Acquired language Disorders aphasia…and

important ideas about aphasia …is a symbolic disruption …is acquired …involves any or all language modalities comprehension: auditory, reading, signed/visual expression: oral, writing, signed/manual …is not a problem of sensation or intellect

Common causes of aphasia CVA TBI tumors infections epilepsy Over 1,000,000 individuals with the US have aphasia - National Aphasia Association

describing aphasia various impairments in any/all language modalities the most commonly observed deficits are in naming and auditory processing generally describe an the language profile as: fluent/receptive; nonfluent/expressive; or severe or global Hegde (1998); Brookshire (1997)

General symptoms: Impairments impacting language use include: impaired auditory comprehension anomia: word retrieval/naming difficulty paraphasias: word or sound substitutions agrammatism: asyntactic production (or reduced syntax) reading and writing disruptions Bid idea: aphasia treatment focuses on the specific deficit, not the “type” of aphasia

the WHO ICF Functioning and Disability Contextual Factors body functions and structures activity and participation Contextual Factors environmental factors personal factors

Treatment and assessment - Linking the WHO ICF restorative/process oriented approaches – impairment (body structure/function) approaches aimed at improving underlying motor or cognitive processes, resulting in generalized improvement in function skills based/compensory approaches – activity/participation approaches that train a new skill/behavior -or- alternative method for communicating however…the distinction of restorative vs. skills based not so clear participation focused approaches – participation approaches focused on improved community participation and quality of life

Response Elaboration Treatment (RET) Semantic Feature Analysis (SFA) Treatment examples Response Elaboration Treatment (RET) Semantic Feature Analysis (SFA)

response elaboration training (RET) client profile: variety of aphasia profiles and severities; reduced semantic and/or syntactic content/form result in limited oral expression target: oral discourse  increased content units and length of utterance rationale: combining behavioral techniques of modeling and forward chaining with cognitive stimulation using loose training results in expanded oral expressive output loose training - uses the client’s response as stimulus

RET Protocol: uses simple line drawings important: used modified RET (mRET) for clients with significant apraxia

measurement in session data: outcome measures: content: number of information units produced (steps 1 and 6) - may vary based on severity of client possibly grammatical production: number of morphemes, nouns, verbs, and modifiers outcome measures: increased MLU in language sample, everyday conversation measure of impact (e.g., questionnaire, GAS)

Semantic Feature Analysis (SFA) client profile: semantic impairment resulting in naming deficit; moderate to severe deficits cause significant difficulty in everyday conversation errors include semantic substitutions and failure to name (anomia) may have a broader semantic deficit target: naming increased content in everyday language; increased ability to say relevant words rationale: based on concepts of semantic nodes and spreading activation - SFA activates the semantic network around the target word, which may a) increase the likelihood the target can be retrieved, and/or b) strengthen the semantic network (Boyle and Coehlo ,1995)

RET protocol: client is shown a picture, asked to name it, then describes it using semantic feature chart example cues: “you use it for…”, “it’s found in…” client generates responses and writes answers in boxes around picture

measurement in session data: outcome measures number of words named without cues (1 step of protocol) notes regarding task performance use a modified SOAP note (current and last session data) and report accuracy on on each set use information about performance that you collected to assess performance variables (e.g., does she always need help with a particular feature? Does it vary?) outcome measures impairment: Boston Naming Test; conversational sample; untrained word probes activity/participation: self report of increased naming (e.g., fewer communication repairs needed with partner; efficiency; successful phone call, etc.)

important ideas always consider your session data and outcome measurement as separate measures - it is not sufficient to see improvement only on treatment tasks and measure the real life impact, not just increased accuracy on a test given client goals, tailor your treatment to the client’s deficit or desired change Karen can give you information about a variety of interventions - drop by!