Aphasia Intervention social-functional, hybrid, cognitive 11/21/24 KNOW WHAT EACH APPROACH GOES WITH WHICH TYPE OF APHASIA- most are nonfluent

Page 1: Introduction to Aphasia Intervention

accessibility: anything that improves access to or communication in activities

• Focus: Social-functional Approaches and Other Programs.

Page 2: Writing Compensatory/Social-Focused Goals

• Goals should aim to help individuals compensate for their communication difficulties by focusing on social interactions.

• goal examples: the client used cues to help convey his meaning. the client will use and select strategies independently to make decisions. when presented with communication breakdowns, client will use compensatory strategies to cope or get through it.

• how would you track their use of strategies at home? explain what you are looking for and tell a caregiver or family member to look for these things and track them

• for example did the client choke on her liquids, family member watches for this and tells you yes or no for each day

Page 3: Specific Compensatory Approaches (Examples)

• Promoting Aphasics’ Communicative Effectiveness (PACE): Emphasizes conversational skills.

• Communication Drawing Program (CDP) and Back to the Drawing Board (BDB): Use drawing as a means of communication.

• Visual Action Therapy (VAT): Aimed at enhancing non-verbal communication skills.

Page 4: Detailed Compensatory Approaches

• Summary of PACE, CDP, and VAT as primary strategies.

Page 5: Promoting Aphasics’ Communicative Effectiveness (PACE)

• Purpose: To enhance pragmatic skills in communication.

• Focuses on conversation rather than grammatical accuracy.

• Aims to assist individuals with word retrieval difficulties and improve turn-taking in conversations.

• Adaptable for various communication partners and group sessions.

• OG used to foster pragmatic skills but has evolved to denote the process of communicating something to person what the word is to get it for example

• goal is successful comm. not accuracy

• adaptable, you can model it

Page 6: Principles Underlying PACE Treatment

• Key Principles:

  • Equal participation for the individual.

  • Introduction of new information.

  • Freedom to choose modes of communication (draw it, ask for it, gestures)

  • Natural feedback among participants.

• Addresses various process-oriented skills.

• Importance of establishing evidence levels and addressing challenges in treatment.

• Q: what “process oriented skills” may be addressed through PACE?

• A: comprehension, verbal responses/expression or gestures,

• Give an example of how a compensatory approach and a restitutional approach may overlap? PACE is compensatory approach

• language stimulation and language facilitation

Page 7: Communicative Drawing Program (CDP)

• Overview: Developed primarily as a compensatory communication approach.

• focues on drawing as a compensatory means of comm.

• pictionary or charades

• Ideal for individuals with severe aphasia with limited oral/written expression.

• Related to the Back to the Drawing Board method.

• someone with nonfluent aphasia may not walk fine or have motor deficits compared to someone with fluent aphasia bc the frontal lobe is also the main motor coordinator

• this means that if they draw their hands may be impaired

Page 8: Principles Underlying CDP- rationale!!

• Drawing as Non-Linguistic Medium: Useful for severe aphasia cases.

• Helps facilitate word retrieval using the intact right hemisphere.

• Assumptions of the approach are debated regarding effectiveness.

Page 9: Steps in CDP

ladder of difficulty, can they recognize correct color or can they recognize cartoon scenes. meet them where they are and progress from there

1. Basic semantic-conceptual knowledge.

2. Understanding color properties of objects.

3. Drawing outlines of distinct shapes.

4. Copying geometric shapes.

5. Completing drawings with missing details.

6. Drawing from memory.

7. Drawing on command from stored representations.

8. Drawing within superordinate categories.

9. Generative drawing of animals and vehicles.

10. Drawing cartoon scenes.

Page 10: Example of Multimodality Communication

• An example of client utilizing drawing to communicate an experience about eating hamburgers with friends, indicating multimodal expression of language through visual and verbal cues.

Page 11: Drawing and AAC (Augmentative and Alternative Communication)

• Usage of Drawings: Serves to compensate for verbal or written language deficits.

• Reduces limitations set by memory and sequential processing issues.

• Drawings enhance communication and can substitute for verbal output.

• drawings do not fade away like words do, they can see them and this helps with memory and more turns taken

Page 12: De-blocking, Semantic Access, and Drawing

• Effectiveness of Drawing: Drawing is more effective than writing for verbal expression.

• Quality of drawings does not affect semantic access capability.

Page 13: CDP Candidate Profile

people who may benefit from drawing

• Ideal candidates possess the following traits:

  • Inability to communicate well through speech/writing.

  • Ability to use a felt-tip pen for drawing.

  • ability to see the page

  • Relatively intact visual memory and good visual attention.

  • Willingness to engage in drawing as a communication strategy.

Page 14: Steps in CDP (Reiterated)

• List of steps designed to improve drawing and communicative effectiveness.

Page 15: Step 1 and 2 in CDP

• Basic Knowledge Tasks:

  • Identifying circles of related objects.

  • Selecting correct colors for drawings.

  • Criteria for successful identification and color selection.

Page 16: Step 3 and 4 in CDP

• Outlining and Copying:

  • Drawing outlines without touching lines.

  • Copying geometric shapes with accuracy criteria specified.

Page 17: Step 5 and 6 in CDP

• Completing Drawings Tasks:

  • Filling in missing features in drawings.

  • Drawing from memory with accurate representation of shapes.

Page 18: Step 7 and 8 in CDP

• Drawing Tasks:

  • Drawing from commands related to stored knowledge. look at this word can you draw it

  • Drawing based on superordinate categories.

Page 19: Step 9 and 10 in CDP

• Generative Drawing and Cartoon Scenes:

  • Drawing animals/transportation.

  • draw a cartoon scene

Page 20: Sample CDP Goals (A.S.)

• Goal: Enhance multimodal communication through drawing.

  • Objectives include producing identifiable drawings and storytelling.

  • the goal is to draw it so that a naive judge can identify it

Page 21: Back to the Drawing Board (BDB)

• Method overview akin to CDP but specifically for severe aphasia.

• Based on principles found in CDP.

• using drawing as a strategy for word retrieval

Page 22: Visual Action Therapy (VAT)

• Approach Overview: Gesture-based and non-vocal.

• Aimed at supporting communication in individuals with global aphasia.

• Enhances symbolic communication using gestures.

• similar but its not drawing it is gestures

• non vocal approach

• intended for global aphasia

• symbolic gestures that are easy, not ASL bc its too hard for PWA bc its a language in itself

• can be alternative mode for compensatory strategies. you can rub your arms to show you are cold rather than saying I’m cold

Page 23: Phases of VAT

• Three types of gestures:

  • Proximal limb gestures (gross motor skills).

  • Distal limb gestures (fine motor skills).

  • Bucco-facial gestures (facial communication).

Page 24: Other Treatment Programs

• Overview of various alternative therapeutic approaches for aphasia.

Page 25: Response Elaboration Training (RET)

• Purpose: To enhance verbal communication for individuals with brocas or non-fluent aphasia.

• not rigid, no set of picture cards to use. client picks what yall talk about, topics that interest client

• anything they say, you respond to and model longer utterances and make them more elaborate

• validate it by responding and adding more info

• Focus on increasing length and information in speech.

Page 26: Principles of RET

• Underlying Principles: Client-controlled communication and interactive training.

• based on loose training programs that reduce SLP control over stimuli, responses, and feedback

• client responds authentically

• geared toward longer and more varied utterances

Page 27: Implementation of RET

• Steps involve showing stimulus pictures and eliciting responses for elaboration without direct corrections.

• don’t say no you missed that, say oh ok tell me more

• elaboration is more important than feedback

Page 28: RET Procedures

• Step-by-step format illustrating client interaction and clinician feedback.

Page 29: Treatment for Aphasic Perseveration (TAP)

PERSEVERATING IS LIKE RUMINATING ON ONE THING THAT THEY CANNOT STOP FOCUSING ON

• Overview: Designed to reduce perseveration in speech-related issues.

• Suitable for individuals with intact comprehension and moderate to severe persistent speech patterns.

• if you have someone with a lot of perseverations

• idea is to reduce perseverations and enhance naming

• good for PWA who have moderate comprehension, good memory, and moderate to severe recurrent perseverations

Page 30: TAP Baseline Establishment

• Methodology for assessing perseveration level and client engagement.

Page 31: Engagement Strategies in TAP

• Techniques to redirect client attention during perseveration instances.

Page 32: Treatment Programs Based on Linguistic Theory

• Examples: Strategies targeting syntactic comprehension and production improvements.

• The goal of linguistic programs is syntax and comprehension

• involve metalinguistic contexts= thinking about your skills like taking apart what they say and analyze it for language and grammar

• works best with nonfluent aphasia

• mapping therapy- client reads sentences and you model it and ask which one is the bird which one is this. modified sentence diagram activity

Page 33: Script Training

• Methodology for teaching scripts tailored to individual client needs for enhancing natural speech production.

• trying to get socially meaningful language

• multimodal for verbal and written modalities

Page 34: Implementation Phase of Script Training

• Collaborative generation of script content and context-appropriate practice.