Artwork by Anne Jones (click on the image to see more of her work!)
The non-fluent aphasias include the following types: Broca’s aphasia, transcortical motor aphasia, and global aphasia. Non-fluent means that the patient has trouble getting words out, but usually has good understanding (this is not true of global aphasia, however, where there are severe-profound deficits with both comprehension and expression).
There are two tests that I use and highly recommend: The Western Aphasia Battery (WAB), and the Boston Diagnostic Aphasia Exam (BDAE). The first test I use with most of my patients that aren’t in the severe to profound range (i.e.-global aphasia). The second test is very thorough and I like to use it with my higher functioning clients because it digs deep into the language sample, syntax, reading, writing, and grammar better than other tests do. Its one drawback is that it takes a fortnight to actually administer the whole thing. I have tried several tests that target the severe part of the spectrum, but usually find that informal testing is more useful and less stressful for these patients.
Patients with anything but global aphasia have a good prognosis overall and benefit greatly from Speech Pathology services (read this if you have doubts ;). Treatment is very specific to the patient and will vary quite a bit from patient to patient. That being said, here are some general tid-bits for thought:
- Allow your family member or patient to fail. By this, I mean don’t be in such a hurry to finish every phrase the person starts. Give hints if you need to (like in a cueing hierarchy), but overall try and allow them space to find the word(s) they are looking for.
- Provide opportunities to work on language and turn off the TV. This can be done by having the person describe their surroundings, talk together about items you see in a newspaper or magazine (“Tell me about the _________ on this page.”), talk about a picture album with them (familiar content!), or take turns describing a picture scene where only the person describing the picture can see it.
- Create or use activities that have multiple modes of language active simultaneously. For example, if naming an object/picture is hard, then pair it with the object name in written format. If that is really easy then give multiple words to choose from with one object/picture in a naming task.
- Scaffolding. This is a term a lot of teachers will be used to hearing, and a man by the name of Lev Vygotsky was responsible for creating this idea. In short, it just means that you find where the person’s strengths and weaknesses are and you provide just enough help to get them over the hump with whatever task you are doing. Sometimes that means that you take a task that someone gives up on and you modify it. If a task is within that zone where someone can do it, then provide the scaffolding needed to allow them to succeed. Then, of course, as they get better at the task, you take away some or all of the scaffolding that was needed to allow them to succeed.
- Automatic speech drills are often good to improve correct fluency or allow more voluntary control by tapping into long-term procedural memory. Examples include: counting 1-20, naming the days of the week, naming the months of the year, the pledge of allegiance, and some highly familiar nursery rhymes.
- Music Therapy. Often overlooked, this therapy can allow a patient to participate in song in ways that they cannot with typical speech production. If the person is too shy to participate in choral style singing exercises (all highly familiar songs at first please!), then encourage singing in privacy. Improvements in fluency, strength of voice, and reduced stress are all outcomes that can be realized through this method. [I almost always use Christmas carols, church hymns, or other basic nursery rhymes/songs].
While this list above is in no way comprehensive or applicable to every patient out there, I do hope that it helps give people a nudge in the right direction. Best of luck with your therapy out there! If you have questions or comments please post them, they will help me and others. If you have specific questions feel free to send them to firstname.lastname@example.org.