Overview of Aphasia Tx Flashcards
Overview of Aphasia Treatment
-Clinical treatment has its limits.
-Treatment is not limited to speech and language
E.g., can work on math, balancing a checkbook, sequencing steps. Can work on anything that deals with cognition
-Aphasia treatment must be structured
> It must emphasize e systematic repetition of appropriate activities
> There is no right number of repetitions
-No single set of tasks or procedures is adequate treatment
> Treatment should be a dynamic, eclectic interchange with the pt at the center
-Aphasia treatment exploits strengths
> Don’t always just choose the area they need to work on. Work on areas that they do well on, and fine tune that area
-Aphasic pts need to become their own clinicians
- Involve others
- Many pts take their moods from the clinician
Overview of Aphasia Treatment continued
There are at least three goals of aphasia treatment
1. To assist people to regain as much communication as their brain damage allows and their needs drive them to 2. To help them to learn how to compensate for residual deficits 3. To help them to learn to live in harmony with the difference between the way they were and the way they are * the first two can be acquired through clinical practice and reading books * the third is gained through experience and maturity * the overall goal of treatment is to prepare an aphasic pt for a lifetime of aphasia
Determine Treatment Candidacy
Look at severity of the brain injury
- The more severe the brain injury the more likely your Tx wont have much of an effect on them
Look at the timing of intervention (2-6 months post onset? conflicting findings in spontaneous recovery)
- Working with spontaneous recovery can really improve results
Overall medical/physical status
- A pt in a lot of pain chances are they aren’t going to want to work on communication
Pt motivation
- indicator of prognosis
If a clinician is still doubtful, hold trail treatment sessions to determine prognosis
What do I treat?
Relative level of impairment
Look at testing to determine which areas are strengths and which are weaknesses
Peaks and valleys when describing a pts weakness. Treat the valleys first although some think to treat the impairments that are moderately impaired
According to Porch (1981), treat those specific areas that are slight to moderate impairment
If scores on subtests very dramatically, treat that area until variability decreases and treatment has approached the pts recovery potential
Fundamental Processes Approach
Treat those areas that are thought to be the underlying cause of aphasic impairments
Want to think about what areas of language are most important to treat
E.g., treat auditory comprehension in aphasia as auditory comprehension improves so will general communicative ability as the improvement generalizes
Activity-Participation Approach or Functional Approaches
Views the purpose of intervention as helping the pts overall success with communication in natural settings
Choose a targeted life activity e.g., talking on the phone, and treatment specific target skills related to this skill. You may choose to target word retrieval (impairment level goal) to make ordering a meal in a restaurant possible (activity related goal)
What does therapy look like?
In a more structured therapy session treating specific impairments:
- opening (conversation)
- accommodation (familiar tasks, high success)
- goal-directed work (challenging, treatment goal oriented tasks)
- cool down- easy tasks, high success
- closing - conversation
In activity-participant approach, treatment follows similar pattern but is slightly less structured, clinician coaches pt in more every day activities
Choosing stimuli
Resource allocation– help the pt toward the target behavior by eliminating processing load
The mental workload that a pt can handle
Stimulus manipulation – intensity (strength, if its an auditory stimulus how loud is it? If visual how bright?) vs. salience (how the stimulus stands out so a bright picture of a man running against a black and white background scene, the man is salient).
Vary the salience if stimulus treatment items to help with resource allocation
Clarity/ Intelligibility – line drawings may be uncertain so choose stimulus items that are going to be clear
Redundancy/ Context – redundancy increases the performance of brain injured adults (show me the small red cup vs show me the cup that is small and red). The context is the background or the setting.
Novelty/Interest Value – pts respond better to more personally interesting stimulus items. (novelty or newness)
Cues – hints given by the clinician when a pt produces an incorrect response.
Cueing Hierarchy
(in order of decreasing power)
- Imitation (say “____”) {most powerful cue}
- First sound/syllable
- Sentence completion – Give me a cup of ______
- Word spelled aloud
- Rhyme
- Synonym/antonym
- Function/location – drink it at breakfast
- Superordinate – it’s something you drink
How else can a clinician control treatment difficulty level?
Manipulate the length and complexity of responses-require sentence length, increased syntactic demand, etc.
Manipulate familiarity and meaningfulness of responses- alter questions making them more or less personal.
Manipulate delay-adding a time delay may increase difficulty of a task.
Giving Instructions and Feedback
Instructions – clear and concise, at an adequate rate for the pt, using language the pt understands.
Feedback –
Incentive feedback – can maintain or eliminate behavior (electric shock, candy)
Information feedback – tells a pt about the accuracy of a response
Full strength praise vs. diluted negative feedback.
Generalization
Use natural maintenance – e.g., hello/goodbye are naturally reinforced by others in daily life via acknowledgement.
Teach the same pattern of response in different settings –office, home, restaurants, etc.
Loose training – teaching with a variety of stimulus items to promote generalization
Sequential Modification – training targets in every setting generalization is desired
Programming common stimuli – making the environment you train the behavior in look like those you wish to generalize to.
Mediating generalization – using mnemonic devices, visualization, etc. to train the pt to cue themselves.
Training generalization – spontaneous generalization that occurs during treatment activities.
Treatment of Auditory Comprehension
- Single-Word Comprehension
- Understanding verbal sentences
- Answering questions
- Following verbal directions
- Sentence verification (yes/no)
- Task Switching drills- point to ___, pick up_____, which one do you write with? Were you born in Fresno, etc.
- Comprehension of Conversation
- Yes/no questions about a conversation read aloud
- Retelling a conversation
- Open-ended questions.
Treatment of Reading Comprehension
- First acquire a “literacy history”
- Want to know how literate the pt was.
- What type of education they had. What type of readings they were reading before injury.
- What type of job they had. This will help you in what you need to treat.
- May start with “survival reading skills”
- Signs, maps, medicine labels, addresses, etc.
- Treating mild-moderate reading impairment
- Printed word drills- orally sound out words/ non-words, discriminate similar words, supply missing letters.
- Printed sentence drills- pt must interpret sentences with syntactically difficult (passive voice) sentences, move to paragraph level, etc.
Treatment of Speech Production
Volitional Speech (word level)
- Sentence completion tasks – “for breakfast I had bacon and \_\_\_\_” - Word repetition (imitation) – “say eggs” - Confrontation naming drills- show picture “what’s this?”
Sentence Production
-Sentence imitation drill- “I had bacon and eggs”
-Repetition- elaboration drill – pt answers then repeats
-Story completion drill – like sentence completion task, but longer
-Story elaboration drill (verbal or with pictures) – Look at picture tell story.
Connected Speech
Picture description- Talk about a given stimulus
- Prompted story telling- pictures sequences are used to elicit speech - Procedural discourse- Telling the steps involved in doing a task, (e.g., making scrambled eggs) - Conversation- Structured conversation
