Aphasia treatment Flashcards
What are 2 considerations for setting treatment goals
-Clients personal priorities
-Reasonable expectations based on client’s performance and knowlegde/experience
Why are client priorities important in treatment?
-Increased tx progess
-Increased tx satisfaction
-Aphasia threatens their roles and autonomy: so give them information and seek their input
-The greatest impairment may not be the most salient, make sure it is what the client wants to work on
What components of the clients performance influence tx expectations
-individuals neurologic, cognitive, metacognitive, and language profile
What 3 key information pieces obtained from assessment help to determine reasonable tx expectations
-What the client can do independently (tx reinforcer)
-What the client can do with support (tx targets)
-What the client can’t do
5 components of treatment goals
- Reflect the individuals personal priorities
- Written in operational language, easily understood by others
- Easily measurable for clear and objective determination and report of treatment response
- Logical and practical progression from STG to LTG
- Emphasize the communication activity
What is progress monitoring
Continuously evaluating and revising of goals as appropriate
Assessment is an ongoing process
3 reasons for documentation of treatment services
- pragmatically more important than therapy
- Proves services took place (if not documented, it didnt happen)
- Shows expertise- explains and justifies reasoning for services and activities
ASHA Documentation guidelines
- Use terminology reflecting technical knowledge
- Indicate rational/function, type, and complexity of activity
- Report objective (quantitative data) showing progress towards measureable goal
- Explain any modifications and give reasoning
- Specify feedback and/or training and client response
How may group tx be beneficial at the individual level
sense of family support
Feeling understood
Community
learn from others
Socialization
How may group tx be non-beneficial at the individual level
May lead to being discouraged
Less individualized
Less structure
individuals may not benefit as much
Less attention to individual
Inconsistent attendance
How may group tx be non-beneficial at the healthcare level
Meeting insurance requirements
Third party payer
Communication is targeted indirectly
Cons of group therapy
Harder to take data
Finding a common activity for alls interests
Inclusion of all participants
Creating equal opportunity for everyone
Less structure
Considerations for composing group therapy
Etiology
Symptomology
Severity
Age
Gender
Family in groups (good and bad)
Standards for participation
Pragmatic skills
Social behaviors
Attendance
Dischanging
Tips for composing group therapy sessions
-Know patient and family members needs, abilities, etc.
-Get family members to fill out questionare about client
-Get a sense of pre-morbid level of funtioning
-Ignore undesireable behaviors and reinforce positve behaviors
-Redirect undesirable behaviors
-Praise any level of participation
-Acknowledge and validate frustrations
3 Types of group tx Programs
- Communication based
- Psychosocial based
- Transactional based
What are communication based group tx programs
Procedural discourse tasks
-Facilitate language in a social setting
-Improve narrative procedural discourse
-Improve content of narrative and procedural discourse
-Improve functional communication in selected roles
What are psychosocial based group tx programs
emphasis on a team
NOT individualized
What are transactional based group tx programs
Facilitate discharge planning for patient and movement from one setting to another
(rehab team to long-term care)
Leader: social worker or case worker
What would be examples of story based tx activities
Pictionary
Acting out scenarios
Guess that word
Show and tell
Charades
What would be examples of arts based activities
Building structures
Baking
Cooking
Directions
Planning
Blueprints
Considerations when selecting documentation instrument for group therapy
-Group tx goals and objectives
-Amount of time needed
-Frequency and duration of group tx
-Examiner skill
-State/company/billing insurance requirements
Examples of documentation
-Standardized tests
-Measures of quantifying verbal output (frequency of initiated conversation, response time, level of engagement, accuracy of message)
-Qualitative measures
-Psychosocial measures
-Task specific measures of information exchange
-Type of communication acts
-Satisfactory levels
-Communication acts profile (children)
Examples of qualitative information that can be measured in group tx
-degree of communication burden assumed by conversational partner
-communication modality
-Self ratings
-list of augmentative strategies used
-list of compensatory efforts used
-psychosocial measures
Examples of psychosocial measures
Mood scales
Well being scales
Affect balance scales
Interactive communication scales
Self ratings
3 types of communication acts
- Assertive: agreeing with others
- Responsive: answering others
- Imitative: copying others
8 specific intervention techniques
- multiple modality teaching
- Providing feedback
- check for comprehension
- Share the leadership role
- Scaffolding
- promote generalization
- compensatory
- Various communciation methods
Define communication
-Information exchange between listener and speaker
-Participants use meaningful mode of communication with set of symbols
-Feedback occurs, which makes the communication participation equal
Purpose of varying stimulation in tx
To add or decrease difficulty level
Want to minimize failures and maximize performance/success
Standardized test for measuring auditory verbal comprehension
Token test
Standardized test for measuring naming
Boston naming test
Standardized test for measuring reading
- Gray Oral Reading Test
- Reading Comprehension Battery for Aphasia
Standardized test for measuring language
- Western Battery Aphasia
- Boston Diagnostic Aphasia Examination
Standardized test for measuring writing
None that measure only writing
Standardized test for measuring repetition
None that measure only repetition
4 biomedical approaches for aphasia
- Pharmacotherapy
- Transcranial Magnetic stimulation
- Stem cell transplantation
- Nerve cell stimulation
Biomedical approaches help to understand?
The neural basis of language
Define pharmacotherapy for aphasia
Manipulation of the brains neurotransmitters (chemical substances that allow electrical messages to be sent from one nerve cell to another)
List some of the neurotransmitters shown to be effective for pharmacotherapy
- Dopamine
- Acetylcholine/Cholinergic
- Amphetamines
- Bromocriptine
- Dopaminergic
- GABA
GABA and cholinergic have been shown to be effective with what type of aphasia?
Fluent aphasia
Amphetamines, Bromocriptine, and dopaminergic have been studied in what type of aphasia?
Nonfluent aphasia
(only amphetamines and bromocriptine are effective)
Pharmacotherapy have been shown to be effective for?
Mild to moderate aphasia, but not severe aphasia
(evidence from not well-designed studies- case studies)
What is transcranial magnetic stimulation
Noninvasive procedure using magnetic fields to create electrical currents in discrete brain areas
This increases or decreases the excitability of neurons in the affected area that lasts beyond the duration of the stimulus itself
Differentiate between slow and fast runs of magnetic stimuli
Slow runs decrease cortical excitability
Fast runs increase cortical excitability
What are some compensatory/alternative approaches to Aphasia Tx
Yoga
Meditation
Mindfulness meditation
Nature based therapy approaches
What are the 3 nature based therapies
- Horticultural therapy
- ANimal assisted therapy
- Natural environment therapy
What did the times say about meditation? Why
Meditation should be treated more seriously like medication because it can be beneficial to a variety of areas:
Depression
Anxiety
Cognitive functions
Immune function
Stress
Sleep
Cancer
Self-compassion
Mindfulness meditation targets what
Divided attention
Increased attention and awareness
Improved relaxation
Increases cortical thickness
Physiologic and cognitive benefits shown with mindfulness meditation
- Physiologic- increase parasympathetic (calming) activity & decrease sympathetic activity (fight or flight)
- Cognitive- attention benefits
What compensatory/alternative approach has been shown to have bio-psychosocial benefits in stroke survivors
Yoga
Yoga has had what 3 effects in stroke survivors
- Improved language abilities (spontaneous sleep and fluency naming)
- Improved visual attention (reaction time, perceptual tracking, and simple/alternate sequencing)
- Decreased levels of anxiety and depression
Describe horticulture therapy
Therapeutic effects of cultivating plants
What is animal assisted therapy
Use of animals to individuals improve:
socially
emotionally
cognitive functioning motivation
What is natural environmental therapy
Exposure to natural environment can improve patients experience and health outcomes
Aimed at improving healing, reducing medicine use, shorten hospitalization, and decrease anxiety/stress
What is agnosia?
-Sensation without perception= sensory acuity being WNL, with inability to recognize/identify sensory stimuli
-Modality specific
-Rare
Define visual agnosia
Failure to respond appropriately to visually presented stimuli
Visual sensory processing, language, and intellectual functioning are intact/preserved
Define auditory agnosia
Problems with the recognition of sounds, while hearing acuity is 100& WNL
Apperaceptive visual agnosia
Inability to match, draw, or point to objects
Apperceptive visual agnosia deficits are possibly due to?
Simultanagnosia
Lesion site associated with Apperceptive visual agnosia
Striate area- visual sensory area in occupital lobe
Peristriate area- areas surrounding striate areaa
Define associative visual agnosia
Inability to identify objects
Able to copy (drawings) or match sample objects
Associative visual agnosia is affected by what effect?
Stimulus abstraction
Line drawings < picture or objects
4 types of associative visual agnosia
-Object agnosia
-Color agnosia
-Prosopagnosia
-Alexia
What is object agnosia
Difficulty with object identification
What is color agnosia
Inability to identify/differentiate between colors
What is prosopagnosia
Face blindness
Inability to recognize familiar faces
They can recognize identifying characteristics of individuals (eye color, hair style, clothing, nose)
What is alexia
Acquired reading disorder
Difficulty with letter identification
2 types of alexia
Peripheral and central alexia
which alexia type affects early stages of reading processes and includes difficulty with perceiving the wirtten word
Peripheral alexia
What is central alexia
Affects later stages of reading process
Impairment in lexical and sublexical processing
Pure word agnosia
Difficulty recognizing/understanding spoken words
Environmental (non-speech) sounds, reading, writing, and speaking abilities intact
How would a person with auditory comprehension deficit may differ from pure word deafness during a repetition task
AC would be able to repetite the words even tho unable to comprehend the words
Pure word deafness would be able to perceive the sound, but not recognize it inorder to repeat
When listening to music, what may pure word deafness hear
Melody
Without words
What is auditory sound agnosia
Difficulty recognizing enviornmental sounds
Speech reception is normal
What is cortical deafness
Inability to recognize any auditory sounds
All other language areas are unaffected
Which type of auditory agnosia often report feeling deaf
Cortical deafness
What is cortical auditory agnosia
A subset of cortical deafness
Able to recognize background noise, but unable to recognize auditory sounds
Feel like something is happening in the background
What is amusia
Difficulty recognizing/discriminating characteristics of music, while being able to hear lyrics/words within a song
What musical characteristics would someone with amusia not be able to discriminate
Pitch
Harmony
Timbre
Intensity
Rhythm
What is agraphia
Acquired writing difficulty
2 approaches to evaluating agnosia
- neurologic model- Agraphia is the core, and the other disorder is associated with agraphia
- Neuropsychological (Cognitive) approach- agraphia exists as a result of a processing deficit or peripheral deficit
What is linguistic agraphia
A problem in processing results in writing deficit (agraphia)
What is peripheral agraphia
Any peripheral (outside) deficit that results in a writing deficit
What peripheral deficits could cause agraphia
-mobility issue (ALS, cerebral palsy, paralysis)
-Vision (blindness, visual neglect)
-Attention deficit
When assessing agraphia, which writing level should writing be assessed?
Paragraph, sentence, and word level
2 types of writing tasks used to assess agraphia
- spontaneous writing task
- Dictated stimuli writing task
Instructing someone to write regular words, pseudowords, irregular words would be considered
Dictated stimuli task
Give an example of a spontaneous writing task
-Write what you did yesterday
-Write a story about a past experience
What is the best way to assess writing
Spontaneous writing task
What are 2 approaches used in treating agraphia
- Phonological Treatment Approach
- Copy and recall treatment
What is the phonological treatment approach for agraphia
Hierarchy to improve writing
- letter sound association
-key word
-picture identification
-copy key word
What is CART
Retrains writing by looking at the word, progressing to spontaneous writing
3 interactive treatments for agraphia
- Train phonological skills
- Lexical checks
- Electronic devices
