Aphasia Therapy: Process Oriented Treatment

Auditory Comprehension

1. Listening Comprehension and Memory (Comp requires adequate memory)

a. Bottom Up: Increasing in complexity from phonology to meaning (Lower/Text)
b. Top Down: Use of general expectation and knowledge (Higher/Heuristic)
* Scripts- mental representations of familiar daily life situations

2. Single-Word Comprehension
a. Pointing drills (severe comprehension issues, no phrase and sentence comp)
b. Match words to pictures; give definitions; synonyms/antonyms
c. If not work: short term memory tx; sentence comp; use of context

3. Understanding Spoken Sentences

a. Yes/No Drills (those who cant usually cant answer open-ended questions)
b. Following Spoken Directions: sequential pointing
* Kearns Hubbard 13- Level Hierarchy:
• Point to one common object by name Point to the pencil
• Point to one common object by function Point to the one you write
with
• Point in sequence to two common objects by function Show me the
one you write with and the one you lock a door with
• Point in sequence to two common objects by name Point to the
pencil and the key
• Point to one object spelled by the examiner Point to the p-e-n-c-i-l
• Point to one object described by the examiner with three
descriptors Which one is white, plastic, and has bristles?
• Follow one verb instructions Pick up the pen
• Point in sequence to three common objects name Show me the
spoon, the pencil, and the dime
• Point in sequence to three common object by function Point to the
one you write with, the one you lock a door with, and the one you
spend
• Carry out two-object location instructions Put the pen in front of
the knife
• Carry out, in sequence, two-verb instructions Point to the knife and
turn over the fork
• Carry out, in sequence, two-verb instructions with time constraint
Before you pick up the knife, hand me the fork
• Carry out three-verb instructions Point to the knife, turn over the
fork, and hand me the pencil
 c. Sentence Verification: patient indicates whether the picture accurately portrays
the meaning of the sentence; one picture, multiple pictures (foils)
d. Task Switching Activities: sentence comprehension drills change each stimulus

4. Discourse Comprehension
a. Client reads aloud a sample of discourse, patient answers questions
*Usually yes/no questions Discourse Comprehension Test (recognition)
* Sentence completion
* Open-Ended Questions
* Retelling

5. Stimulus Manipulation in Treating Discourse Comprehension- Clinician Regs Via:

a. Familiarity- situations and routines. Scripts can be used to facilitate
comprehension of discourse by 1) teaching patients and family that some daily spoken
discourse is predictable, 2) Patients identifying scripts that underlie samples of discourse,
3) Asking patients to predict what is like to happen in sample of discourse representing
scripts
b. Length
c. Redundancy, Cohesion, and Coherence: begins with discourse in which
repetition, paraphrase, and elaboration create redundancy and high levels of cohesion and
coherence.
d. Salience: treatment begins where main ideas are easily identified and treatment
focus is on identification of main ideas.
e. Directness: stated to implied
f. Rate: Increasing salience or redundancy is more dependable than slowing rate

Speech Production
1. Volitional Speech
a. Sentence Completion: common to implied, can precede confrontation naming
for word retrieval
b. Word and Phrase Repetition: less powerful but fairly dependable (for little or
no volitional speech) For apraxia, weakness, paralysis, dysarthria. Can be used to
enhance processes such as word retrieval and sentence formulation. Gradually replaced
by vocab search and retrieval activities such as naming drills
c. Confrontation Naming: for purposeful retrieval, encoding, and production. Not
very functional
d. Cueing Hierarchies: Cueing evaluation: naming, try various cues for what’s
most effective. Train them to self-cue using best cueing techniques through naming
activities. The goal is to self cue to right word
Hierarchies:
• Imitation/Gesture
• First phoneme
• Sentence completion
• Spell
 • Rhyme
• Syn/Ant
• Function/location

2. World Retrieval Failure: Semantic association is most helpful, followed by description

3. Enhancing Word Retrieval in Speech

a. Diagnosis
• Generating a list of words and semantic categories that are
functional; Obtain baseline measures of the patient’s
success/unsucces WR strategies
b. Strategy Development and Practice
• Practice in controlled drill activities from list, reinforce helpful
strategies, introduce other forms of the word when successful
c. Stabilization and Generalization for Less Predictable Times
• Synonyms, antonyms, rhymes; provide lists of words; fill in the
blank sentences or narratives; common roots

4. Sentence Production (Gradually diminish response constraints)

a. Repetition-Elaboration Drills: How are you…What do you like for lunch?
b. Story Completion Drills: Its ten o clock, and late, I tell my kids to…(HELPS)
c. Question-Answer
d. Story elaboration: Tell short story, and follow up questions to elicit phrase
e. Picture-Story Elaboration: Ask questions relating to a picture
f. Sentence Construction Drills: Give me a sentence with boy (2, 3, etc)

5. Connected Speech
a. Picture Description, prompting, procedural, and conservation

Functional and Social Approaches

1. Patients act out daily life situations. Are encouraged to non verbally communicate and
enhance their comprehension of what others say by using the information provided by
others’ gestures and facial expressions and by situational contexts. Treat other
communication partners as well.

2. PACE- a) patient and client exchange new communication, b) clinician and patient
participate equally as senders and receivers of messages, c) Patient has free choice of
communicative modes used to convey a message, d) clinician’s feedback is based on the
patient’s success in conveying messages (responds by clarifying, asking, paraphrasing)
a. Clinician can coach on what behaviours the patient can use to enhance
communication
b. Clinician can teach specific communication strategies and use PACE to
incorporate them into the activities