purpose, population, methodology, aphasia treatments

Purpose: to enhance word-finding and naming abilities in individuals with aphasia through strengthening connections within the lexical system.

PCA

Target client: 

• Phonological and semantic paraphasias

• Word-finding difficulties

• Apraxia of speech

• Moderate-severe aphasia

• Relatively intact semantic knowledge

PCA

• Present the patient with a target picture for naming (e.g., target word is “shoe”)

• Identify and discuss five phonological components:

  • Rhymes with (“coo”, “boo”, or “two”)

  • First sound (“sh”)

  • First sound associate (“shop”)

  • Final sound (“oo”)

  • Number of syllables (1 syllable)

• Reattempt naming after discussing phonological cues

  • If a participant cannot spontaneously respond to each component targeted, he/she is asked to choose one from a list. (e.g., “Does it start with ‘sh’, ‘k’, or ‘b’?”)

  • Regardless of correct or incorrect responses, the clinician reviews the phonological features and asks the participant to name the item again. (“What is this?”)

  • If the client is still unable to name the item, the clinician provides a model for the participant to repeat. (The word is “shoe”.)

  • Repeat these procedures for all items in the treatment set.

PCA

Purpose: designed to improve word retrieval in individuals with aphasia by strengthening connections between words and their features.

SFA

Target client:

• Individuals with aphasia (especially anomic aphasia)

• Patients with cognitive-communication disorders (e.g., traumatic brain injury, dementia)

SFA

Methodology: Target words are personalized, and clients describe the words using a Semantic Feature Grid with six categories, with clinician support. This technique promotes horizontal generalization by applying it to untrained words and real-world scenarios.

SFA

Purpose: to improve word retrieval in people with Primary Progressive Aphasia (PPA) to preserve words despite the neurodegenerative disease progression. Training patients to use different self-cues reflects on the inter-relationship and connectivity of these processes in the presence of word-retrieval difficulties.

LRC

Target client: 

• Semantic variant PPA (svPPA)

• Logopenic variant PPA (lvPPA)

LRC

• Semantic self-cue: The patient is prompted to create a semantic connection to the picture of a target, cues such as “What is it used for?” or “What is it made for?”

• Orthographic self-cue: The patient is prompted to write the first letter or, if able, the whole word instead of verbally producing it.

• Phonemic self-cue: The patient is prompted to produce a phonemic cue of the word's first letter.

• Oral reading self-cue: The clinician provides the written word and prompts the patient to read the word out loud.

• Written/spoken self-cue: The patient is prompted to write the word and say the word three times out loud (if able).

• Semantic plausibility judgment: The clinician asks five semantically relatable questions about the target to test the patient’s knowledge and concept of the target.

• Recall: The patient provides two semantic features and a written and verbal response to the word.

LRC

Purpose: that targets verbs to improve word finding and to create sentences. The treatment targets verbs’ semantic roles (doer vs. receiver of the action) by activating relevant content words (nouns) within the verb’s network, which is hypothesized to strengthen retrieval.

VNeST

• Target client:

  • functional auditory comprehension

  • mild to moderate-severe aphasia

  • functional repetition skills

VNeST

• The clinician lays out the words “who” and “what” on either side of a transitive verb. The client is asked to think of who does the verb and to what object. Three to four patient-agent pairs are generated, with cues from the clinician as needed.

  • It is recommended to avoid pronouns, family names, and general terms (woman, boy) to target specific meanings.

• The client reads each subject-verb-object (SVO) sentence aloud (additional grammatical morphemes (e.g. verb endings, articles) are not required but encouraged).

• The participant chooses one of the SVO targets. Then, the clinician helps the client expand on it by asking the client three wh- questions (when, where, why).

• Out of 12 SVO targets provided by the clinician, the client determines if they are correct or incorrect. (ie. ‘musician chop banjo’, ‘chef cook food’, and ‘nurse drive tank’)

• The clinician asks the client to name the verb (to promote independent retrieval of the verb).

• Step 1 is repeated without cues → The step is finished when the participant retrieves 3-4 pairs OR when the participant cannot create any more pairs.

VNeST

Purpose: Using non-verbal communication, particularly hand and body gestures, to enhance communication.

gesture therapy

Target client: individuals with conditions like aphasia or motor speech disorders, where verbal communication is impaired.

gesture therapy

• The clinician presents an image of a target action or object

• The clinician models appropriate gesture and verbal form of target

• The client attempts the gesture (the clinician may need to manipulate or guide the client’s limbs)

• The client practices the verbal form of the target word with additional modelling and cues from the clinician as necessary

• The client performs gesture and verbal target simultaneously 3 times

• After a delay, the clinician asks the client to perform the gesture with the verbal target once more

gesture therapy

Purpose: to improve expressive language through melodic intonation (pitch, rhythm, and stress) and an emphasis on the preserved singing function

MIT

Target client:

• Severe, nonfluent aphasia

• Unilateral, left hemisphere lesion

• Individuals with Broca’s aphasia 

• Auditory comprehension is better than verbal expression 

• Severe verbal output and repetition deficits

• Good emotional stability and attention span

MIT

• This approach utilizes systematic behavioral training hierarchies organized into five steps. These steps are followed across 3 levels of increasing complexity. Difficulty is periodically increased through the use of additional syllables and greater grammatical complexity. The sentence items should follow a structure pattern of subject-verb-object. This method leads nonfluent patients from intoning 2-3 syllable phrases to speaking up to 5+ syllable phrases. 12-20 high-frequency words or phrases are presented to the patient across 3 levels; however, it may be more appropriate to start with a much smaller set of targets.  

• For phrases, 2 pitches are used for high and low intonation. Stressed syllables should be sung on the higher pitch. The patient is instructed to tap their left hand 1 time per syllable during melodic production.

• Example Level I Stimuli: Clinician and patient hum a melodic pattern (3-4 whole notes) while tapping rhythm stress in unison

• Example Level II and III Stimuli: “I love you” (level II), “I love my children” (level III), and “I love my daughter and son” (level III, advanced)

MIT

Purpose: to improve functional communication in people with aphasia. It works by intensively rehearsing functional, personally relevant scripts until they become automatic and generalizable.

script therapy

Target client:

• Severe aphasia 

script therapy

• The clinician and patient collaborate to create a script. 

• The script is broken down and rehearsed in small components, such as phrases or sentences. 

• The clinician begins by modeling the first phrase or sentence and writing it on a cue card for the patient. 

• They then practice choral reading, where the clinician and patient state the phrase or sentence in unison. 

• The clinician reduces support using the fading technique. 

• The clinician then asks the patient to produce the phrase or sentence without any verbal cues, while still utilizing the visual cue card for support.

• As the patient progresses, the clinician removes the cue card and asks the patient to say the phrase or sentence without any prompts.

• If needed, cues can be reintroduced and earlier steps repeated.

• Once the first line of the script has been mastered, the process continues with the next line in the script.

script therapy

Purpose: improve sentence comprehension and production in individuals with agrammatic Broca’s aphasia by targeting complex sentence structures (e.g., object clefts, passives, wh-questions) instead of beginning with simpler ones (e.g., active declarative sentences). 

TUF

Target client:

• Individuals with agrammatic Broca’s aphasia, particularly those with mild to moderate severity.

• Patients with relatively preserved comprehension who struggle with complex sentence structures.

TUF

• Modeling: The clinician provides a model sentence, often in a complex structure (e.g., "It was the boy who the girl chased").

• Word Identification: The patient identifies key components of the sentence, such as the agent (the girl), the verb (chased), and the theme (the boy).

• Card Arrangement: Using word cards, the clinician and patient manipulate the sentence structure to demonstrate transformations (e.g., rearranging "the girl chased the boy" into "It was the boy who the girl chased").

• Sentence Reading: The patient reads the modeled sentence aloud and identifies grammatical roles within it.

• Reconstruction: The patient reconstructs the target sentence from shuffled word cards, reinforcing word order and structure.

• Independent Production: Finally, the patient generates similar complex sentences independently, without visual cues (e.g., producing "It was the dog that the man fed").

TUF

Purpose: to minimize cognitive load by producing reduced grammatically complex utterances to foster functional communication. It is a compensatory approach because instead of directly targeting the PWA’s impaired syntax, this approach utilizes reduced grammatical complexity to facilitate functional communication. 

REST

Target client:

• Severe agrammatism

• Nonfluent aphasia, particularly Broca’s aphasia

REST

• Level 1: 2-word utterances: VP with direct object

  • prompt: action + what

  • structure: V - N or V - A

  • example: drinking coffee

• Level 2: 3-word utterances: VP with prepositional phrase

  • prompt: action + where

  • structure: V - PP

  • example: putting on table

• Level 3: 3-word utterances: VP plus subject

  • prompt: who + action + what

  • structure: N - V - N

  • example: Katy reading book

• Level 4: 3/4-word utterances: VP plus adverb

  • prompt: action + what + how

  • structure: (N) - V - N - A

  • example: reading book out loud

• Level 5: 3/4-word utterances: VP plus indirect object

  • prompt: who + action + what + to who

  • structure: (N) - V - N - N

  • example: (Katy) reading book to kids

• For all levels, support with written and picture materials and adapt sentences to trained stimuli that reflect personal interests, linguistic skills and communication needs of the patient.

• Each level should be practiced with various stimuli until the PWA is able to move on to a more complex level.

REST

Purpose: target multiple levels of language processing simultaneously at the word, sentence, and discourse level to facilitate everyday interactions in individuals with aphasia. 

NARNIA/NADIIA

Target client: individuals with fluent and non-fluent post-stroke aphasia and primary progressive aphasia (PPA)

NARNIA/NADIIA

• Present the patient with a 3-picture sequence for identification of the overall topic of the narrative (should aim to give it a title) 

• Identify the event and generate verbs and associated nouns related to picture cards (complete pictures one by one and write down the list of words produced)

• Combine words to form complete SVO sentences (N+V+N) and write them down 

  • These can become more complex with additional arguments (e.g. ‘when’, ‘where’ ‘who with’, ‘what with’, etc.) 

  • Introduction of linking words at sentence level (after discourse frame is introduced) 

• Generate introduction to the narrative and identify ‘beginning’ elements (e.g. title, where, when, who)  

• Generate events using mind maps (focus on the ‘middle’ events that happen in the story)

  • Use past tense

• Discuss different linking words to connect events (e.g. and, but, because, then, etc.)

• Generate appropriate ending to the narrative  

• Present the patient with the Rating Scale to accurately reflect on performance

  • Clinician is to provide feedback and discuss where self-ratings differ from clinician ratings

• Repeat and revisit procedures as needed until all discourse genres are covered (personal narratives, procedures, opinions) 

NARNIA/NADIIA

Purpose: conversation to increase conversational self-repair in people with post-stroke moderate to severe aphasia. The intervention aims to improve independent identification of conversation breakdown, development of self-repair skills, and initiation of salient

ECoLoGiC

Target client:

• Individuals with post-stroke moderate to severe aphasia (Broca’s and Conduction aphasia were included in this study representing fluent and nonfluent aphasia)

• Necessary skill: functional receptive language

ECoLoGiC

• The treatment consists of two alternating components: Therapeutic Conversation (TC) and Therapeutic Repair (TR). Intervention always begins with the TC (started by either clinician or patient). Protocols are embedded within each component:

• During the TC

  • Social Conversation Collection Protocol (SCCP)

    • Outlines the actions of the SLP that should or should not occur to foster the PWA’s contribution during the conversation (i.e. the Dos and Don’ts)

    • Examples of Dos: Make comments share stories, give plenty of time, and express lack of understanding

    • Examples of Don'ts: ask a lot of questions, tell/instruct the person regarding strategies, and use phonemic/semantic cueing

• During the TR

  • Cueing hierarchy: least-to-most feedback hierarchy

    • Seven step hierarchy used by SLP to support the PWA’s independent learning

    • Start with step one, but steps can be skipped to individualize the treatment

    • Steps should always follow the order of the hierarchy to ensure the PWA is as independent as possible

    • Steps can be repeated

  • Response guidelines (“SLP response after every hierarchy step”)

    • Each item should be applied in order (from step a to step e) to ensure the TR is accepted by the PWA and the SLP understands the exchange

    • Repeat the steps as needed

    • The PWA may end the TR whenever they would like

ECoLoGiC

Purpose: indirect approach to improve text-level reading comprehension in individuals with aphasia through

reading strategies

Target client:

• Mild-moderate aphasia

• Good decoding skills but difficulty with reading comprehension

• Mild-moderate reading comprehension impairments

• Motivated and able to participate in structured strategy-based sessions

reading strategies

• Visual strategies: underlining or highlighting text, using cards to block lines above and below focused texts

• Content strategies: identification of keywords, summarization, preview of headings, use of mind maps

• Metacognitive strategies: rereading, recall, self-monitoring

• Read paragraph aloud

• Reread 2-3 sentences aloud

• Reread the same 2-3 sentences silently

• Cover text and summarize sentences from memory

• Repeat steps 2-4 until passage is completed

reading strategies

Purpose: Direct treatment approach that targets oral reading rate and accuracy at the text-level. The treatment incorporates a top-down reading approach, which theorizes that the structure provided by the whole (level of semantics/syntax) facilitates processing of the parts (single word forms).

MOR

Target client:

• Pure Alexia (without agraphia) 

• Found to be effective for pure alexia co-occurring with mild anomic aphasia

• Letter-by-letter readers with decreased reading fluency

MOR

• Step 1: Select a 100-500 word reading passage at a 6^th-8^th grade level that is engaging for client.

• Step 2: The client reads the passage aloud for the first time as the clinician tracks the reading rate, words per minute, and error count.  It’s helpful to get a baseline to measure future progress. 

• Step 3: Treatment begins as the client reads the passage aloud several times. The clinician offers corrective feedback, when necessary, without overwhelming them. If needed, they can read in unison for additional support. 

• Step 4: Home practice: client commits to read aloud the same passage for about 30 minutes daily. This helps improve automatic word recognition and fluency. Client may also tape record themselves during home practice.

• Step 5: The client revisits the same passage and rereads it. The clinician again tracks reading rate, accuracy, WPM and errors to compare with the baseline. Once the client reaches the target goal, whether that’s increasing WPM or fewer errors, they can move on to a new passage.

MOR

Purpose: a structured treatment that aims to improve language comprehension within PWA through a system of reading sentences aloud, both independently and in conjunction with a clinician. The treatment promotes improvements in rhythm and pacing and generates opportunities for neuroplasticity.

ORLA

Target client:

• Patients with nonfluent aphasia (Broca’s) 

• Patients with deep alexia

• Mild to moderate reading impairments 

• Relatively intact auditory comprehension

ORLA

• Clinician/computer reads sentence aloud while patient silently follows.

• Patient and clinician read together (choral reading).

• Patient points to individual words and reads aloud.

• Patient identifies and names selected words.

• Patient rereads the entire sentence independently.

ORLA

• Purpose: direct lexical treatments aimed at improving writing single words as a form of expressive communication for patients with nonfluent aphasia. These treatments are based on the cognitive processing of language framework, which explains how people see, hear, or read a word or object and either verbalize or write it. The input is processed by the semantic system, which is where meaning is retrieved. Then, an output is produced through speaking or writing.

ACT/CART

Target client:

• Patients with agraphia

• Patients with nonfluent aphasia

• This treatment is not appropriate for patients with severe auditory comprehension deficits

ACT/CART

• The client is presented with a picture. Then, the clinician provides a verbal prompt to elicit writing (e.g., “Can you write the word phone?”)

• After a correct response, the clinician will provide reinforcing feedback and move to the next target word.

• After an incorrect or no response, the clinician will provide the letters of the targeted word in a nonsequential order (N-O-P-H-E). The clinician encourages the client to try to spell the word in the right order.

• If the client is unsuccessful, The clinician should model the correct order.

• The clinician asks the client to model writing the targeted word three times.

• Then the clinician removes the client’s previous responses then the clinician will present the picture and ask the client to write the target word again.

ACT

• The client is presented with a picture (popcorn). Then the clinician provides a verbal prompt (e.g., “Can you write the word popcorn?”)

• After an incorrect or no response, the clinician will provide a written model of the target word and have the client copy it 3 times.

• The clinician will ask the client to write the word without a model present.

• The clinician will continue to the next targeted word, even if it is incorrect.

CART

Purpose: improves understanding of spoken language to enhance quality of life among individuals with impaired auditory comprehension. Aims to strengthen weak and inconsistent connections by restoring and creating access through reorganization between an auditory signal, lexical word, and meaning.

direct auditory comprehension treatment

Target client:

• Individuals with poor auditory comprehension deficits (not limited to aphasia subtypes).

• Individuals who can independently respond with any preferred mode of communication.

• Clients who do not benefit are individuals with profound auditory comprehension skills.

direct auditory comprehension treatment

• The therapy method is comprised of tasks with no outlined protocol; intensity and repetition of trials within sessions are dictated by the clinician's judgment.

• The clinician selects tasks related to the client’s goals and severity level.

• Tasks should include target words in areas of client’s interest that can be generalized in their daily activities.

• During intervention, clinician feedback to the patient’s response should be multimodal (gestures, written, and visual).

• Tasks appropriate for this treatment approach include: yes/no questions, semantic decisions, commands, phonological word discrimination, spoken word/sentence to picture matching, and picture verification.

  • Ex. - Picture verification: Provide a stimulus of target word and clinician will give feedback regarding the patient's response.

  • Clinician: [provides picture of a book] “Is this a book?”

  • Patient: “Yes.”

  • Clinician: “You are right. It is a book.” [gestural cue of nodding]

direct auditory comprehension

Purpose: a direct attention training program designed to improve underlying attention deficits. It has also been shown to increase self-awareness and monitoring in individuals with impaired problem solving and executive functions.

APT-3

Target client: those who have mild to moderate aphasia who experience comprehension difficulties attributed to attention deficits.

APT-3

• divides attention exercises into two main categories: basic sustained attention and attention requiring executive control which includes

  • selective attention,

  • working memory,

  • suppression,

  • and alternating attention.

• A treatment session lasts approximately 30–40 minutes.

• This program is available on a USB drive and can be used independently by the patient at home orcin a clinical setting.

APT-3

• promotes many communication functions, speech acts, and pragmatic skills.

• provides people with aphasia (PWA) access to multiple communication partners who can offer support, peer modeling, and opportunities to engage in naturalistic communication tasks. 

• supports effective communication and encourages the carryover of techniques into real-world situations for optimal treatment gains.

group therapy

Target client: Mild to severe aphasia

group therapy

Purpose: allows patients to practice treatment targets and strategies outside of the therapy setting. Focuses on the neuroplasticity principle of intensity by allowing clients to practice at home, thus exceeding the amount of therapy that is feasible in a single session and/or reimbursable by third-party payers. Based on the WHO-ICF framework, it primarily focuses on the levels of impairment and activity/participation.

computer-based therapy

Purpose: to improve functional daily living and parallel the framework outlined in the Life Participation Approach to Aphasia (LPAA). An indirect total communication approach that uses all communication modalities to aid or supplement verbal output.

AAC

• Determine the best AAC option and familiarize the client with the device. 

• Clinician models and client imitates to begin practical application of the device.

• Implement communication partner training to encourage generalization in various settings.

• Analyze the effectiveness of device, follow up, and adjust as needed.

AAC

Purpose: To address the cognitive processes behind understanding and expressing emotional prosody. This direct treatment approach theorizes that expressive aprosodia is due to the loss of affective representations in the nonverbal affect lexicon.

cognitive-linguistic approach

Target client

• Patients with expressive emotional aprosodia

• Patients with severe cognitive deficits will not benefit from this treatment.

cognitive -linguistic approach

• Emotion Awareness and Vocabulary: The clinician introduces 4-6 emotions using different prompts and cues, such as picture cards and emojis.

• Listening & Matching: The client listens to a recording and identifies the emotion.

• Contextual Understanding: The clinician then asks for the reasoning behind why the client chose the specific emotion they identified.

• Guided Production: The client practices reading sentences with different emotions.

• Carryover and Family Education.

cognitive-linguistic approach

Purpose: To reorganize the neurological pathways that connect the motor system with emotional prosody. This direct treatment approach theorizes that expressive aprosodia may result from issues with motor programming/planning of the vocal elements that constitute emotional prosody.

imitative-motor approach

Target client:

• Patients with expressive linguistic and emotional aprosodia

• Patients with motor deficits will not benefit from this treatment.

imitative-motor approach

• Auditory Modeling: The client imitates the clinician.

• Visual & Kinesthetic Support: The clinician demonstrates raising of pitch at the end of a sentence for a question by providing a visual prompt, such as raising their hand.

• Practice at Isolation or Phrase Level: The client practices with a neutral sentence, then adds the emotions (“I see a dog. (happy)”; “I see a dog. (scared)”).

imitative-motor approach

Purpose: is a compensatory approach designed to improve awareness and function in individuals with anosognosia. Grounded in motivational interviewing and self-determination theory, targets cognitive-emotional insight by helping patients become aware of their impairments through supportive and reflective dialogue.

MET

Target client: 

• Individuals with mild to moderate anosognosia and some preserved cognitive and emotional insight.

• Not suitable for those with profound anosognosia or severe cognitive impairment

MET

• Empathy: Build trust by validating the patient’s experiences.

• Develop Discrepancy: Highlight differences between the patient’s goals and abilities, fostering self-awareness without confrontation.

• Avoid Argumentation: Reduce defensiveness, maintain empathy, and encourage continued engagement.

• Support Self-Efficacy: Foster confidence in the ability to change by emphasizing strengths.

• Stimuli: Reflective prompts, personal goal discussions, and guided self-assessments.

MET

Purpose: focuses on enhancing spatial awareness in patients with unilateral neglect. Rooted in attentional retraining theories, this approach systematically trains patients to scan their neglected side, compensating for attentional biases caused by brain damage.

VST

Target clients: 

• Patients with unilateral spatial neglect and normal vision.

• Individuals with cognitive ability to follow instructions.

• Not suitable for those with vision impairments, severe aphasia, dementia, or global cognitive decline.

VST

• Seating: The patient is seated in front of a screen to ensure optimal visual input.

• Task Selection: Use tasks like symbol cancellation or target tracking, adjusting difficulty as needed.

• Feedback and Adjustment: Provide real-time feedback and track progress.

• Stimuli: Visual symbols, shapes, and spatial cues, delivered via computerized programs or paper-based tasks.

VST