Treating Impairments in Restoring Spoken Language

Treating Impairments in Restoring Spoken Language

Overview of Lecture Objectives

  • Aligns with module learning objectives to:

    • Describe various treatment approaches for improving spoken language.

    • Analyze and select treatment approaches for treatment plans.

  • Focus on:

    • Lexical retrieval (word finding and syntax).

    • Ques to facilitate word retrieval.

Key Concepts and Approaches

  • Generic Queuing Hierarchy: Demonstration will be present in a video assignment.

  • Technology in Treatment: Familiarization with high and low-tech tools.

    • Tactus Therapy apps (with free versions).

    • Lingraphica's talk tools also available for exploration.

Reading Material

  • Chapters from Hallowell:

    • Important to skim and bookmark relevant information before treatment planning.

    • Understanding client characteristics and evidence supporting treatment methods is crucial.

  • Expectation: Reading material should not be a last-minute reference but incorporated as an ongoing study resource.

Restorative Treatments

  • Learning about specific restorative treatments with elements of compensatory approaches.

  • Example of Client Scenario:

    • Client with moderate Broca’s aphasia, anomia, and agrammatism.

    • Goals include engaging in political conversations and volunteering.

  • Possible Treatments:

    • Word finding and syntax treatments.

    • Script training for conversational starters.

    • Flexible AAC tools with relevant content for topics of interest.

    • Partner training for enhancing social participation.

Treatment Names and Acronyms

  • Recognition of treatment names and acronyms is essential.

    • Example: Semantic Feature Analysis (SFA).

  • Understand whether a treatment is purely restorative, or if it has compensatory aspects.

    • Example: SFA is restorative with compensatory potential via self-cuing for anomia.

Specific Approaches for Enhancing Expressive Language

1. Constraint Induced Language Therapy (CILT)

  • Overview:

    • Restricts non-verbal communication modalities (e.g., no gestures, writing).

    • Enhances reliance on impaired systems to stimulate ability.

  • Treatment Characteristics:

    • High intensity and dosage is required.

    • Best suited for patients in residential aphasia programs.

  • Evidence: Mixed evidence regarding effectiveness; depends on client's resilience and neurologic plasticity.

  • Caution: Alignment with social and participatory models is limited.

2. Script Training

  • Overview:

    • Develops conversational scripts for individuals with non-fluent aphasia.

    • Focus on meaningful, personalized contexts.

  • Process:

    • Support communication strategies to create relevant scripts.

    • Emphasizes fluency, lexical access, and syntactic production through repetition.

  • Example: A client practices an introduction to make virtual connections (e.g., introducing themselves).

3. Melodic Intonation Therapy (MIT)

  • Overview:

    • Facilitates spoken language through exaggerated prosody, suitable for Broca's aphasia with apraxia.

  • Key Techniques:

    • Slow tempo and use of musical elements while speaking.

  • Goal: Foster brain changes to enhance speech production through structured practice.

4. Voluntary Control of Involuntary Utterances

  • Overview:

    • Utilizes automatic utterances to guide therapy.

    • Suitable for severely non-fluent patients with reading abilities.

  • Evidence: Limited effectiveness; however, offers interesting theoretical perspectives.

5. Response Elaboration Training (RET)

  • Overview:

    • Expands on client’s utterances to increase linguistic complexity.

    • Works primarily with Broca's or non-fluent aphasia patients.

  • Process:

    • Encourage client-initiated topics; use of forward chaining to model longer utterances.

6. Treatment for Aphasic Perseveration

  • Overview:

    • Focus on correcting perseverative utterances to restore appropriate selection of language items.

  • Characteristics:

    • Suitable for clients with moderate to severe recurrent perseveration.

    • Requires intact auditory comprehension and memory.

Treatment Approaches for Improving Word Finding and Lexical Processing

1. Queuing Hierarchies

  • Overview:

    • Based on naming performance to assist word retrieval.

    • Tailored to individual client’s strengths and naming problems.

  • Types of Cues:

    • Phonological cues: Relate to sounds and syllable structures.

    • Semantic cues: Related to the word's meaning (e.g., function, definitions).

2. Semantic Feature Analysis (SFA)

  • Overview:

    • Activates semantic networks surrounding a target word to enhance retrieval.

  • Procedure:

    • Focus on identifying and elaborating on semantic features of nouns and verbs as a restorative therapy.

3. Phonological Components Analysis

  • Overview:

    • Focuses on the phonological aspects of target words rather than meaning.

  • Goal: To create meta-awareness of phonology to facilitate naming.

4. Verb Network Strengthening Treatment (VNEST)

  • Overview:

    • Aims to improve both verb and noun retrieval by emphasizing the syntactic organization around verbs.

  • Process:

    • Use verb phrases and relationships to enhance discourse skills.

Approaches for Improving Syntax

1. Treatment of Underlying Forms

  • Focus: Develop metalinguistic awareness around verbs and argument structure.

    • Involves teaching complex grammatical constructions.

    • Aim: Enable retrieval from the syntactic network.

2. Sentence Production Program for Aphasia (SPPA)

  • Overview:

    • Practical approach emphasizing grammatical constructions to improve complexity in spoken utterances.

    • Uses story-based prompts to elicit responses and grammatical structures.

Summary and Future Directions

  • Key points from the lecture reinforce the importance of understanding various treatments and their theoretical bases to apply them effectively in clinical practice.

  • Expectation for students to demonstrate knowledge through assignments and to integrate technological aids in therapy.

Assignments and Assessments

  • Initial quiz focused on recognition of treatment names and principles.

  • Demonstration of a generic cueing hierarchy as a skill assignment.

  • Exploration of high and low-tech treatment support tools, excluding AAC therapies, with hands-on experience with Tactus Therapy apps.