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Tuesday, December 12, 2006

Newsletter Vol.5 Nov./Dec. 2006


aphasiatoolbox.com
Newsletter Vol.5 Nov./Dec. 2006
Tip of the Month
Patience is a sometimes misunderstood virtue.  When we at the Aphasia Center of Innovative Treatment define patience, we consider it to be within the context of the process of improvement.  This simply means that an aphasia patient and caregiver must be patient in understanding that the process takes time to work properly.  It most emphatically does NOT mean that the aphasia patient and caregiver should be passive during periods of little or no progress.  On the contrary, both the aphasia patient and caregiver must always and every day aggressively work the protocols and materials dictated by their progress.  It is time consuming, difficult, and demands a daily dedication to the process, but with patience and an understanding that the eventual goal of a New Normal Level of Communication is achievable, plateaus will be busted and progress will be made.
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Support Group of the Month 
Our Support Group of the Month is the Coffee and Conversation Group at The Stroke Center at North Memorial in Minneapolis, MN.  The Stroke Center has been providing specialized programming for patients with aphasia since 2000.  They offer three programs: Speak Easy ( a ten week class for stroke survivors with aphasia and their friends/family), The Intense Aphasia Program (3 1/2 hours of therapy per day for three weeks), and Coffee and Conversation.  The Coffee and Conversation Group meets each Monday morning from 10-11:00 am and is run by volunteers who are stroke survivors with aphasia.  Most people in the group have been participants in Speak Easy or the Intense Aphasia Program.  While caregivers occasionally participate, each Monday 8-15 members of this group get together in a social setting to maintain their relationships and camaraderie.  Topics of conversation at the Coffee and Conversation Support Group reflect the wide range of interests of the members and give them an excellent opportunity to continually practice what they have learned in therapy.
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 Patient of the Month
This month we are featuring Gail Becker, a member of the Coffee and Conversation Group.  She suffered a stroke in November, 2005.  Since that time she has diligently sought every opportunity to maximize her recovery.  With some initial assistance from her ex-husband they sought services from The Stroke Center and North Memorial when they were not pleased with the therapy she was receiving.  Not only has she never missed a single therapy session in a year, she has NEVER failed to return a home assignment!   She participated in Speak Easy and successfully spoke to the group for the Spring Social in May, 2006.  She has participated in the Intense Aphasia Program twice and also attends Coffee and Conversation.  On top of all that, she has proven that she can live independently using e-mails and a telephone assistance program for correspondence.  She consistently demonstrates a humble and optimistic attitude, which has helped in her progress from moderately/severe to mild Wernickes aphasia in under a year.  Gail plainly demonstrates the kind of aggressive patience that drives successful patients forward.
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Description of Simply Smart Aphasia Therapy (SSAT)
By now, those of you who have read one or more of our monthly newsletters realize that Simply Smart Aphasia Therapy is neither a simple nor simplistic approach to the treatment of aphasia.  While the protocols are written to be as easily understandable by laypeople as we can make them and the materials are built to be flexible and able to cover a multitude of specific treatment situations, the continual practice and the single-minded focus demanded for successfully reaching an aphasia patient’s New Normal Level of Communication can be daunting.  This is why the virtue of patience while working through the process is so necessary.  It is easy to understand why some aphasia patients and/or their caregivers reach a point in the rehabilitation process where they want to throw up their hands and say either “I have achieved as much as I can and I should be happy to be at this point,” or “I give up.  I will never be able to speak conversationally again.” Neither of these statements needs to be accepted as a truism.  In fact, if an aphasia patient and, perhaps more importantly, their caregiver is determined, committed, energetic, and willing to be patient, there is no reason why a person suffering from aphasia can’t in time reach their New Normal Level of Communication.  This will in turn allow the aphasia patient to interact in an understandable manner with those around them as they develop the necessary tools.

When both the aphasia patient and their caregiver reach a point where progress can be seen and measured, it becomes easier to re-discover the virtue of patience and understand the powerful role that aggressive patience plays in the process of continual progress toward your goal.
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Free SSAT Treatment Protocol Sample (will be available at aphasiatoolbox.com)
This protocol description is part of the Simply Smart Aphasia Therapy program.
To learn how to make optimal use of any protocol, visit aphasiatoolbox.com 

Protocol:  Words of Increasing Syllables.    This is one of our most versatile and useful protocols; one that facilitates aggressive patient practice. We find it of special importance as there appear to be so few protocols and sets of materials designed to work on the phonological disturbances that so very often are a difficult part of aphasia.  ”The production of spoken words requires the translation of meaning into sounds” is the opening sentence in a paper by Ruth Herbert and Wendy Best at the 2005 Clinical Aphasiology Conference.  We could not agree more.  If the patient’s difficulties in accessing and utilizing his/her language’s sound system are not effectively addressed, chances of recovery to new normal levels will be poor.  It has been our experience that therapy activities that make use of imitation and external cueing are not effective in remediating this type of problem.  The use of well-designed stimulus materials (in this case word lists such as the Increasing Syllable Practice Materials) is absolutely crucial.

Behavioral Objective:
The patient will self-generate verbally out loud (say), from his/her verbal working memory, a series of three words that increase in length from one, to two, to three syllables in length.   Each of these stimuli words are real words.  These words may maintain root meaning and may vary derivationally (please, pleasing, pleasingly) or may change root meaning (rash, ration, rational).  [This is also an excellent exercise for English as a Second Language clients, apraxic and dysarthric patients, and those with phonological aphasia].  This protocol uses the Increasing Syllable Practice Materials and the Increasing Syllable Demonstration Videos on aphasiatoolbox.com.  

Targeted Mental Processes:
Syllabification (awareness of syllable structure, rhythm and count); lexeme activation; lexical to phonological area interaction (feed forward – feed backward); task focus to task shift; verbal working memory; turn taking; truly listening; phonological access and assembly, phonological memory and retrieval; using prosody to facilitate word flow; phonological judgment and discrimination; improved co-articulation awareness and skills.

Easy Step-By-Step Directions (in parenthesis is what the patient actually says out loud):

The caregiver/therapy assistant/speech therapist says the first word in normal speech pattern at a moderate rate with normal prosodic (pitch, intonation, melody) features.  The caregiver/therapy assistant/speech therapist encourages any production; at first accepting and supporting the patient’s use of self-generated attempts and gradually shifting the patient toward more normal prosody and rhythm . Use a hand gesture if necessary to ensure a pause in the patient’s response (“please”).

  1. The patient says the first, 1-syllable word aloud after mentally rehearsing (in order to facilitate use of new normal pathway and avoid overuse of imitative/repetitious pathway) (“please”)
  2. The caregiver/therapy assistant/speech therapist says the second word in normal speech pattern; moderate rate with normal prosodic features.  (“pleasing”)
  3. The patient says the second, 2-syllable word aloud after mentally rehearsing (in order to facilitate use of new normal pathway and avoid overuse of imitative/repetitious pathway) (“pleasing”)
  4. The caregiver/therapy assistant/speech therapist says the third word in normal speech pattern; moderate rate with normal prosodic features. (“pleasingly”)
  5. The patient says the third, 3-syllabel word aloud after mentally rehearsing (in order to facilitate use of new normal pathway and avoid overuse of imitative/repetitious pathway) (“pleasingly”)
  6. The caregiver/therapy assistant/speech therapist advances this saying the first two words increasing demands on the patient’s verbal memory. (“please, pleasing”)
  7. The patient says the first two words aloud after mentally rehearsing. (“please, pleasing”)
  8. The caregiver/therapy assistant/speech therapist advances this saying all three words increasing demands on the patient’s verbal memory. (“please, pleasing, pleasingly”)
  9. The patient says the fall three words aloud after mentally rehearsing. (“please, pleasing, pleasingly”)

Other tips and suggestions for innovative and helpful use of this protocol will be available at aphasiatoolbox.com.

Horizontal Tweaking:  use attention training techniques (; practice from memory; provide printed stimuli; expose one word at a time; encourage independent production; have patient use text reader software for independent say aloud practice and self correction; drill in cumulative cyclical manner;.

Vertical Stepping:  work at one and two word level for a while; use in sentences or phrases; stimuli can be increased to four syllable words (in; increase, increasing, increasingly).

Copyright © 2005-2006 William A. Connors, M.A., CCC. 
All rights reserved.
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Quote of the Month
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“Let us then be up and doing, with a heart for any fate; still achieving, still pursuing, learn to labor and to wait.”  Henry Wadsworth Longfellow.  Henry Wadsworth Longfellow is one of the greatest poets and writers in American Literature.  Though not read very much anymore other than in English Literature classes, he was a literary giant of his time.  Our quote of the month expresses at once the joy of working toward a worthy goal and the patience necessary to achieve it.  It is important to be patient in working toward a New Normal Level of Communication for the person with aphasia, but it is important to be aggressive and hardworking in your patience.

Will you dare to work with aggressive patience to be an aphasia plateau buster?
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aphasiatoolbox.com update
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At the Aphasia Center of Innovative Treatment, we continue to make progress in the design and development of our website, aphasiatoolbox.com.  We are at the stage where we are actively loading protocols, materials, and videos.  We are also finalizing the administrative backend of our website so that, hopefully, all on-line and behind-the-scenes procedures will work flawlessly.  Stay tuned.

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Bill Connor’s Scheduled Public Events
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Sat. 1/06/07 9:30 a.m.–11:00 a.m. 

The monthly meeting of the Aphasia Support Group of Western PA will be held with a focus on the multiple reasons why physical activity and training are so important for people with aphasia (and all of us actually).  Several experts will discuss innovative and effective physical/occupational therapy and physical exercise training.  Several members and caregivers will discuss how continued effort and smart exercise have helped them move beyond what was expected of them.  The meeting location has yet to be determined.
Sat. 2/03/07 11:30 a.m.-1:00 p.m.
Bill Connors, Chuck Hobbs, ACIT’s Director of Operations, and Joe Miller, ACIT's Director of Information Technology, will lead the second meeting of the Pittsburgh Aphasia Information Technology Club.  The meeting location has yet to be determined.  The goal of the group is to share, teach and create ideas about how information technology may assist our efforts in improving the speech and communication skills of people with aphasia and its related reading, writing and speech problems.  The first meeting’s focus was on the identification and utilization of innovative technological resources. Numerous resources, tips and ideas were discussed and disseminated. Minutes of the first meeting will be available at www.aphasiatoolbox.com.
August 17 and 18, 2007: 

Bill will present at The Stroke Survivors Association of Ottawa’s second Stroke Recovery Conference at the Hampton Inn and Conference Center in Ottawa, Canada   http://www.strokeconference.ca/. The conference highlights best practice and management of stroke in the community by featuring talks by leading researchers as part of the ongoing effort to empower people with stroke and their families to manage better.
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We Want To Hear From You
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To nominate a support group for our “Support Group of the Month,” simply send us the name of the group, some background information, and contact information to:
information@aphasiatoolbox.com.

We select a Patient of the Month from among the members of our Support Group of the Month.  To nominate a Patient of the Month, simply send the information to:
information@aphasiatoolbox.com.

If you know of someone who would like to receive our newsletter, they can sign up at www.aphasiatoolbox.com

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New Blog!
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There is a new blog concerning the International Classification of Funtioning, Disabilty and Health (ICF) and Communications Disorders.  To view the blog go to http://icf.blogs.com.
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New Newsletter Format
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Tell us what you think of the new format! information@aphasiatoolbox.com
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Copyright © 2004 – 2006 ACIT
All Rights Reserved
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© 2006 Aphasia Center of Innovative Treatment
Newsletter Vol.5 Nov./Dec. 2006SocialTwist Tell-a-Friend

Monday, November 6, 2006

October 2006 Newsletter

Aphasiatoolbox.com
October 2006 Newsletter
Quote of the Month
“Retreat?  We’re coming out of here as a Marine division.  We’re bringing our equipment… our wounded… our dead.  Retreat, hell!  We’re just advancing in another direction.”  General Oliver Prince Smith.  It was the bleak and bloody months in 1950 of the United States’ military involvement in the Korean War.  Significantly outnumbered and battered by North Korean and Chinese troops, the United States Marines staged one of the most well-organized and disciplined retreats in military history.  How did they do this?  As General Smith suggests, they did it by pro-actively seizing control of their situation and moving aggressively to control what they could.  Being pro-active in response to your reality frequently brings order from chaos and progress to overcome your difficulties. 

Will you dare to work pro-actively to be an aphasia plateau buster?
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Support Group of the Month 
The Support Group featured this month is Marymount Manhattan College After Care Group.  This group was formed in January, 2005.  They meet every Tuesday at 1:30pm at the Marymount Manhattan College Ruth Smadbeck Center for Communication and Learning, an undergraduate program for Speech Pathology students.  The meetings are conducted by senior undergraduate speech pathology students and are supervised by  
Linda Carozza, Ph.D., CCC-SLP, Director of the Ruth Smadbeck Communication and Learning Center, Department of Communication Sciences and Disorders, Marymount Manhattan College. They have approximately six members at any given time who come with family and/or caregivers.  The members are of all ages, know each other, and work together well.  The format is discussion centered and topics are generated by members. Each person participates at his/her communications skill level.  Therapists use supported conversation - style techniques.   A recent topic was Advocacy through the Arts, which involved a creative arts project. 

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 Patient of the Month
Our Patient of the Month this month is Delores, known simply as DT, from the Marymount Manhattan College After Care Group.  Delores is a woman of boundless energy and determination; beloved by her children and grandchildren, who lives alone, compensates very effectively for her aphasia, and is well known in her community.  Delores was the group’s first, founding member
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Description of Simply Smart Aphasia Therapy (SSAT)
When analyzing the many reasons why the Aphasia Center for Innovative Treatment approach of Simply Smart Aphasia Therapy works, one theme that stands out time and again is that SSAT both fosters and commands a pro-active approach to aphasia treatment.  By its very nature, SSAT from the outset demands the active participation of both patient and caregiver.  If a passive approach is used with SSAT, or for that matter any other therapy, the treatment will never achieve all that can be achieved with a pro-active approach.  Therefore, SSAT was developed so that both patient and caregiver are actively involved, with or without a therapist, in defining the specific communication problem affecting each individual patient.  Both patient and caregiver are actively involved in determining the optimal SSAT protocol for addressing the specific problem.  Both then play vital roles in working with and expanding the materials supplied for each protocol.  The patient and caregiver are challenged to both (1) continually study the protocols for new directions of growth and (2) discipline their use of time to provide for the aggressive application of protocols and materials.

Simply Smart Aphasia Therapy works to support a pro-active approach by the patient, caregiver, and therapist at all times in a number of ways.  The SSAT protocols have been written so that a number of SSAT materials can be used within the framework of any given protocol.  Vertical Stepping and Horizontal Tweaking both allow for and challenge the patient, caregiver, and therapist to aggressively expand the value of the protocol and the use of the material.  The SSAT material has been developed so that it can be creatively added to and revised as the patient progresses from one level of recovery and success to the next.  Finally, the entire SSAT approach begs for active and creative participation by the patient, caregiver, and therapist.

When this becomes a daily pattern of therapy, the pro-activity and the aggressive creativity and discipline demanded by the SSAT approach will work.
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Free SSAT Treatment Protocol Sample (will be available at aphasiatoolbox.com)
This protocol description is part of the Simply Smart Aphasia Therapy program.
To learn how to make optimal use of any protocol, visit aphasiatoolbox.com 
Traditional aphasia therapy has been based on a plan of treatment that attempts to identify a particular level at which a patient begins to experience difficulty with a speech or language task.  The therapist then proceeds to offer assistance, modeling or cueing until the patient is able to either complete the task or modify if the patient fails.  The task is then made just a little more difficult until a final objective is achieved.  For example, if a patient scores 65% on a matching picture to printed word task, therapy would begin there and then have a focus to move toward 90% accuracy.  
 This type of narrow, external to the patient controlled therapeutic focus has given way to broader, more sophisticated approaches that better make use of both the tremendous potential of the human brain to reorganize and the more up to date information currently available on human learning.  One practical case in point is some of the work done by Thompson, Shapiro and others at Northwestern University and supported by the National Institute of Health in which they challenge the notion that aphasia therapy should use simple language structures for practice.  They have found that using more complex sentences results in better and more efficient language improvement.  We agree and have found that methods like this that SSAT employs also results in saving time as less complex phrases and sentences improve as a result of the approach with less direct training.  It also facilitates the third C of effective aphasia practice of the SSAT program in that patients appear to use the newly learned skills in everyday life right away.

 Vertical Stepping then provides ways to gradually or quickly increase the difficulty or complexity of an activity by increasing the nature of the stimuli.  There is a clear step up in linguistic complexity or word frequency/abstraction.  An example from our previous Crossword Puzzle Protocol (Volume 2) would be using puzzles that are more difficult (for example, progressing from the adult-common word News For You to the daily newspaper easy puzzle).

 Horizontal Tweaking allows for responsive and fluid, in-line changes during therapy or practice sessions.  This can be useful as patients may make quicker than expected progress and simple goals would slow them down inadvertently.  An example of tweaking would be adding words, time concepts and/or conjugation linking horizontally during the Right-branching Conjugation Protocol (I; I am; I am leaving, I am leaving soon for home.) drilled through all the subject pronouns.
Resourceful use of the ideas presented in this section will transform one protocol into many protocols.  Using this information will also expedite patient progress by providing techniques to smooth out incremental patient progress or to take advantage of rapid spurts in patient progress.  We do not view therapy as a narrow band of one dimensional treatment activities designed to slowly teach isolated behaviors.  Our image is more of the sound engineer’s board with numerous knobs, switches and buttons.   These need to be manipulated correctly by the patient to achieve successful New Normal cognitive speech communication.  In other words, work smarter, not harder, since as Wolfgang von Goethe observed, “Nothing is worse than active ignorance.” Copyright © 2005-2006 William A. Connors, M.A., CCC.  All rights reserved.
Body Content
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Tip of the Month
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We shared with our readers in our first three ACIT newsletters some intangible variables that are critical to the process of recovering from aphasia.  This month the focus is on the need of the patient, caregiver, and any therapist or other medical professional involved to be pro-active.  What this means is that the patient should always, on a daily basis, aggressively push themselves to continue to learn and grow and stimulate the brain’s communication pathways.  The caregiver should always, on a daily basis, aggressively search for new ways to challenge the patient and, with patience and understanding, push the patient to exceed whatever level has been reached.  The therapist or other medical professional should always be impatient with the status quo.
Rather than passively accepting ineffective or dated treatment methodology and research, he/she should continually be pro-active in searching to expand his/her knowledge and understanding with exposure to new research, with new ways of thinking about aphasia, and with creative ways to build upon protocols and materials in use.

Overcoming the communications difficulties engendered by aphasia could well be the most difficult task faced by an aphasia patient.  These difficulties rarely fade on their own account or disappear over time.  To be conquered, they must be faced squarely and dealt with in an aggressive, pro-active manner.

 
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Aphasiatoolbox.com Update
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At the Aphasia Center of Innovative Treatment, we continue to make progress in the design and development of our website, aphasiatoolbox.com.  We are at the stage where we are actively loading protocols, materials, and videos.  We are also finalizing the administrative backend of our website so that, hopefully, all on-line and behind-the-scenes procedures will work flawlessly.  Stay tuned.

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Bill Connor’s Scheduled Public Events
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Thursday, 11/02/06: 10:00am – Noon:  Bill will facilitate the monthly meeting of the Aphasia Support Group of Western Pennsylvania at Panera’s Bread, Cranberry Township, Pennsylvania
 Saturday, 11/11/06: 9:30 a.m. – 12:30 p.m.  Bill and Joe Miller, ACIT’s Information Technology Director will lead the initial meeting of the Pittsburgh Aphasia Information Technology Club at the Holiday Inn McKnight Road across from Ross Park Mall in Pittsburgh, PA.  The goal of the group is to share, teach and create ideas about how information technology may assist our efforts in improving the speech and communication skills of people with aphasia and its related reading and writing problems.  Our focus will be on identification and utilization of innovative technological resources. 
August 17 and 18, 2007:  Bill will present at The Stroke Survivors Association of Ottawa’s second Stroke Recovery Conference at the Hampton Inn and Conference Center in Ottawa ( http://www.strokeconference.ca/ ).  The conference highlights best practice and management of stroke in the community by featuring talks by leading researchers as part of the ongoing effort to empower people with stroke and their families to manage better.
 
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We Want To Hear From You
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To nominate a support group for our “Support Group of the Month,” simply send us the name of the group, some background information, and contact information to information@aphasiatoolbox.com.

We select a Patient of the Month from among the members of our Support Group of the Month.  To nominate a Patient of the Month, simply send the information to information@aphasiatoolbox.com.
Page Five

If you know of someone who would like to receive our newsletter, you or they can send us the correct contact information with the word “subscribe” to information@aphasiatoolbox.com.
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New Newsletter Format
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Tell us what you think! information@aphasiatoolbox.com
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© 2006 Aphasia Center of Innovative Treatment
October 2006 NewsletterSocialTwist Tell-a-Friend
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