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Grand Rounds on Aphasia Group Treatment ASHA 2000 Washington, D.C.

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Title: SEVERE APHASIA GROUP: TEACHING REFERENCING SKILLS TO ENHANCE BASIC COMMUNICATION Kathryn L. Garrett, Ph.D., CCC-SLP Duquesne University, Pittsburgh, PA – PowerPoint PPT presentation

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Title: Grand Rounds on Aphasia Group Treatment ASHA 2000 Washington, D.C.


1
SEVERE APHASIA GROUP TEACHING REFERENTIAL
SKILLS TO ENHANCE BASIC INTERACTIONAL
COMMUNICATIONKathryn L. Garrett, Ph.D., CCC-SLP
Duquesne University, Pittsburgh, PA
  • Grand Rounds on Aphasia Group TreatmentASHA
    2000Washington, D.C.

2
I. Overview of Duquesne University /Nebraska
Aphasia Group Model
3
A. History
  • University of Nebraska-Lincoln - 1993-1997
    Garrett Ellis
  • Student training programs
  • Adults with a wide variety of aphasia types,
    ages, backgrounds
  • Duquesne University (Pittsburgh) - 1998-present
    Garrett Staltari
  • Ever-increasing demand for services at the
    post-acute rehabilitation phase

4
  • B. Types of Groups (2)
  • Mild-Moderate Aphasia Group
  • Difficulties with fluency, semantic flexibility
    and specificity, organization of discourse,
    timing, and integration of language with high
    level social-pragmatic skills
  • Participants tend to have generally good auditory
    comprehension primarily communicate by speaking
    (although enhancement through other modalities is
    often a goal)

5
  • Severe Aphasia Group
  • Participants have limited to no verbal
    communication. Typically have some degree of
    auditory comprehension breakdown as well -- from
    mild to severe.
  • Have difficulties initiating communication acts
    conveying novel,semantically specific
    information referencing what theyre talking
    about attending to relevant info/conversational
    partners engaging in reciprocal exchanges

6
C. Purposes (4) of Therapy Groups
  • To improve linguistic skills
  • Semantic
  • Discourse
  • To improve interactional skills in
  • Conversational Contexts
  • Transactional Contexts

7
C. Purposes (4) of Therapy Groups (cont.)
  • To increase communicators use of compensatory
    strategies when appropriate
  • To assist clients and significant others to learn
    to live with aphasia (after Lyon, 1996)

8
D. 3 Basic Principles Communication in
Meaningful Contexts
  • (1) USE language vs. practice
  • Embed language targets in a connected sequence of
    communication acts that have a purpose
  • EX Asking your wife out on a date vs.
    practicing her name and I love you in an
    isolated context

9
  • Prepare for challenges to resource allocation
    practice compensating for situational demands in
    tx
  • EX Practice standing up, walking to movie
    counter, asking for a ticket, being bumped,
    getting back on track and requesting a
    ticket

10
  • (2) Communicate at the level of discourse
  • Have a GOAL (conduct a transaction, to tell a
    story, to explain how to do something)
  • ORGANIZE the communication acts you need to
    achieve this goal
  • Ex. Hi honey - come here gesture. Date?

11
  • Add enough REFERENTIAL/ SEMANTIC SPECIFICTY and
    COHESION to convey ideas
  • Ex. Movies - you? or show newspaper
  • Consolidate multiple communication modalities
    into one communication act
  • EX Hand her flowers and say I love you
    vs. practicing speech and gestures separately

12
  • (3) utilize thematic, situational activities
    in tx
  • Examples
  • Planning a party for group member
  • Going to the bank
  • Greeting trick-or-treater
  • May facilitate retrieval of language associated
    with episodic memory
  • Preliminary observations increased complexity
    and automaticity of expressive communication

13
E. Structure of the Model- In Brief
  • Conversation
  • Context-Building
  • Language Mediation
  • Discourse

14
Reference
  • Garrett, K., Ellis, G. (1999) Group
    communication therapy for people with long-term
    aphasia Scaffolded thematic discourse
    activities. In R. J. Elman (Ed.), Group
    Treatment of Neurogenic Communication Disorders
    The Expert Clinician's Approach. Boston
    Butterworth-Heinemann. Pp. 85-96.

15
II. SEVERE APHASIA AND REFERENTIAL COMMUNICATION

16
A. Preliminary observations
  • Some communicators with severe aphasia (across
    modalities) appear to have an elemental challenge
    in referencing ability
  • Need explicit instruction to engage in basic
    referential skills..

17
  • Attending to others (especially speakers)
  • Pointing to request
  • Pointing (indexing) an object, picture or written
    word to clarify the referent when
    answering/commenting
  • Gesturing deictically to request info or indicate
    anothers turn
  • Searching for tangible information when answering
    questions (e.g., in communication notebooks,
    etc.)

18
  • Abbeduto, Short-Meyerson, Benson, Dolish,
    Weissman (1998) described physical referencing
    as
  • ...an understanding that an item that is present
    in an individuals proximal life space may be the
    topic of conversation or concept under
    discussion.
  • Their research indicated that referential skills
    (particularly physical referencing) are present
    in young children as well as older children with
    developmental language delays.

19
B. Hypotheses
  • That individuals with severe aphasia may not be
    able to produce propositional, verbal (speech or
    nonspeech modalities) communication until basic
    referential skills emerge (either naturally or
    with facilitation)
  • That the emergence of meaningful spoken or
    alternative communication coincides/ parallels
    the reacquisition of basic referential skills
    such as pointing to others, shifting gaze to a
    speaker, physically manipulating
    externally-stored info (pictures, words, etc.) to
    answer a question.

20
C. Target Referential Skills - A Proposed
Hierarchy
  • 1. Social-Pragmatic Referential Skills
  • 2. Semantic/Symbolic Referential Skills
  • 3. Discourse Level Referential Skills

21
  • 1. Social-Pragmatic Referential Skills
  • Basic Deixis
  • For turn-taking
  • For requesting additional information
  • Dean - ask Jerry what he thought of the
    election...hand-over-hand assist to point to
    Jerry to request info

22
  • 1. Social-Pragmatic Referential Skills (cont).
  • Tangible Referent Identification- immediate
    envirionment
  • Example Show us what you bought this weekend
    visual prompt to encourage Jane to point to her
    own new sweater

23
  • 2. Semantic/Symbolic Referential Skills
  • Visual symbol referencing
  • Example Photo Album Conversations - point to
    pictures to answer autobiographical questions
    Where was your favorite vacation?

24
  • 2. Semantic/Symbolic Referential Skills continued
  • Point to tangible topics setters to initiate a
    conversational topic (Weiss Ho, 1997)
  • Example Teach family members to place remnant
    of an outing or activity in view or in
    communicators pocket. Use verbal or physical
    cues to trigger presentation of remnant in
    response to peer question Whats new?. Fade
    cues as appropriate

25
  • 2. Semantic/Symbolic Referential Skills continued
  • Access sequence of messages to convey NEWS on a
    Voice Output Communication Aid (VOCA) - no
    selection/minimal sequencing demands

We went gambling
26
  • 2. Semantic/Symbolic Referential Skills continued
  • Access semantically specific messages to answer
    specific questions -- on VOCA

STEAK
Id like to order.
rare
LOBSTER
Well-done
27
  • Point to semantically specific written word
    choices to answer conversational questions
    (Written Choice Conversation Strategy -- Garrett
    Beukelman, 1995)
  • Example Who do you want to win the election
    Gore Bush You dont CARE
    anymore!

28
  • 3. Discourse Level Referential Skills (advanced
    communicators - move to mild-moderate aphasia
    group)
  • Answering questions with semantically specific
    referents
  • Commenting
  • Asking questions
  • Time markers and (then)
  • Continuers and, but

29
  • Explicit, referential communication occurs in one
    or more modalities
  • Gestural - Vocal
  • Verbal - Writing
  • AAC or other external symbols
  • Self-initiated communication acts increase
  • Turn-taking and other pragmatic aspects of
    interactional communication kick in

30
D. How are referential communication
opportunities embedded in group activities for
people with severe aphasia?
VIDEO ILLUSTRATION
31
Additional References
  • Lyon, J. (1996) Optimizing communication and
    participation in life settings for aphasic adults
    and their primary caregivers in natural settings
    A use model for treatment. In GL Wallace (Ed),
    Adult Aphasia Rehabilitation. Boston
    Butterwowrth-Heinemann, 1996 137-160.

32
  • Abbeduto, L., Short-Meyerson, K., Benson, G.,
    Dolish, J., Weissman, M. (1998) Understanding
    referential expressions in context Use of
    common ground by children and adolescents with
    mental retardation. JSHR, 41, 1348-1362.

33
  • Weiss, S., Ho, K. (1997, November) Remnant
    books in aphasia AAC strategies for patients in
    the acute rehabilitation setting. Poster session
    presented at the annual meeting of the American
    Speech-Language, and Hearing Association, Boston,
    MA.
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