication disability, with findings related to general poverty indicators, reduced access to education, low levels of employment, and additional expenditure. Conclusions: The findings suggest a systematic underrepresentation of PwCD in research on poverty and disability with substantial implications for future policy and program planning, directly affecting the availability and provision of services and resources for this population. A failure to provide adequate opportunity for participation of PwCD in research risks leaving those with communication disabilities behind in the pursuit of global poverty eradication.

Coordination of international aphasia research would minimise duplication of effort, support synergistic international activities across languages and multidisciplinary perspectives, and promote high-quality conduct and reporting of aphasia research, thereby increasing the relevance, transparency, and implementation of findings. The Collaboration of Aphasia Trialists (CATs) sought to develop an aphasia research agenda to direct future research activities, based on priorities shared by people with aphasia, family members, and healthcare professionals. Our established international research network spanning 33 countries contributed to this activity. Research literature reporting the priorities of stakeholders was reviewed and synthesized (phase 1). Representatives from Working Groups on Aphasia Assessment & Outcomes, Prognosis & Predictors of Recovery, Effectiveness of Interventions, and Societal Impact & Reintegration participated in a two-day research agenda-setting meeting. The CATs expert panel refined research objectives and identified constituent components of research and methodological developments required to address these research components. The objectives and research components were grouped into overarching themes (phase 2). The resultant list was then circulated to more than 180 CATs members for review, revision, and approval. Consensus on the final aphasia research agenda and roadmap was reached by CATs executive committee (phase 3). The expert panel identified five overarching research themes: (i) evidence-based interventions for people with aphasia, (ii) effective interventions to support those communicating with people with aphasia, (iii) cross-linguistic assessment and core outcomes for aphasia research, (iv) predictors of language recovery, and (v) clinical implementation of research findings. Within these broad themes, 30 research objectives and 91 individual aphasia research components were identified and sequentially ordered. This agenda builds on research priorities identified by people with aphasia and their families, and includes priorities of healthcare professionals and researchers, and will support the rehabilitation and recovery of people with aphasia. Our internationally relevant research agenda promotes rigor in methodology, considers international applicability, synergistic activities, and sharing of resources and expertise.