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
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)
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
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
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
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.
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 DailyLiving (ADL) using COMMUNICATION, not the motor skills of performing the tasks
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
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
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.