HESP 415 Final Exam

10/30 - 11/5

avoidance

a performance of the behavior prevents the occurrence of an anticipated aversive condition

type I

presentation of an aversive consequence after

previewing

planning strategy for oral and written texts

threshold

the level of input at which the sensory system registers and/or responds

what does material selection mean in a therapeutic setting?

choosing the tools or resources used to carry out a therapeutic task

how does material selection impact a therapeutic task

it often determines the type of stimulus presented to the client

two main categories of commercial materials in therapy?

therapeutic materials and recreational materials

what is the difference between commercial and created materials?

commercial materials are pre-made and often purchased

created materials are made by the therapist for a specific client or task

why is material selection important in therapy?

helps tailor therapy to the client's needs which leads the therapy task to be effective

what client factors should be considered when selecting materials for therapy?

age, developmental level, and language level of the client

why is fostering engagement important when choosing therapy materials?

Engagement helps maintain the client's interest, making therapy more effective

what does it mean for therapy materials to promote generalization?

Materials should help the client apply learned skills in different contexts outside of the therapy session

how should materials address the target in therapy

they should address the target directly, either as-is or with modifications made by the clinician

why is branching an important consideration in material selection?

allows for flexibility in therapy, enabling adjustments based on client responses and needs

what is the benefit of using materials that promote high frequency of targets?

it provides the client with multiple opportunities to practice and reinforce the target skill

how can additional stimuli be incorporated into therapy materials?

additional stimuli can be added to support or extend the learning experience

when might a clinician choose to create their own materials for therapy?

when existing materials do not address the therapeutic targets or the client's needs

what does use as directed mean in material use?

involves highlight the communication target that is naturally stimulated or easily prompted when interacting with the material

what are examples of incorporating additional demands?

• earn your turn

• incorporate a target

• support a functional target

material use: creation

create materials specific to the client's needs and preferences

what is aphasia?

a language disorder due to brain damage that results in impaired comprehension and/or formulation of language

what are possible etiologies of aphasia

hemorrhage or blockage of blood flow to the brain

strokes/cerebrovascular accidents (CVA)

Tumors

head trauma

certain disease processes

agrammatism

syntax deficit while semantics remain intact

• tree…man bed… he sleep

anomia

difficulty with word-retrieval

• “it's to sleep in, under trees”

neologism

non-words, typically nouns and verbs

• “that's a blick“

perservation

continuing to respond after achieving response

• “Hammock..Key. Chair. Glove.”

paraphasia

errors in speech output resulting in productions that are close to the target but incorrect

phonemic paraphasia

extraneous or transposed sounds/syllables or substitutions of a phoneme

• “Hammerock” “Hackam” “Pammock”

Semantic Paraphasia

Unintended whole-word substitution, usually within the same semantic category

• “It's a bed”

Nonfluent aphasia

poor verbal/written output with relatively spared comprehension

symptoms of nonfluent aphasia

• reduced vocabulary

• agrammatism

• impairments of articulation, rate, and prosody

• labored and effortful production

fluent aphasia

impaired language comprehension with maintenance of normal melodic speech contour

symptoms of fluent aphasia

• word-retrieval deficits

• paraphasias

• neologisms

• perservation

• melodic, natural quality to speech production

Nonfluent aphasias

• broca's

• transcortical motor

• global

Broca’s aphasia

agrammatism, effortful articulation of short utterances, impaired prosody and intonation, apraxia of speech.

good comprehension

Transcortical Motor Aphasia

Little to no initiation of spontaneous speech, but excellent imitation

good comprehension

global aphasia

severe deficits in all areas of language comprehension and production

fluent aphasia

• wernicke's

• conduction

• anomic

wernicke's aphasia

fluent but meaningless speech, articulation, intonation, and prosody are good.

comprehension is impaired

conduction aphasia

relatively fluent speech, frequent phonemic paraphasias, marked difficulty with imitation

good comprehension

anomic aphasia

significant word-finding difficulties with otherwise fluent and grammatical speech

good comprehension

Functions of Data Collection

Allows the clinician to monitor progress from one session to the next

Permit documentation of the efficacy of a given treatment strategy

Augmentative and Alternative Communication (AAC)

Any system that is used to enhance or replace verbal speech for communication

complex communication needs (CCN)

Those with severe speech, language, and communication differences which prevents functional speech

non-speaking

identity-first language that is most-preferred by this community (also here: minimally-speaking, part-time user)

does AAC delay verbal speech development?

No

what are some common etiologies of non-speakers

autism

down syndrome

cerebral palsy

childhood apraxia of speech (severe)

seizure disorders

genetic disorders

what individuals benefit from AAC?

• non speaking individuals who need an alternative modality to receive and express communication

• individuals with a significant expressive-receptive language gap

• individuals with significantly compromised intelligibility

• individuals experiencing significant frustration with communication

what are some priorities when using AAC?

• Core Vocabulary

• Consistency

• Aided Language Input

what should all vocabulary sets do

• provide words to be utilized across all settings

• allow for redundant learning opportunities

• permit modeling across all settings

• support various pragmatic functions

what types of materials should be used to support cultural sensitivity?

use representative toys, books, media, AAC and visual supports that reflect the client's cultural background

How can you avoid reinforcing stereotypes when selecting materials?

by resisting stereotypical representations and choosing inclusive materials that reflect the client's culture

why should you exercise cultural sensitivity?

to avoid assumptions about holiday observations and be mindful of current events

what should you do first when considering the use of a new material?

consider the material and think about how it can be applied to treatment goals

what is the second step when determining how to use a material?

determine a specific therapeutic use or target

what is the objective of being the last student to contribute?

the last student to share an idea for using the material wins

which language modalities can aphasia impact?

spoken and written language modalities

what are two motor impairments that may co-occur with aphasia?

hemiplegia or hemiparesis, and hemianopsia

Can aphasia affect both understanding and producing language?

Yes, aphasia can impair both comprehension and formulation of language

when does spontaneous recovery from aphasia typically occur?

it occurs, if at all, to the greatest extent during the first two to three months post-injury/insult

what factors influence spontaneous recovery from aphasia?

lesion characteristics (size, location, etiology)

type and severity of initial aphasia

age at onset

overall premorbid health

How does age affect the prognosis for spontaneous recovery from aphasia?

the prognosis is more favorable for younger clients

neuroplasticity

the brain's ability to restructure its neural networks in response to internal and external stimuli

how might neural regions adjacent to a lesion respond after brain damage?

they may adopt functions of the affected area

what role can the right hemisphere play in neuroplasticity after left-hemisphere damage?

right-hemisphere sites that parallel the affected left-hemisphere may take over functions of the affected area

delayed option in intervention timing

initiating treatment once the effects of the spontaneous recovery have likely run their course

what is early intervention in aphasia treatment?

initiating treatment close to onset or injury to accelerate the natural processes of spontaneous recovery

does delaying treatment improve treatment effects in aphasia intervention?

No, delaying treatment has not been shown to improve treatment effects.

why do most clinicians recommend early intervention for aphasia?

to accelerate the natural process of spontaneous recovery and optimize outcomes

what is the main goal of the restorative/linguistic orientation in aphasia treatment?

to strengthen an aphasic individual's disrupted linguistic skills through direct instruction

what kind of participation is needed in restorative/linguistic orientation for aphasia?

intensive and repeated participation in therapy activities

what areas are targeted in restorative/linguistic aphasia treatment?

both comprehension and production skills

what is the primary focus of therapy in the substitutive/compensatory approach?

to establish functional communication

what assumption does the substitutive/compensatory approach to aphasia treatment make?

it assumes that language function has been lost

In the substitutive/compensatory approach, what is encouraged for successful communication?

the use of any available modalities the individual can use to communicate effectively

what kind of tasks are emphasized in the substitutive/compensatory approach?

tasks and responsibilities related to everyday living

what is a positive indicator for successful therapy outcomes?

individuals under 65 years old typically make greater gains in therapy

how many intervention hours are associated with better therapy outcomes?

a total of 20-50 intervention hours

what therapy duration is linked with better outcomes?

continuing therapy beyond 4-week episode of care

what factors are associated with longer-term gains in therapy?

longer-term gains are noted for individuals with milder aphasia symptoms and no deficits in executive functioning

what is recommended for aphasia treatment?

a combination of restorative/linguistic and substitutive/compensatory approaches is encouraged, tailored to what best suits the client

what are the four response levels in aphasia therapy?

1. nonverbal responses (pointing)

2. single-word tasks (responsive naming, confrontation naming)

3. phrase-length responses (sentence completion with phrases)

4. sentence-level formulation (picture description, object function)

what are the seven levels of prompts used in aphasia?

1. function cue

2. rhyming cue

3. written cue

4. spelling cue

5. first-sound cue

6. multisyllable cue

7. direct model

phonemic cue

a cue related to the sounds in the word, such as the first sound or rhyming

semantic cue

a cue related to the meaning of the word, such as providing a function or description of the word

orthographic cue

a cue related to the spelling of the word, such as showing the written word or providing a spelling cue

example of a function cue

describing what the object does

• “You use it to eat soup” for the word “spoon”

what does a rhyming cue involve?

providing a word that rhymes with the target word to aid recall

when might a direct model be used in aphasia therapy?

when the clinician provides the exact word for the client to repeat, as a last step in cueing

what is traumatic brain injury (TBI)?

an external insult to the brain caused by events like vehicular accidents, gunshot wounds, falls, sports injuries, and explosions

what is a closed head injury?

a type of TBI where damage occurs to a widespread area of the brain without any penetration

what is a penetrating head injury (PHI)

A type of TBI where damage is concentrated in specific neurological region(s) due to penetration

how many cases of TBI occur annually in the United States?

approximately 2.87 million cases, with most being mild and due to falls

mild TBI (mTBI)

Brief changes in consciousness and memory, often with less severe symptoms compared to more severe TBI cases

common symptoms of TBI

headaches, blurry vision, dizziness, sleeping problems, irritability, anxiety and depression

How do symptoms differ in severe TBI cases?

in severe TBI, memory loss and periods of unconsciousness are pronounced than in mild TBI

what are the two levels of linguistic complexity in aphasia therapy?

1. literal language

2. figurative language

what is response latency

decreasing the expected time between the clinician's stimulus and the client's response, used as a measure of difficulty once the target is established

No Tech AAC

Involves unaided communication without equipment or materials

• Manual Signs

• auditory scanning

low tech AAC

Non-digital AAC systems

examples:

• paper-based symbols

• tactile symbols

• objects

• core boards

• communication books

• robust paper-based systems