The Aphasia Handbook: A Guide for Stroke and Brain Injury Survivors and Their Families. Martha Taylor Sarno and Joan F. Peters, eds. New York: National Aphasia Association, 2004. 178 pages, $49.95, hardcover: ISBN 0-9758539-0-2.

Last fall, the American Speech/Language Hearing Association (ASHA) Convention was in my hometown of Philadelphia. I was able to attend not only the convention but also a lecture given by one of the ASHA speakers who spoke on the campus of the hospital where I work. Aura Kagan, director of the Aphasia Institute, Toronto, Canada, spoke about her work and research helping persons with aphasia to communicate with the people around them. Her lecture focused on how to promote conversation and the importance of showing others, ie, family members and other professionals, how to communicate best with people with aphasia. Techniques she described included using key words, pictures, gestures, etc-anything that will work, not just verbal language.

Six months later, I received The Aphasia Handbook: A Guide for Stroke and Brain Injury Survivors and Their Families to review for this journal. As I initially glanced through the book, I was immediately reminded of the lecture I had attended last November and the supported conversation1 approach. This book is designed for persons with aphasia and their family members. The book not only explains aphasia and appropriate communication strategies but also provides extensive information and advice regarding issues that a person with aphasia may face. It is clearly laid out with colored tabs to facilitate location of the different chapters and information. There are pictures and key words on every page and for every section. The book begins with a page on "How to use this handbook" and immediately provides a simple and clear definition of aphasia.

The book proceeds in chronological order: having a stroke (or brain injury), the experience in the hospital and in rehabilitation, and then home life. Included are common terms and people that a person in the hospital will encounter, what to expect when you get home, and how to manage along the way. Although most people with aphasia and/or their family members would probably not see this book so early after the onset of the disease, it could well be used to explain what happened to them while they were in the hospital versus what is happening to them as they go through the process. Although I am not convinced that the majority of people with aphasia would be able to benefit from seeing this book while in acute care or acute rehabilitation, this book would be of considerable benefit to those just a little later on in the rehabilitation process and to those with chronic aphasia.

This book would certainly be beneficial to family members of persons with aphasia. Useful information about the disorder, possible complications, what to expect, the process of therapy, and resources available is provided. Indeed, this book may be more helpful to family members than to persons with aphasia as these persons may be limited by problems with reading comprehension that can accompany aphasia and persons with severe aphasia may even have difficulty interpreting the pictures. Some complex, abstract issues presented, such as making complaints, claiming benefits, and changes in social relationships, may be difficult for readers with aphasia to grasp even with the use of consumer-friendly print size, line spacing, pictures, and lower case letters intended to aid individuals with reading comprehension problems due to aphasia.

While the text mentions head injury as a possible cause of aphasia, the focus is clearly on stroke. Given the relatively low incidence of persistent aphasia after blunt head trauma, this book may be used only occasionally by clinicians who work exclusively with this population. However, persistent aphasia does occur occasionally after blunt injuries and may be certainly seen in patients with penetrating injuries. It should be noted that this text does address, at least briefly, several problems that are common after traumatic brain injury. These include motor weakness, decreased balance, impaired vision, swallowing difficulties, continence, decreased sensation, apraxia, decreased sexual functioning, pain, seizures, fatigue, irritability, depression, verbal disinhibition, impaired memory, and affective lability. Sections on assessing outpatient therapies, social services, in-home care, assistive devices, home modifications, coping with emergencies, and governmental benefits are also relevant to traumatic brain injury. Unfortunately, the section on support organizations does not mention the Brain Injury Association of America.

All this information is presented in a user-friendly format. The pictures are clear and the bolded key words attract attention of those who cannot read at the sentence level. The format and explanations are well done. There is an excellent list of resources in the last section. In addition, the supplement in the back cover pocket has "useful things in it": including pocket-sized "I have aphasia" cards with a brief explanation of aphasia and how you (ie, the conversational partner) can help, a "communication tips and what is aphasia" card, and another card addressing "if you've had a stroke" what this means.

There is mention of computers and software that can benefit persons with aphasia, and there is also a page on making a communication book. More information and resources on alternative and augmentative communication devices could be helpful.

The scope of the booklet is exceptional. The detailed information includes discussions of pensions and benefits, rights as a hospital patient and as a person with a disability, services available, vocational issues, relationship issues, and maintaining or establishing interests as well as the more basic explanations of what is occupational therapy, physical therapy, etc. On almost every page, resources are listed with phone numbers and/or Web sites as appropriate for that section. Although normally, this could be seen as repetitious, for this book it is not because it highlights the resources for that particular issue. Each section can be read as needed without the need to have read previous sections.

Overall, this is an excellent resource guide on aphasia. The structure and content of the book emphasize how to maximize communication for persons with aphasia. It is one of the few aphasia resources dedicated to the person with aphasia versus the family or professionals. While this resource will be most useful to persons with aphasia and their families, there is substantial material that is relevant to traumatic brain injury. Clinicians working with persons with stroke or traumatic brain injury will want to check out this user-friendly handbook.

-Susan Robinson, MBA, MA, CCC-SLP

Moss Rehabilitation Hospital Philadelphia, Pa

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