Treatment Issues #2 Flashcards
Object Naming Model
Phonological cues are superior
Semantic cues ineffective for patients who know what the word is
Semantic Treatment for Naming
Exercise Semantic Treatment in isolation of word finding
Patients not required to produce direct name
Focus on semantic activation before lexical retrieval
Questionable generalization to untreated items
ex. picture word matching, semantic judgment task
Semantic Feature Analysis
Naming with multiple semantic cues and questions
ex. what is it used for, reminds me of
Completion of phrases and writing answers
Treated/untreated naming improved
No improvement in spontaneous speech
Phonological Treatment for Naming
Lexical cueing to promote phonological structure
No generalization beyond 30 minutes to treated and untreated stimuli
Contextual Priming
Mass repetition to facilitate better naming
Improved naming with questionable generalization
Includes spoken word and picture matching, name repetition, independent naming (delayed repetition)
Verb Network Strengthening Treatment
Promotion of semantic-lexical connection to enhance word production
Verb presentation with nouns, identification of agents and patients
Promoting Aphasics’ Communicative Effectiveness (PACE)
Total communication treatment
Focuses on pragmatism (relationship between language and context with reference to participants and roles, social settings, codes)
Additional topics include topic relevance, exchange of new info, initiations, turn taking
PACE Rules
Clinician and patient participate equally
An exchange of new info
A free choice of communication modality
Immediate feedback if message is not received
Constraint-induced Therapy
Intensity/mass practice
Repetition
Response shaping
Socially imperative for communication
Constrained verbal modality
3-4 hours/day
Principles of Neuroplasticity
Use it or lose it
Mass repetition
Intensity
Short post-onset time
Therapy done for a large chunk of time every day
Saliency
PICA-based Treatment
Treat tasks at the fulcrum (middle point of the response continuum)
Content Centered Treatment
Focus on communicative effectiveness
Free choice of communication modality
Reduced emphasis on correctness
Problem solving skills
Improvement in spontaneous communication
Voluntary Control of Involuntary Utterances (VCIU)
We want to focus on getting voluntary control of involuntary utterances
Patient should be able to utter a few selected real words
Goal is to improve verbal output in NF patient with limited to stereotyped utterances
VCIU Treatment Steps
They need to have some ability to utter real words
Ask patient to voluntarily orally read their preserved spoken utterances (swear words)
Move to names of pictures objects and conversational use of words
VCIU Candidates
Speech is limited to a few words
Can match written words to picture
Melodic Intonation Therapy (MIT)
Singing to facilitate expressive language in severely NF patients
Assumption is that brain will reorganize with increased RH participation in case of recovery because musical skills are a RH skill
Basic Principles of MIT
Unison humming and hand tapping
Hand tapping and fading
Gradual progression of length and difficulty
Backing (go back to the previous level where the patient succeeded)
Repetition of correct responses
Use of controlled latencies (3-5 seconds ideal, up to 10 ideal)
Self-monitoring of verbal output
Intensive treatment
Sprechgesang (speech + singing)
Hierarchally structured program
MIT Treatment Steps
Humming
Unison singing with fading
Immediate repetition
Response to probe question (what did you say?)
MIT Candidates
Lesion confined to LH (Broca’s area)
Good auditory comprehension
No expressive language, good artic. with stereotypic phrases
Desire to recover
Sentence Production Program
Story completion technique to elicit syntactic constructions for agrammatics
Sentence Production Program Candidates
Non-Fluent (Broca’s, transcortical motor)
Visual Action Therapy (VAT)
Focus on AAC
Manipulation of objects and cards to follow commands, answer questions, describe events
Items include real objects, pictured objects, and action pictures to demonstrate verbs
VAT Treatment Steps
3 levels and 9 steps each
Step one includes matching objects and pictures, placing objects on pictures, placing pictures on objects, pointing to objects, pointing to pictures
VAT Candidates
Global aphasics with severely restricted receptive and expressive language functions
Recovery in Severe Aphasia
Improvement occurs later than for other aphasia types (6-18 months PO)
Continued improvement probably hinges on activity level, social engagement, and life participation
Steps to Facilitate Participation in a Severe Aphasic
Identify specific activities that are personally meaningful
Identify cognitive abilities
Link cognitive skills with activity and target with evidence based intervention
Communicative Drawing Program
Uses drawing as a facilitator
Stimuli include cartoons, objects and actions, stories
Tools include tracing and copying
Treatment of Aphasic Perseveration (TAP)
Treatment on confrontation naming by a non-perseverative response
Goal of naming 90% of the stimuli with no more than 10% of the items with perseveration
Perseveration types
Stuck in variety (inappropriate maintenance of category of response during new task)
Continuous (response prolongation without interruption)
Recurrent (inappropriate repetition of a previously emitted response after intervening stimulus)
Semantic perseveration (recurrence of a previous semantically related response to a new stimulus, eg pear for apple)
Phonemic carryover (part words or phonemes carried to the next unrelated response)
Frequency of Perseveration
Normal subject: 4% of responses
Fluent aphasics: 18% of verbal responses and 21% of nonverbal responses
NF aphasics: 39% of verbal responses and 19% of nonverbal responses
Specific strategies in TAP
Time interval of 5-10 secs between stimulus/response
Gestural cues; tactile cues
Drawing
Description sentence
Sentence completion
Graphic cues
Phonemic cue
Oral reading
Repetition
Unison speech or singing
Symptoms of Wernicke’s Aphasia
Presence of speech with lack of awareness
Reduced comprehension
Euphoria
Poor repetition
Their verbal output has very little meaning
Wernicke’s Aphasia Treatment Focus
Auditory comprehension
Establishing consistent responses
Incorporating word comprehension task
Directing attention to listening by signal or alarm
Charting communicative failures
Treatment for Expressive Aphasics
Treatment in contexts including naming, concept elaboration, grammaticality judgment, oral reading, copying, writing
American Indian Code
Simple signs for patients with basic communicative needs (not ASL)
Cognitive Treatment
Used to promote recognition and comprehension, registration of new info, generation of logical conclusions and alternatives, elicitation of a variety of responses, elaboration of ideas
Mental Operations
Cognition (problem solving, decision making, task planning)
Memory
Thinking (convergent, divergent)
Convergent Thinking
The generation of logical conclusions from given information
Emphasis on achieving conventionally best outcomes
ex. automatic language and focused answers
Lots of things boiled down to 1
Divergent Thinking
Generation of logical alternatives from given info
Emphasis on variety, quantity, and relevance of output from the same source
ex. open ended questions, lists
Evaluative Thinking
Formulation of evaluations in terms of known specifications, such as correctness, completeness, identity, relevance, logical feasibility
Judgmental thinking
Severe Non-Dominant Syndrome Treatment
Treat maladaptive behavior
Modification of environment
Attention to speaker
Maintaining eye contact
Attention to task
Moderate Non-Dominant Syndrome Treatment
Passive orientation (space/person/place/time)
Surrounding awareness (biographical info)
Attentional shift (scanning, cancellation)
General neglect
Reasoning
Mild Non-Dominant Syndrome Treatment
Linguistic subjects (critical vs noncritical info, identification of key points, topic coherence)
Paralinguistic properties (jokes, metaphors)
Cognition (problem solving, abstract reasoning, divergent/convergent)
