Treatment Flashcards

1
Q

Treatment of Aphasia

Stages of Recovery

A

Early Stages: 1-3 months-coincides with the period of spontaneous recovery
Late Stages: months to years after injury

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2
Q

Service Delivery Contexts

A
Acute Care Hospitals
Acute Rehabilitation Centers
Skilled Nursing Facilities
Long-term Care Centers
Home
Outpatient Centers
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3
Q

Prognosis for Recovery

A

Initial aphasia severity is the most important factor for predicting recovery
Not lesion size but the extent of involvement in specific areas that best predicts recovery
Age and recovery-probably health is most predictive
Gender-no evidence strongly favoring either
Handedness-no evidence strongly favoring either

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4
Q

Team intervention with a patient (and family) centered emphasis

A
Physician
Nurse
Case Managers
Pharmacists
Dieticians
Neuropsychologists
Occupational Therapists
Physical Therapists
Speech-Language Pathologists
Support Personnel (COTA, PTAs SLP-A, Nursing Assistants)
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5
Q

Traditional Intervention Approaches

1. Stimulation Approach

A

Most widely used treatment approach
Hildred Schuell 1964
Stimulation approach that employs strong, controlled, and intensive auditory stimulation to maximize the reorganization and recovery of language
Use of controlled Auditory Stimulation
Therapist is NOT retraining BUT stimulating currently inaccessible language centers
The purpose is not to convey new learning but to stimulate old learning-attempt to reorganize a system that has been reorganized by brain damage (Wepman)
Activities for Auditory Abilities, Verbal Abilities, Reading & Writing
Potential Tasks emphasizing Auditory abilities
Point to Tasks
Following Directions/Commands
Yes/no Questions
Sentence or phrase completion

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6
Q

Attend to (stimulation approach)

A
the clarity of the auditory signal
the clarity of the visual materials
combining sensory modalities 
repetitive stimulation
rate and pause
length and redundancy
cues, prompts and prestimulation
frequency and meaningfulness
syntax
order of difficulty
patterns of auditory deficits (slow rise time, auditory buildup)
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7
Q

Potential Tasks emphasizing

A
Auditory abilities
Point to Tasks
Following Directions/Commands
Yes/no Questions
Sentence or phrase completion
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8
Q

Thematic Language Stimulation

A

A systematic approach to aphasia treatment that employs thematically related vocabulary in multimodal stimulation for functional communication.
Firmly rooted in the Schuell model
More person-centered
“changing the way the brain is working by working the brain” (Chapey, p.451)
Focus on functional communication

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9
Q

Melodic Intonation Therapy
(Albert, Sparks, & Helm, 1973)

A

A hierarchically structured program divided into THREE levels aimed at increasing the verbal expression of persons with nonfluent aphasia (Broca’s).
Uses musical elements of rhythm and tone to improve verbal expression
Designed to lead patients from intoning (singing) simple 2-3 syllable phrases to speaking 5 or more syllables.

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10
Q

Best candidates

A

Severely impaired verbal expression
Auditory Comprehension is better than their verbal expression
Unilateral, left hemisphere stroke
Produces real or accurate words when singing
Poor repetition (even for single words)
Motivation, good attention, and emotionally stable

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11
Q

Intonation based on three elements of spoken prosody

A

Variation of pitch
Tempo and rhythm
Points of stress

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12
Q

Melodic Intonation Therapy

A

Each level has 20 high-probability words (e.g. water) and social phrases (e.g. good morning)
Intonation pattern uses a range of 3-4 notes
Elements include an exaggerated melody of at least 2 syllables
MIT is slower, similar to Chant Talking
Progression to longer sentences and questions

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13
Q

Level 1 MIT

A

Establishing understanding of procedures (e.g. handholding; humming

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14
Q

Level 2 MIT

A
Humming
Unison Intoning
Unison intoning with fading
Immediate repetition
Response to probe question
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15
Q

Level 3 MIT

A

Phrase introduction
Unison fading
Delayed repetition
Response to probe question

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16
Q

Level 4 MIT

A
Delayed repetition
Sprechgesang (spoken singing)
Sprechgesang with fading
Delayed spoken repetition
Response to questions
17
Q

C-Speak Aphasia
Nicholas & Elliott (1999)

A

Picture based AAC program (non verbal communication) that allows users to select and combine pictures to make novel messages
Stimulate verbal communication

18
Q

What’s included: c-speak

A
training manual
 85 Speaking Dynamically boards
 screening test with 15 boards
28 stimulus cards
score sheet
19
Q

Best Candidates c-speak

A

Mod-Severe Broca’s Aphasia
Preserved auditory comprehension
Little or no reading comprehension or spelling
Unilateral brain damage
Absence of Hemi-neglect & Visual field cuts
Relatively preserved executive functioning, attention, and memory
—because they have to be able to navigate software of program

20
Q

Training focus c-speak

A

General conversational interchanges
Telephone communication
Writing or email communication

21
Q

Training considerations c-speak

A

May take 2-3 months 2x/week to master
Laptops and handheld devices required
Responses are agrammatic

22
Q

Lingraphica1990
Computer Assisted Visual

Communication (C-ViC) based
Visual Action Therapy
Helm & Benson (1978)

A

Non-verbal hierarchical program used to increase production of gestures for use in functional communication
30 minute sessions 2x/week to accelerate progress

23
Q

Best Candidates VAT

Boston alpha for bostob participant)

A

Left CVA
Severe aphasia (Global)
Inability to produce spoken or written language
Alert & Cooperative
Preserved spontaneous gesture production (e.g. pointing)
Preserved nonlinguistic visuospatial and memory skills
Ideomotor limb apraxia
Can produce some overlearned gestures

24
Q

Three phases VAT

A
Proximal limb (shoulder and arm)VAT
Distal limb (hand and finger) VAT
25
Q

Materials VAT

A

15 real objects
15 shaded line drawings of objects
Action pictures of a simple figure using these objects
Contextual props (e.g. screw in a block of wood for use of screwdriver)

  • objects varied depending on the type of gesture (proximal, distal, or oral).
26
Q

Three levels at each phase (for those with severe global)

Level 1

A

Use of real objects, pictures and action pictures
Step 1: Matching pictures and objects
Step 2: Object use Training
Step 3: Action picture demonstration
Step 4: Following action picture commands
Step 5: Pantomimed gesture demonstration
Step 6: Pantomimed gesture recognition
Step 7: Pantomimed gesture production
Step 8: Representation of hidden objects demonstration
Step 9: Production of gestures for hidden objects

27
Q

Level 2

A

Action pictures substituted for real objects

28
Q

Level 3

A

Use of object pictures only (because pictures are more realistic than words)
* Both Level 2 & 3 begin with Step 5
Step 5: Pantomimed gesture demonstration
Step 6: Pantomimed gesture recognition
Step 7: Pantomimed gesture production
Step 8: Representation of hidden objects demonstration
Step 9: Production of gestures for hidden objects

29
Q

Voluntary control of involuntary utterances

A

Program to improve speech output in individuals with severe non fluent aphasia
Can read single words
Occasionally produces single words
Can orally read single words produced

30
Q

Pragmatic Therapy

PACE & Thematic Language Therapy

A

Promoting Aphasics’ Communicative Effectiveness
PACE, Wilcox & Davis (1985)
An approach that emphasizes the pragmatic aspect of communication and information involving a range of communicative intentions, such as informing, requesting, questioning, negating.
Goals are written to address Activities of Daily Living using communication, not the motor skills of performing the tasks

31
Q

Principles PACE

A
  1. Exchange of new information in a conversational setting
  2. Encouraged to use any expressive modality: speech, signing, gestures, writing
  3. Both therapist and client are senders and receivers engaging in a conversational exchanges.
  4. Feedback is simply the success of communicating, the characteristic of normal communication
32
Q

Goals of PACE

A

What do persons with aphasia gain in this process?
Clinician as a model for appropriate communication
Experience with topic and turn initiation
Experience with sustaining an interaction with several turns on the same topic

33
Q

Best Candidates PACE

A

May be used with all persons with aphasia regardless of severity type.

34
Q

Roles

Speaker PACE

A
Develop an appropriate message
Consider context 
e.g New vs. Old info.
Gain attention of addressee/listener
Self-monitor and reformulate if a lack of 
understanding is relayed from addressee/listener
35
Q

Addressee PACE

A

Decode the message (receptive)
Evaluate comprehension of message
Respond (expressive)
Request for clarification
Conversational Partner Training
Type of intervention rooted in a social model
There is a primary focus on conversation
Interaction between the PWA and his/her significant others
Interaction between the PWA and the community

36
Q

Wave of the future:Traditional treatment and medical intervention
Transcranial magnet stimulation

A

Noninvasive procedure
Magnet fields
Creates electrical currents in discrete brain areas
Current is discharged through coil of wire
Current generates a rapidly pulsing magnetic field
Induces a changing electrical field in the cortex below the coil
Multiple stimuli (trains) can lead to ↑ or ↓ in excitability of the effected cortex
The effects can last beyond the duration of the trains