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Current Practices and Challenges Associated with Administering Capacity Assessments for Individuals with Aphasia: A Review of the Literature

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  • In this paper, I provide an overview of aphasia and the issue of capacity assessment, followed by a summary of the current literature on the topic. The goals of this paper are to discuss current practices and challenges in capacity assessment and to provide a foundation for researchers to guide future studies in this area. Across authors and articles it is evident that there is a need for improvement upon the current guidelines for the administration of capacity assessments for individuals with communication disorders. Information gathered from these studies demonstrated that the highly verbal nature of capacity evaluations makes individuals with aphasia, who have difficulty understanding information and expressing themselves, vulnerable to losing their right to self-determination. These patients are faced with numerous decisions regarding their health and well-being, decisions that must be made amidst a flurry of complex medical terminology, varying opinions and emotional instability. When the family and treatment team question the patient’s ability to make informed decisions, it is important that the treatment team consider the patient’s communication limitations to make certain a fair and accurate assessment. In the reviewed papers, various strategies and clinical protocols are suggested to improve upon the way in which individuals with aphasia are assessed for capacity. Several articles recognized the importance of involving professionals who specialize in communication and cognition in the capacity assessment process. The articles describe numerous ways speech-language pathologists can support patients and treatment teams in addressing communication limitations. One article highlighted the benefits of using alternative and augmentative communication equipment and techniques to allow individuals with severe communication impairments the ability to express their choices more independently. In another article, the authors outlined a model for providing information in a way that facilitates comprehension and included making accommodations for a proxy to support the patient. As a whole, the literature emphasized the complex nature of evaluating capacity in this population and impressed upon the importance of considering individual variability when administering capacity assessments.

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    Attribution-NonCommercial 3.0 International