Chapter 23-33 Hallowel book
What are the four constructs that are especially important as we consider levels of evidence
(1) Efficacy: (2) Effectiveness: (3) Efficiency: (4) Outcome:
What are the purposes of treatment methods?
-Facilitate brain-based recovery of abilities that have been lost or reduced also known as estorative (restitutive) approaches. -Help compensate for language impairments and empower use of intact abilities to maximize effective communication also known as compensatory approaches. -Support people psychologically and socially in coping with lost or reduced abilities. -Encourage the fullest participation in social engagement appropriate for that individual and the people who are important to him or her
How is BDB implemented
1. Create or gather five uncaptioned humorous cartoon panels 2. Show the client the first one-panel cartoon for a short time and then take it away, ask him or her to draw the cartoon from memory 3. Provide the second cartoon panel and give four trials of drawing from memory 4. Once the client successfully draws three of five single-cartoon panels from memory, introduce two-panel cartoons 5. Once the client successfully draws three of five two-cartoon panels from memory, introduce three-panel cartoons
How is CDP implemented
1. Have the client identify and recognize categories of objects 2. Provide the client 12 color markers and ask him or her to color black-and-white line-drawn objects 3. Have the client trace around the contour of black-and-white line drawings 4. Ask the person to copy the following geometric shapes: crescent, oval, star, octagon, cone, pyramid, cylinder, and cube 5. Provide pictures of objects with missing parts (such as a car missing a wheel, a cat missing an eye, or a horse missing a leg) 6. Show the individual a picture and then take it away 7. Name an object on which you have been working 8. Tell the individual a category name and ask that he or she draw an item in that category 9. Ask the person to draw as many items within a category as he or she can, without any examples presented 10. Have the client draw one-, two-, and three-paneled cartoons representing a story or joke
How is PACE treatment implemented?
1.Obtain a set of stimulus cards (words and/or pictures) 2. Place the deck of stimulus cards face-down on a table. Stimulus cards must be unknown to the clinician. The stimuli should be relevant to the client (the importance of ecological validity for maximizing carryover to real-world contexts) 3. Face the client. 4. Discuss with the client the goal of successful communication rather than linguistic accuracy. Adapt your means of expression as needed. Using supported communication strategies, promote total communication. Explain how you will take turns sending and receiving messages. 5.Decide who will take the first turn as sender 6. The sender picks a card and hides it from the receiver's view. 7.The sender uses any modality he or she chooses to convey what is represented on the card 8. The receiver gives feedback about what was understood 9. In the role of receiver, you may request the use of certain modalities, and may also request different types of written or spoken expression, such as physical description of objects, object categories, or functional uses for objects depicted. Expand on the client's utterance to acknowledge the successful components of communication initiated. Keep in mind that your feedback is to focus on effective communication, not on accuracy 10. In the role of sender you may choose descriptions rather than naming, and you may choose varied modalities of expression. 11. Keep taking equal turns until the sender has successfully communicated what is represented on the card. 12. Reverse roles as sender and receiver
What is persistent depressive disorder
A component of chronic major depressive disorder. When depression continues for two or more weeks
What is Visual Action Therapy (VAT)
A gesture-based non-vocal approach intended for people with global aphasia
The underlying causes of these missed opportunities include
A lack of training and mentor-ship in supporting the value of counseling, A failure to appreciate counseling as part of our scope of practice, Discomfort or awkwardness with handling intimacy and depth of social interaction, and adoption of a clinician-centered rather than a person-centered approach to intervention
What is ICF-Focused Approaches The Living with Aphasia: Framework for Outcome Measurement (A-FROM)
A means of conceptualizing intervention for people with aphasia based on the ICF framework.
What is Promoting Aphasics' Communicative Effectiveness (PACE)
A method developed to foster pragmatic skills
What is script training
A method in which the client practices using personally relevant conversational scripts that are written in collaboration with an SLP
What is spaced retrieval training (SRT)
A method of learning and retaining information by recalling the information over increasingly longer periods of time
What is locus of control
A person's own view of what and/or who has shaped the events in his or her life, and of what and/or who has the power to shape his or her circumstances
What is constraint-induced language therapy (CILT)
A restitutive approach where people are restricted in their use of modalities that are the most impaired. Modeled on approaches to constraint-induced therapy in areas involving neuromotor control
What is External locus of control
A sense that other forces, such as God, luck, fate, and other people (family, friends, professionals, etc.) determine what will happen
What are complementary and integrative approaches to wellness?
Alternateive, complementary, integrative, and non-traditional
The Breakfast Club is
An example of a social approach used in a nursing home context and is adaptable to individuals and context
Reduction of edema
As swelling goes down, the compression of surrounding brain tissue is reduced
How is the Problem Solving Approach implemented
Ask the client to write about something, perhaps something about what has happened in his day. When he comes upon a word for which he is unsure of the spelling, suggest that he write it just as it sounds, and then decide if it is correct. If he is still unsure, ask him to try correcting it. Have him look it up using an electronic speller, computer, or smartphone app. Have the client keep a notebook and write in it each day, continuing to practice the writing, spell-checking, and self-correction strategies. Encourage the client to select topics independently. If he has difficulty with that, it may be helpful to assign topics at first. Have the client make a list of the words that were difficult to spell. Review the homework content during treatment sessions. Discuss and provide feedback about strategy use
How is VAT implemented
Assemble 15 objects, line drawings of those objects, and pictures of those objects, Have the client match pictures to objects. As you show each object, have the client use gestures to demonstrate how each object is used. Present an object and a corresponding picture. Have the client demonstrate how the object is used. Show a group of objects. Gesture how one of them is used. Model gestures associated with each object. Model the same gestures again, this time asking the client to choose an object that goes with your gesture. Show one object at a time and have the client gesture its use. Model a gesture (pantomime) associated with each object, without the object in sight. Have the client request an object using only a gesture. Give her the item indicated
How is CART implemented
Assemble a set of cards with personally relevant line drawings printed on each. Provide a paper and pencil or pen to the client. Turn over one card at a time. Say the word that corresponds to the item depicted. Then ask the client to write the word. If he or she writes the word correctly, move on to the next card. If not, write the word or show a printed version of the word already prepared. Ask the client to copy the word three times. Depending on his or her responsiveness, you might cue the client to write it again as needed until three versions are complete. Once the word is written three times, take away all of the examples of the written word. Show the drawing again and ask the client to write the word three times. Give feedback after each attempt, and then cover that written word before the next attempt. If he or she cannot write the word without a model, start the process again with a different picture. If possible, come back to that picture with which he or she had difficulty during the same session. Provide CART homework to be done six days per week. For each day, the client is to: (a) label pictures, copying the same written word 20 times for each picture, and then (b) write the word on a separate "test" page on which only the picture is shown, without looking at any written model. As treatment progresses, include old and new words in the homework. Present mastered words less frequently.
How is ORLA treatment implemented
Assemble materials according to each of four levels based on length and reading level. For Level 1, use simple three- to five-word sentences at a first grade reading level. For Level 2, use eight- to 12-word sentences or combinations of two brief sentences. A third-grade level is recommended. For Level 3, use 15- to 30-word sentence combinations, separated into sets of two or three sentences. A sixth-grade level is recommended. For Level 4, use simple paragraphs of 50 to 100 words at a sixth grade reading level. Have the client read the material in unison with you. Then have him read it again alone. Do not correct errors; rather, focus on correct modeling
On what principles is CILT based
Based on the constraint-induced movement therapy when people with hemiparalysis or hemiparesis of the limbs are restricted in the use of their functional arm or leg, they demonstrate increased motor functioning in their impaired limbs. Maximizing reliance on impaired systems seemed to stimulate impaired abilities
How is SFA treatment implemented
Baseline phase and target selection. Select words that are most relevant and ecologically valid for the individual you are treating. Obtain a corresponding image for each target word. Obtain baseline scores in a confrontation naming task. Show each image, one at a time. Retain those named correctly the first time as "easy" stimuli. Retain those not named even after three consecutive sessions as "target" words. Semantic feature analysis chart method. Select one image at a time, Ask the client to name the word of the image. Acknowledge the accuracy (or lack of accuracy) of the response. Regardless of naming accuracy, use the SFA chart to prompt the client to produce words semantically related to the target word. Write the client's correct responses in the box corresponding to each type of feature. Graphemic organizer method. Use a graphic organizer to lead the client in considering semantic features of the target word and distinguishing it from other words or concepts in the same category. Have the client indicate whether a certain feature fits an object (marked by +) or not (marked with a -) Once the chart is completed, support the client in decisions to change any question marks to a + or - Also, discuss any item for which you do not agree with the response. Discuss which items within the category are most alike (share the most features), which rows have the most similar responses, which cells have mixed responses and why, and which responses (if any) require further verification
Cortical reorganization
Basic brain-behavior relationships are modified as areas of brain tissue that were not centrally involved in certain functions prior to injury take over those functions
What is the best level of complexity for treatment foci
Begin treatment at a level of complexity that is relatively easy for an individual and then to progressively build up the level of difficulty as treatment progresses
Reperfusion
Blood flow is restored to areas of hypo-perfusion (e.g., ischemic penumbrae)
How may coaching enhance self-advocacy
Carrying print material to share with others about the nature of their communication challenges. Aphasia ID Card
What general cognitive neuropsychological approaches are applicable to treatment
Cognitive and neuropsychological treatment approaches are based on information processing models such as Focus is on underlying impairments, The primary goal is to foster restitution of brain function, The secondary goal is to help compensate for lasting deficits, Limitations and challenges, Oversimplification of the overlapping and parallel nature of processing , Inability to capture the complexity of actual neural structures and processes, A tendency to focus on decontextualized impairment-level problems
What other treatment parameters are important to consider
Cognitive-linguistic treatment based on motor-learning principles. Varied practice. Random practice. A greater number of repetitions. Low frequency of feedback. Knowledge of performance. Inter-stimulus intervals (ISIs). The degree of ecological validity of stimuli used. Modalities of treatment. Stimulation through multiple modalities leads to greater storage of and access to information. Enhances long-term potentiation (LTP). Increases the likelihood of activating that network
How is VAC treatment implemented
Collect baseline data for each of two levels. Level I: Present verbs; for each verb, ask "who" and "what" questions to elicit a subject-verb (agent-patient) response. Level II: Add questions with "what", "when", "how", "where", and "why" to elicit subject-action-object responses. Start treatment at a level for which the individual's performance is about 60% accurate. Initiate treatment from one level/sub-level to the next, using words that are relevant in terms of the individual's everyday use of language
What are memory books and memory wallets
Collections of pictures, phrases, and words associated with familiar people, places, and events that a person may have difficulty remembering (Bourgeois, 1992)
What is Emotional lability, or pseudobulbar affect (PSA)
Common in people with neurogenic communication disorders. A potential confound in assessment. A potentially debilitating condition in terms of its impact on communication. It can easily sidetrack a conversation or activity. It may lead to feelings of shame or embarrassment around others
PACE treatment may be easily adapted for use in
Communication partner training and Group treatment
What are the primary principles of CILT
Communication should be restricted to verbal expression e.g. Nonverbal modality use should be discouraged. Practice should be intense
What are specific approaches for improving expressive language abilities
Constraint Induced Language Therapy (CILT), Script Training, Melodic Intonation Therapy (MIT), Voluntary Control of Involuntary Utterances (VCIU), Response Elaboration Training (RET), Treatment for Aphasic Perseveration (TAP)
What is the role of the SLP in addressing depression in people with neurogenic communication disorders
Consulting in the diagnosis of depression. Making referrals for psychological counseling and possible pharmacotherapy.Ongoing assessment of mood states, coping strategies, self-esteem, optimism, and level of adjustment to changes in body function and structure and life participation
C stands for
Continuity, Continue the same topic of conversation for as long as possible, Prepare the individual if a new topic must be introduced
What are the specific treatment approaches that target reading and/or writing at the impairment level
Copy and Recall Treatment (CART), Anagram and Copy Treatment (ACT), The Problem Solving Approach, Multiple Oral Rereading (MOR), Oral Reading for Language in Aphasia (ORLA)
How can behavioral treatment facilitate brain recovery
Cortical growth and synaptic transmission are supported at every age. Enriched environmental input (including multimodal stimulation). Active engagement in cognitive-linguistic activity. The acts of learning and remembering increase synaptic efficiency in the brain in all people. The specific treatment approaches we use lead to different effects on cortical reorganization
What are some helpful information-sharing strategies and resources
Counseling and coaching involve not only empathic support but also information sharing. Explanations about the causes and nature of cognitive-communication challenges as well as in referrals and extension of opportunities for support. Social media provide opportunities for people with aphasia and caregivers to connect with one another for information exchange and support
How might counseling moments be influenced by the time course of recovery and intervention
Counseling or coaching moments often arise spontaneously, according to evolving needs and circumstances such as following a traumatic change, at the start of intervention, related to ax results and sharing prognosis, during treatment, at discharge.
What are important considerations related to counseling and scope of practice
Counseling people with communication disorders is within the scope of practice of SLPs. Holland and Nelson (2014) suggest that SLPs should view counseling not just as a specific service we provide, but that we see it as integrated with the rest of the work that we do.
How might a speech-language clinician adopt a counseling mindset
Counseling starts from the moment we connect with a person we are serving professionally. Before you go meet the person you are about to serve, take a deep breath and gear up to be the best helpful, knowledgeable, reassuring, and confident professional you can be. Ideally we provide counseling and life coaching throughout the intervention process
How is VCIU implemented
Create a list of all of the words that the client is known to have produced spontaneously and write each on a separate card. Ask the client to read one card at a time aloud. For each card, if he or she reads it correctly, keep the card; if not, discard it. Present pictures of the target words and ask the client to name each one. If he or she cannot name it, show the corresponding written word and ask him or her to read it aloud. Any time the client produces a different real word, discard the former target word and replace it with the new word. Provide the target word card to the client to practice at home. Through supported communication, encourage progression from oral reading and confrontation naming to use in natural conversation
Specific approaches for improving word finding and lexical processing include
Cueing hierarchies for the treatment of anomia, Semantic Feature Analysis (SFA), Phonological Components Analysis (PCA), Verb Network Strengthening Treatment (VNeST ), Verb as Core (VAC)
What are cueing hierarchies for the treatment of anomia
Cueing strategies have been used in intervention with people who have neurogenic language disorders, frequently provide cues to support their communication, making use of a person's communicative strengths (e.g. writing, auditory comprehension) to facilitate word retrieval, generally considered impairment-based stimulation methods. They may also be considered compensatory in that the client ideally learns to implement strategies to improve his or her own naming abilities when he or she has difficulty retrieving a word
Neuronal regeneration
Dendritic branching, Collateral sprouting
How is ACT implemented
Develop a set of words that would be highly relevant and useful to the client. Progressing from easy to more difficult words, show an anagram and then ask the client to arrange the letters in the right order to spell the word. Once the letters are arranged successfully to spell the word, have the client copy the word. If she cannot arrange the letters correctly, do so for her and then have her copy the word in her own writing. Make the task more difficult by adding two foil letters (a vowel and a consonant) and begin the sequence again. Have the client write the word from memory. Repeat this until she spells the word correctly three times. Assign daily homework. Have the client repeatedly copy words using pictures that are labeled with each target word for 30 minutes per day. Also, have her copy target words as with CART. As treatment progresses, shift from your own selection of target words to the client's selection of words
What is the Communicative Drawing Program (CDP)
Developed primarily as a compensatory approach to communication that focuses on the use of drawing as a compensatory means of communication which was Intended for people with severe aphasia who are limited in oral and written language expression
D stands for
Direct, Keep sentences short, simple, and direct. Use specific, concrete nouns, rather than pronouns. Use hand signals, pictures, and facial expressions
How is script training implemented
Discuss the goals of script training with the client. Have the client generate topics that are most relevant to her. The scripts may be monologues or dialogues. Use supported communication strategies to collaborate with the client in generating a written script for specific content he/she wants to be able to convey. Practice reading the script aloud with the client, then have him/her read it alone, supporting his/her as needed. For homework, assign repeated reading aloud of the script several times a day. Have the client practice using the script in contexts where the content is socially appropriate. Have the client practice the script with new conversational partners
Counseling related to assessment results and sharing prognosis includes
Documenting and sharing assessment as well as discussing prognosis
On what principles is CDP based
Drawing is intrinsically non-linguistic and so may be useful even in people with severe aphasia; to facilitate word retrieval, drawing exploits use of the intact right hemisphere, the assumptions underlying this argument have been contested
On what principles is PACE treatment based
EQUAL PARTICIPATION where the client and the clinician take equal turns sending and receiving messages. During any given exchange, one is considered the sender and the other the receiver. NEW INFORMATION where the stimulus to be described is not seen by the receiver which ensures that there is true, not simulated, information exchange. FREE CHOICE OF MODALITIES in which in the role of sender, the client and clinician determine the communication mode that each will use to convey the message. NATURAL FEEDBACK that consists simply of the clinician's or client's responses regarding whether each message was successfully sent or received. Communicative success is considered a more natural form of feedback shared between clinician and client than declarations of linguistic accuracy.
What are effective ways to address emotional lability during clinical interactions
Educate others that the emotions you he or she shows do not necessarily reflect what he or she is really feeling. Ask others to move on in a conversation or activity when an emotional outburst occurs rather than trying to comfort or give other emotional feedback. Find a means of distracting him or herself
On what principles are cueing hierarchies for the treatment of anomia based
Elicit correct naming with the least amount of cueing possible; Using the most powerful cues in terms of their ability to elicit a correct response, reduce cueing from the clinician as soon as the cues are not needed. Help the client generate self-cueing strategies to enhance naming. All cues have stimulus power
What are the best practices in the treatment of neurogenic language disorders?
Embrace communication as a human right. Recognize assessment as an ongoing intervention process. Be person-centered. Include family members, caregivers, and others whose roles are relevant. Have a clear sense of purpose and goals and begin with the end in mind. Engage communication partners outside of the client's immediate circle of friends. Embrace cultural and linguistic differences. Encourage self-coaching. Consider optimal timing. Consider optimal locations and conditions. Contextualize treatment in real-world environments. Focus on functional communication by using the cueing hierarchy approach, or the life participation approach to aphasia. Focus on abilities the individual really needs and wants to improve. Focus on relevant material. Focus on strengths. Be an interdisciplinary team player. Use evidence-based approaches. Blend art with science. Encourage aphasia-friendly communication. Attend to behavioral challenges that impede successful interactions which is known as antecedent-based behavior management.
How might multicultural differences impact counseling and coaching
Empathic responding requires seeing the world the way it is seen by another person. The more we know about a person's background, including his or her values, cultural traditions and religious or spiritual beliefs, the more empathic we may be. Tuning in to a person's locus of control is one aspect of the intersection of culture and personality that can influence the effectiveness of our counseling efforts. Locus of control
How may apps and computer software may be used to support communication and aid in treatment
Enable extensive practice outside of treatment, tailored to individual needs. May help consolidate and generate treatment stimuli to be used in treatment, saving valuable preparation time and helping to ensure that stimulus images are not outdated
How is cueing hierarchy treatment implemented
Engage in naming assessment using a standardized assessment battery, as well as by using a set of picture stimuli that are personally relevant to the individual with whom you are working. Whenever the client is unable to name an item, provide a cue E.g., Initial phonemes, the printed first letter, the printed word, a rhyming word, an object description, a sentence completion task, a gesture showing how an object to be named is used, or a verbal description of the item. Keep careful notes regarding which cues led to the correct production of the word. Based on the data you collect during the naming assessment, order the cues, or therapeutic stimulus types, or tasks, along a continuum according to their effectiveness in stimulating correct word retrieval performance. Engage in confrontation naming tasks using pictures and objects, first providing cues with the greatest stimulus power and progressively using cues with less stimulus power. Coach the client about the importance of his or her initiating the very types of cues that you are providing. Engage in generative naming tasks, having the client come up with words that fit in certain categories. Continue the same approach to cueing, gradually reducing the strength of your cues. Progress to generalization tasks such as picture descriptions, prepared monologues, story retelling, and role-playing
What is the theoretical foundation of the Montessori approach
Enhances activation of intact intellectual and communicative activities, Improves compensatory strategies through any means of supported communication
How is TAP implemented
Establish a baseline by calculating the percentage of words perseverated during the confrontation naming portion of the BDAE-3. Explain what perseveration is, and give examples. Ask client to pay attention to his/her perseverations to try to avoid them. Engage in a confrontation naming activity, with five-second intervals between items. Arrange the stimuli according to the severity of perseveration the person has exhibited on the confrontation naming task. The intent is to start where he or she will have the greatest success and then to move to more difficult items in a hierarchical fashion. important to use pictures that are most personally relevant to each individual. Continue to draw attention to moments of perseveration. Write the incorrect utterance that was spoken and then rip it up in front of the client. If he or she perseverates on the same word again, point to the ripped paper as a reminder. As you have the client name one picture at a time, track. The number of items (pictures) named correctly (providing up to three cues for each). The number and type of words on which the person perseverates (regardless of the number of times he or she perseverated on each word). Cues may be gestures, drawings, spoken descriptions, graphic cues (initial letters, syllables, or the whole word), phonemic cues, requests for repetition, or requests to speak or sing the word in unison
How is VNeST implemented
Establish a baseline for object and action naming, using a standardized naming battery. Present picture cards showing actions and possible agents and patients of those actions. Stimulus selection and creation. Select about 10 verbs for which the client has low accuracy of naming. Write each of the following words, each on a separate wh- card. Who; what; where; when; why. Generation of agent-patient pairs. Show the client a target verb card. Lay the who and what cards on a table. Have the client generate his or her own words to make a sentence using the verb. Wh-questions about agent-patient pairs. Have the client choose an agent-patient pair. Choose another agent-patient pair and ask wh- questions using those words. Semantic judgments. Remove the cards from the table. Read 12 sentences that contain the target verb. Generation of agent-patient pairs again. Without referring to the cards, ask the client to name three verbs and the agents and patients that go with each. Have the client produce a sentence using the words he or she generates. Give feedback and encouragement as appropriate
E stands for
Exchange, Keep up the normal exchange of ideas we find in conversation, Begin conversations with pleasant, normal topics, Ask easy questions that the individual can answer, Give the individual clues as to how to answer
F stands for
Face to face, Face the individual directly, Attract the individual's attention, Maintain eye contact
What are the two basic forms of SRT
Fixed-interval/uniform approach and randomized-interval/adjusted approach
What is the optimal focus of initial treatment soon after a stroke or brain injury
Focus on communication needs. Focus on counseling and sharing information. Promote rest. Sleep is essential to cortical health and healing. Consider the balance of compensatory with restitutive approaches.Consider pros and cons of focusing on attention
Why are complementary and integrative approaches increasing in popularity
Frustration with current options. Increasing awareness, Expanded funding for non-allopathic services, A growing evidence, Aggressive commercial marketing
Resolution of diaschisis
Functions associated with brain structures remote from the area of damage that had been initially impaired improve over time
What are best practices in responding to seemingly misguided statements by patients and their significant others
Gentle guidance and hands-on demonstration by someone who cares to take the caregiver's perspective is likely to be far more effective than refuting her "misguided" statements. The ultimate excellent clinician considers creative and compassionate ways to heighten the degree to which the partner's assumptions are realistic, yet keep her motivated and engaged in collaborating to seek ways of further enhancing communication
How may group treatment be implemented and how can it help people with aphasia and related disorders
Group treatment can be a more affordable option for many. Bonds among group members can help them cope with multiple challenges. Supported communicative interactions in authentic social contexts ideally promote generalization of conversational strategies
What are intensive and residential aphasia programs and how can they help people with aphasia and related disorders
Harness the power of intensive treatment and practice to advance neuroplasticity in recovery; Provide social support through information sharing and group activities
What is Compassion
Has the connotation of shared feeling, not just understanding. Also linked to a sincere desire to provide support and help
On what principles is the Problem Solving Approach based
Having the client with dysgraphia learn to evaluate her own writing problems (spelling in particular) and independently implement those strategies will improve her writing abilities. A focus on phoneme-to-grapheme conversion ideally helps the individual improve spelling through repeated stimulation and corrective feedback.
On what principles is TAP based
Helping people become aware of their perseverations we may help them suppress them
What are the optimal times during recovery to initiate treatment
Immediately following stroke or brain injury, the focus of health care tends to be on the individual's survival. A great deal of changes occur in the brain in the days and weeks following brain injury such as Changes in blood flow around ischemic penumbrae, Resolution of diaschisis, and Reduction of edema. An approach that does not work at one time may work later
What is the prevalence of stress reduction
Important for the overall health and well-being. People with acquired neurogenic disorders and their caregivers tend to experience more stress than people in the general population. Important for overall cerebrovascular health and stroke prevention, and for coping with challenges to life participation (see Chiesa & Serretti, 2010 for a review). Promoting healthful living for the prevention of neurological disorders and for lessening their impacts on life participation is a critical aspect of our role as advocates
How is MOR implemented
In the initial session determine the person's reading rate and accuracy for paragraph-level text. Choose reading material that is of interest to the client. Choose a portion of text that is at an appropriate level of difficulty for the client and have him read it aloud. Score his reading rate in words per minute, and note reading errors. Also note any self-corrected errors. Ask the client to reread the text. Support his reading as appropriate and correct errors as he proceeds. Re-reading the passage helps increase his familiarity with the text, which should help enhance his accuracy. Provide the written text as homework. Thirty minutes of repeated reading of the same text one or twice a day is recommended. Having the client keep a log of daily practice is recommended. In subsequent treatment sessions, review the log and discuss progress with homework. Then assess reading rate and accuracy with the text he has been practicing. Plot these data graphically. Set a target reading rate, based on what seem realistic given his current level. When he attains that rate with the same passage, move on to a new passage
Internal locus of control
Includes one's sense of having the power and the ability to do something about one's situation
What is the status of script training in terms of evidence-based practice
Increased accuracy of production and good generalization to spontaneous use for two people with aphasia. Significantly reduced communication difficulty using a computer-based script training for 20 people with chronic aphasia. Greater intensity of script treatment led to better treatment gains in 17 people with aphasia, especially in people with more severe language impairment. The grammatical morpheme production, rate of speech, syntax, and overall conversational success of two individuals with aphasia improved, using script training delivered through a combination of in-person and online videoconferencing sessions. The most common category of monologue scripts was personal stories (68%).The most common category of dialogue scripts was conversations with families (21%)
How might some aspects of life improve after onset of an acquired neurogenic communication disorder
Increased time and availability to help others wisdom, Patience, appreciation for others, Renunciation of workaholic tendencies, Deepened loving relationships and friendships, Clarity in priorities
What are Montessori approaches to dementia management
Initially developed for use with children in educational environments where multimodal sensory exploration is encouraged
What is the status of PACE in terms of evidence-based practice
It enhances communicative effectiveness in people with aphasia. There has been little conformity in treatment fidelity and outcomes assessment, and not all people with aphasia benefit equally from this approach. Means of indexing outcomes associated with the method have also varied across studies.
The Living with Aphasia: Framework for Outcome Measurement takes into account four interrelated life-affecting impacts of aphasia such as
Language and related processing, Participation, Personal factors, identity, feelings, and the environment
What general social and life participation approaches are applicable to treatment
Life Participation Approach to Aphasia (LPAA), ICF-Focused Approaches, The Living with Aphasia: Framework for Outcome Measurement (A-FROM), and Supported communication
What is the status of the evidence base supporting alternative approaches to improving cognitive-communicative abilities
Limitations in many research studies on complementary and integrative approaches to intervention such as Insufficient sample sizes, Heterogeneity of samples studied, Poor control of cognitive and linguistic measures, Lack of control groups, lack of placebo or sham groups and conditions, lack of randomization, Use of non-standardized measures, Use of subjective descriptions without objective measures, Lack of overall detail in published reports, Failure to report and describe additional behavioral, pharmacologic, or non-traditional interventions being provided, Failure to report dosage, intensity, and frequency of treatment. Failure to address possible underlying neurobiological causes for reported effectiveness
What is the status of VAT in terms of evidence-based practice
Little research has been published
The motivation for The breakfast club approach is
Long-term care residents with MCI and dementia because they are at risk for social isolation and have reduced opportunities for social interaction
What is Multiple Oral Rereading (MOR)
MOR involves repeated reading aloud of the same text to facilitate whole-word rather than letter-by-letter reading. It is a restitutive, stimulation approach designed for people with aphasia who have acquired reading impairments (alexia with or without agraphia), especially those with difficulty accessing the graphemic input lexicon but retaining orthographic knowledge (Beeson & Hillis, 2001; Beeson & Insalaco, 1998; Beeson, Magloire, & Robey, 2005)
What is the status of RET in terms of evidence-based practice
Mainly case studies and single-participant studies. Increases in the amount of verbal information provided by people with Broca's aphasia in response to picture stimuli. RET effects have been shown to generalize to other conversational partners, picture stimuli, and social settings
On what principles is MOR treatment based
Many people with aphasia acquire a letter-by-letter approach to reading. This makes it especially difficult to read longer words. MOR is intended to improve access to the graphemic input lexicon either directly or through compensatory processes. The clues provided by sentence contexts and increasing familiarity with the text may be part of what makes the treatment effective. Repetition is fundamental to the method, so completion of daily homework is an essential component
Some consider counseling in the realm of mental health professionals, which is problematic because
Mental health services are not always available. Mental health services are often not covered by third-party payors. Even when services are available and reimbursable, many do not have a solid background in communication disabilities, and many do not have training in supported communication. Some people, even when referred, do not pursue the referral
What are ways in which opportunities for counseling can be missed
Missed counseling opportunities may be due to SLPs' tendencies to take control of interactions by focusing on facts rather than feelings or discussions about abstract or vague ideas. Engaging in "staged" conversation. using humor to deflect emotional expression. Transitioning from expressions of emotion to "objective therapy tasks"
What is the status of SFA in terms of evidence-based practice
Most SFA studies to date entail single-subject, multiple-baseline, pre- and post-treatment designs, and case studies. Improvements are generally noted for trained items. Most SFA studies have concentrated on single-word training, with inconsistent generalization of improved lexical retrieval to discourse. Even within studies, certain individuals tend to respond better to SFA than others. Individuals demonstrate differences in the amount of carryover to naming of untrained items. Treatment fidelity throughout the SFA literature is not strong. SFA research studies vary in terms of inclusion/exclusion criteria of participants
What are basic principles that underlie most writing- and reading-focused programs for people with aphasia
Most approaches developed specifically to help foster reading and writing abilities are based on psycholinguistic models of language processing. Writing- and reading-specific approaches meant to enhance communication require that the client have a preserved semantic system. Writing may be accomplished via phonological spelling, bypassing semantic representations that are essential to conveying meaningful content through writing. Segmenting auditory input into its component sounds. Translating phonemes into corresponding graphemes. Converting graphemes to letters.
What is the status of CILT in terms of evidence-based practice
Most of the research on CILT to date has been done with people who had severe Broca's aphasia and apraxia of speech but research with people who have mild aphasia and/or more "fluent" forms of aphasia is needed and few outcome measures have been used consistently across studies. There is a need for more research on CILT, with larger numbers of people with varied types of aphasia at varied levels of time post-onset
What is the status of ORLA in terms of evidence-based practice
Most studies involve case series and case studies. reported that 25 individuals improved in overall aphasia language battery scores compared to a no-treatment phase. ORLA has been shown to lead to improvements not only in reading but also to improvements in other modalities (speaking, writing, and auditory comprehension) in people with varied forms of "fluent" and nonfluent" aphasia
Facilitating synaptic transmission within intact neurons boosts the health of intact neural connections through
New learning. Experience. Pharmacological agents. Diet.Nutritional supplements.Exercise. Social support
On what principles is ORLA treatment based
ORLA is a stimulation approach based on neuropsychological models of reading. Repetitive stimulation is intended to strengthen phonological and semantic routes for reading. By incorporating connected speech rather than individual words, it is said to permit more natural prosody when clients read aloud. Using text-level stimuli permits practice with varied grammatical forms in meaningful contexts
What is Oral Reading for Language in Aphasia (ORLA)
ORLA is a treatment method for people with dyslexia associated with any form and severity level of aphasia. The intent is to foster recovery or re-learning of reading comprehension through practice using the phonological and semantic routes and associated feedback. Through a hierarchical ordering of material (easy to difficult, and increasing in length), the clinician guides the client in reading in unison, and then independently
Memory books are
Often in the form of three-ring binders,Contain photographs and printed words, Can easily be edited and added to over time, Photo albums may also be used
O stands for
Orientation, Orient the individual by repeating key words several times, Repeat sentences exactly, Give the individual time to comprehend what you say
What introduction played an important role in raising awareness of ways to work on communication goals at the level of conversation
PACE
How can communication counseling enhance end-of-life care
People who are nearing the end of life are often attended to medically rather than in a holistic, supportive, life-affirming way. SLPs can play a pivotal role in reducing the focus on medicalization of care through counseling and communicative support, and in encouraging conversations about things that matter most to people nearing the end of life and those who care about them. SLPs may also be helpful in mutual support of colleagues coping with client death and bereavement
How might intervention in neurodegenerative conditions slow cognitive-linguistic decline
People with degenerative conditions may have periods of improvement or plateaus. Affected functional abilities will continue to decline over time
What is the rationale for the use of memory wallets and memory books
People with dementia tend to retain long-term memory abilities far beyond the time that they lose short-term memory abilities. Repeated practice with personally relevant stimuli helps to enhance access to associated facts, words, and names
On what principles is VAT treatment based
People with severe language impairments often retain symbolic abilities that underlie language use
What are specific compensatory approaches
Promoting Aphasics' Communicative Effectiveness (PACE), Communication Drawing Program (CDP), Back to the Drawing Board (BDB), Visual Action Therapy (VAT)
What are three types of VAT
Proximal Limb VAT (PL VAT), Bucco-facial VAT (B/F VAT)
What is the Life Participation Approach to Aphasia (LPAA)
Puts the life concerns of people with aphasia at center of decision making. Recognizes that communication problems affect interpersonal bonds and virtually all aspects of one's life
On what principles is RET based
RET is based on loose training programs that reduce clinician control over stimuli, responses, and feedback during treatment. Considered as an interactive loose training program geared toward lengthening of utterances and increasing variety in linguistic formulations
Counseling during treatment includes
Reassurance regarding persistent strengths
Counseling at discharge includes
Recognizing that people may feel abandoned when treatment is terminated, or that emotional attachments to clinicians may make it especially difficult to suddenly lose access to such a key source of support
How can pharmacological agents facilitate brain changes
Reduction of edema (in the acute phase). Drugs regulating the permeability of the blood-brain barrier to water. Reperfusion of ischemic penumbrae. Thrombolytic agents such as tPA (tissue plasminogen activator). Long-term potentiation (during post-acute care). The use of specific drugs improves cognitive abilities. Modulation of brain activity. Dopaminergic drugs (e.g., bromocriptine) may enhance language comprehension/formulation. Collateral sprouting. The use of amphetamines (e.g., Aderoll) as possible means of neuromodulation. Serotoninergic drugs blocking pre-synaptic transfer of the transmitter serotonin. Cholinergic drugs impacting the thalamic nuclei and their connections to the cortex.
On what principle is ACT based
Repeated recall and practice strengthens the graphemic representation of words. Manipulating anagram letters is easier than writing letters. Because the individual need not select letters from memory and can rearrange letters in various ways before deciding on a correct arrangement.
What is the status of ACT in terms of evidence-based practice
Research on ACT to date consists of case series and single-case designs. Writing for trained words has improved, but there has been minimal carryover to untrained words. positive results for a person with severe global aphasia, as characterized by a reduced need for self-correction and time to respond
What is the status of CART in terms of evidence-based practice
Research on CART is based primarily on case studies and single-case design experiments. Repetitive spelling, a key element of this approach, has been found to be an essential aspect of what makes the approach effective. Group treatment may be useful in enhancing the effects of CART following individualized CART treatment. described the incorporation of smartphone text messaging into a modified version of CART for a person with Broca's aphasia
What is Semantic Feature Analysis (SFA)
SFA is a treatment approach targeting word-finding abilities that is based on earlier approaches developed for TBI survivors with the goal of to enhance naming abilities by improving access to semantic networks
What is the stimulation-facilitation approach
Schuell's stimulation approach Based on the functional interconnectivity among brain structures involved in language. A method of "strong, controlled and intensive auditory stimulation of the impaired auditory symbol system" in people with aphasia .
On what principles is script training based
Script training is based on the assumption that repetitive practice of pre-established, personally relevant conversational text will decrease the amount of effort involved in speaking during conversation and increase spontaneous language generation
What is the status of MOR in terms of evidence-based practice
Several descriptive case studies and single-case series results have demonstrated that MOR is effective in increasing reading rate and oral reading accuracy. MOR has also been shown to demonstrate carry-over to new, unpracticed text in some studies.There is less evidence to support the use of MOR for facilitating reading comprehension. The fact that MOR is often combined with other treatment approaches (for reading or for other aspects of language) makes it difficult to discern the specific effects of MOR in several studies
How is RET implemented
Show a stimulus picture depicting an everyday activity and elicit an initial verbal response. Encourage the client to elaborate on whatever he or she is reminded of when looking at the picture. Avoid having him or her describe the picture or name items depicted. Respond to the client's initial response with your own comments, and encourage him or her to expand on the initial response. Continue to make additional comments in response to his or her comments as appropriate. Ask Wh- questions regarding his or her own responses. Model sentences that combine his or her initial and subsequent responses. Ask the client to repeat your combined sentences. Do not directly correct the client's responses; instead provide natural feedback through conversational modeling.
Challenges in documented treatment efficacy to date include
Small numbers of participants within studies. Variations in participant inclusion and exclusion criteria (e.g., type, severity, and etiology of aphasia), treatment dosage, control for personal relevance and complexity of stimuli, the type of feedback provided by the clinician to the client
On what principles is VCIU treatment based
Spontaneously-produced, automatic speech can be used to facilitate the production and intentional use of real words in conversation. Using words uniquely tailored to each individual, with stimuli based on actual prior productions, will help ensure personal relevance
S stands for
Structure, Structure the questions to give the individual a simple choice to respond with, Provide only two options at a time, Provide options that the individual would like
What is the status of PCA in terms of evidence-based practice
Studies to date have entailed case series. Further research with many more people with aphasia is needed to determine what client strengths and weaknesses may lead to the best treatment gains using PCA. Evidence regarding carryover of treatment effects to word finding in natural conversation is needed
What other types of intervention may facilitate brain changes
Surgical interventions, sensory stimulation, nutritional supplements, Antioxidants, Other means, Good nutrition, Solid rest, Strong social support, Avoidance of negative substances/factors on the brain
What is Treatment for Aphasic Perseveration (TAP)?
TAP is an impairment-level approach originally designed for people with aphasia who tend to perseverate on speech sounds, words and utterances they have already said with goal being to reduce perseverations and enhance naming
How is CILT implemented
Tasks during CILT have been focused on spoken language production, often using a cueing hierarchy approach. Treatment intensity has generally been about three to four hours per day for at least five days per week over two weeks or 10 consecutive days
What are additional forms of programming to support people with dementia
The Breakfast Club and The Savvy Caregiver Program
What is Empathy
The ability to see the world from another person's point of view. Involves tuning into another's emotional state, desires, and sense of need
What is the optimal intensity and duration of treatment?
The concept of treatment intensity (treatment dosage) includes consideration of different aspect of treatment sessions. Number. Frequency. Duration
What is the optimal intensity and duration of treatment
The concept of treatment intensity (treatment dosage) includes consideration of different aspect of treatment sessions. Number. Frequency. duration
What is positive psychology
The discipline of helping people to lead full, meaningful lives and pursue wellbeing and happiness by focusing on Optimism, resilience, hope, mindfulness, affirmation, and positive thinking
Long-term potentiation (LTP)
The efficiency of transmission at the synaptic level is increased in surviving neurons
What is the status of TAP in terms of evidence-based practice?
The evidence base is poor. Single case design study. Further research needed.
What is a challenge of the CDP approach
The focus on accuracy of drawing as opposed to the communicative content conveyed.
Optimal intensity depends on several factors
The health and well-being of the person being treated as well as personal and environmental support. The nature of his or her cognitive linguistic-impairments and their life-impacting consequences. The goals of treatment. The treatment methods implemented. The therapeutic relationship established between the clinician and the person treated.
Optimal intensity depends on several factors
The health and wellbeing of the person being treated as well as personal and environmental support. The nature of his or her cognitive linguistic-impairments and their life-impacting consequences The goals of treatment. The treatment methods implemented. The therapeutic relationship established between the clinician and the person treated
What are the limitations of RET studies
The lack of consistent metrics used to demonstrate outcomes, Small sample sizes, and a lack of randomization and control groups
What is stimulus power
The likelihood of a particular cue eliciting a target word
Counseling at the start of intervention includes:
The most immediate needs tend to be for information, reassurance, and hope.
Unmasking of preexisting pathways
The reactivation of neural connections that helps compensate for connections lost through injury
MIT takes advantage of three principles
The right hemisphere mediates music and speech prosody in most people. The right hemisphere is typically preserved in individuals with aphasia such that singing abilities are spared in most individuals with left hemisphere lesions alone. Preserved musical and prosodic capabilities can be used to facilitate language production in people with aphasia
What is the best time to initiate treatment with people who have neurodegenerative conditions
The sooner the better Once symptoms related to language of generalized intellectual impairment arise. It is vital to develop memory aids and communication supports while a person is still able to participate in active decision making about what content and activities are most important
what is Therapist drift
The tendency for clinicians to vary a treatment protocol according to their own predilections in response to behaviors of the individual being treated
What is Randomized-interval/adjusted RTI approach
The time between trials is adjusted according to he individual's performance and it enhances long-term retention.
What is fixed-interval/uniform RTI
The time between trials remains constant. Helps transfer information into long-term storage
What is the status of MIT in terms of evidence-based practice
The treatment group showed significant improvements compared to the control group in a randomized, controlled single-blind study. After one to two months of MIT treatment, three people with aphasia demonstrated increased expressive language abilities in propositional speech, including the ability to answer questions and converse with peers. Overall, reported treatment outcomes are generally positive but the overall quality of the supportive research is not strong. The lack of treatment fidelity across many studies. The great variability in treatment outcomes measures
What is the status of VNeST in terms of evidence-based practice
There are few published studies to date documenting treatment outcomes associated with VNeST. Studies to date are limited to the first two phases of clinical outcome research. There has not been a high degree of treatment fidelity in terms of dosage, means of word selection, numbers of items used across studies.
Why is it important for clinical aphasiologists to learn about complementary and integrative approaches?
There is increasing likelihood that we will play a consultative role in helping people with neurogenic communication disorders consider complementary options to direct behavioral intervention to improve or slow declines in speech, language, and cognition. Popularity is longstanding in Eastern regions and is increasing steadily in the West. Many of the people we serve clinically are likely to be engaged in some form of complementary treatment or practice. Most clinicians in training to become SLPs have some experience with complementary and alternative modalities in their own self-care. Some clinical SLPs advocate passionately for the integration of commentary approaches to communication disorders within SLP curricula
What are challenges with CILT
There is little consistency across studies in terms of the actual treatment protocol implemented and the focus has been more on what participants with aphasia were not allowed to do.
What is the goal of SRT
To enhance accessibility to stored representations by repeatedly activating them and making a person aware of them
What general treatment methods fit within social and life participation models
Total communication approaches, Encourage any means of communication to convey and receive information, No particular modality is required, The content is more important, Augmentative and alternative communication (AAC), Different means of communication (high-/low-/no-tech),The Participation Model of AAC , visual scene displays (VSD), Partner and caregiver training, Programs for enlisting and training volunteers in local communities to support social and conversational participation, The Communication Partner Scheme (McVicker et al., 2008), Conversational coaching (Holland et al., 1991), Aphasia Couples Therapy (ACT; Boles, 2009), Reciprocal scaffolding, Empowering the person with a language disorder through a teaching role, Aphasia mentoring programs, People with aphasia serve as mentors to students in clinical education programs in the health sciences, Toastmaster programs (or affiliated "Gavel Clubs"), People with language disorders prepare, practice, and deliver speeches to one another, Humor as therapy, The use of humor as a treatment, Other socially-focused programs
What surgical interventions can facilitate brain changes
Transcranial magnetic stimulation (TMS; a.k.a., repetitive TMS, or rTMS) and Transcranial direct current stimulation (tDCS)
What is the status of VAC in terms of evidence-based practice
Treatment studies have indicated improvement in small numbers of people with aphasia. Performance on language battery scores. Ability to generate agents and patients for trained and untrained verbs. The influence of VAC on abilities to use verbs in the context of a variety of complex sentence types has not been studied methodically. The published work on this method does not address carryover of any improvements into natural conversation. The published work on this method does not address carryover of any improvements into natural conversation.
Memory wallets are
Typically plastic wallet inserts; Contain emergency contact information, words that are important to remember, scheduling/calendar/appointment information, addresses, names, phone numbers, and associated pictures
U stand for
Unsticking, Help the individual become "unstuck" when he or she uses a word incorrectly by suggesting the word they are looking for, Repeat the individual's sentence using the correct word, Ask, "Do you mean...?"
The complexity account of treatment efficacy (CATE)
Uses more complex stimuli and tasks actually seems to optimize recovery such as Non-exemplar word training, Abstract word training, Complex verb training, Complex syntactic structure training
On what principles is VNeST based
Using thematically related words enhance production at the sentence level. The meaning of verbs is tied to thematic roles, which entail grammatical relationships with other words. These associations have been shown to elicit priming effects of verbs on agents and patients that are typically associated with those verbs. Priming is a vital result of semantic activation. Thematic roles are defined as the related agent (subject) and patient (object) of a given verb in a given grammatical context. Repeated activation and use of neural networks associated with verbs is thought to strengthen access to verbs as well as to associated nouns that may serve as agents and patient
What is Verb as Core (VAC)
VAC is also known as verbal cueing. VAC is another treatment approach focused on verbs (like VNeST). The treatment is intended to improve expressive verb use and verb understanding as well as language performance in general in people with agrammatic aphasia. The approach involves auditory and visual processing of sentences with a focus on verbs, and practice through spoken and written language.
On what principles is VAC treatment based
Verbs carry critical meaning for communication and literally serve as the "core" of all sentences. People with agrammatism have particular challenges with accessing verbs, yet impairment-level treatment approaches tend to focus much more on nouns than they do on verbs.
What is the status of VCIU in terms of evidence-based practice
Very limited research has been done on the efficacy of VCIU. A great deal more research must be done to support the evidence base for this approach
How does a clinician listen and respond empathetically and compassionately?
We best express compassion and empathy as active listeners, not as experts trying to fix a person's problems. Empathic responding involves listening and reflecting with true concern about a person's feelings and perceived needs
How are complementary and integrative approaches relevant to neurogenic disorders of language and cognition
Wellness is an essential concern in our work, and promoting healthful living for the prevention of neurological disorders and for lessening their impacts on life participation is a critical aspect of our role as advocates
What is the status of cueing hierarchies for the treatment of anomia in terms of evidence-based practice
When we work on naming, people get better at naming the items practiced. Sometimes people get better at naming items we did not use in the training, but mostly they get better at the words used in treatment. Transfer of gains to untrained words is typically weak. This finding highlights the importance of the using words that are personally relevant to the individual. Complementing this finding, there is evidence that people achieve greater carryover to real-word contexts when personally relevant words are used in treatment. Generalization from naming practice to natural conversation using only a cueing hierarchy approach is limited
SpeechBite
a free online, searchable data-base of intervention studies relation to speech-pathology, along with rating of research quality for each study
What is cognitive rehabilitation
a general term often used to encompass intervention to facilitate cognitive-communicative recovery following TBI
Integrative approach is
a holistic health focus (e.g., integration of body and mind, which are seen as intertwined, inseparable entities. The combination (integration) of complementary and allopathic medical approaches into mainstream healthcare and health promotion programs
Effect size
a statistical measure degree of likelihood that a treatment will be beneficial or harmful
Randomized control trial
a trial in which participants who meet explicit selection criteria are assigned randomly to treatment and control groups, often conducted across multiple sites
Stimulation facilitation approach suggest that Aphasia is
a unidimensional disorder
According to the stimulation facilitation approach
all people with aphasia tend to have at least some difficulty with auditory comprehension
What is Back to the Drawing Board (BDB)
an approach much like CDP intended for use with people with severe aphasia
RTI is Classified as
an errorless learning method
The Savvy Caregiver Program (SCP) is
an example of a caregiver training program that is focused on mediating caregiver stress through improved interactions with people who have dementia
Cochrane Collaboration
an international network of scholars, professionals, and consumers established to help consider the evidence base that supports any area of health-related intervention
What is Supported communication
an unspecified method or philosophy and set of tenets and strategies. Communication support is defined as "anything that improves access to or participation in communication, events or activities" (King, Simmons-Mackie, & Beukelman, 2013, p.9).
What approach helps attend to behavioral challenges that impede successful interactions?
antecdent-based behavior management
PACE was developed for people with
aphasia, primarily those with word-finding challenges. May be used with people who have goals related to turn-taking and other aspects of pragmatics, and goals related to any of myriad expressive and receptive linguistic abilities.
What is Voluntary Control of Involuntary Utterances (VCIU)
approach designed to improve expressive, propositional communication in people with severe nonfluent aphasia whose speech is limited to automatic production of few words.
What is Anagram and Copy Treatment (ACT)
approach for people with dyslexia who especially have difficulty at the level of the graphemic output lexicon and graphemic buffer. ACT may be especially useful for those who have limited oral language and speech output (e.g., people with Broca's aphasia and apraxia of speech) because writing is an important compensatory mode of communication. As with CART, good candidates for ACT have good visual recognition and graphomotor ability (the physical ability to write) ACT is based on the use of anagrams, which are scrambled sequences of letters
How might SLPs support people considering complementary and alternative approaches to
cognitive-communicative wellness, Stay within your scope of practice. Engage only in methods you are trained and competent to carry out. Emphasize complementary over alternative approaches to direct intervention for speech, language, and cognition. Keep an open, non-judgmental attitude and appreciate multicultural differences. Encourage caution when counseling people considering alternative and complementary approaches (e.g., The effectiveness of using hyperbaric oxygen therapy)
Impaired long-term potentiation (LTP) may be a primary cause of
cognitive-linguistic decline in Alzheimer's disease and other forms of dementia
Promoting Aphasics' Communicative Effectiveness is a
compensatory approach
What is the status of the CDP in terms of evidence-based practice
controlled studies are lacking. Enhances accuracy of drawing for conveying of content leading to enhanced communication. important to take individual preferences into account
The likelihood of benefit of treatment to an individual under average conditions
effectiveness
The likelihood of benefit from a given treatment for a defined population under ideal conditions
efficacy
An index of productivity or how much can be gained with a minimum of expense, time, and effort. Important in comparing two or more treatments that have been found to be efficacious
efficiency
What is the Problem Solving Approach
entails teaching the client with dysgraphia to implement strategies that help facilitate spelling
Proximal limb VAT focuses
extremities closer to the torso, such as arms and legs, relates to gross motor skills (e.g., hitting a desk with a gavel)
Distal Limb VAT (DL VAT) involves
extremities farther away from the torso, such as fingers and toes and relates to fine motor skills (e.g., dialing a telephone)
Bucco-facial VAT (B/F VAT) incorporates
facial gestures (e.g., drinking form a straw)
There are several types of treatment groups that meet to
facilitate recovery, learn coping strategies, be involved in information sharing, get/give social support
What is Melodic Intonation Therapy (MIT)
facilitating spoken language through the exaggeration of three elements of spoken language prosody: pitch, the tempo and rhythm of utterances, and stress for emphasis. Variation of spoken pitch is reduced and made more constant or monotonic. Tempo is slowed down so that the utterance is lyrical in nature. Stress is exaggerated for emphasis using pitch and volume changes. Speaking tasks are gradually increased in length and complexity as treatment progresses in a hierarchical fashion, starting with shorter, easier speaking tasks and ending in longer and more grammatically complex utterances. MIT is intended for people with severely limited oral expression, especially people with Broca's aphasia (with or without apraxia of speech)
On what principles is MIT based
functions associated with the intact right hemisphere might be tapped to improve the language functions of a damaged left hemisphere
Memory book and wallet are generally used with people who
have memory loss. People with language of generalized intellectual impairment. People with memory loss associated with TBI
Cognitivie rehabilitation may be focused on
impairment or life participation
What is Copy and Recall Treatment (CART)
impairment-focused stimulation method that entails repeated writing practice through a progression of singe-word writing tasks. It has also been called delayed-copy treatment Because it involves progressively taking away written examples.
RTI targets
implicit memory, Unconscious and involuntary memory. Considered to be relatively robust in people with memory disorders associated with TBI and various forms of dementia
What is Verb Network Strengthening Treatment (VNeST)?
improve verb retrieval through enhanced activation of semantic and grammatical or relational aspects of verbs (the verb network) the goal is to help the client generalize the ability to produce verbs within sentences, and ideally to carry this over to discourse contexts. The approach was developed to address challenges with the single-word focus of SFA. Nouns as well as verbs are the focus of treatment stimuli and activities
How is MIT implemented
in a hierarchy of increasing difficulty that consists of four levels, each with different steps. The recommended frequency of intervention is two 30-minutes sessions daily, five days per week. The recommended criterion for progression from one level to the next is 90% or better accuracy for ten consecutive therapy sessions. If a failure occurs on a step, even when a trial is repeated from the previous step, then that utterance is to be discontinued.
SFA is a restitutive approach in that
it has been shown to enhance recruitment of activation of left hemisphere areas
VAT May be considered a compensatory approach because
it is used to support an alternative modality for expressive communication
The merging of cognitive-neuropsychological approaches with social and life participation approaches is
key to clinical excellence
What is the status of BDB in terms of evidence-based practice
limited
SFA is also a compensatory approach because
one of the long-term aims of SFA treatment is to help people with dysnomia learn to cue themselves independently and in natural everyday conversational contexts to produce target words
An index of change as a result of time, intervention, or both that encompasses efficacy, effectiveness, and efficiency
outcome
What are optimal candidates for TAP
people with aphasia who have at least moderately intact comprehension, good memory, and moderate to severe recurrent perseveration
Who is script training intended for
people with aphasia who have limited expressive language
Discovery phase
phase I of Robey and Schultz five-phase outcome research model in which investigators develop hypotheses about treatment, estimate the optimal treatment intensity, and specify the population to benefit from treatment.
Optimizing Phase
phase II of robey and schultz five phase outcome research model in which hypothesis are refined, a rationale for the treatment method is specified, the selection criteria for participatns are explicitly detailed, and the reatment protocol is standardized
Efficacy test phase
phase III of robey and schultz five phase outcome research model which involves testing of a treatment method developed between phases I and II with large samples of people who represent the target population in a randomized control trial.
Effectiveness test phase
phase IV of robey and schultz five phase outcome research model in which the effects of a treament arleady stduied in phase III are studied under average clinical conditions
Effectiveness and efficiency test phase
phase v of robey and schultz five phase outcome research model, in which time allocation and cost are studied along with satisfaction and quality of life indices in large samples of individuals treated as well as significant others and caregivers
How do we promote a positive outlook without conveying a Pollyanna attitude
positive psychology and empowering attitude is central to being a positive presence. It does not mean that we act as if all is fine and well.
What is VAT used for
promote the use of symbolic gestures to communicate when language expression is severely impaired Geared toward fostering the use of symbolic gestures for stimuli that are not visually present
Which RTI approach is featured in most of the relevant published literature
randomized-interval/adjusted approach
Alternative Approaches are
recommended in place of common Western medical approaches aka, Allopathic approaches, which most often target specific bodily systems or disease states
How does the excellent clinician apply evidence-based practice?
repeated hypothesis generation data collection analysis interpretations action planning
What is the status of the Problem Solving Approach in terms of evidence-based practice
reported significant improvements in spelling when the problem-solving approach was used for 10 weeks with each of two people who had spelling impairments following stroke
Cognitive rehabilitation may be
restitutive and/or compensatory
Semantic Feature Analysis is a
restitutive approach
Stimulation facilitation is a __________ approach
restitutive approach
MIT is
restitutive in terms of the goal to foster brain changes to enhance speech output and prosody but may also be considered compensatory in that a person may learn to use melody and rhythmic patterns to facilitate his or her own speech
VAT May be also considered restitutive because
studies have shown that stimulation provided in VAT enhances brain activity
What is the goal in PACE exchanges
successful communication, not accuracy of phonology, morphology, syntax, and not necessarily success through any particular mode of communication
"Strategies, material, or resources" used by the person with the language disorder and anyone communicating with him or her is known as:
supported communication
"Supportive attitudes that foster communicative participation"
supported communication
Modifications to the person's environment or activities is known as:
supported communication
What is transcranial magnetic stimulation
surgical procedure that reduces diaschisis through activation of areas that are intact but have ceased to function normally. It helps inhibit over-activation of right-hemisphere homologues of damaged left-hemisphere brain regions specialized for language
Complementary Approaches are ones
that do not replace allopathic medical approaches, but rather ones that are used in conjunction with them. Also called adjunct or adjuvant approaches
On what principles is CART based
that repeated attempts to accurately spell target words assist in activating the words' graphemic representations
In Response Elaboration Training a forward-chaining technique is implemented in which
the clinician responds directly to anything the client says, and models and reinforces longer utterances based on client-initiated utterances. Successful communication of novel ideas is encouraged rather than accuracy of production
What two approaches focus on functional communication in patients with aphasia
the cueing hierrachy approach the life participation approach to aphasia
Readability
the degree of ease or difficulty of comprehending written text
What is treatment fidelity
the degree to which an intervention method is administered, In a reliable way and In accordance with a specific protocol
Legibility
the ease or difficulty of identifying printed letters, numbers, characters
In general, more intense intervention leads to
the greatest brain changes as well as the greatest functional abilities
MIT targets speech output at
the impairment level
On what principles is SFA treatment based
the spreading activation theory of semantic processing that states by activating the semantic network surrounding a target word, the target word may be activated above its threshold, thereby facilitating retrieval. When the sematic network involved in representing a certain concept is activated, an individual is more likely to be able to produce the target word. Even access to non-target words may be facilitated by enhancing semantic activation of related concepts.
In people with neurological disorders, if intensity exceeds one's ability to attend and participate actively, or if it leads a person to tire of or resist treatment
then it is no longer beneficial
Who are good candidates for CART
those who have good visual recognition abilities and the ability to write letters (graphomotor abilities)
What is the goal of MIT
to draw on the prosodic features of language to facilitate verbal output
What is the goal of writing-specific treatment
to help a person independently and effectively communicate information (convey requests and protests, ask and answer questions, and relay personal information) through writing.
What is the goal of reading-specific treatment
to help a person independently and effectively comprehend information in the written modality
Non-traditional approach refers
to non-allopathic approaches, may represent traditional approaches (e.g., Chinese and Ayurvedic medicine)
What is the goal of script training
to produce relatively fluent speech and natural language production in socially meaningful contexts, may be considered to be impairment-focused It also fits within a social and life participation model because it entails use of trained scripts in actual real-life communicative contexts.
What is the the goal of FOCUSED
to promote the best quality of interactions, and thus quality of life, with people who have dementia
What is the purpose of VCIU
to stimulate the use of propositional language in individuals who mainly use involuntary utterances, but who are able to read and comprehend at least one word at a time. The clinician uses the client's current automatic utterances as a starting point for therapy
In general, more intense intervention leads
to the greatest brain changes as well as the greatest functional abilities
PACE may be considered a
total communication approach
Cognitive rehabilitiation may include
training, teaching, coaching, modelling, behavior modification programming, and/or counselling
What is Response Elaboration Training (RET)?
used as a means of increasing the length and improving the information content of oral language of people with Broca's or "nonfluent" aphasia. In contrast to more formalized methods, during RET the client is seen as the primary communicator, and client-initiated topics are encouraged
What strategies are used in the problem solving approach
writing partially correct responses, self-correction, making sound-to-letter correspondences, and using an electronic speller or tablet/smartphone app to obtain alternatives when the client is unsure about a spelling