8 - Aphasia Treatment Flashcards
A high functional dynamic can be observed in the ___________ after stroke, which has been associated with reorganization processes in the ____________ network, its right-hemisphere homologues and in the vicinity of the lesion site.
First days and weeks
Left-lateralized language
What seven things can cause improvement in Aphasia post-stroke?
Physiological change occurring during the evolution
Behavioral-physiological relationships in aphasia recovery
Reperfusion of the ischemic penumbra
Diaschisis, disconnection and reconnection
Upregulation of right hemisphere homologues (equivalent areas in RH)
Reactivation of peri-lesional areas
Functional reorganization of language networks
If you don’t know why you are doing something then…
You probably shouldn’t be doing it.
Is every aphasia patient a candidate for therapy?
No
Will all patients improve with treatment?
No
How many patients will return to 100% of premorbid levels of function?
Very few
Do all patients want to be in treatment?
No
What has a major influence on our ability to provide treatment?
Insurance coverage
What is Treatment Outcome?
A comparison of an outcome to a later point in time
What is Treatment Efficacy?
The probability that a treatment will benefit individuals in a defined population for a given population under IDEAL conditions
What is Treatment Effectiveness?
The probability that a treatment will benefit individual in a defined population for a given problem under AVERAGE conditions
What is Treatment Efficiency?
2
Treatment that is effective with a minimum of waste, expense, and necessary effort
High ration of output to input
What are Cochrane Reviews?
Summary reports on all kinds of treatment
They usually focus on big studies
How does the average effect on treated recovery compared to the average effect of untreated recovery?
Treated recovery has twice as much success
What should be the minimum weekly amount of therapy for aphasia its?
2 hours per week
Who treats aphasia patients?
7
Neurologists
Physiatrists
Speech-Language Pathologists
Occupational Therapists
Physical Therapists
Therapeutic Recreation Specialists
Neuropsychologists
What often dictates the frequency and duration of treatment?
What are clinicians required to do?
When does discharge planning begin?
3rd party payers
Criteria for deciding how long a treatment program should last
Onset of treatment
What should be the three goals of aphasia treatment?
Facilitating effective communication despite residual impairments
Facilitating “communication competence” (the use of language in naturalistic environments)
Generalization
What should be the focus and progression of aphasia treatment?
(4)
Treat to test approach (identifying deficit areas on tests and construct tasks to mimic these)
Selective treat-to-the-test approach (assign more importance to some tests than others)
Treat underlying processes approach (treat underlying cognitive processes that impact language domains)
Reactivation or restimulating approach (Treating underlying process)
What are five metacognitive processes important to treatment outcomes?
Self-awareness and Insight
Motivation
Self-monitoring
Self-initiation
Goal-oriented Behavior
Does beginning treatment early vs late have an effect on recovery?
Yes
What five things can effect a patient’s candidacy for treatment?
Amount and duration
Location of injury
Medical and Physical condition
Enthusiasm and motivation
Financial Resources
What four things should treatment focus on?
Individual
Functionality
Patient’s strengths
Patient’s level of breakdown
What a patient can do
What sort of improvement is often seen in aphasia patients in a 1+ years after initiating event?
Functional improvemetn
What is constraint induced therapy?
What is the time committment?
Forcing a patient to use areas of weakness
30 hours of treatment over two weeks
Do patients make major gains due to intense therapy (5+ hours per week)?
(2)
No
2-4 hours per week are equally as effective
Are most patients able tolerate more than 2 hours of treatment immediately post-stroke?
No
What is CATE (Complexity Account of Treatment Efficacy)?
2
A program to treat expressive speech
Training sentences that increase in complexity
What are often treatment targets in CATE (Complexity Account of Treatment Efficacy)?
Atypical categories
What is often the focus for SLPs in acute settings?
2
Swallowing is taking priority
Communication is taking a back seat
