Areas of assessment
During an aphasia assessment, what areas of expressive language should be considered? What specifically will you look at in each area?
Repetition (single words, object names, verbs, numbers, letters, function words, progressively longer sentences)
Naming (Responsive naming, confrontation naming, word fluency of naming items that belong to a specific category "name all of the animals you can think of")
Sentence production, narration, and discourse (single sentences with supplied word, production of multiple sentences, narrative skills, discourse, monologue)
Speech Fluency (dysfluencies or speech tempo/rate)
Automated Speech & Singing (alphabet, days of the week, months, numbers, humming, singing)
Name screeners and standardized assessments that might be used for aphasia evaluation.
Screeners - Aphasia Rapid Test, Bedside Western Aphasia Battery, Boston Diagnostic Aphasia Examination-3 Short Form, Mississippi Aphasia Screening Test
Standardized assessments: Western Aphasia Battery (WAB), Boston Diagnostic Aphasia Examination (BDAE)
How would you target writing skills for someone with aphasia? (what functional areas would you target, and how would you go about teaching them)
-Writing functional words (e.g. ones own name, names of family members)
-Writing functional lists (grocery list)
-Writing short notes, reminders, addresses,
-Filling out forms
-Writing letters.
Depending on the client's current writing skills...
-point to correct printed letter clinician names
-point to printed words and phrases
-saying the sound of a printed letter
-saying a printed word
-tracing printed letters
-copying printed words and phrases
-spelling words correctly
-writing to dictation
-spontaneous writing of phrases, sentences, and more
Name some general tips that you might provide to a family member to increase communicative effectiveness with a patient with aphasia.
-Reduce/eliminate background noises
-Make sure you have the person's attention before you start
-Keep communication simple but still adult. Simplify sentence structure, reduce rate of speech, emphasize key words. don't "Talk down" to someone with aphasia.
-Give them time to speak, resist the urge to finish sentences or offer words.
-During conversation sit directly in front or in view of the person with aphasia so they can see your mouth and body
-Use writing, drawings, gestures, and facial expressions in addition to speech.
-Confirm that you are communicating successfully with yes/no questions.
-Engage in normal activities whenever possible, do not ignore them in group conversation.
-Encourage independence and avoid being overprotective.
This therapy approach is used to target naming and asks the client to name or describe semantic functions (including group, description, and function) of the target word.
Semantic Feature Analysis (SFA)
During an aphasia assessment, what areas of receptive language should be considered? What specifically will you look at in each area?
Auditory comprehension of spoken language (hearing, vision, nonverbal responses to clinician's verbal commands, comprehension of natural commands and multistep commands)
Auditory comprehension of single words (comprehension of single items "point to your nose"; comprehension of words that very semantic class and phonemic similarity)
Auditory comprehension of sentences, paragraphs, and discourse (comprehension of simple sentences given as commands, brief and simple story, more complex stories, understanding conversational speech)
This assessment provides an in-depth look into reading comprehension for single words, sentences, paragraphs, and functional written material.
The Reading Comprehension Battery for Adults 2 (RCBA)
When is it appropriate to target reading and writing skills for an individual with aphasia?
1. Current need (or want) for reading and writing (is it functional??)
2. If current levels are same as pre-morbid levels, it is generally not appropriate
Describe the Life Participation Approach to Aphasia (LPAA)
The Life Participation Approach to Aphasia (LPAA) is not one specific treatment technique. Rather, it is a mindset or general approach to aphasia therapy.
According to LPAA, the primary goal of therapy is enhanced life participation. Life participation can mean different things to different people. It is based on what is important to each person. For some, it’s getting back to work. For others, it’s being involved with family or their community. For many, it’s being involved in a hobby or activity that they enjoy doing.
LPAA prioritizes the person with aphasia and their life goals. It is a collaborative model where the person with aphasia, their family, and the speech-language pathologist (SLP) are a team. They identify life participation goals and work together to reach them. With LPAA as a therapeutic mindset, the SLP can address how communication impacts life participation. The SLP can design therapy activities that will help the person with aphasia to engage in activities that are important to them. The primary goal of LPAA is increased life participation and improved quality of life.
Describe Verb Network Strengthening Treatment (VNeST) and when it is used.
Verb Network Strengthening Treatment (VNeST) is a therapy technique that focuses on verbs. It aims to improve word finding in order to produce sentences. People who have used VNeST have improved at word-finding and sentence structure.
VNeST can be used with people with many types of aphasia. People will be most successful if they have basic comprehension. However, the therapy can be modified for people who have comprehension impairments.
When using VNeST, the speech-language pathologist (SLP) will present verbs to the person with aphasia. The SLP and patient will work together to create sentences with the verb. This is done by filling in the “who” and the “what” related to the verb. These words are represented on index cards. For instance, the SLP might use the verb “eat.”
The activity is most meaningful if the sentences are true and about people and items in everyday life.
Name other areas related directly to communication that are important to consider during an aphasia assessment.
Functional communication (can they make simple requests, participate in conversation, write own name, make a grocery list, understand environmental signs, recognize faces and voices)
Reading (comprehension of silently or orally read material, verbal completion of printed sentences)
Writing (letter formation, general writing skills, automatic writing, confrontation writing, writing to dictation, narrative writing, compare to premorbid samples)
Gestures and pantomimes (can they make them and can they understand them)
This stand alone assessment provides information about auditory comprehension.
Revised Token Test
How would you target reading skills for someone with aphasia?
1. Survival reading skills (letters, menus, bank statements, medication labels)
2. Newspapers, books, letters
3. Reading and comprehension of printed words
4. Reading and comprehension of phrases and sentences
5. Reading and comprehension of paragraphs and extended material
SCA teaches communication partners how to support the person with aphasia. Does not focus on the person with aphasia. Helpful for all types of aphasia, the goal is to improve conversation for people who have trouble speaking or understanding languages. It uses a multi-modal communication approach encouraging communication in any form, including writing, drawing, speaking, gesturing.
Examples of strategies that are taught include:
-Speaking in a normal tone of voice
-Acknowledging communication difficulties and trying to fix them
-Writing key words
-Using drawing or gestures, focusing on one word at a time
-Keep a written "log" of conversation that can be reviewed
-Asking yes/no questions to confirm understanding
-Summarizing (reflecting back) what the person with aphasia has communicated.
Describe Script Training and when it is used.
In Script Training, the person with aphasia and the speech-language pathologist (SLP) work together to create scripts. A script is a predictable sequence of sentences. A script can be a story that the person with aphasia tells, also known as a monologue. A script can also be between two people, such as ordering food in a restaurant. In either of those cases, the words the person with aphasia will use are easy to predict.
The person with aphasia and SLP can identify scripts that will be useful in the person’s everyday life. Practicing these scripts then helps the person with aphasia to be able to interact with others in everyday scenarios.
Improvements can be seen in sentence formation, rate of speech, and confidence. Once the person with aphasia has success with a script in one setting, it is easier to use the same script in other settings or with different people. People who communicate with AAC devices can also use scripts. The scripts can be programmed into the device and the user can use the device to speak or use it as a cue to improve their own speech.
-Script Training has been successful with both fluent and nonfluent aphasia.
-Script Training has also been successful with acquired apraxia of speech.
What are indicators for prognosis when it comes to aphasia recovery? (Or, what things make a person more likely to recover in treatment for aphasia)
Prognosis is better if individuals are:
-Younger and healthier
-Better educated and in verbally demanding occupations
-Have smaller lesions
-have no other medical or behavioral disorders
-Have good hearing acuity and normal /adequately corrected vision
-Have better motor skills
-Have better preserved language skills
-Have less severe aphasia
-Receive treatment soon after onset
-Receive effective treatment techniques in an accurate manner for a long enough duration
-Receive support from family members who get involved with treatment
-Maintain their health during the course of treatment (in part preventing more strokes from happening)
Name published assessments that look at functional communication targets for someone with aphasia.
Functional communication assessment:
Communicative Abilities in Daily Living - Third Edition (CADL),
Burden of Stroke Scale (BOSS),
Communicative Effectiveness Index (CETI),
Functional Independence Measure (FIM)
This area of treatment focuses on systematically increasing the length and complexity of target responses.
What are some published treatment programs that target this?
Expansion of verbal expression
2.
-Response elaboration training (RET)
-Promoting Aphasics Communicative Effectiveness (PACE)
Describe Promoting Aphasics’ Communication Effectiveness (PACE) therapy and when it is used.
Promoting Aphasics’ Communication Effectiveness (PACE) therapy is a multimodal treatment approach. Multimodal treatments encourage the use of any type of communication to get a message across.
The goal of PACE therapy is to improve conversation and general communication. In PACE therapy, the person with aphasia and speech-language pathologist (SLP) take turns being the speaker or listener. The speaker has a picture or message on a card that they need to communicate to the listener, but they cannot show the listener what they have.
They can use any mode of communication that they choose in order to convey the message. If needed, the SLP can provide feedback and prompting to convey the message.
Once the message has been received, both partners can discuss what worked best. The SLP might also set an amount of time to end the attempt if the message is not received. The SLP and person with aphasia can then work together to figure out how else the message could have been communicated.
Because PACE therapy can be adapted to different skill levels, it is appropriate for people with many types and severities of aphasia. One benefit of PACE therapy is that it positions the person with aphasia and the SLP as equals. They each take the same number of turns as the speaker and the listener. This encourages a positive communication environment. It also removes some of the burden of therapy from the person with aphasia. The therapy also has the feel of a game. Many people find it fun and an opportunity for increased social interaction and natural conversation.
Describe Oral Reading for Language in Aphasia (ORLA) and when it is used.
Oral Reading for Language in Aphasia (ORLA) is a reading treatment for people with aphasia. It focuses on reading full sentences rather than single words. The goal of using sentences instead of single words is to improve the reader’s intonation and prosody.
Prosody is the rhythm of speech – the natural ups and downs that people without aphasia use without thinking about it. However, many people with aphasia experience dysprosody, meaning that their speech sounds monotone and lacking rhythm. ORLA addresses this concern as well as reading abilities at the same time. ORLA might also have some benefit for comprehension and writing.
When practicing ORLA, the person with aphasia and the speech-language pathologist (SLP) read sentences out loud together. The SLP will first read the sentence alone as a model. Then, the SLP and person with aphasia will read the sentence together. The SLP can point to individual words as they read the sentence. The sentences are repeated multiple times. The person with aphasia then reads the sentences independently, if they can.
Different levels are available depending on the person’s ability levels. The sentences become more complex as the treatment proceeds. At first, the reading will be single sentences. As the person with aphasia makes progress and moves through the levels, they can progress to reading paragraphs.
Although ORLA is a specific therapy tool, the techniques can be used with any text. For instance, an SLP can select a news article or any text about a topic of interest. They can use the techniques described to read the text together.
ORLA can be done with an SLP, and there is also a computer version that is available for home practice. ORLA is usually used with people with basic reading abilities who want to make improvements in their reading, speech and prosody. It is usually used by people with nonfluent aphasia, such as Broca’s aphasia. ORLA may be too advanced for people who have severe comprehension or reading impairments.
Aside from language, what areas should be considered during an aphasia assessment?
-Cognition
-Co-occurring disorders (Apraxia, dysarthria)
-Oral mech exam
-Case history
-hearing screening
Naming is one of the most frequently targeted expressive verbal skill. Naming treatment techniques include initially modeling the target response and subsequently cueing to evoke a response without modeling the actual response. The clinician promptly reinforces all correct or approximate responses.
What cues are commonly used when targeting naming?
-Incomplete sentences ("You write with a ______")
-Cloze statements (Up and ____. Left and ____. In and ____. The more predictable the easier they will be)
-Phonetic Cues ("The word starts with a p")
-Syllabic cues ("The word starts with spoo__")
-Silent phonetic cues (Clinician exhibits silent articulatory posture for /p/ in pen)
-Semantic cues (related to the meaning of the word, "it's used to call people")
-paired objects or pictures with printed name
-Patient's spelling or writing as stimulus for naming (if these skills are preserved)
-Rhyme
Describe Melodic Intonation Therapy, principles behind it, and when it is used.
Some people with aphasia notice that they are able to sing much better than they are able to speak. This is because music uses different areas of the brain than speech. Melodic Intonation Therapy (MIT) takes advantage of this singing ability. It applies musical elements to speech in order to improve language production.
MIT uses the melody and rhythm of speech in an exaggerated way, making speech resemble singing. The speech-language pathologist (SLP) will start with simple phrases. The SLP will demonstrate how the phrase can be “sung” by giving it a melody. The person with aphasia will then practice repeating the phrase, or the SLP and person with aphasia might sing the phrase together. The SLP can provide cues to help if needed. The person with aphasia is often encouraged to tap their finger and slow down speech. As the person with aphasia improves, longer sentences will be used. In addition, the melody will be faded out so that it resembles typical speech.
Traditional MIT used a pre-determined list of words, phrases and sentences. It also suggested that two tones be used. However, SLPs have interpreted MIT in many ways and use it in different forms. There is not a specific melody or intonation that has to be used. The SLP can create the intonation for each phrase. Each phrase will typically have at least two different tones, and the SLP’s vocal tone will rise and fall on certain words. Because of this, MIT will be different from one therapist to the next. Some therapists incorporate other elements of music, such as a musical instrument or using familiar songs.
MIT is usually used for people with non-fluent aphasia. It can be helpful for people with moderate or severe aphasia. One benefit of MIT as applied by most SLPs is that it can be done with any phrase or sentence.
***Also good for Apraxia of Speech!!