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CETP - SLP > Neurologically Based Communication Disorders > Flashcards

Neurologically Based Communication Disorders Flashcards

1
Q

Expressive language error that is not the result of a motor deficit

A

Paraphasia

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2
Q

Who are more prone to strokes?
- Men or women?
- Younger or older?

A

Men, older

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3
Q

What is more likely to occur? Ischemic or Hemorragic stroke? Which one has a better survival rate?

A

Ischemic (87%), Ischemic has better survival rate

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4
Q

Name the aphasia:
- Aphasia caused due to a right hemisphere brain lesion in right-handed individuals
- The right hand remains unaffected, and therefore, patient’s writing skills are intact

A

Crossed aphasia

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5
Q

Name the aphasia
- Extensive subcortical damage, with our without the involvement of the cortical areas of the brain

A

Subcortical aphasia

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6
Q

How to Tx auditory comprehension

A

Sequenced as follow:
- Comprehension of single words
- Comprehension of spoken sentences
- Discourse comprehension

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7
Q

Tx of verbal expression: naming

A
  • Incomplete sentencing (you write with a ___)
  • Phonemic cueing (it starts with a p)
  • Syllabic cues (the word starts with pen___)
  • Silent phonetic cues (SLP exhibits silent articulatory posture for /p/)
    -Personalized verbal cues that is specific to the patient
  • Functional descriptions of objects (you use it to write)
  • Ex. Semantic feature analysis
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8
Q

Tx of verbal expression: expanded utterances

A
  • Goal is to increase length and complexity of utterances
  • Ex. action-filled picture and stories
  • Conversational speech is the final target
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9
Q

Tx of reading skills

A
  • Based on Ax of premorbid reading skills and the current need for reading
  • Survival reading skills (reading letters, menus, bank statements, maps)
  • Reading newspaper, books and letters
  • Reading and comprehension of printed words
  • Reading and comprehension oh phrases and sentences
  • Reading and comprehension of paragraphs and extended material
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10
Q

Tx of writing skills

A
  • Based on Ax of premorbid writing skills and the current need for writing
  • Initially functional words (own name, names of family members)
  • Writing functional lists (grocery lists)
  • Writing short notes, reminders, address, etc.
  • Filling out forms
  • Writing letters
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11
Q

Group Tx for aphasia

A

Can be more efficient than individual Tx.
- Create a comfortable environment for client to interact with others who are going through similar experiences
- Depends on the member’s skill level

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12
Q

Social approaches for treating aphasia

A

358

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13
Q

Tx of bilingual speakers w/ aphasia

A
  • More research is needed
  • Tx on the weaker language MAY produce beneficial generalized effects on the stronger language
  • Tx is tailored to the individual’s needs and patterns of social communication
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14
Q

Alexia, agraphia, agnosia

A

Alexia: Loss/impairment of ability to read. Usually lesion in occipitotemporal region

Agraphia: Loss/impairment ability to write. Usually lesion in medial frontal gyrus (Exner’s writing area)

Agnosia: Impaired understanding of certain stimuli.

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15
Q

Infectious dementia

A

HIV and Creutzfeldt-Jakob disease can cause dementia.
- Dementia progression is slow in the beginning, but deterioration is rapid in late stages

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16
Q

Main symptoms of RHD

A
  • Perceptual and attention deficits
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17
Q

Tx of RHD

A

Must be tailored to individual needs

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18
Q

What’s typical in an Ax for TBI?

A

Initial bedside assessment
- Few questions about time, place and person orientation about the accident are asked.
- Examples of screening tests: Brief Test of Head Injury (BTHI), Montreal Cognitive Assessment (MoCA)

Assessment of memory impairments
- Post-traumatic amnesia or pre-traumatic amnesia may be assessed by an interview in which client-specific questions surrounding the trauma may be asked

Assessment of executive functions
- Planning, organizing, initiating and completing various activities.
- May be assessed by asking client to describe how he or she might plan a vacation, organize a picnic, prepare a meal, etc.

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19
Q

Two types of Tx for persons with TBI

A

Cognitive rehabilitation
- Clinicians trains components as attention, visual processing, and memory, which may not result in improved communication.
- Attempts to improve these things may be better integrated with communication treatment.
- Pts with TBI recover their memory skills as their conditions improves; nonetheless, memory training (the kind used with patients w dementia) is known to produce beneficial results

Communication treatment
- Often involves direct behavioural procedures.
- Goals should be functional, and the initial emphasis should be effectiveness of communication, not grammatical correctness.
- Family members should be involved in Treatment

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20
Q

nfvPPA (nonfluent) is associated with what structural changes and which disease?

A

Structural and metabolic changes of the perisylvian language area, including Broca’s area.
Pathology typical of Pick’s disease and Alzheimer’s may be evident.

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21
Q

svPPA (semantic) is associated with which disease?

A

Frontotemporal dementia

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22
Q

lvPPA (Logopenic) is associated with which diseases?

A

Alzheimer’s and frontotemporal dementia

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23
Q

Which PPA is associated with these characteristics?
- Early signs of anomia
- Memory and cognition usually preserved until 2 years post-onset
- Phonemic paraphasias
- Apraxia of speech, subsequently, reduced fluency
- Slow progress of the disease - 8-10 years survival rate

A

nfvPPA (nonfluent)

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24
Q

Which PPA is associated with these characteristics?
- Progress loss of word meaning
- anomia
- semantic paraphasia
- initially intact fluency and repetition skills; repetition of words not named or comprehended
- Logorrhea
- Impaired turn-taking in discourse
- Progessively shorter and shorter sentences
- Visual agnosia and prosopagnosia
- Behavior changes

A

svPPA (semantic)

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25
Q

Which PPA is associated with these characteristics?
- Slow speech, with word-finding pauses but NO agrammatism
- moderate naming difficulties in the early stages
- Severe difficulty repeating phrases and sentences
- Behavioral changes
- Impaired sentence comprehension

A

lvPPA (logopenic)

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26
Q

Which PPA is apraxia of speech present in?

A

nfvPPA (nonfluent)

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27
Q

Parkinsonism

A

Refers to a group of neurological disorders that include hypokinesia, tremors, and muscle rigidity.
Possibly due to both genetic and environmental factors.

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28
Q

Name the dementia:
- Cortical type
- Mild: wandering, getting lost
- Moderate: Trouble recognizing friends/family
- Severe: Cannot communicate
- Intensified visuospatial problems
- worsening of symptoms at night (sundowner syndrome)

A

Alzheimer’s

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29
Q

Name the dementia:
- Progressive loss of vocabulary and consequent paraphasia and circumlocution
- Inappropriate social behaviors
- Difficulty with coordination, shaky hands
- Emotional disturbances (flatness or excessive emotions)
- Pick’s disease

A

Frontotemporal dementia

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30
Q

Sundowner syndrome

A

When symptoms are worst at night. Alzheimer’s disease sometimes has this syndrome.

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31
Q

Name the dementia:
- Degeneration of cortex AND subcortex due to deposits of lewy bodies
- Sleep disorders (insomnia or sleeping during the day)
- Visual hallucinations
- Inability to concentrate, stay alert

A

Lewy body dementia

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32
Q

Name the dementia:
- Forgetting current or past events
- Misplacing items
- Trouble following directions or learning new information
- Hallucinations or delusions
- Caused by ischemic stroke

A

Vascular dementia

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33
Q

Name the dementia:
- Repeated brain injuries, especially those that cause prolonged periods of unconsciousness
- Cortical, subcortical and mixed types of damages

A

Dementia associated with TBI

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34
Q

Name the dementia:
- Infarction within the deep structures of the brain
- Atrophy of subcortical white matter caused by repeated infarcts
-

A

Dementia associated with multiple CVAs

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35
Q

Name the disease:
- Caused by vitamin B1 deficiencies
- Often related to chronic alcohol abuse
- Other causes: dietary deficiencies, eating disorders, chemotherapy

A

Wernicke-Korsakoff syndrome

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36
Q

What is the main clinical concern for patients with dementia?

A

Offer intervention that will help slow the progression of dementia, sustain communication and other skills to the extent possible, improve daily communication and living skills.
Helping family members is also a major concern.

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37
Q

Main goals for dementia patients in the early stages and main goals for late stages

A

Early stages: Communication, memory, behavioral management
Late stages: providing communication with caregivers

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38
Q

T or F? HIV infection can cause dementia

A

True. AIDS, encelopathy or Creutzfeldt-Jakob disease can cause dementia.

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39
Q

HD or PD?
- Slow voluntary movements (bradykinesia)
- Tremors in resting muscles, starting in hand or foot and spreading
- Mask-like face
- Reduced eye-blinking
- Swallowing disorders
- Sleep disturbances
- Cogwheel rigidity, or tension in a muscle that gives way in little jerks when the muscle is passively stretched

A

Parkinson’s disease

40
Q

HD or PD?
- Reduced speech volume
- Voice problems that include monopitch and monoloudness
- Long and frequent pauses in speech
- Slow, fast or festinating speech
- Dysarthric speech
- Impaired visuospatial perception
- Memory problems
- Micrographia

A

Parkinson’s disease

41
Q

HD or PD?
- Chorea (irregular, spasmodic, involuntary movements of the neck, head and face)
- Increasingly incontrollable tic-like movement disorder
- Gait disturbances and progressively reduced voluntary movements
- Slow movement in the advanced stages, leading to little or no voluntary movements
- Behavioral disorders that include excessive complaining, nagging, irritability, emotional outbursts, suicide attempts
- schizophrenic-like behaviors (delusions and hallucinations)

A

Huntington’s disease

42
Q

HD or PD?
- Deterioration in intellectual functions including memory, attention, concentration, and executive functioning skills
- Dysarthria
- Sleep disturbances, sleep reversal and dysphagia
- Muteness in final stages

A

Huntington’s disease

43
Q

Clinical management of dementia

A

Management of daily activities, memory and communication skills
- Ex. Establishing simple routine, keeping phone numbers and possessions in specific place, carrying card or wearing bracelet with names, phone numbers of caregivers, external cues to improve memory and behavior (memory wallet), writing down information when memory begins to fail

Communication training
- Ex. Improving or sustaining basic, functional communication skills as long as possible, caregiver and family involvement in communication training is crucial

44
Q

T or F? Perceptual and attentional deficits dominate the symptoms of RHD

A

True

45
Q

In RHD, which side is neglected?

A

Left neglect; reduced awareness of the left side of the body and generally reduced awareness of stimuli in the left visual field

46
Q

Tx of auditory comprehension

A

Comprehension of single words
Comprehension of spoken sentences
Discourse comprehension

47
Q

Tx of verbal expression: Naming

A

Semantic feature analysis

48
Q

Tx of reading skills

A

Target reading skills are selected based on Ax of premorbid reading skills and current need for reading.

  • Survival reading skills (reading letters, menus, bank statements and maps)
  • Reading newspapers, books and letters
  • Reading and comprehension of printed words
  • Reading and comprehension of phrases and sentences
  • Reading and comprehension of paragraphs and extended material
49
Q

Tx of writing skills

A

Target writing skills are selected based on Ax of premorbid writing skills and current need for writing.

  • initially writing functional words (ex. name, family member’s name)
  • Writing short functional lists (grocery list)
  • Writing short notes, reminders, addresses, etc.
  • Filling out forms
  • Writing letters
50
Q

Describe how ALS might impact speech.

A

Progressive/degenerative nervous system disease that affects nerve cells in the
brain and spinal cord, causing loss of muscle control
Neurologically based speech disorders will worsen overtime

51
Q

How does guillain-barre syndrome impact speech?

A

Rapid onset of symptoms; denervation of muscles, which causes weakness, with expected improvement given treatment. Recovery time is generally 3 years.
Neurologically based speech disorders will: mostly improve given ongoing
intervention

52
Q

How does MS impact speech?

A

Dysarthria is considered the most common communication disorder in those with MS. It is typically mild, with severity of dysarthria symptoms related to neurological involvement
Neurologically based speech disorders will: likely remain stable with ongoing
treatment of disease, worsen later on in life expectancy

53
Q

How does myasthenia gravis impact speech?

A

A chronic autoimmune disorder in which antibodies destroy the communication
between nerves and muscle, resulting in weakness of the skeletal muscles - lesions occur at neuromuscular junction
Neurologically based speech disorders will: likely worsen as disease progresses

54
Q

How might wilson’s disease impact speech?

A

A rare, progressive, genetic disorder characterized by excess copper stored in
various body tissues, particularly the liver, brain, and corneas of the eyes.
Prognosis depends on time of diagnosis and ongoing treatment. Causes tremor,
involuntary movements, lack of coordination, and muscle rigidity
Neurologically based speech disorders will: worsen overtime

55
Q

Describe a right hemisphere disorder.

A

Resuls in visuospatial deficits, visual (left) neglect, denial and poor awareness of impairment (anosognosia), prosodic, inferencing, and discourse deficits, sustained and selective attention deficits.

56
Q

How might some medications impact communication assessments?

A

Neuroactive medications: dosage timing may affect observations made during assessment.
Sedatives: lethargy may influence communication function
Antihypertensives, antihistamines, diuretics: may affect vocal quality.

57
Q

What aspects of language decline with age?

A

Confrontation naming (word-finding) and generative naming may decline but not so to the extent that it interferes with communication
Language comprehension may be affected if information is complex and presented rapidly
Main effects on language are secondary to slower processing and poorer attention

58
Q

What is spontaneous recovery?

A

Associated with aphasia
No definite predictions concerning its length or extent
Maximum improvement in first 3 months
Probably continues for at least 6 months
In global aphasia, probably starts later, lasts longer; likewise in severe TBI (not in hypoxic injury)
At this point, several aphasia studies have looked at spontaneous recovery in absence of treatment
All support statistically significant improvement in first weeks after stroke

59
Q

What are some important factors to consider in acute care intervention?

A

Patient status depends on medical factors
For stroke, type of stroke and extent of brain damage
Hemorrhage patients (if they survive) begin spontaneous recovery later, improve more than patients with thromboembolic strokes. True of cortical and subcortical stroke
For other ABI, recovery depends on extent of axonal vs. neuronal damage
Symptoms may evolve rapidly

60
Q

What structures, aetiologies, and syndromes are commonly involved in language, according to the localization framework?

A

Left hemisphere: stroke and aphasia

61
Q

What structures, aetiologies, and syndromes are commonly involved in cognition, according to the localization framework?

A

Frontal lobe: TBI and CCD
Right hemisphere: right-hemisphere pathology and RHD
Mesial temporal lobes: neurodegeneration and dementia

62
Q

How can you differentiate dementia from other temporary or treatable conditions? Name some of those conditions.

A

Behavioural and cognitive symptoms.
Delirium—an acute state of confusion associated with temporary, but reversible, cognitive impairments (Mahendra & Hopper, 2013)
Age-related memory decline
Other conditions that have inconsistent symptoms or are temporary and/or treatable, including: infections (e.g., urinary tract infection [UTI], meningitis, syphilis); toxicity (e.g., drug-induced dementia, toxic metal exposure); vitamin B-12 deficiency; metabolic disorders (e.g., kidney failure); hormonal dysfunction (e.g., thyroid problems); and pseudodementia due to psychiatric disorders (e.g., depression, generalized anxiety disorder, schizophrenia, mania, conversion disorders

63
Q

What does a right hemisphere disorder affect and not affect?

A

Not: syntax, grammar, phonological processing, and word retrieval.
Yes: semantic processing, discourse processing (including narrative), prosody, and pragmatics.
Can also impact other cognitive domains including attention, memory, and executive functioning.
Other impairments include anosagnosia (reduced awareness of deficits) and visual neglect, which can affect spoken and written language.
Can have a significant affect in social and vocational settings.

64
Q

What is crossed aphasia?

A

In a very small proportion of right-handed individuals, the language centers are located in the right
hemisphere of the brain, rather than in the left hemisphere. In these individuals, damage to the right hemisphere may result in symptoms of aphasia similar to those normally associated with a left
hemisphere lesion.

65
Q

What is the life participation approach?

A

Assessment should include determining relevant life participation needs and discovering competencies of clients → client should be directly involved in treatment planning
Clinicians are equally as interested in assessing how the person with aphasia does with support along with assessing language and communication deficits.

66
Q

What are the core values of the LPAA?

A

Explicit goal of enhancing life participation
Supporting all those affected by aphasia - i.e. offering service to immediate family
Targeting both personal (internal) and environmental (external) factors
Emphasis placed on the availability of all services at all stages of aphasia

67
Q

What is the A-FROM?

A

A-FROM is a framework for measuring aphasia outcomes
It is a user-friendly version of the ICF that is specific to aphasia
In contrast to the ICF, it does not emphasize “body structures and functions”
However, it does emphasize participation, activity, environment, and personal factors
The overlapping circles in this model show explicit interaction between all four factors

68
Q

Why is it not good to do an assessment during an acute phase of recovery?

A

Generally the acute phase is not a good time to do an assessment as things can change rather quickly.
Most studies support statistically significant improvement in the first weeks after stroke.

69
Q

What are some activities you could complete during the acute phase of recovery in lieu of an assessment?

A

Informal conversation assessment (instead of standardized assessment)
Each day, you can ask the same questions and document changes that could help give strategies to staff.
Other functional language assessment activities:
- Reading get well cards
- Study and fill in hospital menus
- Use a write board to write families names
- Name objects around the room
- Present commands to be followed
- Check yes/no comprehension and response type
- Track comprehension in conversations

70
Q

What are some supportive conversation techniques?

A

1) Acknowledge the competence of the person
2) Reveal competence: This both helps the person with aphasia understand you better (getting the message in) and enables the person with aphasia to express themselves better (Getting the message out)

71
Q

How might we acknowledge competence?

A

Help the person feel respected and treated as an intelligent adult.
Acknowledge their fears and frustrations
Speak naturally, using an adult tone of voice.

72
Q

What are some facilitators to aphasia assessment?

A

Facilitators - family support, availability of communication partners able to provide communication support to persons with aphasia in daily interactions, personal motivation to return to prior level of function, desire for greater communication independence, ability and willingness to use compensatory techniques and strategies, including AAC.

73
Q

What are some barriers to aphasia assessment?

A

Lack of regular and willing communication partners who are able to provide communication support to the person with aphasia in daily interactions, reduced confidence in one’s ability to communicate with familiar and unfamiliar speakers, cognitive deficits, visual and motor impairments, other comorbid chronic health conditions.

74
Q

Name some word finding interventions for aphasia.

A

Verb Network Strengthening Treatment (VNeST)

Semantic Feature Analysis

75
Q

Describe VNeST.

A

Focuses on verbs, encouraging participants to think of the people who
perform the actions (agents) and the objects or people the actions are performed on (patients).
Connections to nouns will strengthen all the words in the mental network around the verb
Does not use pictures as it is meant to activate the mental images and words in the brain and encourage flexible
thought
Evidence that findings generalize beyond the words work on in therapy
Effective in mild to moderate-severe aphasia.
Goal: To promote sentence production and connected speech

76
Q

Describe semantic feature analysis.

A

Based on the principles for spreading activation theory (SAT).
If we are thinking about the word in terms of semantic category (e.g. how it is used,
features, where it is found), we can help the PWA with word retrieval by activating
associated words with their neural networks to reach the target word.
Enables patients to use and practice circumlocution to help move conversation
forwards, even if the target word is not found.
May be effective for words PWA have not used previously with this approach.
Also demonstrated that the effects of using this approach are generalizable: PWA who have practice this approach for certain words have more success with word-finding for words that are semantically related to the words they practice with than they have with words not semantically related.
May be effective in training communication partners in learning what questions to ask when the client is struggling to find a word.

77
Q

What are the steps to Semantic Feature Analysis

A

1) Graphic organizer is shown to PWA with a picture of the object in the centre
(see below for image)
2) The PWA tries to name the item in the picture (move on regardless of response)
3) Ask each of the questions around the picture, writing the correct answers as they’re discussed. Give clues when needed. (Keep going even if they name the object)
4) The PWA tries to name the picture again. If they can’t say it on their own,
have them repeat after you.

78
Q

What are the major aspects of counselling?

A

Receiving information the client and family want to share with you
Giving information
Clarifying attitudes, beliefs and emotions
Providing options for changing behaviours

79
Q

Name and describe a therapy approach for targeting utterance length for individuals with aphasia.

A

Response elaboration training.
Designed to help clients with non-fluent aphasia increase the amount of information they share about a topic and the length of their utterances.
Relies on clinician responses and prompts to model and promote increased verbal expression.
Considered an informal training program and
involves incidental learning and positive reinforcement for correct responses.
Focuses on content rather than form.

80
Q

What are the steps to response elaboration training?

A

Present a picture scene to the client. Prompt the client for a response (e.g., “Tell me about this picture”, “What does this remind you of?”, “Tell me what is happening”)
Repeat what the participant had said, and reinforce it (e.g. “Man… great
that’s a man”.
Ask the client to elaborate on what they had said from Step 1 using wh-questions.
Reinforce the client’s utterance from Step 3 then model a phrase/sentence
which combines the client’s
productions from Steps 1 and 3 (e.g., “ Right, shaves, Man shaves”).
Provide a model of the combined production again, and request the client to repeat it.
Take away the picture, wait ~5 seconds, bring the picture back and ask the client again to describe the picture.

81
Q

Name and describe an approach to targeting reading and writing in PWA.

A

Reading and writing stimulation.
This approach aims to develop a systematic, client-specific hierarchy of massed reading and writing practice.
This involves considering various aspects of reading difficulty, including length, relative frequency of words, ability to use context and
prior knowledge, as well as the client’s current level of independent reading comprehension.
Considerations for writing difficulties:
- Commonness of spelling
- Relative frequency of words
Example:
1. Copy single short relevant
words with reference photo,
onto dashed lines (one line per letter)
2. Copy single short relevant
words with reference photo, onto one long line
3. Write single short relevant
word from relevant photo
4. Copy longer relevant word, or two short relevant words with reference photo, onto dashed line (one per letter)
5. Copy longer or pairs of words onto long line
6. Write longer relevant word, or two short relevant words from reference photo

82
Q

Name an approach to targeting reading comprehension in PWA.

A

Oral reading for language in aphasia (ORLA)
Aim is to improve reading comp. by providing practice in grapheme to phoneme conversion
The backing idea is that as oral reading becomes more fluent, the reader can focus on comprehension.
It focuses on reading full sentences rather than single words with the goal of also improving intonation and prosody.
Levels:
- Level 1. Simple 3-5 word sentences at a first grade reading level.
- Level 2. 8-12 words that may be single sentences or two short sentences, at a
third grade reading level
- Level 3. 15-30 words, divided into 2-3 sentences, at a sixth grade reading
level
- Level 4. 50-100 words comprising a 4-6 sentence simple paragraph

83
Q

What are the steps to Oral reading for language in aphasia (ORLA)

A

SLP uses a whiteboard to write a sentence (4 words in length)
SLP reads the stimulus out loud
SLP reads stimulus aloud to patient with SLP and patient pointing to each word
SLP and patient read allowed together, with patient continuing to point to each word
SLP adjusts rate and volume
Steps above are repeated twice more.
For each line or sentence, the SLP states a word for the patient to identify
Pt reads stimulus aloud with SLP reading aloud as needed

84
Q

Name and describe a therapy approach for targeting speaking fluency in PWA.

A

Melodic intonation therapy.
This approach is effective for improving production of words and phrases in multiple aphasia profiles and
improving the intelligibility of dysarthric speech.
Hierarchy (see below from image):
Level 1 & 2:
1. Humming
2. Unison intoning
3. Unison intoning with fading
4. Immediate repetition
5. Response to question
Level 3: Delayed repetition
Level 4: Fading into normal prosody.
Key components: intensive, structured language requirements, exaggerated tone/intonation, choral/unison singing/intoning, repetition.

85
Q

Name and describe an approach targeting conversation in PWA

A

This is a client-centered strategy that focuses
on functional communication.
The client will identify daily situations where a script would be beneficial (e.g. ordering a coffee, talking on the phone, going shopping).
The clinician moves through various steps to build the client’s independence with the script, targeting one short sentence at a time.
The underlying principles for this approach is the lexical-semantic approach, which focuses on improving output content at the discourse level by focusing on meaningful segments rather than single words, and the instance theory of automatization, the belief that automatic processing is fast and effortless and
that memories are formed with repeated exposure to a consistent task, like the script.

86
Q

What are the steps to script training?

A

The client will attend to the clinician modeling the first sentence of the script
with the clinician.
The client and clinician say the sentence together.
- Substep = if they struggle, break it down and blend it
together.
The clinician fades support at the end of the sentence (begin by saying the sentence together, and the client finishes the sentence on their own).
The client reads the sentence off a cue-card independently.
The client says the sentence independently without the cue card.

87
Q

Name some possible interventions for Moderate-severe ABI.

A

Partner training
Environmental modifications
Metacognitive strategy training
Identity mapping
External aids
Cognitive training software

88
Q

Describe partner training and provide some examples.

A

This involves providing strategies for communication
partners to help facilitate transmission and receiving of
information.
This approach focuses on adapting the environment/ situation to facilitate communication.
Heavily ICF focused as it emphasizes the environment/ personal factors in order to identify barriers/facilitators to communication.
Key aspects:
- Educating on communication challenges individual may experience
- Identifying communicative behaviours that disrupt
communication and working to mitigate them.
- Providing structured training in the behaviours that support successful interactions.
Examples: Learning effective listening and speaking skills
Asking positive questions
Learning how to keep
conversation going with turn
taking.
Supportive conversation training (similar to training provided for clients with aphasia).

89
Q

Describe identity mapping.

A

Take the idea of identity and provide a way of collaborating with a client to identify an alter ego based on someone/ something that they admire (see below table for an example map).
This approach focuses on the client’s values and personal heroes, and creates goals that center around everyday activities.
Key Steps:
- Talking to client about desirable activities to identify
their personal centre- their hero
- Discussing facts about their hero and associations with the client’s own life.
- Talk about relevant associations with being their
hero.
- Talk about goals associated with being their hero.
- Talk about how the client would feel if they were able to achieve those goals.
- Talk about various actions and action strategies that
would be necessary/useful in achieving these goals.

90
Q

What are the 3 components of dementia intervention?

A

Memory Training (Spaced retrieval, errorless learning, vanishing cues)
Environmental and Partner Supports (discussed in interventions for ABI listed above + brief description listed below)
LEEPs

91
Q

Describe spaced retrival.

A

A method used to teach new information and skills to people with memory problems.
The goal is for the person to remember and recall information over long amounts of time.
Steps:
1) Identify the information, habit, or skill you want the person to remember and how they will be cued to remember (eg. walk in the door (cue), hand the keys on the hook (response).
2) Practice the cue-response pair over longer and longer time intervals. First show the cue-response, then give the cue and ask for the response, keep increasing the time between each
cycle.
3) If the person gives the wrong response or struggles to remember, stop them immediately. Show the correct pair and have them produce the response, then return to the last time
interval.
4) Generally stop at a 16 minute interval.
5) At the end of every session, add up the number of errors and correct responses. If errors > correct responses, the pair is not
the best fit for the person and needs to be changed.
6) The goal is considered learned when the cue is presented to the person first thing the next day and they give the correct response.

92
Q

Describe errorless learning.

A

The clinician uses cues and instructional strategies to minimize the chance of the client making errors.
Based on the idea that to learn and retain new information, persons with memory deficits should engage in “errorless” practice with the new
information.
Declarative memory deficits prevent self-monitoring and correcting of responses during training; therefore errors during training must be inhibited by now allowing a time delay before the response and not prompting with a hierarchy of cues, (i.e not allowing for the incorrect
response).
Has been shown to be effective in several studies, more so than errorful
learning.
Idea is that you interrupt prior to the person making a mistake.
Often used in conjunction with other methods.

93
Q

Describe vanishing cues

A

Another way to conduct errorless learning that is designed for more complex information or behaviours.
The client is provided with enough information to provide the correct response on the initial trial.
Over several successful trials, the information is gradually withdrawn and the client is required to respond with fewer cues.
If the client finds this difficult, cues are added and then faded.

94
Q

What are some considerations when choosing a delivery model?

A

Severity of impairment (are they capable of benefiting from a group setting?)
Funding:
- Do they have insurance?
- What is going to be the best use of their money and time?
Are there other issues that are more pressing to address?
- Swallowing or motor issues
- Other serious medical complications that may be of higher priority
Living arrangements:
- Location
- Access to transportation
- Mobility
- Comfort with technology
Self-awareness of impairments

95
Q
A

CETP - SLP (16 decks)

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