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Speech and Language Therapy Methods of Intervention

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Title: Speech and Language Therapy Methods of Intervention


1
Speech and Language TherapyMethods of
Intervention
  • The Patients Journey through Acute,
    Rehabilitation and into Long-term Care

2
Overview of Our Service
3
Identifying Needs to Develop Intervention Methods
4
Acute Phase Needs Patient, Family and Therapist
  • Establish current and pre-morbid communication
    skills
  • Establish baseline communication skills
  • Give information about Aphasia
  • Identify ward based communication needs
  • Provide counselling and support

5
Acute Phase Methods
  • Communication History Form
  • Meet with family and friends
  • Assessment formal/informal (screen)
  • Aphasia Information Sheet
  • Introduce supported communication, to facilitate
    communication, orientation and understanding
  • Liaise with MDT, Medics, Nursing staff
  • Provide basic communication chart
  • Give SLT contact details

6
Rehabilitation Phase Needs Patient, Family and
Therapist
  • Assessment of specific impairment needs
  • Ongoing information giving and updates
  • Building communication links and skills with
    family and friends
  • Setting individual therapy goals
  • Implementing individual and group therapy
  • Developing ward based communication skills
  • Ongoing counselling and support

7
Rehabilitation Methods
  • Direct Methods
  • Use of specific sub-tests, detailed assessments
    e.g. PALPA, Boston, CAT
  • Aphasia Friendly information on Stroke and
    Aphasia (CONNECT)
  • Errorless/Errorful learning (BAS)
  • Narrative therapy (Brody 1994, Donald 1998, Byng
    at al 2000)
  • Colourful Semantics (Bryan 1997)
  • Phonological Awareness Therapy (Morrison 2001)
  • Conversation Groups Chatter Groups
  • Individual Communication chart
  • Indirect Methods
  • Carers Evening
  • Regular patient/therapist/family meetings at
    bedside
  • Daily communication diary
  • Weekly Case Conferences close liaison with MDT
  • Training for families and friends on therapy
    techniques
  • Training the Trainers MDT and family
  • Aphasia and Stroke Information including PALPA
    model of language processing

8
Rationale for Rehabilitation Methods
  • Errorless and Errorful Learning (BAS Conference)
  • 120 words collated and divided into three sets.
    Each set comprised 20 verbs and 20 nouns.
    Errorless therapy was used on one set and
    errorful therapy used on the other set. Results
    showed significant therapy effects across both
    therapies. Greater improvements in noun naming
    over verb naming. Errorless took 50 less time
    than errorful, was more engaging, satisfying and
    gives implicit feedback
  • Colourful Semantics (Bryan 1997)
  • A visual colour coding system of supporting
    development of correct grammatical language
    structure with written words, also used to
    encourage focused word finding skills across a
    set group of nouns and verbs for verbal output.
    Aims to teach the identification of underlying
    thematic roles in written sentences and encourage
    the use of thematic role knowledge to create
    predicate argument structures in written or
    verbal sentences e.g. subject, verb object, or
    subject, verb, location using colour coded
    system. Gives patient back a logical language
    structure and focus and dramatically improved
    word finding and self monitoring skills in fluent
    aphasia.
  • Narrative Therapy (Brody 94, Byng at al 00)
  • Illness narratives are stories that attempt to
    repair the damage that the illness has done to
    that persons life, attempting to reconstruct the
    future in light of the illness. Different types
    of narratives come through at different stages of
    the persons illness. Narratives take patients
    from the sick role into the health role i.e.
    put the patient in control. They are educative,
    diagnostic and therapeutic.

9
Long Term Care Needs Patient, Family and
Therapist
  • Making therapy functional and relevant
  • Developing sense of self awareness and self
    identity
  • Preparing patient for Living with Aphasia
  • Developing autonomy and independence
  • Ongoing support and training courses

10
Long Term Care Methods
  • Direct Methods
  • Conversation Groups (weekly)
  • Patient Focus Group (weekly)
  • Living with Aphasia Group (weekly)
  • 11 Functional therapy (1-2 weekly)
  • Aphasia Day (6 week course)
  • Training the Trainers (6 week course)
  • Life History Book
  • Indirect Methods
  • Carers Focus Group (evening course)
  • Training the Trainers (6 week course)
  • Carers Evening

11
Rationale for Long Term Care Methods
  • Functional Therapy (Worrall 1999, Addlestone 02)
  • The Functional Communication Therapy Planner
    (FCTP) aims to provide the structure for
    therapists to develop, administer and evaluate
    therapy, ensuring the patients needs are at the
    centre. It takes you through the decision-making
    processes involved in providing functional
    communication therapy. It uses a questionnaire to
    obtain information about social networks,
    preferences for conversational topics, their
    perceived pre-morbid communication style and an
    interview to determine communicative needs. It is
    flexible with the severity of the aphasia and
    determines areas to concentrate on in therapy.
  • Chatter Groups (Kagan Gailey 93, 98)
  • These groups would focus on promoting total
    communication, supported conversation and
    increasing social interaction. Groups look at
    current affairs and topical issues to stimulate
    interaction between members, with the emphasis on
    conversation and getting the message across in a
    relaxed way, highlighting the importance of
    conversation in maintaining psycho-social
    well-being.
  • Patient and Carer Focus Groups (Buck 68, Rollin
    00)
  • A recent initiative in St Jamess Hospital has
    been to invite patients largely from the Long
    Term Care stage to discuss, share and express
    their opinions on the service they received
    during all phases of their Stroke Care Pathway.
    Therapists act as non-biased facilitators within
    the discussion group. These groups help to
    address the psychosocial aspects of aphasia, not
    just for the individual, but for the family also
    (Buck, 1968). Separate intervention fo family
    members can help target the emotional response,
    change old behaviours and develop a different
    manner of living (Rollin, 2000).
  • Living with Aphasia Group (Brumfitt Sheeran
    97)
  • This group focuses on encouraging self advocacy
    and independence, with patients taking a lead
    role. It enables patients to share their
    experiences of communication disability in the
    real world and develop methods and strategies
    of managing these. Group work has long been known
    to improve psycho-social well-being in the person
    with aphasia. Group work has included development
    of aphasia friendly leaflets by patients.

12
References
  • Acute Phase
  • Holland, A Fridriksson, J. (2001) Aphasia
    management during the early phases of recovery
    following stroke. American journal of
    speech-language pathology.10 19-28.
  • Peach, R. K (2001) Further thoughts
    regarding management of acute aphasia following
    stroke. American journal of speech-language
    pathology. 10 29-36.
  • Marshall, R. C (1997). Aphasia
    treatment in the early postonset period Managing
    our resources effectively. American journal of
    speech-language pathology, 6(1), 5-11.
  • Rehabilitation Phase
  • Byng, S, Pound, C Parr, S (2000) Living with
    Apahsia A Framework for Therapy Interventions.
    In Papathanasiou, I (2000) Acquired Neurogenic
    Communication Disorders A Clinical Perspective.
    London, Whurr.
  • Morrison, S (2001) Phonology Resource
    Pack for Adult Aphasia. Speechmark, Bicester.
  • Brody, H (1994) My Story is Broken can You
    Help Me Fix It. Medical Ethics and the Joint
    Construction of Narrative. Literature and
    Medicine 13 1 pg 79 92
  • Bryan, A (1997) Colouful Semantics. In language
    Disorders in Cghildren and Adults
    Psycholiguistic Approaches to Therapy, edited by
    S, Chiat, J, Law, J, Marshall. London Whurr.
  • Long Term Care Phase
  • Addlestone, S (2002) The Sourcebook of
    Practical Communication A Programme for
    Conversational Practice and Functional
    Communication Therapy. Speechmark, Bicester, UK
  • Brumfitt Sheeran (1997) An Evaluation
    of Short Term Therapy for People with Aphasia.
    Disability and Rehabilitation 19, 6, pg221 230
  • Buck (1968)
  • Kagan, A Gailey, G (1993) Functional is not
    Enough Training Conversational Partners for
    Aphasic Adults. In A, Holland M, Fords (eds)
    Aphasia Treatment World Perspectives pgs 199
    225, San Diego, Singular Press
  • Kagan, A (1999) Supported Conversation for
    Adults with Aphasia Methods and Resources for
    Training Conversational Partners. Apahsiology 12,
    pgs 816 830.
  • Rollin, W (2000) Counselling Individuals with
    Communication Disorders. Boston Butterworth
    Heineman.
  • Worrall, L (1999) Functional Communication
    Therapy Planner. Winslow Press, Bicester, UK
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