#science/speech
Chapey, R. (2008). Language intervention strategies in aphasia and related
neurogenic communication disorders (5th ed.). Philadelphia: Lippincott Williams & Wilkins
Assessment of communication for pts with severe/global aphasia best is best achieved through using both formal and informal measures.
Given the generally poor outcome in chronic global aphasia and the negative results that have been reported for treatment programs aimed specifically at remediating verbal skills, treatment for these patients may emphasise functional and/or social approaches that attempt to improve participation in communication activities as well as impairment-based approaches that attempt to reduce the severity of the language impairment.
A realistic goal for treatment consists of improving auditory comprehension, supplemented with contextual cues, to permit consistent comprehension of one-step commands in well-controlled situations.
For the most severe comprehension deficits, picture matching, accompanied by the clinician's production of the name of items to be matched, may provide the most basic level of auditory stimulation.
Complexity for this task may be increased by:
Comprises four phases:
Based on the observation that pts with global aphasia often can recognise names that contain two salient features, differentiate cards by suit, and place cards in a sequence when they are unable to perform similarly with other stimuli.
Despite conclusions that traditional treatment focused on verbal communication skills may be ineffective for global aphasia, short-term attempts to establish or expand verbal expression may be a legitimate therapeutic activity during both the acute and chronic phases of recovery.
Patients use available methods (e.g., showing fingers, pointing, gesturing,
writing, matching, and selecting objects) to confirm the meaning of any
successfully elicited verbalisations. Including among these may be
serialisations, imitated words & phrases, or automatic, meaningful responses to conversations relating to a variety of topics.
Patients who succeed in these tasks are taught to produce a small repertoire of useful spoken/spoken+gesture responses.
Uses modelling, expansion, and feedback to develop the verbal responses of pts with severe aphasia in conversational contexts.
Props & written cues are provided to facilitate verbal expression.
Ten conversational levels are identified, ranging from concrete, structured
contexts (e.g., manipulating objects or acting out and describing sequences) to more open contexts (e..g, structured interview/discussion).
This approach may be particularly helpful in developing contextually appropriate communication for pts with global aphasia.
The verbal output of many pts with global aphasia consists primarily of
stereotypic recurring utterances or speech automatisms. For these pts,
productive use of single words or phrases may not be a realistic goal. However, the Voluntary control of involuntary utterances program aims at bringing these stereotypes into more productive usage.
Words that are involuntarily & inappropriately used are identified and used as later targets in treatment. These words are trained in a sequences of
activities, including oral reading, confrontation naming, and, finally,
conversational usage, until a vocabulary of 200–300 words is established.
Not effective, except in the short term and in an item-specific context.
Limited evidence for effectiveness: 1 x pt studied, significant improvement at 1yr post-stroke.
Adapted from Amer-Ind sign, a gestural system based on the concepts underlying words rather than the words themselves.
Amer-Ind Code is concrete, pictographic, highly transmissible, easily learned, agrammatical, and generative. The system can be applied in aphasia rehabilitation as an alternative means of communication, as a facilitator of verbalisation, and as a deblocker of other language modalities.
Can also be combined with other nonverbal means of comm., e.g., drawing.
Uses gestures to reduce apraxia and improve the pt's verbal expression/ability to use symbolic gestures. Three programs constitute this approach: proximal limb, distal limb, and buccofacial VAT.
A hierarchical procedure is used to move the pt a performance continuum, from the basic task of matching pictures & objects to representing hidden items with self-initiated gestures.
Reported improvements in auditory & reading comprehension, verbal repetition, and graphic copying.
May be appropriate for a pt who cannot use Amer-Ind Code.
May be used initially, or on an interim basis, until other comm. systems can be developed.
Supports the capacity to make categorical and associational semantic discriminations while being sufficiently easy to allow an understanding of the nature & purpose of tasks.
Establishes a necessary precondition for subsequent treatment with communication programs using iconicsubstitutional language (e.g., communication boardsC-ViC).
For severely impaired pts, a typical board will contain personally relevant words & pictures, numbers, and the alphabet.
A visual symbol system of pictograms and Ideograms.
Investigated as a means to deblock written & verbal comm, with substantial evidence being gathered to supports its effectiveness as an aid to communication.
Using procedures similar to those of visual communication, but in a microcomputer environment, C-ViC is an iconographic system in which pts construct communications by selecting symbols from six “card decks” and arranging them according to certain syntactic conventions.
The card decks contain:
A speech-generating device combining images, animation, text, and spoken words to provide computer-based communication. It contains a large number of words presented by icons and can be customised with a user’s special words and pictures.
A computer-based graphic symbol communication system that offers orthographic and graphic symbols along with synthetic speech outputs.
AKA, ‘PACE.’
Because PACE procedures allow patients to freely choose the channels through which they will communicate, the technique provides opportunities for patients to use either a verbal strategy or any of the nonverbal strategies described above, with or without accompaniment, to convey messages. In this way, PACE emulates natural conversation by allowing participants to communicate through multiple modalities.
Characteristics of natural conversation that provide guiding principles for the implementation of PACE:
Social approaches target communication partners or other ways to reduce communication barriers in addition to improving language or compensatory functional language.
The SCA program teaches techniques to conversation partners that will help them better reveal the competence of people with aphasia—i.e., helping people with aphasia reveal what they think, know, and feel.
Developed by Audrey Holland in Arizona, this strategy aims at increasing communicative confidence through the practice of scripted conversations. With assistance from Leora Cherney in Chicago, this method has been integrated into a computer program. Called “AphasiaScripts,” it includes a virtual therapist to provide help for the person with aphasia.
Aphasia Therapy Guide - National Aphasia Association
An umbrella term for a wide range of techniques designed to enhance the CP’s ability to communicate effectively with persons who have aphasia.
Reciprocal Scaffolding Treatment (RST) is one of several potentially beneficial life participation approaches for aphasia. In RST, treatment occurs during genuine, relevant, and context dependent interactions that represent goals at the activity and participation levels of the World Health Organization International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) and is based on an apprenticeship model of learning where novices are taught skills by a more skilled partner. RST was used to construct a communicatively challenging environment in which an expert with aphasia (AE) taught novices (graduate student clinicians) how to communicate with persons with aphasia in the context of conversation group treatment sessions. This is in contrast to many treatment techniques when the person with aphasia is the novice who is trying to relearn communication skills during treatment sessions with a speech‐language pathologist as the expert.
Jan Avent, Janet Patterson, Angelica Lu & Kelly Small (2009) Reciprocal scaffolding treatment: A person with aphasia as clinical teacher, Aphasiology, 23:1, 110-119, DOI: 10.1080/02687030802240211