management of aphasia: practical application aphasia islha b… · 3/23/2012 1 new concepts in the...

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NEW CONCEPTS IN THE MANAGEMENT OF APHASIA: PRACTICAL APPLICATION

Written and Presented By:

Kara Kozub O’Dell, M.A. CCC-SLP, BIS

Allied Health Manager, Neurological Recovery Unit

The Rehabilitation Institute of Chicago

APHASIA

APHASIA TREATMENT TECHNIQUES

Verbal Expression Combined

Semantic/Phonological Cueing Hierarchy

Complexity of Treatment in Syntactic Deficits

Constraint Induced Language Treatment (CILT)

Conversational Scripting Mapping Treatment Melodic Intonation

Treatment (MIT) Multiple Oral Reading Naming Complexity

Treatment Oral Reading for Language in

Aphasia (ORLA) Promoting Aphasic

Communication Effectiveness (PACE)

Prompts for Restructuring Oral Muscular Targets (PROMPT)

Reciprocal Scaffolding Response Elaboration

Treatment Schuell’s Stimulation

Approach Semantic Feature Analysis Semantic Cueing Hierarchy Sentence Production Program

for Aphasia (SPPA)- Supported Conversation for

Adults with Aphasia Thematic Language

Stimulation Treatment for Aphasic

Perseveration Treatment of Underlying

Forms Voluntary Control of

Involuntary Utterances

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Auditory Comprehension Auditory Comprehension

Training Auditory Retention &

Comprehension Tasks Complexity of Treatment

in Syntactic Deficits Conversational Scripting Language Oriented

Treatment Mapping Treatment Reciprocal Scaffolding Schuell’s Stimulation

Approach Supported Conversation

for Adults with Aphasia Thematic Language

Stimulation

Reading Comprehension Multiple Oral Reading Oral Reading for

Language in Aphasia (ORLA)

Schuell’s Stimulation Approach

Supported Conversation for Adults with Aphasia

Thematic Language Stimulation


Written Expression Agraphia Treatment Copy and Recall

Treatment (CART) Promoting Aphasic


Reciprocal Scaffolding Schuell’s Stimulation

Approach Supported

Conversation for Adults with Aphasia

Thematic Language Stimulation

Non-Verbal Communication Back to the Drawing

Board Promoting Aphasic


Supported Conversation for Adults with Aphasia

Visual Action Therapy


Motor Speech Back to the Drawing

Board Dabul & Bollier Prompts for

Restructuring Oral Muscular Targets (PROMPT)

Rosenbeck Sound Production

Treatment Techniques for

Speechless Apraxic patient

Wambaugh

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Research: Evidence

Change in Thinking: New

Concepts

Approaches to Managing Aphasia

Clinical Practice

“NEW” CONCEPTS

Intensity TechnologyLife Participation

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BARRIERS TO APPROACHES

Challenges to incorporating new concepts and implementing new approaches Time Patient population Setting Access to materials, CEUs, knowledge Payer requirements

EXPANDED DEFINITION OF EVIDENCE BASED PRACTICE : SACKETT, ET AL, 2000

Evidence Based

Practice

Clinical Expertise

Best Current Research Client Values

PRINCIPLES OF NEURAL PLASTICITY

1. Use it or lose it2. Use it and improve it3. Specificity4. Repetition matters5. Intensity matters6. Time matters7. Salience matters8. Age matters9. Transference10. Interference

(Kleim & Jones, 2008)

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CLINICAL APHASIA EVIDENCE FOR PRINCIPLES OF EXPERIENCE-DEPENDENT PLASTICITY

1. Timing of treatment delivery2. Use it or lose it3. Generalization or transfer of treatment effects4. Intensity of treatment

(Raymer, et al, 2008)

INTENSITY: NEW CONCEPTS

There is conflicting evidence as to whether or not speech and language therapy is efficacious in treating aphasia Most positive studies provided intense therapy over a

short period of time Most negative studies provided less intense therapy

over a longer period of time

INTENSITY: THE EVIDENCEStudy N Methods Intensity of Therapy Outcome Result

Bakheit et al. 2007 97 Patients post first stroke were assigned to either 5

one hour sessions/week or 2 one hour

sessions/week; WAB given at 4, 8, 12 and 24 weeks

5 hours/week or 2 hours/week for

12 weeks

Overall , no significant differences noted in performance

on WAB between standard and more intensive therapy.

None of the patients assigned to intensive group finished

their course.

‐

Brindley at al. 1989 10 Patients with Broca’s aphasia per BDAE without

predominate apraxia 1 year post stroke

5 hours over 5 days a week for 12

weeks

Significant improvement on FCP. +

Lincoln, et al. 1984 327 Aphasic patients 10 weeks post stroke randomized

to either receive 2 one hour sessions for 34 weeks

or no treatment

2 one hour sessions/week for 34

weeks

Both groups demonstrated improvement, but no

significant improvement between groups.

‐

Marshall et al. 1989 121 Males 2‐12 weeks post onset from a single left

hemisphere thrombosis infarct were randomized

to home therapy by wife, friend or relative,

therapy by SLP or therapy by SLP deferred for 12

weeks.

8‐10 hours/week for 12 weeks At 12 weeks, the SLP group showed significantly more

improvement than the deferred therapy group, but home

therapy group did not differ from SLP therapy group.

+

Poeck et al. 1989 160 Aphasic patients with only L hemisphere

involvement as shown by CT and beyond the acute

stage. Patients received intensive treatment for 9

hours/week for 6‐8 weeks and results were

compared with a previous study of 92 patients

who did not receive therapy.

9 hours/week for 6‐8 weeks Gains were significant for both the treatments and

control groups.

+/‐

Wertz et al. 1986 121 Male veterans under age 75 years of age who were

2‐4 weeks post onset of single thromboembolic

stroke. Patients demonstrated language severity

in the 10th‐80th percentiles on the PICA and were

randomized into 8‐10 hours therapy/week for 12

weeks followed by 12 weeks of no treatment or 8‐

10 hours/week of treatment by a volunteer for 12

weeks followed by no treatment for 12 weeks or

treatment deferred for 12 weeks followed by 12

weeks of treatment by an SLP

8‐10 hours/week for 12 weeks Clinic patients performed significantly better on PICA

than those deferred. No significant difference between

home and clinic groups. No significant difference

between any group after 24 weeks.

+

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INTENSITY : NEW CONCEPTS

Intense therapy over a short amount of time could improve outcomes for patients with aphasia Positive treatment effects for a mean of 8.8 hours of

therapy/week for 11.2 weeks

VERSUS

Negative studies that provided 2 hours/week for 22.9 weeks

(Bhogal et al., 2003)

INTENSITY : APPROACHES

Oral Reading for Language in Aphasia (ORLA) Oral expression + reading comprehension + written

expression

Conversational Scripting Oral expression + auditory comprehension

Constraint Induced Aphasia or Language Therapy (CIAT or CILT) Oral expression

Copy and Recall Treatment (CART) With Repetition of a Spoken Model Written expression + oral expression

Anagram and Copy Therapy (ACT) Written expression

ORAL READING FOR LANGUAGEIN APHASIA Initially developed based on neuropsychological

models of reading Improvements may occur in other modalities,

including oral and written expression Incorporates repetitive multimodality stimulation

and practice Strengthens lexical information, so that the benefit

extends to other modalities Technique may be efficacious in treating apraxia

because it incorporates three elements—rhythm, pacing, and linguistic templates

(Cherney, 1995, 2004)

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ORAL READING FOR LANGUAGE IN APHASIA

Purpose Improve reading comprehension by providing practice in

grapheme-to-phoneme conversion Improve oral expression and auditory comprehension of

sentences by strengthening the lexical-semantic system

Appropriate Patients Patients with various severity levels of fluent and non-

fluent aphasia

Materials Sentences and paragraphs up to 100 words in length

Procedures SLP sits across from patient SLP reads stimulus aloud pointing to each word as

he/she reads it


Procedure (cont’d) SLP reads stimulus again with both SLP and patient

pointing to each word SLP and patient read stimulus aloud together with patient

pointing to each word; repeat, varying rate and volume For each line or sentence, SLP states word for patient to

identify For each line or sentence, SLP points to a word for patient

to read Patient reads stimulus aloud (SLP helps as needed)

Resources Cherney, LR (2004) Cherney, L, Merbitz, C and Grip, J (1986) Cherney, LR (1995)


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Sample Goals Severe aphasia: reading comprehension Moderate aphasia: oral expression Mild aphasia: written and oral expression

Patient will achieve 80% accuracy reading comprehension of 3-5 word sentences with moderate cues.

Patient will achieve 100% accuracy oral expression while reading 3-5 word sentences aloud in unison with SLP with maximal visual and verbal cues.

Patient will write 3-5 word sentences to describe pictures, actions or thoughts with 85% accuracy with moderate cues.



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CONVERSATIONAL SCRIPTING

A “script” is a series of functional sentences spoken in routine communication situations

Also utilized with patients with autism to focus on “turn taking”

Can be used with patients with AAC devices

Principle: generalization or transfer

CONVERSATIONAL SCRIPTING Purpose

To facilitate communication and participation in conversational exchanges specific to routine activities

Patients can focus on speech initiation, turn-taking and socialization once scripts become “automated”

Appropriate Patients Patients with multiple levels of aphasia severity

Materials Completed needs assessment to determine patient’s

communication needs and interests A script

Procedures Mass practice with a specific script

CONVERSATIONAL SCRIPTINGCustomer Service Rep (CSR): Hello, this is Comcast. How can I help you?

Patient (P): Yes, I need to pay my cable bill.

CSR: May I have your phone number?

P: Yes, it’s 555-1212.

CSR: Thank you. Can you verify your address, please?

P: It is 345 East Superior Street in Chicago, Illinois.

CSR: Your bill this month is $124. How do you wish to pay?

P: With my MasterCard on file, please.

CSR: Thank you. Can you verify the last 3 digits, please?

P: Yes, four seven two.

CSR: Thank you. Your card has been charged and your payment will be reflected on your account. Is there anything else I can do for you today?

P: No, thank you.

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CONVERSATIONAL SCRIPTING

Resources The Center for Spoken Language Research

http://cslr.colorado.edu/beginweb/skriptalk.html RIC: The Rehabilitation Research and Training

Center on Technology Promoting Integration for Stroke Survivors: Overcoming Societal Barriers http://www.rrtc-stroke.org/research/r3.php

Cherney, Halper, Holland & Cole, (2008)

Sample Goals Patient will use a specific script to take four

conversational turns at the sentence level, given minimal cueing after one review.

Patient will express three wants, needs or preferences via use of a specific script at the word level in 75% of trials with moderate cues after review x3.

CONSTRAINT INDUCED LANGUAGE THERAPY (CILT)

Extended from traditional forced use paradigms

Patients with chronic aphasia use most accessible communication channels

Major components: forced use AND massed practice

Principle: Use it or lose it

CONSTRAINT INDUCED LANGUAGE

THERAPY (CILT) Purpose

Create an environment that constrains patients to systematically complete intensive practice of speech acts with which they have difficulty

Limit the use of writing, gesturing, drawing or giving up on a message all together in order to promote oral expression

Appropriate Patients Patients with chronic aphasia

Materials Routine therapy tasks (games, PACE, conversation)

Procedures (Example: “Go Fish”) All communication must be spoken words

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THERAPY (CILT)

Procedure (cont’d) Each patient selects a card (dog) and requests the

object on the card without showing it to the other players (clinician changes level of difficulty as appropriate i.e. “dog” vs. “Do you have a dog?”)

Other players respond verbally in the appropriate manner (i.e. “here” vs. “I have a dog”)

Treatment is provided on an intensive schedule that varies by protocols (3 hours+ hours/day at least 5 days a week)

Resources Cherney, L, et al. (2008) Maher, LM, Kendall, D, et al. (2006)

CONSTRAINT INDUCED LANGUAGE THERAPY (CILT)

EVIDENCE SUMMARY:

Positive effects of CILT and intensive aphasia treatment primarily for individuals with nonfluent chronic aphasia

CILT can result in improved language function and everyday communication for those patients with aphasia

Need additional research, contrasting forced language use and treatment intensity in individuals with acute aphasia and those with fluent types of aphasia


THERAPY (CILT)

Sample Goals 80% accuracy verbal expression of single words

during a structured task following a model with moderate cues.

Patient will verbally express a sentence length response to a question given minimal assist in 80% of trials.

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COPY AND RECALL TREATMENT WITH REPETITION OF A SPOKEN MODEL (CART+REPETITION)

Lexical retrieval difficulties affect written and spoken language

CART created to improve orthographic representations in patients with aphasia

Engages both phonological and orthographic processing of lexical items


Purpose Pairs writing treatment with repeated oral naming

practice to improve written and oral naming of target words

Appropriate Patients Patients with moderate aphasia who have naming

deficits

Materials (Word Level) List of 20 relevant common and proper nouns Recorder with pre-recorded productions of target

words with picture cards for each target

COPY AND RECALL TREATMENT WITH REPETITION OF A SPOKEN MODEL (CART+REPETITION) Procedure

A line drawing of one of the 20 target words is presented; the patient is cued to orally name and write the word

A spoken or recorded model is presented and the patient is cued to “listen, repeat and copy”

Unsuccessful oral responses are followed by opportunities for the patient to achieve correct production by prompting verbalization three times (“It sounds like this. Coffee. Can you say it? Say it again. One more time.”)

Unsuccessful written responses are followed up by presenting a handwritten model of the word and cueing the patient to write it three times (“It looks like this. Coffee. Can you copy it? Write it again. One more time, write coffee.)

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Procedure (cont’d) Remove all examples of written words and prompt

patient to name a picture. Whether or not it is correctly named, have the patient listen to the target word. Do this three times.

Next, have the patient write the target without a written model. Have them write it three times, giving feedback and covering their attempt after each.

It is recommended that 10 targets are used each session until 80% accuracy is achieved.

Homework requiring patient to use an audio recording to listen to word, name and then write 20 times is given and should take 30-60 minutes to complete.

(CART+REPETITION)

(CART+REPETITION)

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ResourcesBeeson, PM, Rising, K & Volk, J (2003).

Beeson, PM & Egnor, H (2006).

Sample Goals: Patient will name and write a set of 5 pictures/objects

on the 4th trial following 3 verbal and 3 written productions of each target word with 80% accuracy with minimal cues.

Patient will name and write a set of 5 pictures/objects following guided copy practice with 80% accuracy and moderate cues.

ANAGRAM AND COPY TREATMENT (ACT)

Purpose Provides patients with a core set of specific written words

to communicate basic wants and needs Improves link between graphemic representations and

semantics (spelling) Principle: Timing of treatment delivery

Appropriate Patients Non-verbal patients with severe aphasia

Materials A core set of approximately 20 words, 3-9 letters in length

Procedure Patient is asked to write a word and is shown a picture of

the target; a semantic cue may also be provided

ANAGRAM AND COPY TREATMENT (ACT) Procedure (cont’d)

If the target is correctly written, move to the next item. If it is NOT correct see the steps below

Present component letters in random order and ask the patient to manipulate them to spell the word

Once the word has been correctly spelled, the patient copies it 3 times

After copying 3 times, the written copies are removed and the spelling is assessed 3 times

Reference Beeson, PM, Hirsch, FM & Rewega, MA (2002)

Sample Goals Patient will achieve 80% accuracy of spelling (as a

precursor to written expression ) of a core set of 10 words when presented with component letters in random order with moderate cues.

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TECHNOLOGYProvide limitless opportunities for

interactive language activitiesComputers

Programs Internet E-Mail

Mobile PhonesE-ReadersAAC

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TECHNOLOGY: COMPUTERS

Considerations Accessibility

Voice recognition softwareEnlarged keyboardsABCDEF vs. QWERTY

Instruction Range of programsTherapeutic programs, photo programs, greeting

cards, games, e-mail, etc.

Features of programsSpell check / thesaurus

TECHNOLOGY: COMPUTERS Computer based aphasia therapy

Provides a means for massed practice and increased intensity

Minimizes therapist time and resources

Computerized programs AphasiaScripts™ (The Rehabilitation Institute of Chicago, 2007)

ORLA™ (The Rehabilitation Institute of Chicago)

Parrot (Parrot Software, West Bloomfield, Michigan)

Bungalow (Bungalow Software, Inc., Blacksburg, Virginia)

SentenceShaper ® (SentenceShaper Software; Psycholinguistic Technologies, Inc., Elkins Park, Pennsylvania)

Evidence Computer based interventions can improve language

skills at the impairment level, but there is limited evidence that improvements generalize to functional communication


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AphasiaScripts™ (The Rehabilitation Institute of Chicago, 2007)

TECHNOLOGY: MOBILE PHONES

84% of individuals with disabilities surveyed own or have regular access to a mobile phone

6 semi-structured interviews with individuals with aphasia; 3 semi-structured observations of individuals with phones in key scenarios

18 barriers to mobile phone use Device design

Small phone buttons, small screen, use of unclear symbols in menus, too many features

Written support and trainingUnclear user manuals, inadequate training in use

OtherUnique language used with texting, complexity of use

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TECHNOLOGY: MOBILE PHONES 9 factors that may help Design

Labels on all controls Keyboards arranged in alphabetical order (not

QWERTY) Use of texting vs. voice communication Word prediction software Preprogrammed numbers Flip open handsets

Written support and training Adequate support and training Written cues and images in instructions Familiar communication partner

(Morris and Mueller, 2010)


Smart Phone and Tablet Apps Lingraphica®

SmallTalk AphasiaSmallTalk PhonemesSmall Talk Conversational

PhrasesSmall Talk Daily Activites

MyVoice™: Communication Aid

Tactus Therapy Solutions: TherAppyComprehensionNamingReadingWriting


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LIFE PARTICIPATION

Internal Classification of Functioning, Disability, and Health (ICF) Framework Implementation in 2001 with unanimous

endorsement of the classification by the 54th World Health Assembly

Healthcare classification framework for describing and measuring health and disability

Used for functional status assessment, goal setting & treatment planning and monitoring, as well as outcome measurement in clinical setting

Takes into account the social aspects of disability

ICF: DEFINITIONS

Impairments: problems in body function or structure such as a significant deviation or loss.

Activity: the execution of a task or action by an individual.

Participation: involvement in a life situation. Activity Limitations: difficulties an individual may

have in executing activities. Participation Restrictions: problems an individual

may experience in involvement in life situations. Environmental Factors: make up the physical,

social and attitudinal environment in which people live and conduct their lives.

LIFE PARTICIPATION APPROACH TO APHASIA (LPAA)

Call for a broadening and refocusing of clinical practice and research on the consequences of aphasia

Focus on re-engagement in life Places life concerns of those affected by aphasia

at the center of all decision making Empowerment and collaboration on interventions

may lead to more rapid return to active life and reduce the consequences that lead to long-term health costs

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LIFE PARTICIPATION APPROACH TO APHASIA (LPAA)

Assessment includes determining relevant life participation needs

In addition to assessing communication and deficits, clinicians should be equally interested in how the patient does with support

Clinicians take on take on roles in addition to doing therapy, such as “communication partner”, “coach” or “problem solver”

Clinicians evaluate and document on: Life activities and satisfaction Social connections and satisfaction Emotional well-being

(Chapey, et al, 2010)

SOCIAL PARTICIPATION OF STROKE SURVIVORS WITH APHASIA

Impact of stroke – Are survivors with aphasia different from those without? 126 participant divided into two groups (aphasia and

no aphasia) and surveyed at 2 weeks, 3 months and 6 months post onset

Outcomes improved significantly over time Scores comparable for:

Physical abilities Well being Social support

Scores for people with aphasia significantly lower than those for people without aphasia on: Participation in activities Quality of life

(Hilari, 2011)

SOCIAL PARTICIPATION OF STROKE

SURVIVORS WITH APHASIA

Interviews (adapted to communication needs of the individuals) of 150 stroke survivors with aphasia Variation in social participation Low home integration scores (finances, childcare,

housework, meals, etc.) Low productivity scores (work, retirement, education,

volunteer, etc.) Age, gender, performance on ADLs and aphasia

severity related to social participation

(Dalemans, et al. 2010)

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LIFE PARTICIPATION

Severity of aphasia Environment Activity participation Person, identity, attitude and feelings

versus

Traditional language domains Functional communication abilities

LIFE PARTICIPATION Communication Disability Profile - CDP (Swinburn &

Byng, 2006)

The Stroke and Aphasia Quality of Life Scale-SAQUL-39 (Hilari et al, 2003)

The Burden of Stroke Scale – BOSS (Doyle et al., 2002)

The ASHA Quality of Communication Life -ASHA-QCL (Paul et al, 2003)

The only tool that assesses communication confidence “I am confident that I can communicate”

Confidence: “a feeling or consciousness of one’s powers” (Miriam Webster Online)

LIFE PARTICIPATION

Supported Conversation for Adults with Aphasia (SCA)

Group Therapy: Book clubs, conversation groups

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SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA) An emphasis on the social unit of dyad

incorporating the conversation partner, rather than sole focus on the person with aphasia.

Interaction/social connection is given as much weight as transaction/exchange.

The person with aphasia is treated as a competent person capable of making decisions, if appropriate support is provided.

Social & societal barriers to conversation & participation in daily life are taken into account with a commitment to providing the support necessary to decrease these barriers.

Principle: Use it or lose it; generalization

(Aphasia Institute, 2004)

SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)

Purpose Provide an “assistive device” for communication by

emphasis on incorporating the conversational partner Technique is not just used in therapy, but in daily

interactions

Appropriate Patients Patients with all types and severities of aphasia

Materials BLACK marker Unlined paper Pictures, photos, drawings


ProceduresStep 1: Acknowledge Partner’s Competence

Strive for feel / flow of natural adult conversation Use appropriate tone and sense of humor Handle incorrect / unclear responses respectfully Encourage partner when appropriate Acknowledge competence when partner is

upset/frustrated “I know you know what you want to say”

Take on communicative burden as appropriate to help partner to feel comfortable

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Step 2: Reveal Competence Ensures that the adult with aphasia understands How much support is provided relative to what’s

needed? Verbal – short, simple sentences, redundancy /

repetition, verbal adaptation Nonverbal – gesture, writing, pictures /

resources, drawing Response to communicative cues – reacting to

facial expressions that indicate lack of comprehension


Step 2: Reveal Competence (cont’d) Ensures that the adult with aphasia has a means

of responding Verbal – fixed choice, yes/no

Nonverbal – gesture, writing, resources, drawing

Response to communicative cues – giving enough time to respond

SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)Step 3: Verification Accuracy of adult with aphasia’s response not

automatically assumed Verbal – “So let’s see if I’ve got this right…”

Nonverbal – gesture, writing, resources, drawing

Response to communicative cues – appropriate handling of inconsistent yes/no responses

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Resources Kagan, A (2004) Kagan, A (2001)

Sample Goals Patient will express 3 wants, needs or ideas during a

5 minute supported conversation via total communication with maximal assist

Patient will comprehend and express a variety of topics during a 5 minute supported conversation with no more than 2 communication breakdowns with moderate assist

WHY SCA WORKS Aphasia can be defined as an acquired

neurogenic language disorder that may mask competence normally revealed in conversation.

There is an interactive relationship between perceived competence & opportunity for conversation.

The ability & opportunity to engage in conversation & reveal competence lie at the heart of “communicative access” to participation in daily life.

Competence of people with aphasia can be revealed through the skill of the conversation partner who provides a “communication ramp” for increasing communicative access.

(Aphasia Institute, 2004)

SCA MATERIALS AVAILABLE FOR PURCHASE FROM NATIONAL APHASIA

INSTITUTE

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GROUP THERAPY

Different methods and types of groups Engagement is critical in order to be maximally

successful Process by which people establish, maintain and

terminate collaborative interactions Clinician facilitates and monitors to prevent an

individual session with observers

Appropriate support should be provided Cue for strategies and total communication: gestures,

scripts, picture choices, etc.

Principle: Use it or lose it and generalization

GROUP THERAPYRules of Engagement

Structure seating to promote engagement Clinicians as participants Monitor signals of engagement

GazeBody language/positionShared laughter, frustration, other emotionsGesture

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GROUP THERAPY

Purpose Cost effective way to maximize limited language

therapy resources Provide opportunity for and encourage social

interactions, practicing of communication strategies and peer support

Evidence There is moderate evidence that group intervention

results in improvements on communication and linguistic measures among individuals with chronic aphasia.

There is limited evidence that group therapy results in improved communication.

Research: Evidence

Change in Thinking: New

Concepts

Approaches to Managing Aphasia

Clinical Practice

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REFERENCES The Aphasia Institute https://www.aphasia.ca

Babbitt E & Cherney, L (2010). Communication confidence in persons with aphasia. Top Stroke Rehabil, 17(3): 214-223.

Bakheit AM, Shaw S, Barrett L, et al. (2007). A prospective, randomized, parallel group, controlled study of the effect of intensity of speech and language therapy on early recovery from poststroke aphasia. Clin Rehabil, 21, 885-894.

Beeson PM, Hirsch FM & Rewega MA (2002). Successful single-word writing treatment: Experimental analyses of four cases. Aphasiology, 16: 477.

Beeson PM, Rising K & Volk J (2003). Writing treatment for severe aphasia: Who benefits? Jour Speech, Lang and Hear Resear, 46: 1044.

Beeson PM, & Egnor H. (2006). Combining treatment for written and spoken naming. Jour Internat Neuropsy Soc, 12: 816-827.

Bhogal S, Teasell R, & Speechley M (2003). Intensity of aphasia therapy, impact on recovery. Stroke, 34, 987-993.

Brindley P, Copeland M, Demain C, Martyn P (1989). A comparison of the speech of ten chronic Broca’s aphasics of following intensive periods of therapy. Aphasiology, 3: 695-707.

Chapey R, Dunchan JF, Elman RJ, Garcia LJ, Kagan, A, Lyon, J, Simmons-Mackie N. Life participation approach to aphasia: a statement of values for the future. Available at: http://www.asha.org/public/speech/disorders/LPAA.htmAccessed December 30, 2010.

Cherney LR, Halper AS, Holland AL & Cole, R (2008). Computerized script training for aphasia: preliminary results. Amer Jour Speech Lang Pathol, 17: 19-34.

Cherney L, Merbitz C & Grip J. (1986). Efficacy of oral reading in aphasia treatment outcome. Rehabilitation Literature, 112-119.

Cherney LR. (2004). Aphasia, alexia and oral reading. Top Stroke Rehabil, 11(1), 22-36.

Cherney LR, Patterson J, Raymer A, Frymark T, & Schooling T (2008). Evidence-Based Systematic Review: Effects of Intensity of Treatment and Constraint-Induced Language Therapy for Individuals with Stroke-Induced Aphasia. J Speech Lang Hear Res, 51, 1282-1299.

Cherney LR. (1995). Efficacy of oral reading in the treatment of two patients with chronic Broca's aphasia. Top Stroke Rehabil, 2 (1), 57-67.

Dalemans RJ, De Witte LP, Beurskens AJ, Van Den Heuvel WJ & Wade DT (2010). An investigation into the social participation of stroke survivors with aphasia. Disabil Rehabil, 32 (20):1678-85.

Elman RJ & Bernstein-Ellis E (1999). The efficacy of group communication treatment in adults with chronic aphasia. J Speech Lang Hear Res, 42: 411-419.

Hilari K (2011). The impact of stroke: are people with aphasia different to those without? Disabil Rehabil, 33(3): 195-203.

Hilari K, Byng S, Lamping DL & Smith SC (2003). Stroke and aphasia quality of life scale-39 (SAQOL-39): evaluation of acceptability, reliability, and validity. Stroke, 34: 1944.

Kleim JE & Jones TA (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. J Speech Lang Hear Res, 51(1):S225-S239.

Lincoln NB, McGuirk E, Mulley GP, et al. (1984). Effectiveness of speech therapy for aphasic stroke patients: a randomised control trial. Lancet, 1: 1197-2000.

Maher LM, Kendall D, Swearengin JA, et al. (2006). A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. J Int Neuropsychol Soc, 12(6) 843-852.

Marshall RC, Wertz RT, Weiss DG, Aten, JL et al. (1989). Home treatment for aphasic patients by trained nonprofessionals. J Speech Hear Disord, 54: 462-470.

Kagan A. (2004). Lecture and materials from Supported Conversation for Adults With Aphasia (SCA): A Life Participation Approach. June 24-25, 2004, Rehabilitation Institute of Chicago.

Kagan A., et al. (2001). Training Volunteers as Conversation Partners Using Supported Conversation for Adults With Aphasia (SCA): A Controlled Trial. Journal of Speech, Language and Hearing Research, (44): 624-638.

Morris J, Mueller J & Jones M. (2010) Toward mobile phone design for all: meeting the needs of stroke survivors. Top Stroke Rehabil. 17(5):353-61.

Poeck K, Huber W, Wilmes K (1989). Outcome of intensive language treatment in aphasia. J Speech Hear Disord, 54: 471-479.

Raymer A, et al (2008). Translational research in aphasia: from neuroscience to neurorehabilitation. J Speech Lang Hear Res,51(1):S259-S275.

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Sackett DL, Straus SE, Richardson WS, Rosenberg W & Haynes RB (2000). Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh & New York: Churchill Livingstone.

Simmons-Mackie N & Damico J (2009). Engagement in group therapy for aphasia. Semin Speech Lang, 30: 18-26.

Simmons-Mackie N & Elman RJ (2010). Negotiation of identity in group therapy for aphasia: the Aphasia Café. Int J Lang Commun Disord. 2010 Sep 17 {Epub ahead of print].

Wertz RT, Weiss DG, Aten DL, Brookshire RL, et al. (1986). Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study. Arch Neurol, 43: 653-658.

Thank you to Kathryn Miller, MS, CCC-SLP and Lisa Naylor, MA CCC-SLP for their assistance with videotaping examples for this presentation.

management of aphasia: practical application aphasia islha b… · 3/23/2012 1 new concepts in the...

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