Aphasia Final Flashcards
Principles of Adult Learning
Self Concept
Prior Experience
Readiness to Learn
Psychosocial consequences of injury
5 Steps During Therapy
- Info gathering
- Collaborative goal setting
- Pretx assessment (baselining)
- Treatment
- Reassessment
Aphasia Treatment Essentials
CAPE
- Connecting PWA
- Augmentative/Alternative Communication
- Partner Training
- Education & Resources
* “Aphasia friendly” info
Steps of Good Evidence-Based Practice
- Frame clinical question (PICO)
- Population, intervention, comparison, outcome - Find/assess scientific evidence
- Analyze evidence
- Integrate external evidence w/ client values and circumstances
- Self-assessment/evaluation
Phase 1 - Pre-efficacy Studies
- See if evidence has therapeutic value
- Small sample sizes, case studies, single-subject design
Phase 2 - Pre-efficacy Studies
- Develop, standardize, optimize & validate procedures
- Explain why treatment works, who are ideal candidates
- Small group and case studies
- More hypothesis driven than phase 1
Phase 3 - Efficacy Studies
- Test treatment efficacy under ideal conditions of use
- Randomized control trials
- Large samples, control/parallel groups
Phase 4 - Effectiveness Studies
- Effectiveness of treatment under ordinary use
- Large samples of target population
Phase 5 - Effectiveness Studies
-Explore efficiency, cost-benefit, PT/family satisfaction, QoL
Class III Evidence
Weakest level
- Expert opinion, case series, case reports, historical controls
- Single subject multiple baseline across behaviours
Class II Evidence
Intermediate Level
- Well-designed observational studies w/ concurrent controls
- Single subject multiple baseline across subjects
Class I Evidence
Strongest Level
-One or more well-designed, randomized, controlled clinical trials, including overviews (meta analysis of such trials)
Constraint-Induced Language Therapy (CILT/CIAT)
Based on CIMT principles, it’s a “small group therapy”.. using therapeutic language games restricting responses to only spoken language
CILT Principles
- Constraint/Forced Use
- Massed Practice
- Behavioural Shaping
- “Enriched environment”
Pros of CILT
- Large gains over short time
- Group therapy
- Quick/cheap materials
- Sense of ownership over own rehab
- Active engagement
Cons of CILT
- Time commitment
- Huge family involvement
- Not appropriate for all aphasia types
- People use non-verbals a lot
Intervention for Anomia
Cueing hierarchies
Cueing Hierarchy Steps
- Determine what cues facilitate PT’s word retrieval
- Arrange cues in hierarchy (least to most or most to least supportive)
- Present pictures/objects
- If PT can’t correctly name object, start with first cue @ the top of the hierarchy
- If following that cue PT is still wrong, use next cue
- Continue w/ cues until PT is able to name the item correctly
Semantic Anomia Treatment
Stimulation approach
- Strengthen semantic representations
- Increase comprehension & production (naming)
ex: sorting or matching pics by categories, spoken or written word picture matching, answering Qs about target items, “Semantic Feature Analysis” - Use atypical exemplars to generalize
Phonological Anomia Treatment
Stimulation approach
-Strengthen/facilitate access to phonological representations
Comprehension tasks: spoken word to picture or written word matching
Production tasks: repeating, reading aloud, naming using phonological cues in hierarchy
Self Cueing Strategies
What is it, candidates?
“Self analysis” to avoid and self-correct errors
-Foster self-generated cues, facilitate removal of intended word
Chronic mild-moderate aphasia with anomia as major symptom
Training Semantic Self-Cueing
What, who?
- Facilitate circumlocution to trigger wd retrieval
- Resolve communication breakdowns by producing semantic info
- Mild-moderate aphasia (anomic, conduction, Broca’s), need some intelligible utterances
- Not for AOS
-Train PT to use “Semantic Feature Analysis”
Phonemic Self-Cueing
What, who?
-Get PT to provide own phonemic cue
Need intelligible expressive language, good auditory comprehension, can write word or initials
“Relay words” to make letter sound association
Pure Alexia
LBL reading
Impaired access to orthographic lexicon
Word length effect
PCA stroke
Surface Alexia/Agraphia
Difficulty w/ irregular words
Over-reliance on sublexical phonology
Regularity Effect
PCA stroke
Phonological Alexia/Agraphia
Difficulty with non-words
Impaired sublexical route
Lexicality effect
MCA stroke
Deep Alexia/Agraphia
Damage to lexical-semantic & sublexical
Semantic errors
MCA stroke
Global Alexia/Agraphia
Damage to lexical-semantic & sublexical
Severely impaired spelling words & nonwords
Large MCA stroke
Multiple Oral Reading (MOR)
Repeated oral reading of text to increase rate/accuracy
Text-based alexia treatment
For: pure, phonological, mixed, deep alexia
Oral Reading for Language in Aphasia (ORLA)
Repetitive multimodal (reading, pointing & auditory input) stimulation presented to elicit response For: deep, mixed alexia/aphasia across range of severities (possibly AOS too)
Cross-modality Cueing
Tactile/kinesthetic tx that bypasses the visual access to the orthographic lexicon “training up” letters to speed up accuracy of reading
For: Pure alexics with POOR letter identification/ naming
Writing Treatment: Lexical Approach
Retraining spelling of specific words
For: Global, deep agraphia (maybe severe aphasia)
Tx: CART, ACT
Copy and Recall Treatment (CART)
Lexical spelling treatment: Present a picture PT names it If right, PT writes it If wrong, they write it 3 times
Anagram & Copy Treatment (ACT)
Lexical spelling treatment:
They write word
If wrong, present letters & make them spell it
If right copy 3 times
If wrong, clinician arranges letters correctly & they copy 3 times
etc.
Writing Treatment: Phonological Approach
Retraining sound-letter correspondences using “key words”, CART, & cueing hierarchy
For: Phonological agraphia
Interactive Approach
Training interactive use of residual lexical and phonological knowledge to improve spelling
*Establish problem-solving procedures: use phonology to sound out, self-detect, check w/ app
For: Surface agraphia
Treatment for Aphasic Perseveration (TAP)
Bring perseveration to awareness, help PTs suppress it & produce correct responses
For: Mod-severe perseveration during confrontation naming, good auditory comprehension, good memory
Melodic Intonation Therapy (MIT)
3 level hierarchical tx to stimulate prepositional speech skills
-Intone high probability phrases & sentences
For: LH stroke, non-fluent, poor artic, some intelligible utterances while singing, poor repetition, good auditory comprehension, good attention/motivation, can do intensive therapy
3 Types of Perseveration
- Stuck in set - frontal lobe
- Continuous - dementia, RHD
- Recurrent - aphasia
Management of Perseveration
TAP Explain tasks Establish when using new sets Use visual cues Avoid quick stimulus presentation
LPAA Core Values
- *Enhance life participation
- All affected get services
- Documented life-enhancement changes
- Personal/environmental factors considered
- Emphasis on available services at all stages
Health Related Quality of Life (HQoL)
Impact that health status has on a person’s ability to lead a fulfilling life
- Functional communication ability/linguistic ability
- Emotional state/psychological well-being
- Social support
- Social participation
Parameters that Define Cultures
Individualism vs. Collectivism View of work Space & time Language (formal/informal, pragmatics, non-verbals) Roles Rituals/superstitions Class & Status Values
Factors affecting Aphasic Impairments in Bilingual/Multilinguals
Sociocultural history
Acquisition & communicative experiences
Cognitive stratgies
Types of Bilingual Aphasia Recovery
Parallel recovery (most) Non-parallel recovery (differential, blended, selective)
Aphasia Framework for Outcome Measurement (A-FROM)
Considers: WHO-ICF (QoL) + Language impairments Participation Personal Factors Communication envt Goal: Living successfully w/ aphasia!
