Acquired language Disorders aphasia…and

important ideas about aphasia …is a symbolic disruption …is acquired …involves any or all language modalities comprehension: auditory, reading, signed/visual expression: oral, writing, signed/manual …is not a problem of sensation or intellect

Common causes of aphasia CVA TBI tumors infections epilepsy Over 1,000,000 individuals with the US have aphasia - National Aphasia Association

describing aphasia various impairments in any/all language modalities the most commonly observed deficits are in naming and auditory processing generally describe an the language profile as: fluent/receptive; nonfluent/expressive; or severe or global Hegde (1998); Brookshire (1997)

General symptoms: Impairments impacting language use include: impaired auditory comprehension anomia: word retrieval/naming difficulty paraphasias: word or sound substitutions agrammatism: asyntactic production (or reduced syntax) reading and writing disruptions

the WHO ICF Functioning and Disability Contextual Factors body functions and structures activity and participation Contextual Factors environmental factors personal factors

Treatment and assessment - Linking the WHO ICF restorative/process oriented approaches – impairment (body structure/function) approaches aimed at improving underlying motor or cognitive processes, resulting in generalized improvement in function skills based/compensatory approaches – activity/participation approaches that train a new skill/behavior -or- alternative method for communicating participation focused approaches – participation approaches focused on improved community participation and quality of life

TReatment examples

Anagram and copy Treatment (ACT) WHO ICF: activity/participation client profile: clients with little to no writing, but who show abilities with writing letters and letter identification; ability to complete homework target: independent writing of functional single words for everyday communication rationale: repeated exposure to words through solving anagrams and copying improves representation of single words in the lexicon (thereby increasing access)

ACT Protocol:

measurement in session data: outcome measure: in SOAP note, report independent writing of target words if not independent, ability to write word in step 4 of protocol still take data on anagram and anagram+foil steps in order to note any trends outcome measure: independent writing of target words in everyday conversation; self and SO reports of increased understanding, reduced frustration, etc may incorporate logs, rating scales, GAS

response elaboration training (RET) WHO ICF: impairment client profile: individuals with reduced oral expression; variety of aphasia profiles and severities target: oral discourse  increased content units and length of utterance rationale: combining behavioral techniques of modeling and forward chaining with cognitive stimulation using loose training results in expanded oral expressive output loose training - uses the client’s response as stimulus

RET Protocol: uses simple line drawings important: use modified RET (mRET) for clients with significant apraxia

measurement in session data: content: number of information units produced (steps 1 and 6) - may vary based on severity of client possibly grammatical production: number of morphemes, nouns, verbs, and modifiers outcome measure: increased MLU in everyday conversation; measure of impact (e.g., questionnaire, GAS)