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