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Sunday, July 26, 2009

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 ( ).
In our treatment approaches at the Pittsburgh Aphasia Treatment, Research and Education Center and, 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
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 ( including work with a client 22 years post stroke and 10 years post aphasia therapy.
Contact with questions or comments
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