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Friday, October 8, 2010

The Brain Compatible Treatment ( BCAT )

The Brain Compatible Treatment Program
Brain Compatible Aphasia Treatment (BCAT) takes advantage of the powerful recovery and reconnective potential of brain plasticity.  The brain's ability to continually grow, learn and recover is well documented [ ].  Our experienced speech/language pathologists (SLP) blend the best of aphasia research and clinical evidence with neuroscience, learning theory, technology and clinical expertise.  In doing so, we are able to emphasize the values, needs and goals of the person with aphasia ( PWA ) as part of our evidence-based aphasia program.   Our SLPs use formative assessment techniques to assess your progress on an ongoing basis in order to continually respond to your progress and grow the scope of your program accordingly.  As your speech and conversational skills improve, we make sure you can use them in fully functional ways as you participate in our online small support, conversation and activity groups ( )
Moreover, since aphasia truly is different for everyone, we work hard to ensure a program that is effective, personalized, affordable and available for everyone.   Since traveling the pathway of aphasia recovery often takes time, there is no expiration date on your participation in our programs.
Finally, given the demonstrated value of an intensive component to aphasia treatment [ ], we offer the Intensive Interval Aphasia Treatment Program that alternates shorts bursts ( 2-3 days ) of onsite intensive treatment with ongoing treatment session weekly and lots of daily client practice [ ].
 As you can see, the Brain Compatible Aphasia Treatment approach and its pioneering tools and techniques expand your program beyond what traditional treatment approaches can achieve.  Our treatment Tenants, Components, Protocols and Tools emanate from evidence-based research and clinical studies.
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Guiding Treatment Principles for BCAT
1.    Be sure to have a working definition that facilitates metaphasia for the PWA.
2.    Recognize and act on the fact that, "Aphasia is different for everybody." , ( Ginnie Anguish, PWA, 2000 )
3.    Keeping in mind that each PWA is different, use formative assessment to monitor current levels as well as changes.
4.    The BIG IDEA of Aphasia Therapy:  Everything revolves around and comes back to propositional speech and conversation.
5.    The Essence of Aphasia and Apraxia Therapy: Get the PWA skilled at:
a.    knowing where to focus his/her mental attention
b.    acting on that point of focus
c.     efficiently shift to next point of focus.
6.    The Key Elements of  Aphasia Therapy ;  Faith  &  Rhythm
7.    Have the PWA work from his/her own memory or thoughts.
8.    Help the PWA regain faith in his/her memory.
9.    The Missing Ingredient in Aphasia Therapy: A tremendous amount of smart, effective independent, patient practice It is all about therapeutic time on task in a variety of situations including a therapeutic social network. ( ;
10. Say it, say it, say it, type it, say it again... then make it natural. Involve both the lexical and phonological conditions for practice
11. Work on reconnecting neural pathways that are used for propositional, generative, conversational speech.
12. Address the cognitive underpinnings for speech and language production.
13. Establish early skills in saying subjective pronouns.
14. Move into conjugation.
15. Right branch conjugated sentences into longer utterances.
16. Expand into reverse word order question asking conjugation.
17. Be a master of stimuli.
18. Challenge the PWA .
19. Guide the PWA toward being his/her own SLP. 
20. Make every activity truly therapeutic.
21. Focus early on Verbs.
22. Work ASAP in sentences starting with canonical.
23. Incorporate time concepts.
24. Use all possible angles to reconnect the neural pathways.
25. Software for Aphasia should SHEAR:
a.    Simple to use
b.    Human touch remains
c.     Effective for clients
d.    Affordable
e.    Responsive to change and client growth
26. When possible, take advantage of technology.
27. Deal effectively with the effects of apraxia treating it as a movement disorder.
28. Focus on conversational interaction and discourse. 
30. Minimize or eliminate picture stimuli.
31. Obtain lots and lots of self-generated patient neural flows - utterances and/or sentences. 
32. Make sure the patient practices out loud, especially when he/she is alone.
33. Maintain eye contact whenever possible.
34. Have the PWA create or at least be very involved in the design of his/her own materials/stimuli for practice.
35. Have the PWA BLINK IT!  ( Blink: The Power of Thinking without Thinking by Malcolm Gladwell, 2005)
36. Recognize that there is no such thing as a patient plateau. ( )
37. Recognize that your client is not a data point or a statistic.
38. Keep your eye on the truly important aphasia treatment outcomes: to return to work; to converse with his wife; to read stories to her grandkids; to shoot the breeze over coffee in Starbucks; to lead a productive life.
39. Put the PWA's values, needs and goals into the driver's seat for evidence-based practice ( ). 
40. Never, ever, ever give up. However, if you must, deliver a list of quality resources and referral sources to the PWA and caregivers.
41. Consider an ongoing intensive program that incorporates innovative treatment with lots of patient practice, and peer interaction, and a never give up attitude.
42. Address issues of syllable structure knowledge and production early.
43. Establish vowel knowledge and production skills early when needed.
44. Fold in work on prosody ASAP.
45. Reconnect Spelling Skills.
46. Reconnect, or teach, keyboarding skills and screen literacy.
47. Pay attention to the phonological neighborhood
48. Encourage the brain to make multiple associations with the same material in order to give that information more neural scaffolding.
49. Vary the type of material studied in a single sitting in order to leave a deeper impression on the brain than concentrating on just one skill at a time.
50. "It ain't over till it's over...and that takes time and persistence."
51. Emphasize metapraxia, the patient's understanding of and insight into the planning and execution of movement patterns.
52. When appropriate, provide quick, clean, diverse and descriptive feedback. 
53. When giving feedback or instructions, tell the PWA or coach only what to do.
54. Help the client learn the skill of truly listening.
55. Make sure that the PWA is working with peers and working/participating in groups.
56. Focus on normal skills.
57. Be a reconnectionist.
58. Help the PWA learn to embrace his/her mistakes.
59. Recognize that worksheets don't grow dendrites.
60. Train and utilize coaches.
61.  Know the differences among: homonyms; homographs; heterograph; heteronym; homophone; antonym; and synonym and take advantage of them.
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