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Aphasia Therapy Guide

There are two general categories of therapies, and most clinicians utilize both:

Impairment-based therapies are aimed at improving language functions and consist of


procedures in which the clinician directly stimulates specific listening, speaking, reading and
writing skills.

Communication-based (also called consequence-based) therapies are intended to enhance


communication by any means and encourage support from caregivers. These therapies often
consist of more natural interactions involving real life communicative challenges.

Decisions about approach depend on an individuals needs and wishes. Therapy


for a very mild impairment is likely to differ from therapy for a very severe
impairment. Also, therapy changes over time as the person with aphasia
improves.
Impairment-based therapies
A person with aphasia initially wants to speak better and make sense of language
spoken by others. Therefore, speech-language pathologists attempt to repair
what is broken. Therapies focus an individuals attention on tasks that allow him
or her to comprehend and speak as successfully as possible. A therapy session
may be the only time of the day in which the mental mechanics of language are
exercised with minimal frustration.
Seemingly limited time with a therapist may be supplemented with homework
and computer programs. Computer software has been designed to exercise
word-finding, comprehension, and real life problems such as exchanging money.
Therapy time can be extended with professionally guided assistance from
caregivers.
Clinical researchers have been developing therapies focused on specific area of
language impairment such as retrieving verbs and formulating sentence
structure. One example of experimental treatment includes the use of a virtual
therapist speaking from a computer monitor. A great deal of clinical research has
gone into providing evidence for the effectiveness of impairment-based
therapies.

Communication-based therapies
Although someone with aphasia wants mostly to speak better, communication
may still be frustrating. Communication oriented treatments, in part, assist the
person in conveying messages and feelings with alternative means of
communicating. This orientation is also said to involve compensatory strategies.
In addition, an individual is encouraged to use any remaining language ability
that succeeds in conveying messages. Therefore, communication-based
activities continue to be partly language-based and are likely to incorporate
impairment-based objectives simultaneously.
Rehabilitation specialists are attending to the consequences of disability for
quality of life. Speech-language therapists are enlisting group activities to
facilitate a persons participation in daily life. We may hear these activities
referred to as social approaches or participation-based approaches. Methods
range from providing meaningful contexts within a rehabilitation facility to
venturing outside of such facilities. These methods may emphasize a return to
former activities and interactions, but also there are a few centers staffed by
volunteers which effectively create a new community for people with aphasia.
Examples of Specific Therapies
There are many names for aphasia therapies. Some represent slight variations of
fundamental procedures, and one could exaggerate by saying that there are as
many methods as there are therapists. However, certain methods are somewhat
unique and well-known, and clinical researchers are investigating new strategies
or new wrinkles for established strategies. The following presents a few
examples of specific therapies.
Impairment-based
Contstraint-induced therapy (CIT): This therapy is modeled after a physical
therapy for paralysis in which a patient is forced, for example, to use an
impaired side of the body, because the good side has been restricted or
constrained. In applying this principle to communication functions, a person with
aphasia may be constrained in using intact gesture in order to direct the
individual to use impaired spoken language.
A second, and perhaps more well-known, component of this treatment is that it is
more intensive than typical therapy schedules and it lasts for a relatively short
duration. For example, the therapy may be administered for three hours daily for

two weeks. Studies of CIT have been expanding beyond Germany and Houston,
but it is not yet covered by insurance.
Constraint-induced therapy is almost the opposite of compensatory strategies in
which the person with aphasia is encouraged to use intact abilities to
communicate. It is likely that a therapist will employ both approaches.
Melodic Intonation Therapy (MIT): Developed by Robert Sparks in Boston, MIT
is based on an observation that that some persons with aphasia sing it better
than saying it. The method is a series of steps in which an individual practices
an artificially melodic production of sentences. It has been recommended for
people with an expressive type of aphasia and good comprehension. We are
careful to watch for the individual who speaks much better with melodic
intonation but fails to carry this performance over to natural conversation.
Tele-rehabilitation: Established procedures are provided over the Internet with
web cameras so that the therapist and person with aphasia can see and hear
each other. Not yet widely available and not yet covered by Medicare, it is being
developed by William Connors in Pittsburgh.
Specific Communication-based methods
PACE therapy (Promoting Aphasics Communicative Effectiveness): This
procedure is a slight variation of the basic picture-naming drill, but the
adjustments introduce elements of conversation into the interaction These
adjustments include the person with aphasia and the therapist taking turns
conveying messages, pictures for messages hidden from the listener, and a free
choice of modalities for conveying messages. Developed by Jeanne Wilcox and
Albyn Davis in Memphis, it appears to have been popular in Europe where most
studies have been conducted.
Conversational coaching: Developed by Audrey Holland in Arizona, this
strategy aims at increasing commuunicative confidence through the practice of
scripted conversations. With assistance from Leora Cherney in Chicago, this
method has been integrated into a computer program. Called AphasiaScripts, it
includes a virtual therapist to provide help for the person with aphasia.
Supported conversation: Originated by Aura Kagan in Toronto, Canada,
supported conversation is a particular strategy for enhancing communicative
confidence that is commonly found in community support groups. Volunteers are
trained to engage in real conversations with persons who have aphasia. Similar

therapies have been described, called conversation therapy or scaffolded


conversations.
A General Comment
There are many other therapies, and most of the therapies mentioned are
continually being studied for their effectiveness. A speech-language pathologist
tailors a therapy program to the wishes and abilities of the individual client, also
considering the capacities of the rehabilitation facility and the availability of
caregiver support.
Click here for more about evaluating therapy and research claims.
Written by G. Albyn Davis, Ph.D., CCC-SLP (Feb 2011)

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