8.5 - Aphasia Treatment Models vs. Treatment Approaches vs. Treatment Techniques Flashcards
What does the Stimulation-Facilitation Model of Aphasia Treatment target?
Auditory Processing Deficit
What is performed in the Stimulation-Facilitation Model of Aphasia Treatment?
(5)
Intensive auditory stimulation
Meaningful varied material
Repetitive sensory stimulation
Elicited not forced responses
Stimulation not correction
What does the Modality Model aphasia treatment model target?
Uni or Multi-modality deficit
What is performed in the Modality Model aphasia treatment model?
(2)
Remediate input and output modalities, singly or in combination
Pair weak with strong modalities to “deblock” impaired performances
What does the Linguistic Model aphasia treatment model target?
Selective deficit in language system or subsystems
i.e., Phonology, lexical-semantics, morphosyntax
What is performed in the Linguistic Model aphasia treatment model?
Restoring language performance by organizing stimuli according to linguistic system and linguistic complexity
What does the Processing Model aphasia treatment model target?
Aphasia reflects the product of spared language in response to impaired modules or impaired
relational processes and/or in the “executor” that allocates attentional resources to modules and processes
What is performed in the Processing Model aphasia treatment model target?
Restoring or compensating for language-specific and language-related processing deficit
What is the Minor Hemisphere Mediation Model?
Using one’s minor hemisphere abilities to mediate communication through use of imagery, drawing, melody, contextually rich stimuli, novel stimuli, humor
What is the Language Dominant Hemisphere specialize in?
Sequential, linguistic information processing
What is the Language Non-Dominant Hemisphere specialize in?
3
Visual-spatial skills
Holistic, melodic, contextual processing
Novel stimuli
What does it mean if the Minor Hemisphere Mediation Model is correct?
Treatment should be designed to…
- Capitalize on spared abilities - Activate minor hemisphere abilities (drawing, melody, context, humor)
What is the purpose of the Functional Communication Model?
4
To facilitate more normal communication
Emphasizing pragmatic function over linguistic form
Enhancing inter-modality flexibility
Establish strategies for circumventing and/or repairing communication breakdowns
What areas does treatment focus on in the Functional Communication Model?
(4)
The specific tasks the patient wants/needs to achieve
Calling 911
Naming family members
Answering “yes” and “no”
What is the purpose of Response Elaboration Training (RET)?
What does it enhance?
To increase MLU in confluent patients by capitalizing on preserved oral repetition (“house” -> “big house” -> “live in big house”)
Initiation ability
What does Promoting Aphasics’ Communicative Effectiveness (PACE) use?
What does it emphasize?
All channels of communication (verbal, gestural, writing)
Content over form
How do the clinician and clients interact in Promoting Aphasics’ Communicative Effectiveness (PACE)?
(2)
Pt. + clinician simulate conversation interactions (message sending- receiving)
Pt. + clinician participate equally as senders and receivers of messages
What is the Life Participation Approach?
A consumer-driven service-delivery approach
Supports individuals with aphasia and others affected by it in achieving their immediate and longer term life goals
(Note that “approach” refers here to a general philosophy and model of service delivery, rather than to a specific clinical approach)
What is the emphasis of the Life Participation Approach?
Broadening and refocusing of clinical practice and research on the consequences of aphasia.
What is the focus of the Life Participation Approach?
How long does it last?
Re-engagement in life
Begins with initial assessment and intervention, and continuing, after hospital discharge, until the consumer no longer elects to have communication support.
What is the goal of the Social Approach to aphasia?
To promote membership in a society and participation in personally relevant activities by those with aphasia
What approach is the Social Approach to aphasia consistent with?
The Life Participation Approach
Social Approach to Aphasia moves from ______ model (problem with individual) to _______ model where problems emerge from interaction between individual and the environment.
Medical
Social
What are the principles of the Social Approach to aphasia?
9
Dual Goals of Transaction + Interaction
Address Communication Within an Authentic Contex
Communication as Dynamic, Flexible, + Multidimensional
Communication as Collaborative
Focus on Natural Interaction: Conversation
Focus on Adaptations and Enablement Rather Than Impairment + Disability
Focus on Personal and Social Consequences
The Perspective of Those Affected by Aphasia
Qualitative as well as Quantitative Measures
What are the five benefits of the Social Approach to aphasia?
Enhancing communication
Increasing participation in events
Providing support systems
Increasing confidence and positive identity
Promoting advocacy
What was Language Oriented Treatment designed to address?
A range of language issues among individuals with aphasia.
Language Oriented Treatment approach is highly _______ and offers important ______ with regard to treatment replication.
Structured
Advantages
What are the treatment targets for receptive deficits in Language Oriented Treatment?
(3)
Improving discrimination of speech sounds
Improving access to word meanings
Changing the individual’s communication environment to support auditory comprehension
What are the treatment targets for expressive deficits in Language Oriented Treatment?
(3)
Semantic processing (e.g., semantic cueing, semantic judgments, categorization and word-to- picture matching)
Accessing phonological word forms such as phonemic cueing
Cueing spoken output with written letters, repetition and reading aloud
How are activities presented in Language Oriented Treatment?
Why?
In increasing order of difficulty
It facilitate improvement and minimize frustration.
How are stimuli presented in Language Oriented Treatment?
4
In blocks of 10 items
70% achievement on two blocks of items is required to move to the next level of difficulty.
When 70% is not achieved, the clinician repeats the block with the patient.
The difficulty of specific tasks are decreased to a lower level of difficulty if the patient cannot achieve the 70% criterion
Individuals with aphasia often use the _______ that is accessible to them with the least amount of effort. __________ supresses these strategies and emphasizes ______ communication.
Communication channel
Constraint Induced Language Therapy
Verbal
What does Constraint Induced Language Therapy emphasize?
The interaction between patient and clinician in natural communication situations
What does Constraint Induced Language Therapy NOT focus on?
Linguistic “code”
What sorts of goals are targeted in Constraint Induced Language Therapy?
(4)
Topic maintenance
Discourse
Problem management
Discourse roles
How are pragmatic treatment goals addressed in Constraint Induced Language Therapy?
In conjunction w/linguistic therapy
What are the benefits of Constraint Induced Language Therapy?
(3)
Therapy materials are relevant
Carry-over is emphasized
Strategies are practical
What is Computerized Applications in Aphasia Treatment?
What do they designed to address?
The use of computers and software to improve communication in individuals with aphasia
Multiple language modalities
What does Computerized Applications in Aphasia Treatment allow for?
Independent practice
Why is Computerized Applications in Aphasia Treatment limited in nature?
The static nature of interaction
Many programs have moved to IOS platforms
What are the benefits of Group Therapy for Aphasia?
7
Initiate various forms of communicative acts
Practice communication skills learned in therapy
Engage in turn taking
Maintain good communication and social pragmatic skills
Interact with a variety of communicative partners
Learn practical information from others who are more experienced in living with aphasia
Receive and offer psychological and emotional support
What are six treatment techniques for Aphasia?
Sentence Production Program for Aphasia
Melodic Intonation Therapy
Voluntary Control of Involuntary Utterances
Treating Aphasic Perseveration
Visual Action Therapy
Script Training
What is the goal of the Sentence Production Program for Aphasia?
Improving the ability of nonfluent individuals with aphasia who demonstrate agrammatism to make statements and requests, ask questions, and converse
Who is a candidate for the Sentence Production Program for Aphasia?
(4)
Agrammatic spontaneous speech output
Good single-word auditory comprehension
Fair to good comprehension of sentences and paragraphs
Good attention and memory span
What is the Melodic Intonation Therapy (MIT)?
2
Hierarchical structured program to stimulate speech production
Capitalizes on R hemisphere in processing intonational contours of spoken sentences
What does Melodic Intonation Therapy begin with?
What does it progress to?
Multisyllabic words and short phrases matched w/sequences of tones (tonal sequences lacking musical rhytmn)
Longer and more complex sentences which are gradually produced normally
Who is a candidate for Melodic Intonation Therapy?
5
Dominant hemisphere stroke
Poorly articulated, nonfluent output, maybe limited to stereotypy
Some comprehension skills
Poor repetition skills, facilitated
by superimposed tones
Well motivated w/good attention
What are the five techniques used in Melodic Intonation Therapy?
Clinician
Person with Aphasia
Hand Tapping
Back Up
Unison
What is Voluntary Control of Involuntary Utterances (VCIU) designed to improve?
Volitional speech production in severely aphasic patients whose speech is limited to stereotypic productions
What is the goal of Voluntary Control of Involuntary Utterances (VCIU)?
To take what the patient produce involuntarily and bring it under voluntary control
Who is a good candidate for Voluntary Control of Involuntary Utterances (VCIU)?
(3)
Severely limited speech w/only a few real words
Can match words correctly to pictured objects and actions
Some oral reading even if inconsistent
Why was Treating Aphasic Perseveration (TAP) developed?
For aphasic patients who have at least moderate degree of perseveration with confrontational naming tasks
What is the Premise of Treating Aphasic Perseveration (TAP)?
“Deblocking” language ability by decreasing perseverative behavior
Who is a candidate for Treating Aphasic Perseveration (TAP)?
3
Moderate-severe degree of perseveration in confrontation naming tasks
Some comprehension skills
Alert and motivated
Why was Visual Action Therapy (VAT) designed?
To establish symbolic representation as precursor to communication
What is the Visual Action Therapy (VAT)?
A hierarchical approach beginning w/tracing objects, matching objects to pictures, imitating gestures and finally producing gestures to communicate regarding hidden pictures
Who is a good candidate for Visual Action Therapy (VAT)?
5
L hemisphere strokes
Severely restricted expression of spoken and written language
Severely restricted comprehension of spoken and written language
Alert and cooperative
Moderate to severe limb apraxia
What is Script Training?
Intervention for individuals with aphasia that emphasize the use of dialogues or monologues that are learned verbatim.
What is the goal of Script Training?
That the individual with aphasia achieves “islands of automatic speech” that can then be produced fluently in real life situations
What is the purpose of Script Training?
To achieve automatic production via repeated practice of large and meaningful units
How do individuals with aphasia move through in Script Training?
Script lines using a hierarchy of repetition, choral reading, and independent production
Can script training be practiced independently?
Yes
