The mind is not a vessel to be filled but a fire to be kindled. - - On Listening to Lectures by the Greek historian and essayist, Mestrius Plutarchus (c. 46-127 A.D.), known in English as Plutarch1

Stories achieve their meanings by explicating deviations from the ordinary in a comprehensible form. - -Jerome Bruner (1990) in Acts of Meaning (p. 47)

How does a person regain a sense of meaning after life has taken a nasty turn? This is our paraphrase of the key question addressed by issue editor, Michael Kimbarow, and the authors he invited to contribute to this exemplary issue on "life participation approach to aphasia" (LPAA; LPAA Project Group, 2000, 2001). We call it exemplary because it so clearly addresses the two key purposes of Topics in Language Disorders: (1) bringing together researchers and clinicians who share an interest in language and literacy development and disorders across the lifespan, transcending disciplinary and national concerns; and (2) providing relevant information to support theoretically sound, culturally sensitive, research-based practices with diverse individuals with spoken and written language disorders.

The master clinician/researchers who have contributed to this issue explain the LPAA revolution in aphasia treatment. They examine revised roles for working with individuals with aphasia and their families in ways that are more relevant, theoretically sound, culturally sensitive, and increasingly, research-based (see Elman, this issue, for a review of research evidence). As several of the authors note, the LPAA revolution is consistent with the World Health Organization's (2001) focus on participation and functioning in its International Classification of Functioning, Disability and Health (ICF). That is, beyond focus on the language impairment that constitutes aphasia, the LPAA, like the ICF:

[horizontal ellipsis]takes into account the social aspects of disability and does not see disability only as "medical" or "biological" dysfunction. By including Contextual Factors, in which environmental factors are listed, ICF allows [clinicians] to record the impact of the environment on the person's functioning. (World Health Organization, 2001)

When the focus shifts from treating and fixing impairment to participating actively in life, shifts occur as well in the contexts of intervention, roles of interventionists, and targeted outcomes. Elman's article introduces the research base for LPAA and the social-interaction principles that promote involvement of groups that come together to generate shared goals for participating in purposeful activity. In the article that follows, Kagan and Simmons-Mackie describe how LPAA shifts views of successful outcomes, and how starting with a revised view of outcomes shifts how the intervention process works as well. Although severity of aphasia remains a key component of the authors' A-FROM model (standing for "Living with Aphasia: Framework for Outcome Measurement"), the model also incorporates personal, contextual, and life situation factors as components of living with aphasia. By redefining what constitutes a successful outcome as meaningful participation, the process of intervention shifts from working on communication behaviors to working with people who have personal goals that may be achieved in a variety of ways.

Social-constructivist learning theory, as Kimbarow points out, is synergistic with the LPAA. As Plutarch observed, attempting to pour new learning into the vessel of any human brain (fully intact or not) simply does not work. Master clinicians focus more on raising awareness that positive change is possible than on repairing what is wrong. Ownership for new learning and the development of personally established learning goals is part of rekindling this expectation. The role of the clinician, as Holland points out, is to interact with clients and their families using the methods of counseling or coaching. This contrasts with a unidirectional or "pouring in" role, in which treatment is viewed as something a clinician does to a patient. The goals and methods of coaching are well suited to helping individuals find the internal resources and best solutions to address their unique concerns. The aim is to help people learn how to move forward positively down their recently altered path, deciding what they want to happen next, thus regaining a sense of control and navigation even though it is not a pathway they would have chosen.

The focus on lives and their meanings, which is central to LPAA, is captured by Shadden and Hagstrom in their discussion of the role of narrative in working with people with aphasia. It brings to mind Bruner's (1990)Acts of Meaning, which is quoted in the second lead-in to this column. In Acts of Meaning, Bruner sought to explain the revolution of cognitive psychology to emphasize meaning rather than information processing or behavior. As Bruner wrote in his Introduction:

It was, we thought, an all-out effort to establish meaning as the central concept of psychology-not stimuli and responses, not overtly observable behavior, not biological drives and their transformation, but meaning. It was not a revolution against behaviorism with the aim of transforming behaviorism into a better way of pursuing psychology by adding a little mentalism to it. Edward Tolman had done that, to little avail. It was an altogether more profound revolution than that. Its aim was to discover and to describe formally the meanings that human beings created out of their encounters with the world, and then to propose hypotheses about what meaning-making processes were implicated. It focused on the symbolic activities that human beings employed in constructing and making sense not only of the world, but of themselves. (p. 2)

As Bruner (1990) went on to describe, when ordinary lives take an extraordinary turn, narratives are generated that can provide an interpretation of those events and give them meaning. Narratives can make new possibilities seem reasonable. Bruner wrote:

In contrast, when you encounter an exception to the ordinary, and ask somebody what is happening, the person you ask will virtually always tell a story that contains reasons (or some other specification of an intentional state). The story, moreover, will almost invariably be an account of a possible world in which the encountered exception is somehow made to make sense or have "meaning." (p. 49)

Shadden and Hagstrom show how LPAA involves supporting individuals with aphasia to construct and reconstruct the narratives of their lives after stroke. Shadden and Hagstrom convey the importance of respecting the right of the "author" of this interpretative life tale to tell the story as he or she has experienced it, and in the process, to interpret and reinterpret that life story. Shadden and Hagstrom also convey the importance of patience at moments when clinicians might feel an urge to rewrite other people's stories for them. That approach has the same "pouring water in a vessel" limitations as simply telling someone what to learn.

For readers newly encountering the LPAA model, Glista and Pollens provide a particularly clear image of how LPAA looks in practice. Glista and Pollens state their immediate purpose as showing how to educate new clinicians to work with individuals with aphasia using the LPAA. While describing how LPAA can be implemented in an interdisciplinary university clinic, the authors also kindle ideas for integrating the components of LPAA in any setting. It is one thing for experienced clinicians to assume new roles as coaches within the LPAA; it is another to prepare novice clinicians to assume nontraditional roles. Once again, Bruner's (1990) comments show how narratives can influence the process of helping others learn, whether it is a novice clinician or a person with aphasia:

When we enter human life, it is as if we walk on stage into a play whose enactment is already in progress-a play whose somewhat open plot determines what parts we may play and toward what denouements we may be heading. Others on stage already have a sense of what the play is about, enough of a sense to make negotiation with a newcomer possible. (p. 34)

The metaphor of a play is particularly apt for people with aphasia as well as for student clinicians. Producing a play is one of the contexts that groups of individuals with aphasia may select as an activity for participation and helping their communities grow. When a person experiences a stroke, a head injury, or other life-altering event, it is akin to walking onto an entirely new stage. Without a coach, the new role may seem impossible to play, or even, not worth attempting. With a troop of players with whom one can interact and negotiate meaning and alternatives for playing the role, active participation in the play of one's life story might seem not only possible again, but joyful as well.

Nickola Wolf Nelson, PhD, Editor

Katharine G. Butler, PhD, Editor Emerita

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