Elizabeth Usher memorial lecture: Beyond our practice borders-using a biopsychosocial framework to improve long-term outcomes for people living with aphasia.

Purpose: Over 140 000 Australians live with aphasia after stroke, with this number of people living with aphasia increasing significantly when aphasia arising from traumatic brain injury, neoplasm, and infectious and progressive neurological diseases is also included. The resulting communication disability frequently compromises every aspect of daily life, significantly impacting everyday activity, employment, social participation, mental health, identity, and family functioning. Rehabilitation services rarely meet the needs of this group who have, for example, poorer healthcare outcomes than stroke peers without aphasia, nor address long-term recovery and support needs. Method: In this discussion paper, I argue that given the broad impacts of aphasia, a biopsychosocial approach to aphasia rehabilitation is required. Rehabilitation must include: interventions to improve the communication environment; programs that directly target identity, wellbeing, and mental health; and therapies focusing on functional activity, communication participation, and long-term self-management. Result: The evidence for these approaches is mounting and includes strongly stated consumer needs. I discuss the need for multidisciplinary involvement and argue that for speech-language pathologists to achieve such comprehensive service provision, an expanded scope of practice is required. Conclusion: There is a need to rethink standard therapy approaches, timeframes, and funding mechanisms. It is time to reflect on our practice borders to ask what must change and define how change can be achieved.