MANAGEMENT OF APHASIA: PRACTICAL APPLICATION Aphasia ISLHA B… · 3/23/2012 1 NEW CONCEPTS IN THE...
Transcript of MANAGEMENT OF APHASIA: PRACTICAL APPLICATION Aphasia ISLHA B… · 3/23/2012 1 NEW CONCEPTS IN THE...
3/23/2012
1
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
3/23/2012
2
APHASIA TREATMENT TECHNIQUES
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
APHASIA TREATMENT TECHNIQUES
Written Expression Agraphia Treatment Copy and Recall
Treatment (CART) Promoting Aphasic
Communication Effectiveness (PACE)
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
Communication Effectiveness (PACE)
Supported Conversation for Adults with Aphasia
Visual Action Therapy
APHASIA TREATMENT TECHNIQUES
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
3/23/2012
3
Research: Evidence
Change in Thinking: New
Concepts
Approaches to Managing Aphasia
Clinical Practice
“NEW” CONCEPTS
Intensity TechnologyLife Participation
3/23/2012
4
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)
3/23/2012
5
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.
+
3/23/2012
6
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)
3/23/2012
7
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
ORAL READING FOR LANGUAGE IN APHASIA
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)
ORAL READING FOR LANGUAGE IN APHASIA
3/23/2012
8
ORAL READING FOR LANGUAGE IN APHASIA
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.
ORAL READING FOR LANGUAGE IN APHASIA
ORAL READING FOR LANGUAGE IN APHASIA
3/23/2012
9
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.
3/23/2012
10
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
3/23/2012
11
CONSTRAINT INDUCED LANGUAGE
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
CONSTRAINT INDUCED LANGUAGE
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.
3/23/2012
12
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
COPY AND RECALL TREATMENT WITH REPETITION OF A SPOKEN MODEL (CART+REPETITION)
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.)
3/23/2012
13
COPY AND RECALL TREATMENT WITH REPETITION OF A SPOKEN MODEL (CART+REPETITION)
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)
3/23/2012
14
COPY AND RECALL TREATMENT WITH REPETITION OF A SPOKEN MODEL (CART+REPETITION)
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.
3/23/2012
15
ANAGRAM AND COPY TREATMENT (ACT)
ANAGRAM AND COPY TREATMENT (ACT)
ANAGRAM AND COPY TREATMENT (ACT)
3/23/2012
16
ANAGRAM AND COPY TREATMENT (ACT)
ANAGRAM AND COPY TREATMENT (ACT)
TECHNOLOGYProvide limitless opportunities for
interactive language activitiesComputers
Programs Internet E-Mail
Mobile PhonesE-ReadersAAC
3/23/2012
17
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
ORLA™ (The Rehabilitation Institute of Chicago)
3/23/2012
18
ORLA™ (The Rehabilitation Institute of Chicago)
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
3/23/2012
19
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)
TECHNOLOGY: MOBILE PHONES
Smart Phone and Tablet Apps Lingraphica®
SmallTalk AphasiaSmallTalk PhonemesSmall Talk Conversational
PhrasesSmall Talk Daily Activites
MyVoice™: Communication Aid
Tactus Therapy Solutions: TherAppyComprehensionNamingReadingWriting
TECHNOLOGY: MOBILE PHONES
3/23/2012
20
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
3/23/2012
21
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)
3/23/2012
22
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
3/23/2012
23
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
SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)
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
3/23/2012
24
SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)
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
SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)
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
3/23/2012
25
SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)
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
3/23/2012
26
SUPPORTED CONVERSATION FOR ADULTS WITH APHASIA (SCA)
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
3/23/2012
27
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
3/23/2012
28
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.
3/23/2012
29
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.