1. Acquired language Disorders
aphasia…and

2. 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

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

4. 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)

5. 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

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

7. 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

8. 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

9. Treatment examples

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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)