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 except… 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

big picture aphasia treatment targets the specific area of language or communication functioning impacted by aphasia we do not treat by type of aphasia the treatment should directly target the impacted area and/or your careful measurement shows the effect of treatment on the client’s stated goal

Treatment examples

CART – Copy and Recall Treatment client profile: individuals with lexical impairments in writing; unable to write single words reliably target: improved access to items in the written lexicon; improvement of trained words dosage: 1-2 times per week rationale: repeated copying of words retrains orthographic representations

CART protocol this intervention can be in-session plus homework, or home program only session protocol - present picture; if they can not write the target: clinician hand writes word and client copies x 3 clinician covers examples and client copies x 3; this step done three times Clauson and Beeson, 2003

measurement session data: outcome measures: accurate written production of words without a model (independent on step 1) reliable completion of homework outcome measures: increased use of trained words in everyday conversation/ communication contexts increased perception of communication efficacy and/or QOL (self report/questionnaire; GAS)

response elaboration training (RET) client profile: individuals with reduced oral expression; variety of aphasia profiles and severities target: oral discourse  increased content units and length of utterance dosage: 2-3 times per week 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, or CAAST for clients with goals in both areas

measurement in session data: outcome measures: 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 measures: increased MLU in language sample, everyday conversation measure of impact (e.g., questionnaire, GAS)