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Sunday, August 23, 2009

Third in a series of free, innovative treatment protocols

Free Treatment Protocol :  Triple Ms - Multiple Meaning Manipulation
No matter how old we are, our brains are, ".. flexible and capable of change.." and can respond to brain injury thanks to neuroplasticity  [ Journal of Speech, Language and Hearing Research Vol.51 s259-275 February 2008].  The key question is, "How can we maximize aphasia recovery?"
Words that have multiple meanings [ ] can be a great source of effective practice in aphasia therapy. Mentally activating various word meanings is an important element in aphasia treatment.   This can include words that have differing or similar meanings in noun and verb forms, for example squash [ a vegetable/to smash] vrs plate [ a dish/to put food on a dish]  [Brain and Language, Vol 95, Issue 2, Nov 2005, pages 293-303] .  This Multiple Meaning treatment protocol is especially responsive to complexity training [ American Journal ofSpeech-Language Pathology Vol.16 3-5 February2007. doi:10.1044/1058-0360(2007/002) ].
 Protocol -- Self-help exercise guideline:  Triple Ms -- Multiple Meaning Manipulation -- 
 Easy Step-By-Step Directions: 
Say to the patient, "Tell me a meaning of the word 'beat' and then say a different word that expresses that meaning." (the patient says "stir up eggs" -- mix) 
The  patient writes the word  [do it for the patient if he/she cannot write] on the Multiple Meaning Stimuli Sheet to mentally anchor it.  (M I X)
Say to the patient "Now create and say aloud a sentence using the word 'beat'            with the mix meaning."  ("I beat eggs for cooking")  
Continue with 1-3 above with additional meanings (hurt someone -- hit; policeman's beat-- route;  when I am beat -- tired)
ü  How to make this activity a little easier:  If patient can only come up with 1 or 2  meanings, suggest a meaning indirectly to the patient. ('When I am tired I feel this way."); take turns coming up with meanings; start with words with a higher number of meanings and a higher frequency of occurrence [ Garratt, BR, Jones,B, Brain Lang 1987 Jan30(1):106-15];
ü  How to make this activity a little harder: Have the patient write a sentence using the target word with various meanings ('I beat the eggs.; She beat the carpet.; The song has a great beat.) using the Triple Ms --Multiple Meaning Manipulation practice materials on;
ü  How to expand this activity:  Use a website such as:;  for a little different approach to practice.
ü  How to get extra practice for this activity:  Use the Multiple Meaning word and sentences lists on our Aphasia Sight Reader Software Program.
Horizontal Tweaking and Vertical Stepping are simply more advanced ways to expand the basic activities or to make them easier or harder.   Effective use of the basic procedures above and the advanced ideas below will grow the activities as the patient makes progress and will facilitate formative assessment.  
Horizontal Tweaking for this protocol -- exercise activity:  Impose a delay in patient response that gradually increases;  adjust for individual patient issues (perseveration; initiation); drill in cumulative cyclical manner;  practice written sentence from memory; provide semantically supportive information; work from denotative[ literal meaning] toward more connotative [ additional associated meanings; experiential and metaphoric relationships]; 
Vertical Stepping for this protocol -- exercise activity:   Use words in conjugation; advance through sentence pattern types from less to more difficult for the individual patient; play other word games that encourage multiple meanings of words including websites and board games; 
Behavioral Objective for this protocol -- exercise activity: "The patient will generate by saying aloud words that connote various meanings of a target word presented by the therapist/caregiver in printed and verbal form at a    % accuracy."  In following the Rule of 3Cs, the patient will say aloud a sentence that contains each verb with appropriate semantic context.  This protocol links with the Triple Ms -- Multiple Meaning Manipulation and the Multiple Meaning practice stimuli on the Aphasia Sight Reader program. 
Targeted Mental Processes for this protocol -- exercise activity: Lighting up the lemma (lemma activation); complexity training; lexical to semantic neural area interaction; increased awareness of semantic-syntactic elements of sentences; mental flexibility; divergent word recall; utilization of contextual cues; metalinguistic judgement;

To learn how to make optimal use of this protocol, or if you think your patient would benefit, contact us at: 
This protocol is part of the Simply Smart Aphasia Therapy program.

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