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Tuesday, September 29, 2009

Conquering Alexia


Practice + tools = aphasia and alexia overcome
For a copy of our first newsletter in the series about the importance of patient practice in aphasia rehabilitation, send a request to bill@aphasiatoolbox.com


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Time. Success in aphasia rehabilitation is about therapeutic time on task. This newsletter is the second in a series about the critical value of lots of patient practice both outside the clinic and more importantly when formal treatment is finished. The best evidence for how important independent or coached practice is to success in aphasia rehabilitation is a true story of one individual persevering and overcoming the effects of stroke on his/her communication abilities. This is one such story.

Dr. Roy Ivy of El Paso, TX faced a dilemma. He fervently wanted to engage in his passion- practicing medicine and helping his patients, but, he could not. A stroke left him unable to read (acquired alexia) accurately and quickly enough to see patients. Months of speech/language therapy and personal effort had failed to help him accomplish his goal. He was informed that as more time elapsed his recovery would slow and that he would reach an untreatable plateau. True to his persistent nature, Dr. Ivy and his wife Charlotte, who likewise was unwavering in her determination to see Roy maximize his recovery, searched for an answer. They knew intuitively that with the right tools and guidance, Roy could read again. The search was on.

On February 6th, 2009 they found www.aphasiatoolbox.com and the Aphasia Sight Reader Program. After an online consultation, the Ivy's and I created a plan, incorporating our Pure Alexia Treatment Protocol, AphasiaPhonics Program and extensive use of the Aphasia Sight Reader practice software. Charlotte trained to become Roy's practice coach. Taking advantage of neuroplasticity and a reconnectionist rehabilitation approach, we made the program highly individualized and multifaceted. See (http://convention.asha.org/2006/handouts/855_1436Small_Steven_091028_111206014434.pdf ; http://www9.georgetown.edu/faculty/friedmar/pdfs/Lott_et_al_2008_much_from_mud_pies.pdf ) . Together, we consistently nurtured and grew the plan. Dr. Ivy spent 2-3 hours each day with therapeutic time on task, practicing, growing, and reconnecting neural pathways. We utilized the flexibility of the Aphasia Sight Reader program to make continual adjustments such as: reducing time the stimulus was exposed; using words that began, ended, or had in the middle the same letter; words of a similar category; manipulation of key word sentence placement and semantic content complexity; gradual expansion of number of words flashed; focus on cognitive skills of verbal working memory and attention training and learning from reading errors instead of experiencing frustration. See http://www.speechpathology.com/askexpert/display_question.asp?question_id=243 .

From the beginning, Dr. Ivy had acquired some bad habits and strategies that were inadvertently counterproductive. For example, following some ill-advised advice, he moved his entire head to read a short sentence. We switched Roy to a more normal brief scan of his eyes to sight read the sentence quickly. Dr. Ivy had assumed, given information provided to him, that he had right visual field loss. With lots of smart practice, however, his brain and eyes made adjustments and eventually he missed very few words at the end of a sentence. See http://speech-language-pathology-audiology.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206475 . Finally, instead of continuing to utilize a letter-by-letter approach, he began to use more normal word attack and whole word/phrase sight-reading skills. See http://content.karger.com/ProdukteDB/produkte.asp?Doi=52668 ; http://journals.cambridge.org/action/displayAbstract;jsessionid=5B39D82D1DB9E6A33ED5834A034355E2.tomcat1?fromPage=online&aid=49433.

Using the Aphasia Sight Reader's data collection capabilities, we found that at the onset of his program, he required 45 minutes to read a short paragraph [ 5 sentences; 68 words ] with 15 % comprehension and 10 % retention at 10 minutes; he read 3-word canonical sentences [ containing a Subject-Verb-Object ] at a rate of .3 words per second [ 18 words per minute ] with 45% comprehension.

After 3 months of independent, self-help practice, Dr. Ivy required 3 minutes to read a short paragraph [ 6 sentences; 70 words ] with 95 % comprehension and 75 % retention at 10 minutes; he read 3-word canonical sentences [ containing a Subject-Verb-Object ] at a rate of 1.5 words per second [ 72 words per minute ] with 90% comprehension. He began to read again - newspapers, novels and professional journals. Eventually, his reading and comprehension progress allowed him to return to seeing patients. He is able to read patient charts and other medical information.

A 75% decrease in time required to read a paragraph and an increase in words read per minute of 54 in just 3 months - these statistics reflect a remarkable accomplishment. I am so very proud of what this determined, yet humble man achieved. Dr. Ivy's story is just one of the many fantastic success stories that our clients and subscribers want to share with you. We know now that time since stroke and a person's age are irrelevant to a person's potential for improvement in speaking and reading skills. Our programs, materials and software tools are totally unique and available only to our subscribers at www.aphasiatoolbox.com . For a personal demonstration of the power, versatility and effectiveness of the Aphasia Sight Reader, please contact me at 724.494.2534 or bill@aphasiatoolbox.com . We use www.skype.com and www.oovoo.com for our online consultations and treatment.

Bill Connors

References:

Beeson, P., & Insalaco, D. (1998). Acquired alexia: Lessons from successful treatment. Journal of the International Neuropsychological Society, 4, 621-635.

Francis, D. R., Clark, N., & Humphreys, G. W. (2003). The treatment of an auditory working memory deficit and the implications for sentence comprehension abilities in mild receptive aphasia. Aphasiology, 17, 723-750.

Mayer, J. F., & Murray, L. L. (2002). Approaches to the treatment of alexia in chronic aphasia. Aphasiology, 16, 727-744.

Orjada, S. & Beeson, P.M. (2005). Concurrent treatment for reading and spelling in aphasia . Aphasiology, 19. 341-351

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Sunday, September 20, 2009

Practice Makes Perfect


Practice MakesPerfect; Perfect Practice Makes Normal. 

Memoirs of Ruth Resch

Ruth Resch's aphasia memoir, Through the eyes of..., has been published by  http://www.persimmontree.org/  .   We highly recommend this wonderfully-written story.  

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Last chance to view this educational program by Joan Green at Innovative Speech.

Innovative Interventions for Aphasia- free viewing offer - only 2 more weeks

To view this recorded webinar go to http://tinyurl.com/mckddp

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The Importance of Therapeutic Time On Task.

Malcolm Gladwell, in his best selling book Outliers ( #5 New York Times) http://www.nytimes.com/pages/books/bestseller/ , debunks the idea that  those who succeed and achieve expertise do so primarily because of talent and potential.  He presents an undisputable case for the overwhelming importance of lots and lots of practice. He calls this the 10,000 hour rule. "In fact, researchers have settled on what they believe is the magic number for true expertise, ten thousand hours." Galdwell explains.   That was the case for Bobby Fisher in chess, the Beatles in music, and even Bill gates in computing.   We propose the same is true for aphasia rehabilitation.  Lots and lots of practice using smart activities and innovative tools can help people with aphasia accomplish remarkable things.  Recovering the ability to speak is even more important than becoming an expert chess player, musician or computer programmer.  People with aphasia, who want to converse again, should be practicing lots and lots everyday.

All too often, the critical nature of independent and/or supported practice is not appreciated sufficiently in traditional aphasia treatment.   For example, I reviewed an article in Seminars in Speech and Language  ( vol 30, August, 2009 , pp. 174-186, http://www.thieme-connect.de/ejournals/toc/ssl/97930 ) that discussed treatment in bilingual speakers with aphasia.  I highly recommend this excellent issue and in particular this fine article.  In the article, Katherine Kohnert looked at 13 clinical treatment studies.  Of these studies, only 3 (23%) were reported to mention patient practice outside of the clinical setting (#1: 3-5 hours for 6 weeks; #2: 70 minutes a day for 8 weeks; #3: 2 hours a day for 10 days).  In the summary table in this article, patient practice was not even addressed by the author.  The lack of attention to the importance of patient practice outside of the clinic is noteworthy and, given what we know about the need for hours and hours of practice, troublesome.  A cursory examination of other aphasia treatment studies during preparation for this newsletter suggested a consistent laissez-faire clinical attitude toward patient practice in aphasia rehabilitation. 

The need for plenty of patient practice has support from many points of view. Common sense tells us, "Practice makes perfect."  Educators present clear positions on the need for time on task for effective learning.  As Cathy Vetternott proposes in Rethinking Homework, 2009, "Teachers know that learning certain skills require practice to perfect, and often homework is used for practice."  Reconnecting skills in aphasia rehabilitation likewise requires lots of practice. 

The literature and research on intensive treatment programs for aphasia does demonstrate a strong support for progress supplied by hours of practice in the clinic setting (http://etd.lsu.edu/docs/available/etd-04032008-161153/unrestricted/Cain_thesis.pdf ). How and how much the patient practices, both during formal treatment and when formal treatment ends, is of the utmost importance.   Moreover, this practice needs to be done in a focused manner with smart work in a supportive practice culture.  The clients we work with online at the Aphasia-Apraxia Treatment CyberClinic average 2:40 hours of practice everyday.

In our next newsletter we will present an amazing case study of what lots of therapeutic time on task (TTOP) using tools and activities can accomplish.   We will see how the Aphasia Sight Reader at www.aphasiatoolbox.com affordably provides, in a simple to use manner, unlimited stimuli and practice for speech pathologist, clients and caregivers.  No aphasia practice should be without a tool such as this.

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