8 - Aphasia Treatment

Question 1

A high functional dynamic can be observed in the ___________ after stroke, which has been associated with reorganization processes in the ____________ network, its right-hemisphere homologues and in the vicinity of the lesion site.

Answer 1

First days and weeks

Left-lateralized language

Question 2

What seven things can cause improvement in Aphasia post-stroke?

Answer 2

Physiological change occurring during the evolution

Behavioral-physiological relationships in aphasia recovery

Reperfusion of the ischemic penumbra

Diaschisis, disconnection and reconnection

Upregulation of right hemisphere homologues (equivalent areas in RH)

Reactivation of peri-lesional areas

Functional reorganization of language networks

Question 3

If you don’t know why you are doing something then…

Answer 3

You probably shouldn’t be doing it.

Question 4

Is every aphasia patient a candidate for therapy?

Answer 4

No

Question 5

Will all patients improve with treatment?

Answer 5

No

Question 6

How many patients will return to 100% of premorbid levels of function?

Answer 6

Very few

Question 7

Do all patients want to be in treatment?

Answer 7

No

Question 8

What has a major influence on our ability to provide treatment?

Answer 8

Insurance coverage

Question 9

What is Treatment Outcome?

Answer 9

A comparison of an outcome to a later point in time

Question 10

What is Treatment Efficacy?

Answer 10

The probability that a treatment will benefit individuals in a defined population for a given population under IDEAL conditions

Question 11

What is Treatment Effectiveness?

Answer 11

The probability that a treatment will benefit individual in a defined population for a given problem under AVERAGE conditions

Question 12

What is Treatment Efficiency?

2

Answer 12

Treatment that is effective with a minimum of waste, expense, and necessary effort

High ration of output to input

Question 13

What are Cochrane Reviews?

Answer 13

Summary reports on all kinds of treatment

They usually focus on big studies

Question 14

How does the average effect on treated recovery compared to the average effect of untreated recovery?

Answer 14

Treated recovery has twice as much success

Question 15

What should be the minimum weekly amount of therapy for aphasia its?

Answer 15

2 hours per week

Question 16

Who treats aphasia patients?

7

Answer 16

Neurologists

Physiatrists

Speech-Language Pathologists

Occupational Therapists

Physical Therapists

Therapeutic Recreation Specialists

Neuropsychologists

Question 17

What often dictates the frequency and duration of treatment?

What are clinicians required to do?

When does discharge planning begin?

Answer 17

3rd party payers

Criteria for deciding how long a treatment program should last

Onset of treatment

Question 18

What should be the three goals of aphasia treatment?

Answer 18

Facilitating effective communication despite residual impairments

Facilitating “communication competence” (the use of language in naturalistic environments)

Generalization

Question 19

What should be the focus and progression of aphasia treatment?

(4)

Answer 19

Treat to test approach (identifying deficit areas on tests and construct tasks to mimic these)

Selective treat-to-the-test approach (assign more importance to some tests than others)

Treat underlying processes approach (treat underlying cognitive processes that impact language domains)

Reactivation or restimulating approach (Treating underlying process)

Question 20

What are five metacognitive processes important to treatment outcomes?

Answer 20

Self-awareness and Insight

Motivation

Self-monitoring

Self-initiation

Goal-oriented Behavior

Question 21

Does beginning treatment early vs late have an effect on recovery?

Answer 21

Yes

Question 22

What five things can effect a patient’s candidacy for treatment?

Answer 22

Amount and duration

Location of injury

Medical and Physical condition

Enthusiasm and motivation

Financial Resources

Question 23

What four things should treatment focus on?

Answer 23

Individual

Functionality

Patient’s strengths

Patient’s level of breakdown

What a patient can do

Question 24

What sort of improvement is often seen in aphasia patients in a 1+ years after initiating event?

Answer 24

Functional improvemetn

Question 25

What is constraint induced therapy?

What is the time committment?

Answer 25

Forcing a patient to use areas of weakness

30 hours of treatment over two weeks

Question 26

Do patients make major gains due to intense therapy (5+ hours per week)?

(2)

Answer 26

No

2-4 hours per week are equally as effective

Question 27

Are most patients able tolerate more than 2 hours of treatment immediately post-stroke?

Answer 27

No

Question 28

What is CATE (Complexity Account of Treatment Efficacy)?

2

Answer 28

A program to treat expressive speech

Training sentences that increase in complexity

Question 29

What are often treatment targets in CATE (Complexity Account of Treatment Efficacy)?

Answer 29

Atypical categories

Question 30

What is often the focus for SLPs in acute settings?

2

Answer 30

Swallowing is taking priority

Communication is taking a back seat