Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Treatment of Aphasia


What is the objective of aphasia treatment?

To increase communication

Treatment Guidelines

  • Patient needs to know they will always be aphasic, but it’s a matter of degree.
  • Individual treatment
  • Have a structure but don’t die by it- change things if no progress, try new things be creative in therapy materials
  • Prepare for generalization
  • Involve patient and family in therapy planning and implementation

What are the general conclusions regarding the amount and timing of intervention?

  • Treatment pays off in all periods of recovery
  • Aphasic individuals should receive therapy as early as possible
  • Payer policies that deny claims from reimbursement during later stages of recovery should be changed
  • Therapy is best on 2 hours plus/week in acute and post acute
  • Holland suggest 3 hours/week for 5 months
  • Primary predictor: medical compromise

Typical Session format

  1. Hello segment
  2. Accommodation segment
  3. Work segment
  4. Cool-down segment
  5. Goodbye segment

Do patients with aphasia have memory impairments?

Short term impairments often exist on the verbal level.

Kearns and Hubbard’s 13 level hierarchy. What is it used for, can it be individualized for pts?

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

What is literacy history? What role does it play in the treatment of neurogenic reading and writing impairments? What are survival reading and survival writing skills? How could you address this in treatment?

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.

Treatment for Auditory Comprehension

Word level

Pointing drill

Use carrier phrase ‘point to the______”

Warm-up activity

Sentence level

Answer questions

Yes/no

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?)

Discourse level

Clinician reads a passage and then pt answers questions about it

Yes/no, sentence completion tasks, recalling retelling

Treatment for Speech Production

Word level

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

Confrontational naming

Naming pictures or objects (salience, familiarity, semantic, delay, more or less objects)

Sentence level

Imitation

Repetition/elaboration drills

Story completion

Question answer drill- tell me about your wedding day

Story elaboration- ask questions about a story that require answering in phrase or sentence

Picture-story elaboration

Sentence construction

Discourse level

Picture description (pinic scene, cookie jar)

Prompted story telling – tell story in picture

Procedural discourse – tell me how you bake a cake

Conversation

Cueing Hierarchies

  1. Imitation (say coffee)
  2. First sound or syllable (Kof)
  3. Sentence completion (Pour me a cup of ______.)
  4. Word spelled aloud (c-o-f-f-e-e)
  5. Rhyme(it rhymes with toffee)
  6. Synonym/antonym (folders, decaf)
  7. Function/location( you drink it at breakfast)
  8. Superordinate (its something you drink)

Also Consider:

*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

Rosenbeck Three Part Program:

Part 1. Diagnosis

Make a list of words and semantic categories, baseline of wrong and right responses, what words are important to the patient and family.

Part 2. Strategy Development and Practice

Teaching self-cueing strategies

Practice list in structured drill

Then words in phrases

Part 3. Stabilization and Generalization

Focus on using strategies in natural environment

Overt with covert strategies replacement

Nine Principals of Social Approaches to Aphasia

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

Specific Interventions:

PACE – Promoting Aphasics’ Communicative Effectiveness

Box of cards with people doing things and you describe it and they try and guess what they are doing

TWA – Therapy for Wernicke Aphasia

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

SFA – Semantic Feature analysis

Naming target pic

Naming semantic features

Elicit semantic features

Record on chart

Produce name

Record data

Use chart to help list properties, location, actions, group, and use of a target word to help them think of the word

TAP – Treatment for Aphasic Perseveration

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

Conversational Script therapy

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

VAT- Visual action therapy

Trace and match object to line drawings

Object to picture

Gesture for absent object

RET – Response Elaboration Training

Scaffolding and building conversation

You elaborate on what they give you

Similar to script therapy

MIT – Melodic Intonation Therapy

3-4 notes intonation pattern to say things

SPPA – Sentence Production Program for Aphasia

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.

18 comments on “Treatment of Aphasia

  1. Kelly Cleary
    November 26, 2013

    Hi, I am a speech pathologist and inquiring to see if there are any medical writing or editing employment opportunities. Thank you for your time.

    • Admin
      November 26, 2013

      Contact me at Medicalspeechpathology@gmail.com for more information. FYI: this site is free and done as a hobby- I’d love to have contributions, but there are no ads and no financial remuneration.

  2. Aliyah Daigneaux
    December 10, 2013

    Nice tips for aphasia therapy – I’ll be doing practicum in adult settings soon.

  3. Myra
    April 22, 2014

    I am trying to make a chart on 7 types of aphasia. I would like to add goal samples for each, is there any place I could find them? This website has already helped me so much!

    • Admin
      April 23, 2014

      That’s a great idea Myra! I don’t have anything that structured on the site, but since I’m always looking for more collaboration on these sorts of things, I’d be glad to add some if you get a finished product that your happy with.

      Also from my experience, the pure types of aphasia are less common than you might think. The types are a great model for thinking about aphasia and what is going on, and even how to approach it differently from a therapy standpoint. But, most patients have a more complex aphasic profile that won’t fit neatly into Broca’s, Wernicke’s, or other pure types.

      Thanks for commenting and visiting the site!

  4. Virginia Newton
    May 2, 2014

    Are there published materials you could recommend for a family’s use with a patient who has been denied more in- patient rehab but still needs lots of help? Thank you!

    • Admin
      May 4, 2014

      Yes, but it would be general advice only. I don’t know what’s best for your particular case without more information, and it’s always best to actually evaluate a patient before dispensing specific advice. But some of the materials I like to use in aphasia therapy are as follows in no particular order:

        Aphasia Rehabilitation

      by Deborah Ross, M.A., CCC-SLP and Sara Spencer, M.S., CCC-SLP; and

        Take Time to Talk

      by Patricia F. White, M.A., CCC-SLP.
      This is, admittedly, a short list. There are lots of great books out there. I just listed two aphasia exercise books, but many companies like Linguisystems sell a good line of books called The Source for _____________. Fill that blank in with many different speech, language, and cognitive books that have a host of graded exercises.

      My only other caveat about this sort of advice is that these types of books aren’t systematically addressing the complexity of your case, but are good resources that can guide your recovery. Don’t give up the good fight. Even though you aren’t getting intensive inpatient rehab now, you can definitely keep making gains if you keep practicing the exercises that you started in therapy.

      Some of that advice my sound cliche, but the truth is I’ve seen many people improve dramatically in rehab. Two of the biggest factors for improvement, in my opinion, are good family support and the patient having a positive mindset that won’t take no for an answer.

  5. Virginia Newton
    May 4, 2014

    Thank you for your input… I will look up those books and see if I can get them in my area!!

  6. justineoops
    July 20, 2014

    It’s hard to find aphasia treatment information in other media

  7. LP3K
    August 31, 2014

    I’m currently an SLP student preparing for my first client who has severe aphasia. I cannot thank you enough for how helpful all of this information is!!!

    • Admin
      September 1, 2014

      Thanks for commenting on the site! I am glad to hear that it’s helping some folks out there.

  8. Erin
    October 22, 2014

    How do i cite this information for a paper i am writing?

  9. Hannah B
    January 18, 2015

    great site, thank you. I will be forwarding the link to my students as a great start for resources for adults, I think it must be a 10:1 ratio of children: adult stuff out there. Thank you for taking the time.

    • Admin
      January 18, 2015

      Thanks so much for dropping in and leaving a nice note. Also, feel free to add to the site! I would love for this to be more of a community endeavor. Thanks again!

  10. Shay
    February 9, 2015

    I saw your listing of Treatment for Wernicke’s Aphasia (TWA). I have been trying to learn more about this treatment, but I can’t find any studies on it. Can you direct me to your sources? Thank you!

    • Admin
      February 11, 2015

      For this, and several other areas on the site, I used my notes from grad school. If I can find time, I will try and see what books we used for the aphasia sections. Some of this is also based on the clinical experiences of my instructors in grad school. I also try and edit out things that haven’t worked in my practice.

  11. Lauren
    March 11, 2015

    Is core vocabulary therapy good for a patient with aphasia. I am in the SLPA program and I am wondering if core vocabulary therapy is good not just for SSD but also for aphasia?

    What is the age group(s) that technique is targeted for? Can this be modified? How?
    I have been reading and it is mostly for children, but I have been thinking that it would also be good for adults that have unintelligible speech

    Can technique be used with a different communication disorder? Which ones? How?
    I was thinking Aphasia but maybe I am wrong?

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