Week 6: Traditional Approaches to Aphasia Intervention

(Acute Care) Patient in mid-50s with Wernicke’s aphasia s/p TBI, improving but unable to communicate effectively with staff

Goals

1. Trained caregivers (Hospital staff), family members, etc. regarding the AAC strategies that were effective for the patient in the moment.

2. Provided multiple modalities for communication as needed (paper, white board, apps, phone)

3. Sign above that instructed caregivers depending on daily needs: “Use white board to ask questions, “Allow patient to keep phone with him at all times

4. Educated RNs and caregivers on needs before frustration occurs by attending daily shift change meetings

Acute care: targeting family members + staff bc patient is barely healing and is not in the proper cognitive state to start working on therapy and receiving direct treatment already

(Sub-acute rehab) Patient with dx of Anomic aphasia s/p CVA. Family highly concerned due to change in “personality” has been very talkative, outgoing, and managed all finances and personal care needs.

Goals

1. SLP asked family members to bring in personal pictures. Conversation-based therapy was directed around the topics of family & community, however was interactive and not simply interrogative. Pictures were used to stimulate conversation, not judged for accuracy of naming.

   • Scaffolding was used (subtle prompts, writing key words) to support as needed

   • Dyad (SLP & client) AND group setting (other patients, family therapists) with a rotating theme (grandchildren, pets, vacation)

2. Prepared for weekly meeting (brief and stressful) with the doctor by planning questions, developing a script (direct training), identifying problems, rehearsing with SLP

3. repairing communication when there is a breakdown (e.g., purposely using circumlocution)

   • forcing patient to keep trying to say wife’s name will make them feel bad. You need to help patient feel like they can have a decent conversation with another adult, and not feel like a child having to learn the ABCs all over again

   • Conversation is real life and will help him become a better communicator

This therapy is targeted for actual person

(Acute Care) Patient in mid-50s with Wernicke’s aphasia s/p TBI, improving but unable to communicate effectively with staff

Goals

1. Trained caregivers (Hospital staff), family members, etc. regarding the AAC strategies that were effective for the patient in the moment.

2. Provided multiple modalities for communication as needed (paper, white board, apps, phone)

3. Sign above that instructed caregivers depending on daily needs: “Use white board to ask questions, “Allow patient to keep phone with him at all times

4. Educated RNs and caregivers on needs before frustration occurs by attending daily shift change meetings

Acute care: targeting family members + staff bc patient is barely healing and is not in the proper cognitive state to start working on therapy and receiving direct treatment already

(Sub-acute rehab) Patient with dx of Anomic aphasia s/p CVA. Family highly concerned due to change in “personality” has been very talkative, outgoing, and managed all finances and personal care needs.

Goals

1. SLP asked family members to bring in personal pictures. Conversation-based therapy was directed around the topics of family & community, however was interactive and not simply interrogative. Pictures were used to stimulate conversation, not judged for accuracy of naming.

   • Scaffolding was used (subtle prompts, writing key words) to support as needed

   • Dyad (SLP & client) AND group setting (other patients, family therapists) with a rotating theme (grandchildren, pets, vacation)

2. Prepared for weekly meeting (brief and stressful) with the doctor by planning questions, developing a script (direct training), identifying problems, rehearsing with SLP

3. repairing communication when there is a breakdown (e.g., purposely using circumlocution)

   • forcing patient to keep trying to say wife’s name will make them feel bad. You need to help patient feel like they can have a decent conversation with another adult, and not feel like a child having to learn the ABCs all over again

   • Conversation is real life and will help him become a better communicator

This therapy is targeted for actual person

(Theory Approaches) Stimulation approach (Schuell):

• An obstacle to access language processing: a general problem varying only in severity

• Hypothesized Mechanism of Change: Restoration

• Examples of Influential Therapy Technique: Intensive auditory stimulation

• If patient is healthy and ready, the physicians look to you for information regarding swallowing, communication, can they communicate in an emergency?

  • You have to reflect on this before sending patient home (if they don’t have verbal output, how are you going to send them home? If there’s an emergency, how will they call for help?). You help patient dial 911 to ensure that they will be safe when they go home. You’re not working on accuracy of goals, functional!

  • Voice concerns for discharge if you know that the patient will not be safe alone

What is the process of therapy for the stimulation approach?

• Intensive stimulation of disrupted language processes, then reeducation or correcting language

Stimulation Approach:

• Evolved out of the holistic school

• Conceptualize aphasia as:

  • knowledge of language is not lost but cannot be accessed due to cerebral damage

  • breakdown of a central mechanism for processing language

• Scuell (1964) and Wepman (1951)

What 2 researchers developed the stimulation approach?

• Scuell (1964)

• Wepman (1951)

Schuell’s method 1964:

Thematic Language Stimulation

• you want patients to have good comprehension (e.g., Broca’s aphasia). If it is not intact, this will not be effective (e.g., Global aphasia, Wernicke’s aphasia)

• MIT: patient should at least be able to understand what you want them to do

• Good attention span

• if there’s a right hemiparesis, you wouldn’t tap the right hand.

• You come up with rhythmn, model tapping pattern. First tapping w/ everything eventually – Slowly ask client to just say it in plain sentence, without rhythm.

• Good for ppl who have a cooccuring apraxia of speech bc it stimulates the right hemisphere, bc it’s using music to stimulate, the oral movements also tend to get better. Person may only bea ble to say word with rhytm. Severe aphasia w/ apraxia → last resort

• Must be functional for patient to use exact way

• not targeting comprehension

Response Elaboration Training (RET)

• training patients to create more elaborate responses (e.g., word level response → phrase level) instead of just sweater you help them say “give me my sweater”

• verbal output (nonfluent aphasia, you want to expand length of expression)

• repetition must be intact, but this is true for most verbal output

• single word (limited output), will not be able to repeat phrases bc repetition is limited to words dependent on verbal fluency bc it’s limited. VERBAL output/expression is ultimate goal (e.g., writing on white board to highlight the word they missed, pointing out things in addition to what they providing initially). Not holistic or social based, more so focused on impairments. In traditional RET, pictures weren’t used.