Curiosity, Dialogue, and Knowledge
To increase communication
Short term impairments often exist on the verbal level.
Useful in setting up task difficulty for clients, you can personalize it for each client by assessing their performance at various levels in the hierarchy
Literacy history is what level the client could read at before the stroke, you find out what they liked to read, how often and at what level, and what is important for them to get back (is it important for you to work on it?). Survival reading skills are reading signs, reading labels, and reading checks. Survival writing skills are being able to sign name, make shopping lists, etc., and you can address this in therapy by practicing important things to the patient, and doing homework activities- work on core vocabulary and sentence skills.
Use carrier phrase ‘point to the______”
General knowledge- Does it snow in july?
Verbal retention span – Pig and cow are they animals?
Semantic discrimination – Do you brush your teeth with a comb?
Phonetic discrimination- Do you wear a shirt and pie?
Syntactic analysis – Do we wear feet on your shoes?
Semantic relationships- Is a banana a vegetable?
Open ended questions
Follow directions (Kearns and Hubbard Hierarchy)
Point to common objects by name
Point to common object by function
Point in sequence to two objects by name
Verify the meaning of sentences
Listen to spoken sentences and make judgments about the relationship between picture and sentence (point to the picture where the man is hugging).
Task switching (harder) listener changes unpredictably from stimuli to stimuli (pick up the spoon, point to the black one, which one do you drink from?)
Clinician reads a passage and then pt answers questions about it
Yes/no, sentence completion tasks, recalling retelling
Volitional speech – used as warm-up activity
Sentence completion task
A cup of _____., We wear shoes on our ______?.
Automatic sentence completion can be used to facilitate confrontational naming tasks
Word phrase and repetition – focus on mechanics of speech production, work on list of words that are important
Naming pictures or objects (salience, familiarity, semantic, delay, more or less objects)
Question answer drill- tell me about your wedding day
Story elaboration- ask questions about a story that require answering in phrase or sentence
Picture description (pinic scene, cookie jar)
Prompted story telling – tell story in picture
Procedural discourse – tell me how you bake a cake
*Both of these will be lower on the cueing hierarchy.
Target word plus 2 related foil words
Line, bee, goat
3 words that are semantically related to target word
Sting, honey, hive
*Start with smallest cue on hierarchy
*If the patient gets it, then move to the next one. If not, move to more cueing; continue until you elicit the correct response.
*When the patient gets it, on the next word move to a harder stage in the hierarchy (less cues) use a less powerful cue with each correct response, when they get all the way through move to self-cueing strategies
Make a list of words and semantic categories, baseline of wrong and right responses, what words are important to the patient and family.
Teaching self-cueing strategies
Practice list in structured drill
Then words in phrases
Focus on using strategies in natural environment
Overt with covert strategies replacement
Information sharing and social relationships are complementary goals of communication
Communication takes place with authentic, relevant, and natural context
Communication is dynamic, flexible, and multidimensional
Communication is collaborative
Intervention should be focused on natural interaction, particularly on conversation
Intervention should consider personal and social consequences of aphasia
Intervention should emphasis adaptations to communicative impairments
Intervention should consider the perspective of those affected by aphasia
Intervention should include qualitative as well as quantitative measures
Box of cards with people doing things and you describe it and they try and guess what they are doing
Set of words in lowercase that patient can:
Match with pic
Read aloud correctly
Repeat without printed stimuli
Select form group of 8 pics when hearing the word without printed stimuli
Naming target pic
Naming semantic features
Elicit semantic features
Record on chart
Use chart to help list properties, location, actions, group, and use of a target word to help them think of the word
Concept of “Getting stuck”
“Set” before each stimuli
Monitor rate between stimuli 5-10 seconds
Raise awareness with the patient: write it down, identify it as incorrect, and use it as a cue for incorrect responses
Theory of automatization, practice a script in a situation that they want to be able to do
Start at the single word level and move to conversation level
Patient writes their own script
And clinician cues through the script
Trace and match object to line drawings
Object to picture
Gesture for absent object
Scaffolding and building conversation
You elaborate on what they give you
Similar to script therapy
3-4 notes intonation pattern to say things
Show a picture with the sentence below and they fill in the blank. This is used to increase proper use of grammar at the sentence level.