1. 8. Aphasia TREATMENT STRATEGIES

2. General Treatment Strategies Use intact modality or stronger modality to BEBLOCK impaired modality/ies. Circumvent difficulty via self-cueing strategy. Self-cueing is generalized from clinician cueing Stimulation before response expectation Using functional or pragmatically based therapy, such as promoting Aphasics’ Communicative Effectiveness (PACE) Scaffolding language activities Family/caregiver inclusion

3. Treatment Strategies for Broca’s Aphasia 1. Melodic Intonation Therapy –Best candidates are patients whose Auditory Comprehension is better than their verbal expression and verbal expression is severely impaired –Strategies: Intonation pattern uses a range of 3-4 notes Elements include an exaggerated melody line composed of at least 2 syllables. The rhythm and point of stress help to convey meaning MIT is slower, similar to Chant Talking Program Progresses to Longer syntactic units and to Clinician Question, Client Answer using progressively faster melodic patterns. 2. Response Elaboration Training (RET)

4. Treatment Strategies for Broca’s Aphasia 2. Response Elaboration Training (RET ) –Designed for nonfluent aphasia patents in order to increase the length and information content of verbal responses –Strategies Elicit spontaneous response Model and reinforce initial response Expand and elaborate response through scaffolding Reinforce client’s attempts at elaboration Always repeat and expand the client’s utterance Modeling and Expansion based on Scaffolding of Client’s response

5. Wernicke’s Aphasia Promoting Aphasics’ Communicative Effectiveness –Therapist and client take turns conveying information to each other participating equally as senders and receivers of messages. –There is an exchange of new information. –Therapist can model communication options. –Any Communication channel is acceptable: visual, gestural, graphic, verbal –Barrier Activities useful in PACE therapy

6. Scheull’s Stimulation Approach to Rehabilitation Primarily use of controlled Auditory Stimulation –employs strong, controlled, and intensive auditory stimulation of the impaired symbol system –Because it is an auditory stimulation approach, materials and procedures should be extensive. Therapist is NOT retraining BUT stimulating currently inaccessible language centers Activities for Auditory Abilities, Verbal Abilities, Reading & Writing

7. Chapey’s Cognitive Linguistic Therapy Language is a knowledge of a code for representing ideas about the world through a conventional system of arbitrary signals for communication. Cognition is the use of the five mental operations of recognition, memory, convergent thinking, divergent thinking and evaluative thinking. Therapy is divided into 4 levels depending on a patient’s ability Each level has specific activities pertaining to each of those 5 cognitive skills as they relate to LANGUAGE, including the 4 modalities. Excellent therapy ideas for more traditional therapy and for beginning clinicians.

8. Promoting Aphasics’ Communicative Effectiveness, PACE Therapy PACE therapy is a type of Functional Communication Therapy (FCT) –purpose: emphasis on PRAGMATIC aspect of communication and information involving a RANAGE OF COMMUNICAITON INTENTIONS, such as informing, requesting, questioning, negating primary objective of traditional therapy has been to stimulate (Schuell) or restoration of patient’s language function across 4 modalities –leads to isolated modality practice –Goals are written to address Activities of Daily Living (ADL) using COMMUNICATION, not the motor skills of performing the tasks

9. PACE Therapy, continued –Principles 1. Exchange of new information in a conversational setting 2. Encouraged to use ANY EXPRESSIVE MODALITY: speech, signing, gestures, writing 3. Both therapist and client are senders and receivers engaging in a variety of COMMUNICAIOTN INTENTIONS 4. Feedback is simply the success of communicating, the characteristic of Normal Communication –Pragmatically based=emphasis on content that is personally relevant Materials such as newspapers, Barrier activity using relevant materials

10. 9. Differential Diagnosis A clinician should be able to differentiate between the following disabilities Normal Elderly Expectations Aphasia Dementia Alzheimer’s Dementia Progressive Aphasia Right Hemisphere Damage Closed Head Injury

12. Questions for Tx. 1. Describe the general treatment strategies suggested by Chapey. 2. What is the difference between traditional therapy strategies and Functional Communication therapy approaches? 3. Is the differentiation of stimulation vs. restoration relevant to Aphasia treatment? 4. Describe the approaches for Broca’s Aphasia. 5. Describe the approaches for Wernicke’s Aphasia 6. Describe Schuell’s Stimulation Approach 7. Describe PACE therapy 9. Differentiate between two other diagnostic categories a clinician should consider in a differential diagnosis.

13. End of Discussion