Presentation on theme: "Communication in FTD Daisy Sapolsky, MS, CCC-SLP"— Presentation transcript:
1Communication in FTD Daisy Sapolsky, MS, CCC-SLP Speech-Language PathologistMGH Department of Speech, Language and Swallowing Disorders & Reading DisabilitiesMGH Frontotemporal Disorders Unit
2Topics Subtypes of FTD Communication challenges Compensatory strategiesMGH FTD Unit and Progressive Communication Disorders Program
3TermsAphasiaAn acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence.Can have impairment in one or more areas:speakingunderstanding othersreadingwriting/spellingspeech:language: what words mean, combining words into meaningful and grammatical sentences, using words in ways that are appropriate to the context (you may use different wording when you’re speaking with your boss and when you’re speaking with your spouse)
4Terms Primary Progressive Aphasia (Mesulam, 1982) A language disorder (“aphasia”) that worsens over time (“progressive”), and is the most prominent problem the person experiences (“primary”)speech:language: what words mean, combining words into meaningful and grammatical sentences, using words in ways that are appropriate to the context (you may use different wording when you’re speaking with your boss and when you’re speaking with your spouse)
6Progressive nonfluent aphasia (PNFA) agrammatismnonfluent speech, may be telegraphichesitant, effortful, pauses, hesitations, fillers (e.g., umm)difficulty with verbs and functor words (e.g., the, for, an, to)knowing what you want to say, but can’t think of the word or can’t get the word outcomprehension is (typically) intactthere may be difficulty in comprehension of complex syntactic forms
7Progressive nonfluent aphasia (PNFA) impaired reading and writingdifficulty with forming grammatically correct sentencesdifficulty with reading complex sentences; comprehension of single words usually intactor, writing may be significantly better than speech in some patientsspelling difficultyyes/no confusionpronoun confusion
8Progressive nonfluent aphasia (PNFA) picture description:“Umm, you know, the umm, the family for uh the picnic...umm...maybe the Cape...you know, the umm, like sailing and fishing and umm the ah, uh, girl is umm, the umm, the sandcastles, and umm the picnic man’s reading a book and umm the lady is uh, wine, and you know, like summertime, summertime.”
9Picnic scene pictureWestern Aphasia Battery-Revised (Kertesz, A., 2007)
11Semantic dementia (SD) loss of knowledge of the meanings of wordslower frequency/uncommon words most affected“What is a ___?”use of vague/general words (e.g., stuff, thing)speech content has an empty qualitylack of detail, common/vague wordsbut, speech is fluent and grammatical
12Semantic dementia (SD) picture description:“There’s a guy and a dog and this, and then there’s a girl and another dog, and something. And, they’re eating. This is the...I should know that because I always do it...I always know that usually.”
14Logopenic Progressive Aphasia (LPA) intermittent word-finding hesitationsimpaired namingphonemic paraphasias (saying words or nonwords that share some sounds with the correct word)“octible” for octopus“rackel” for racquet“glow” for globe
15Logopenic Progressive Aphasia (LPA) picture description:It looks like a family is, has a hou, uh, I think it’s a house or a friend’s place, on the leck lake...Uh, and uh, there’s somebody who’s uh finishing, uh, fishing...Uh some friends are in the boat, in the so, sailboat, sail, sailboat...They uh, the mother is putting some, I’d like to think it’s wing uh wine...
17Behavioral variant FTD (bvFTD) As patients may do well in testing, they are often not thought to have a primary speech/language disorder.However, the hallmark changes in behavior and personality directly affect daily communication and functioning, and therefore can result in a communication disorder.
18Behavioral variant FTD (bvFTD) apathetic variantflat affect, emotional bluntingnot expressing emotion, not understanding or reading someone else’s emotionwithdrawal, loss of interest (apathy)not engaging in conversation or previously enjoyed activitieslack of initiationonly speaks when spoken to
19Behavioral variant FTD (bvFTD) disinhibited variantsaying inappropriate things or in an inappropriate wayinappropriate increase in talkingpress of speechnot reading social cues that someone is not interested in the conversation or is ready to stop the conversationcompulsive behaviors
20Topics Subtypes of FTD Communication challenges Compensatory strategiesMGH FTD Unit and Progressive Communication Disorders Program
21Common communication challenges knowing what you want to say but the words won’t come out → frustrationable to express basic wants and needs, but difficulty with higher-level conversation“I miss the discourse.”feeling rushed and pressured to get your thoughts outmay result in withdrawing from social situationsone patient said she doesn’t want to make people wait for her to come up with words
22Common communication challenges communicating the problem to friends and family, people at workcarrying out routines and activitiesdifficulty reading and writing may mean the loss of previously enjoyed and practical activitiesadjusting to new communication style“I used to be a fast talker.”
23Topics Subtypes of FTD Communication challenges Compensatory strategiesMGH FTD Unit and Progressive Communication Disorders Program
24Example compensatory strategies key words and semantic cueingpatient provides key words instead of attempting to say full sentencespatient describes the concept/word using semantic features5 w’s templatehelps patient organize thoughtsvisual guidemultiple-choice questionspartner asks multiple-choice or yes/no questions
25Example compensatory strategies visual materialsuse a newspaper headline, photo, or other visual material as conversation topicelaborationhelp patient elaborate on previous responsegesture (e.g., past, future, yes/no, size, shape)
26Example compensatory strategies pre-written “scripts”write brief scripts to be used in specific situationspracticing may reduce the pressure of the momentcan be used to read from or to show to the partnerPlease pump $20 worth of gas.How was your vacation to Paris?I need to find a dress to wear to a wedding.I need to return these shoes because they didn’t fit.
27Example compensatory strategies communication bookprimary or supplementary communicationupdate topics/formats as neededpoint to pictures/words:people (family members, friends)places (shops, restaurants)foodactivitiesemotionstime/date
28Example compensatory strategies slow down – both patient and partnerpatient has more time to think of words and organize thoughtsallows patient time to process what is being said to him/herrelieves the pressure of a fast-paced conversation
29Example compensatory strategies Identify barriers to functioning in the home or workplace and be creative in brainstorming solutionse.g., a patient with non-fluent speech allows calls to go to voic , enabling her to take time to formulate a response, write a script, or send an response
30Example compensatory strategies Identify activities, hobbies, and volunteer opportunities that have low demand on language (arts, music, gardening).Discuss when a job or responsibility is no longer manageable. Create an action plan to leave the situation.
31Example compensatory strategies Prompt the patient to use any means of expressiongesturing, writing, drawing, pointing to pictures or words, facial expressionRefer to an AAC (Augmentative & Alternative Communication) centerFor apraxia of speech, try traditional motor speech strategies
32Example compensatory strategies Some patients have reported success!From anScript for a phone conversation for friends, a business, and doctors - I practice the script until I can speak decently.Gestures, facial expression, and body language...two-thumbs-up, wave, and five high slap...and dance around with my body.Syllable attack is very helpful. I break down the long word into syllables and practice them slowly. Then I quicken my speed until I can pronounce the word properly...They (strategies) are helpful. It takes a long time to practice a script on the phone but it pays off. The reward is speaking more normally...not perfect!
33Strategies: Behavioral variant Set up situations and routines that allow the patient to respond to others, instead of needing to initiate communication themselvesBrainstorm ways to engage the patient in activities and communication
34Strategies: Behavioral variant Break down tasks into manageable steps that are not overwhelming (e.g., setting the table)daily calendar/schedule to provide a list of activities and to-do itemsdo this together so that the patient has inputphone message template
35Topics Subtypes of FTD Communication challenges Compensatory strategiesMGH FTD Unit and Progressive Communication Disorders Program
36MGH Progressive Communication Disorders Program goals of the evaluation:identify strengths and weaknesses in speech/language abilities, compensations already in use, communication partners, and what is/isn’t working in daily lifedevelop functional goals:to maintain and enhance communication; andto prepare for future declinegoals of the therapy program:teach/practice compensatory strategies to facilitate communication in everyday situationseducate the patient/partner about the diagnosis and implications for communicationbrainstorm suggestions for modifying the environment to facilitate communicationtroubleshoot barriers to communication and participationprovide check-ins and ongoing supportprogram structure:individual sessions that vary in frequency and duration for patient and partner“tune-up” sessions to review strategies and determine if another round of therapy is warrantedgroup therapy to practice strategies within a comfortable setting and to meet others