Acquired language Disorders - PowerPoint Presentation

Slide1

Acquired language Disorders

aphasia…and

important ideas about aphasia

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

CVATBItumorsinfectionsepilepsyOver 1,000,000 individuals with the US have aphasia- National Aphasia Association

describing aphasia

Hegde (1998); Brookshire (1997)

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

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

the WHO ICF

Functioning and Disabilitybody functions and structuresactivity and participationContextual Factorsenvironmental factorspersonal 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 functionskills based/compensatory approaches – activity/participationapproaches that train a new skill/behavior -or- alternative method for communicatingparticipation focused approaches – participationapproaches focused on improved community participation and quality of life

except…

big picture

aphasia treatment targets the specific area of language or communication functioning impacted by aphasia

we do not treat by type of aphasia

the treatment should directly target the impacted area and/or your careful measurement shows the effect of treatment on the client’s stated goal

Treatment examples

CART – Copy and Recall Treatment

client profile

: individuals with lexical impairments in writing; unable to write single words reliably

target

: improved access to items in the written lexicon; improvement of trained words

dosage

: 1-2 times per week

rationale

: repeated copying of words retrains orthographic representations

CART protocol

this intervention can be in-session plus homework, or home program onlysession protocol - present picture; if they can not write the target:clinician hand writes word and client copies x 3clinician covers examples and client copies x 3; this step done three times

Clauson and Beeson, 2003

measurement

session data:

accurate written production of words without a model (independent on step 1)

reliable completion of homework

outcome measures:

increased use of trained words in everyday conversation/ communication contexts

increased perception of communication efficacy and/or QOL (self report/questionnaire; GAS)

response elaboration training (RET)

client profile

: individuals with reduced oral expression; variety of aphasia profiles and severities

target

: oral discourse



increased content units and length of utterance

dosage

: 2-3 times per week

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 drawingsimportant: use modified RET (mRET) for clients with significant apraxia, or CAAST for clients with goals in both areas

measurement

in session data:

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)