8. Aphasia TREATMENT STRATEGIES

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8. Aphasia TREATMENT STRATEGIES
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General Treatment Strategies

• Use intact modality or stronger modality to
  BEBLOCK impaired modality/ies.
• Circumvent difficulty via self-cueing strategy.
  Self-cueing is generalized from clinician cueing
• Stimulation before response expectation
• Using functional or pragmatically based therapy,
  such as promoting Aphasics Communicative
  Effectiveness (PACE)
• Scaffolding language activities
• Family/caregiver inclusion

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Treatment Strategies for Brocas Aphasia

• 1. Melodic Intonation Therapy
• Best candidates are patients whose Auditory
  Comprehension is better than their verbal
  expression and verbal expression is severely
  impaired
• Strategies
• Intonation pattern uses a range of 3-4 notes
• Elements include an exaggerated melody line
  composed of at least 2 syllables. The rhythm and
  point of stress help to convey meaning
• MIT is slower, similar to Chant Talking
• Program Progresses to Longer syntactic units and
  to Clinician Question, Client Answer using
  progressively faster melodic patterns.
• 2. Response Elaboration Training (RET)

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Treatment Strategies for Brocas Aphasia

• 2. Response Elaboration Training (RET)
• Designed for nonfluent aphasia patents in order
  to increase the length and information content of
  verbal responses
• Strategies
• Elicit spontaneous response
• Model and reinforce initial response
• Expand and elaborate response through scaffolding
• Reinforce clients attempts at elaboration
• Always repeat and expand the clients utterance
• Modeling and Expansion based on Scaffolding of
  Clients response

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Wernickes Aphasia

• Promoting Aphasics Communicative Effectiveness
• Therapist and client take turns conveying
  information to each other participating equally
  as senders and receivers of messages.
• There is an exchange of new information.
• Therapist can model communication options.
• Any Communication channel is acceptable visual,
  gestural, graphic, verbal
• Barrier Activities useful in PACE therapy

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Scheulls Stimulation Approach to Rehabilitation

• Primarily use of controlled Auditory Stimulation
• employs strong, controlled, and intensive
  auditory stimulation of the impaired symbol
  system
• Because it is an auditory stimulation approach,
  materials and procedures should be extensive.
  Therapist is NOT retraining BUT stimulating
  currently inaccessible language centers
• Activities for Auditory Abilities, Verbal
  Abilities, Reading Writing

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Chapeys Cognitive Linguistic Therapy

• Language is a knowledge of a code for
  representing ideas about the world through a
  conventional system of arbitrary signals for
  communication.
• Cognition is the use of the five mental
  operations of recognition, memory, convergent
  thinking, divergent thinking and evaluative
  thinking.
• Therapy is divided into 4 levels depending on a
  patients ability
• Each level has specific activities pertaining to
  each of those 5 cognitive skills as they relate
  to LANGUAGE, including the 4 modalities.
• Excellent therapy ideas for more traditional
  therapy and for beginning clinicians.

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Promoting Aphasics Communicative Effectiveness,
PACE Therapy

• PACE therapy is a type of Functional
  Communication Therapy (FCT)
• purpose emphasis on PRAGMATIC aspect of
  communication and information involving a RANAGE
  OF COMMUNICAITON INTENTIONS, such as informing,
  requesting, questioning, negating
• primary objective of traditional therapy has been
  to stimulate (Schuell) or restoration of
  patients language function across 4 modalities
• leads to isolated modality practice
• Goals are written to address Activities of Daily
  Living (ADL) using COMMUNICATION, not the motor
  skills of performing the tasks

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PACE Therapy, continued

• Principles
• 1. Exchange of new information in a
  conversational setting
• 2. Encouraged to use ANY EXPRESSIVE MODALITY
  speech, signing, gestures, writing
• 3. Both therapist and client are senders and
  receivers engaging in a variety of COMMUNICAIOTN
  INTENTIONS
• 4. Feedback is simply the success of
  communicating, the characteristic of Normal
  Communication
• Pragmatically basedemphasis on content that is
  personally relevant
• Materials such as newspapers, Barrier activity
  using relevant materials

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9. Differential Diagnosis

• A clinician should be able to differentiate
  between the following disabilities
• Normal Elderly Expectations
• Aphasia
• Dementia
• Alzheimers Dementia
• Progressive Aphasia
• Right Hemisphere Damage
• Closed Head Injury

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Questions for Tx.

• 1. Describe the general treatment strategies
  suggested by Chapey.
• 2. What is the difference between traditional
  therapy strategies and Functional Communication
  therapy approaches?
• 3. Is the differentiation of stimulation vs.
  restoration relevant to Aphasia treatment?
• 4. Describe the approaches for Brocas Aphasia.
• 5. Describe the approaches for Wernickes Aphasia
• 6. Describe Schuells Stimulation Approach
• 7. Describe PACE therapy
• 9. Differentiate between two other diagnostic
  categories a clinician should consider in a
  differential diagnosis.

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End of Discussion