global and severe aphasias

Name specific examples from each of Parr et al.’s thematic categories:

• Infrastructural

• Interpersonal

• Personal

infrastructural: limited access to employment, inadequate income, services (health, housing, education, leisure), resources

interpersonal: limited association to groups in society (community, family, friends), relationships, healthcare professionals, being ignored or ridiculed

personal: isolation, self-identity, low self-esteem, depression, loss of control/independence, anger

global equals what NOT what?

impairment in expressive and receptive language

NOT meaning severe

In summary, 386 stroke-centered hospitals (__%) provide little to no information about aphasia while 32 (_%) stroke-centered hospitals provide decent/good information about aphasia.

92%; 8%

infrastructure is affected even at strome-cetnered hospitals

Speech Language Pathologists (SLPs) and People with Aphasia (PWA) need to team up with the stroke-centered hospital’s Stroke Coordinators (SC) to help ____________ to aphasia awareness and _______ the hospitals, healthcare providers, and the wider public about this thing called aphasia, that few people have ever heard of!

break down the barriers; educate

assessments

Boston Assessment of Severe Aphasia (BASA)

Communicative Effective Index (CETI)- rating scale

For global and severe aphasia, focus on evaluating __________________ and ________________ for ____ communication approach

communication strategies and environmental support; total

(look at the whole picture)

do not rule out what in assessment??

impairment-based assessment and intervention (use A-FROM)

but still make sure to focus on the full picture

CAPE framework

• connecting PWA to others

• AAC

• partner training for important people in environment

• education and resources

May be accomplished via aphasia groups, through formal visitation programs, online, monthly support groups, etc

Connecting people with aphasia to others, especially other people living with aphasia.

on a continuum from low tech to high tech--using whatever is most appropriate and functional for that particular person/situation to allow communication and life participation in his/her environment(s

AAC

teaching supportive communication techniques; for example, in an inpatient medical setting, it would be important to train CNAs, nurses, physicians, etc. in addition to family members and friends

Partner training for all important people in the environment

ensuring that these resources are created to be aphasia friendly) as well as providing appropriate national and community resources to family members, friends, and others in the larger community

education and resources

2 parts of principles of supported communication

1. acknowledge competence

2. demonstrate competence

acknowledge competence

how do you do that?

• natural adult talk appropriate to context (no elderspeak)

• sensitivity to partner (take responsibility if unclear)

demonstrate competence

how do you do that?

• ensure that PWA understands

• ensure that PWA has a means of responding

• verification of PWA response not automatically assumed

main points about education

• relevant information for family members

• caregiver training

• resources

Family members want __________ about aphasia at ___ stages (from _____ through _____)

relevant education; all (acute through chronic)

Results suggest that information is not forthcoming or appropriate, and families feel …

uncomfortable asking for information (they don’t know what they don’t know)

in education, what is paramount?

caregiver training

Provide resources about who to contact for ______ and _____ such as…

information and support

National Aphasia Association, ASHA, local associations or groups (UT Health)

Frequent in all types of aphasia, but especially challenging in ____ and _____ aphasias

Global and Wernicke’s; perseveration

what types of aphasia are they aware vs unaware

aware: broca’s- frustrated

unaware: wernicke’s and global

relationship of WAB scores and perseveration

negative!

the higher the perseveration the lower the WAB score is

types of perseveration

• Stuck-in-set/ ideational perseveration (conceptual)

• Continuous perseveration (only one production of a sound)

• Recurrent perseveration (keeps coming up but not continuously)

ideational perseveration example

perseverating on an idea that you want them to do

the inability to shift from one thought or idea to another

Theories based on one of two key components for perseveration (how to get rid of them)

Strength of activation

Rate of decay

strength of activation (AI model)

• strength of activation for the target is not enough (inadequate) as it should be and one competitor item is strong

• The target needs to be stronger than the one that keeps popping it

• train them to ignore the one that keeps popping up

rate of decay

it’s supposed to decay, but in perseveration, it doesn’t decay, it stays in the threshold of activation

reducing perseverations (if decay is the problem)

• Establish a new set of tasks intentionally (ex. change from numbers to letters)

• Use time-out and distraction (add a distracting comment or short break)

• Gently increase awareness of perseverations (be careful, often times just ignore perseverations)

• Conceal previous responses (for written perseverations)

• TAP

interventions for more severe aphasia

• script training

• melodic intonation therapy (MIT)

• gesture therapy