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Sunday, July 26, 2009

The Pittsburgh Aphasia Treatment, Research and Education Center


The Pittsburgh Aphasia Treatment, Research and Education Center
What does work in aphasia therapy?
NEW - We now have a free, informative Q&A- Question and Answer fact sheet for consumers and for speech-language pathologists.  To receive a copy, contact us at bill@aphasiatoolbox.com  or call 724.494.2534 


In our last newsletter, we discussed why 1.25 millions residents of the USA and Canada continue to suffer the often devastating effects of aphasia.  We presented 12 reasons why traditional approaches to aphasia therapy have failed to help so many people despite millions and millions of dollars spent on unsuccessful attempts.  

We promised also to present specific information about  what we have found truly does work.  Here are 12 reasons why so many of our patients and clients have made real progress toward conversing, reading, writing, typing and talking again.  By following these treatment principles , strategies and tactics, we are able to make each activity and practice session truly therapeutic and make patients eager to practice hours each day.

Twelve keys to productive and successful aphasia therapy:
1.  We focus on you speaking and conversing again in a natural fashion.  This means that the you are using your own ideas and thoughts when independently generating speech and conversation.  We do not believe that using imitation, closure tasks, naming tasks, pointing, or being cued by another person leads to the propositional conversation that you and every person with aphasia wants.  

2.  We work on reconnecting brain pathways that you use for normal, conversation speech by taking advantage of brain plasticity.   Instead of picture stimuli, we have you work from your own memory or thought, whenever possible, then work on what you want to say [ intent; speech acts] and organizing your words into sentences.  We have found in our approach that years since your stroke and your age are not critical factors in your eventual aphasia recovery.  

3.  We challenge you.  Your treatment program is not only highly individualized, but also nurtured and developed on an ongoing basis.   We even create materials and treatment protocols specifically for you and your special needs and strengths.  No busy work.   We reduce caregiver stress in most cases by saving time, encouraging patient involvement and increasing patient time spent with self-help practice.

4.   We strengthen your cognitive underpinnings so very critical to your speech.  These include: verbal working memory; focused, selective and alternating attention skills; problem solving; mental resource allocation; and flexibility of thought.   Success in aphasia recovery requires bolstering these.

5   We guide you to becoming your own speech therapist.  We help you and your caregivers genuinely understand aphasia [ metaphasia ] and focus on building effective self-help strategies and tools.  In the long, only you can speak for yourself.  

6.  We make treatment affordable.  By combining self-help strategies; training of caregivers and practice assistance; use of the Aphasia Sight Reader program at http://www.aphasiatoolbox.com , innovative tools, and the Interval Intensive Aphasia Treatment program, you can engage in this aphasia treatment at a fraction of the cost of traditional and intensive programs.  We can do all this in your home using distance therapy online.

7.  We use SMART treatment activities.  We go beyond the clinical and research evidence utilizing knowledge from numerous sources including learning theory and cognitive neuroscience.  We work at the sentence level whenever possible.  We focus on verbs as they are the essence of a simple sentence.  We avoid boring, tired drills.

8.  We use all possible angles to reconnect neural pathways: reading; writing; prosody [ melody, intonation, rhythm, etc]; gestures; technology; cognitive skills while we keep our focus on improving your  conversational ability.

9.  If you have a more severe problem speaking, we deal effectively with the effects of apraxia using our Cognitive Restructuring for Apraxia Program and the effects of phonological aphasia [ difficulty finding or saying the correct speech sounds when you know the word in you head ] using our AphasiaPhonics Program.

10. We find ways for you to practice, and to want to practice, daily.  Successful aphasia recovery takes time,  persistence, and the use of smart treatment techniques and tools.  We offer the exclusive Interval Intensive Aphasia Treatment Program that combines short burst of intensive treatment with lots of ongoing self practice using innovative tools and materials. 

11. We collaborate with other speech-language pathologists or therapists you might be working with.  Teamwork is essential as is referring you to the finest of resources available to maximize your recovery.   You will  feel connected to a network of patients, caregivers and professionals sharing a mission.  You get to join a community of people aggressively traveling the pathway of aphasia recovery.  

12. We never give up; neither should you.  You get to work with a successful program that is innovative and dynamic knowing that we will never give up on you. 


Interested? Contact us Bill Connors at bill@aphasiatoolbox.com or call him at 724.494.2534.
We are eager to hear your comments and to learn from divergent points of view.  Please us know what you think at bill@aphasiatoolbox.com .  





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Free Treatment Protocol - Verbing





Free Treatment Protocol - Verbing 
First in a series of newsletters devoted to presenting innovative treatment techniques based in evidence, clinician experience, patient needs and common sense.
Following a number of requests for discussion of what innovative treatment for aphasia looks like, this newsletter begins a series that will discuss ideas, materials and tools for effective aphasia rehabilitation.   
The topic today is VERBS.  Despite the fact that verbs have been identified as absolutely critical to conversional, propositional speech and that verbs tend to be more difficult for people with aphasia (PWA) to say (Berndt et al., 1997), most clinical research studies seem to have focused on naming nouns (Kiran & Thompson, 2003).   Moreover, when a PWA improves his/her ability to retrieve and say verbs, the object in a sentence tends to become easier to say as do other types of words (Mikyong, Kim, 2005).  Cynthia Thompson and her colleagues have led the way in “...providing blueprints for clinical protocols..” in terms of syntax and the importance of verbs in the aphasia recovery process ( http://www.communication.northwestern.edu/faculty/?PID=CynthiaThompson ).
In our treatment approaches at the Pittsburgh Aphasia Treatment, Research and Education Center and www.aphasiatoolbox.com, we rarely spend time on noun retrieval but instead focus on verbs and the wonderfully effective treatment and progress activity they facilitate.  Verbs to us are the essence of a sentence and we hold that, for the most part, people think and talk in sentences.  Good things happen when clients improve their fluent use of verbs in sentences.   Typically, we work in sentence contexts during therapy, even with more severely impaired clients.  It saves recovery time, is much more advantageous clinically, and it feels good.  
Below is our most fundamental treatment protocol for addressing verb recovery:
Easy Step-By-Step Directions: for Verbing – 1.24 
Read aloud to the patient a noun (object) from the Verbing worksheet (“coffee”).  
The patient says a verb that goes with (probably most commonly associated with) the noun object   (“drink”).
The patient says the verb and object together in a short phrase several times (“drink coffee”). 
The patient creates independently and says aloud an SVO (canonical) sentence, by adding a subject, until it is smoothly produced from immediate memory without the printed stimulus.   (“I drink coffee”).   Provide minimal assistance if necessary.  Do not use imitation.
The patient self corrects this sentence (if necessary with least amount of help) first out loud then in writing.  If the patient uses _____ing ending for verbs, she should learn to use conjugation and approximation/self-repair technique to more easily self correct. (“I drink coffee. → I drink a coffee.”)
Repeat 1-4 with new object phrase.  (“pen; write pen; I write a pen; I write with a pen”).
Practice cyclically to address verbal working memory improvement ( after completing a new item return to the first and work through the list having the patient recall the verb in a rhythmic verbal manner ).   Rhythm is a very important element in useful word recall for conversational and propositional speech.
When the list is done (we use 15 per list on our Aphasia Sight Reader Program ), be creative in extra practice.  For example, you give the verb and the patient says the object or you give the object and the verb and the patient says aloud a second verb.  We have many variations on this activity.
How to make this activity a little easier:  Provide additional help to the patient by showing the object noun from the printed list. 
How to make this activity a little harder: Have the patient write or type the sentence he/she created on the Verbing worksheet. 
How to expand this activity:  Have the patient recall the sentences from memory in a cyclical, cumulative fashion.
How to get extra practice for this activity:  Use the Verbing Arguments and the Direct Objects stimuli word lists on our Aphasia Sight Reader Software Program at www.aphasiatoolbox.com
Please feel free to share this with anyone you think may benefit.
This is one treatment of many that we have created for addressing verbs and their arguments and sentences.  We have experienced excellent results with this kind of therapeutic focus (www.strokesurvivor.com) including work with a client 22 years post stroke and 10 years post aphasia therapy.
Contact bill@aphasiatoolbox.com with questions or comments
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