SLP 564 - Final

neurolinguistic approaches

branch of linguistics that analyzes the language impairments that follow brain damage in terms of the principles of the language structure

neurolinguistic treatment methods are based on...

neurolinguistic principles and are specific for each linguistic impairment

interventions based on neurolinguistic approach

- no systematic application of a specific linguistic therapy to aphasia treatment

- semantic feature analysis treatment

- phonological component analysis treatment

- verb network strengthening treatment

semantic feature analysis (SFA)

- improves retrieval of conceptual information by accessing semantic networks

- patient has to produce words semantically related to the target word

- based on spreading activation theory

- name the group, it's use, action, location, etc.

phonological component analysis (PCA)

- comparable phonological comparison for SFA approach

- goal is to produce concepts phonologically related to target words

unaided communication

communicating without using an aid beyond the user's own body (gestures, body language, etc.)

aided communication

any tool, device, or equipment used that is outside or in addition to the user's body (picture board, sgd, etc.)

low tech AAC

- do not require electricity or batteries

- least expensive

- some are generative, some are not

high tech AAC

- require electronic components

- usually generative, dynamic, multi-layered

- non-dedicated and dedicated

non-dedicated AAC

devices that have been adapted for use as a communication aid but can be used for other functions (ipad, etc.)

aac assessment in aphasia (2 types of communicators)

- independent communicators

- partner dependent communicators

independent communicators

individuals who are able to independently initiate use of different communication strategies

partner dependent communicators

individuals who consistently depend on a partner to manage informational demands and provide communication choices within highly familiar contexts

subtypes of partner dependent communicator

- emerging communicator

- contextual choice communicator

- transitional communicator

subtypes of independent communicators

- stored message generator

- generative message communicator

- specific need communicator

steps to apply AAC in medical settings

1- establish a program

2- prepare your toolkit

establishing a program

- provide all departments with basic, low-tech comm boards and encourage their use

- discuss AAC options and services

- make the use/need for AAC visiible

- train family members

preparing your toolkit

at all times, should have ETRAN/eye gaze board, whiteboards, notepads and pencils, communication needs signs/boards, pain scales

AAC assessment

- as possible/needing

- consider position, seating, cognitive status, symbol use, language/literacy

AAC selection

- will depend on physical abilities, disease progression, and situational needs

- make recommendations proactively

AAC implementation

- initial education to patient and caregivers

- don't overlook social competence

social approach: overall

- how people use language

- all components of ICF

social approach: target of intervention

- not only communication

- psychosocial well-being

- environmental limitations

- attitudinal barriers

social approach: method of intervention

- overall life goals are prioritized

- meaningful activities in therapy

- socially relevant tasks in real life contexts

compensatory strategy training

- based on social approach

- interactive drawing and creative communication

interactive drawing approach

training drawing as a collaborative effort between communication partners

creative communication approach

generating pantomime scenarios (gestures) and other novel strategies in contextualized interactions

supported conversation for adults with aphasia (SCA)

partners learn strategies to support communication, provide context, and alter expectations/perceptions

steps of SCA

- acknowledge the competence of the adult with aphasia

- help the adult with aphasia to reveal his or her confidence

how to acknowledge the competence of the adult with aphasia

- use a natural tone

- choose adult or complex topics

- integrate techniques into natural talk

- partner says "I know you know", I'm not explaining/understanding this well"

how to help the adult with aphasia to reveal his or her confidence

- getting the message in/out

- verify message

conversation therapy

- based on social approach

- focuses on social communication skills

- builds discourse structure, social roles, self-esteem, and participation skills

- complex activity to build generalization

conversation therapy: implicit approach

- modeling and mediating

- not overtly practicing or instructing clients regarding particular skills or behaviors

conversation therapy: explicit approach

- overt discussion of behaviors and goals being targeted

- behavior, strategy, or pattern is labeled, described and made explicit for purposes of intervention

methods employed to change conversational skill or participation

- using supports for message transmission

- facilitating routinized elements of conversations

- practicing specific skills

- promoting conversational participation

- educational external methods

- embedded methods used while engaging in conversation

facilitated authentic conversation (FAC)

- explicit treatment, with some implicit strategies

- more natural, meaningful conversation

FAC: pre-conversational stage (3-4 min)

- raise awareness of conversation in general

- establish general principles of conversation

- raise awareness of the person with aphasia's own conversation patterns

FAC: intra-conversational stage (35-40 min)

- model strong conversation skills

- employ conversational shaping (conv. contingencies, calibrated corrections, positive conversational reactions, bracketed critiques)

conversational contingencies

- inhibit behaviors by allowing and highlighting the natural consequences of problematic behaviors in conversation

- natural reaction, not pointing out the mistake

- allowing the breakdown to exist and repairing it instead of avoiding it

calibrated corrections

- inhibit behaviors by employing implicit correction and mediation to model more effective strategies during conversation

- not highlighting the mistake

- not making them repeat

positive conversational reactions

- facilitate behaviors by providing positive and/or heightened demonstrations of alignment during conversation

- preventing communication breakdowns

- continue with related topic if you knew what they meant to say

providing bracket critiques

- facilitate behaviors by providing feedback on specific techniques or strategies before re-establishing the flow of conversation

- explicit feedback

FAC: post-conversational stage (2-4 min)

evaluative discussion of person with aphasia's performance

ECoLoGiC

- explicit treatment method

- therapeutic conversation (TC)

- therapeutic repair (TR)

- focus on repairing communication breakdowns in natural conversations

ECoLoGiC: TC

- show interest eye contact, body language, nodding

- make comments, share stories, let topic naturally shift

- give plenty of time

- be receptive to all modalities

- clarify misunderstandings

- paraphrase what is understood

- don't make it feel like an interview

- don't instruct on communication strategies

ECoLoGiC: TR

1- identify need for a repair

2- make a general comment

3- request specific information

4- request circumlocution

5- request nonverbal communication

6- request specific nonverbal communication

7- give choices

better conversations with aphasia (BCA)

- similar to FAC

- always includes PWA and a communication partner

- dyadic treatment

context-based approach (CBA)

- improve auditory comprehension and conversational exchange in authentic communicative contexts

- context: multifaceted concept

- manipulation of linguistic and paralinguistic context enhances the comprehension of PWA and improves information exchange

in clinical practice, we should...

- use social approaches and conversation based treatments

- question over-use of impairment based treatments

collaborative referencing intervention (CRI): basis

- implicit based treatment with a barrier game

- based on social learning theory

- repeated engagement for a meaningful interaction

social learning theory

you learn language by speaking in different situations

CRI: goal

- match personal photographs to locations

- collaborate in generating labels

- share meaningful stories from personal life

- reduction of collaborative effort across tasks

- use multimodalities, facial expression, gestures, etc.