Aphasia intervention process oriented and mechanisms 11/12/24, 11/19/24

Page 1: Aphasia Intervention

• Aphasia Intervention: Focus on process-oriented treatment and recovery mechanisms.

Page 2: Nature of Recovery

• Nature of Recovery: Examination of reasons for discussing language therapy options.

Page 3: Recovery Mechanisms

• Recall Therapy Orientations:

  • Process-oriented/Restitutive: Aimed at restoring lost functions.

  • Compensatory/Life Participation: Focused on adapting to losses and enhancing life participation.

• Questions for Consideration:

  • Question 1: Are process-oriented and compensatory strategies mutually exclusive?

  • Question 2: What does recovery truly mean?

  • Question 3: What factors contribute to recovery?

  • recovery, for everyone, is wanting to go back to normal again. going back to how they were pre-stroke

Page 4: Mechanisms of Brain Injury Recovery

• Importance of Understanding Recovery Mechanisms: Recognizes different pathways to recovery.

  1. Reduction of Edema: Swelling decreases, relieving pressure on brain tissue.

  2. Reperfusion: Restoration of blood flow to damaged areas (ischemic penumbrae).

  3. Resolution of Diaschisis: Improved functioning in remote brain areas affected by injury.

  4. Neuronal Regeneration:

     • Dendritic branching.

     • Collateral sprouting.

  5. Long-term Potentiation (LTP): Increased efficiency of synaptic transmission in surviving neurons.

  6. Unmasking Preexisting Pathways: Reactivation of neural connections compensating for lost functions.

  7. Cortical Reorganization: Brain areas not involved before injury adapt to take over lost functions.

     • medications can help manage pain, treat symptoms of depression, psychostimulation to increase frontal lobe activity, movement problems like with parkinsons

Page 5: Other Treatments

• Various Treatment Strategies:

  • Surgical Interventions.

  • Transcranial Magnetic Stimulation (TMS):

    • Reduces diaschisis; activates intact but inactive brain areas.

    • Inhibits over-activation of right-hemisphere counterparts for language processing.

  • Transcranial Direct Current Stimulation (tDCS).

  • Sensory Stimulation.

  • Nutritional Supplements:

    • Antioxidants and general nutrition.

  • Other Supportive Means:

    • Good nutrition, adequate rest, strong social support, and avoiding harmful substances.

Page 6: Treatment Complexity Levels

• Traditional Approach:

  • Start at an easier complexity and gradually increase difficulty.

• Complexity Account of Treatment Efficacy (CATE):

  • Utilizing complex stimuli may enhance recovery effectiveness.

    • Examples: Non-exemplar word training, abstract word training, complex verb and syntactic structure training.

Page 7: Sentence and Discourse-Level Interventions

• Focus on Sentence and Discourse Interventions: Continued emphasis on enhancing communication skills through higher-level treatment strategies.

Page 8: Melodic Intonation Therapy (MIT) Overview

• MIT Characteristics:

  • Utilizes exaggerated prosody.

  • Adjusts pitch to reduce variation, slowing tempo for lyrical utterance.

  • Emphasis on stress using pitch and volume.

  • Gradual task progression might include tactile components like tapping.

  • not singing, just more melodic way of saying sentences like with different tones like a singsong voice, tapping, tapping left hand to engage the right hemisphere which is responsible for melody and rhythm

Page 9: Norton et al Ideal Candidates for MIT

• Characteristics for Good Response to MIT:

  • Unilateral left-hemisphere stroke.

  • Poorly articulated or limited speech output.

  • Some intelligible speech while singing.

  • Poor repetition skills.

  • Moderately preserved auditory comprehension.

  • High motivation and emotional stability.

Page 10: Goals of MIT

• MIT Goals:

  • Use prosody to enhance verbal output.

  • Address speech output at impairment level to stimulate brain changes.

  • Can be seen as both restitutive and compensatory for people with aphasia (PWA).

  • Reference to visual example: https://www.youtube.com/watch?v=QzLqNQ4PYik.

  • great starting point and good for families to do with patient

Page 11: Principles of MIT

• Foundational Principles of MIT:

  • Intact right hemisphere functions may support damaged left hemisphere language recovery.

  • Right hemisphere involvement in prosody and music helps facilitate language production.

Page 12: MIT Implementation Steps

• Implementation Guidelines:

  • Hierarchical structure of steps; recommended frequency is two 30-minute sessions, five days a week.

  • Progress criteria: 90% accuracy for ten consecutive exercises.

  • Procedure for handling failures during steps.

Page 13: MIT Complexity Levels

• Levels of Speech Complexity in MIT:

  • Elementary Level: Basic phrases like "I love you."

  • Intermediate Level: Slightly more complex phrases.

  • Advanced Level: Increased complexity, e.g., including family references.

Page 14: Procedure Steps of MIT

• Step Procedure:

  1. Humming: Introduce target phrases with visual cues and tap timing.

  2. Unison Intoning: Therapist and patient sing together.

  3. Unison Intoning with Fading: Gradual decrease of therapist assistance.

  4. Immediate Repetition: Patient repeats phrases after therapist without visual cues.

  5. Response to Probe Questions: Elicit target phrases through questioning post-repetition.

Page 15: Advanced Procedure Steps of MIT

• Further Steps Development:

  1. Delayed Repetition: Patient repeats phrases after a delay.

  2. Introducing Sprechgesang: Emphasizing rhythm over melody in phrases.

  3. Sprechgesang with Fading: Therapist fades while the patient completes the phrase.

  4. Delayed Spoken Repetition and Response to Probes: Similar to previous steps but without assistance.

Page 16: Speech Production Overview 11/14/24

• Speech Production Focus Areas:

  • Emphasis on discourse and picture description techniques.

  • different picture cards depicting sequences, emotions and/or expressions, describe how they are feeling or what they are doing. helps aphasic people with connected speech

  • absurd pictures like ads can also elicit some good language

  • some pictures can elicit words (left: mountains, trees, sunset) and some can elicit sentences (right: he is feeding the squirrels, there is a puppy)

  • this means that some are more dynamic

Page 17: Picture Description Distinctions

• Different Picture Descriptions by Graduate Student:

  • Description from MTDDA: A descriptive narrative of a scene.

  • Description from BDAE: A detailed narrative highlighting chaotic domestic actions.

    • what is the difference between the two descriptions

Page 18: Prompted Storytelling

• Storytelling Techniques:

  • Use of prompts to stimulate narrative discussion.

  • you can vary the difficulty on this or make it easier by using less pictures, maybe from 6 to 4.

Page 19: Procedural Discourse**

• Key Elements:

  • Lack of syntactic complexity; familiarity of tasks; conversation strategies.

  • Techniques for prompting narrative responses and problem-solving.

  • conversational work overlaps with social/functional

  • topic starters: wh- questions. why would be good to get them say more than a phrase. ex: why do we eat food?

  • vocation-specific: topic starters related to their job? what do they do? how do you become one? interests they have about their job, cool things that happened to them at their job

  • verbal problem solving: you’re walking down the street, you’re parked in the MEW parking lot and they block off the road. what do you do?

Page 20: Supported Picture Description Therapy Idea

• Therapy Activities: Using photos, eliciting sentences about them, and refining syntax and getting them to tell me more.

• what can they tell me about the picture?

• ask them questions about it

• if they can only say a single word, ask more questions like what were you doing, why, etc. get as much out of them as you can

• taking their words and modeling the expansion

Page 21: Challenges in Reading for PWA

• Common Reading Difficulties:

  • Normal reading rate, letter and word perception, semantic and syntactic processing, and memory retention.

Page 22: Reading Processes

• Types of Reading Processes:

  • Word recognition approaches including whole-word, phonemic analysis, and context usage.

  • whole word word recognition is the most typical, followed by phonologic/phonemic analysis bc it might not be as familiar or in their vocabulary

  • context: using contextual cues to make sense of it

Page 23: Dyslexia Types

• Types of Dyslexia:

  • Distinctions between surface and deep dyslexia, with implications for processing at different levels.

Page 24: Survival Reading Techniques

• Survival Reading Strategies:

  • Assessing needs for reading and using flash cards for identification.

  • analyze their reading needs and what they need to recognize

  • do this by giving them a probe

Page 25: Importance Ranking of Reading Activities

• Ranked Reading Activities: Based on importance to PWA, focusing on personal and practical literacy tasks.

Page 26: Challenges with Single-Word Comprehension

• Single-Word Comprehension Issues:

  • Deep dyslexia influence on ability to sound out and discriminate words; importance of training context utilization.

  • deep dyslexia: they see printed words but they cant really associate them with what they sound like

  • it is important to discriminate between phonologically ( shuttle/shovel) and visually similar (hear/clear) words

  • work on if they can name the missing letter

  • what about individual letters? ABCs. picture books

  • these adults are not learning to read like little kids, they have a reading impairment due to a brain injury

Page 27: Sentence Comprehension Techniques

• Strategies for Sentence Comprehension:

  • Activities including sentence completion and rearranging.

Page 28: Passage Comprehension Variables

• Considerations for Passage Comprehension:

  • Familiarity, length, redundancy, vocabulary, and readability impact.

  • things may be easier to comprehend if it is familiar, shorter rather than longer sentences or phrases, if it is direct and easy to spot the main ideas, is it readable?

Page 29: Writing Challenges in PWA 11/19/24

• Writing Process Similarities: Overlaps in cognitive processes with spoken language; spelling and syntax difficulties are common.

• these processes overlap

• these writing deficits parallel spoken word deficits

• we can expect auditory comprehension deficits if someone has writing deficits and vice versa

• physical involvement= handedness is important. if someone cant use their hand due to stroke, they cant write properly

• you can combine writing with word-retreieval and word prediction

Page 30: Examples of Writing Responses from PWA

• Typical Written Responses: Demonstrate challenges in articulation and syntax from individuals with different forms of aphasia.

Page 31: Writing Treatment Considerations

• Writing Approach Guidelines: Includes keyboarding, spelling drills, survival writing techniques, and word prediction methods.

• survival writing= what writing do we have to do to survive or function in daily life? texting, typing, handwriting

• spelling is also extremely important!!! can they recognize or correct misspelled words, can they point out missing lettters

Page 32: Copy and Recall Treatment Example (CART)

• Rationale for CART: Repeated spelling attempts help activate graphemic representations.