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Aphasia treatment Flashcards

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1
Q

What are 2 considerations for setting treatment goals

A

-Clients personal priorities
-Reasonable expectations based on client’s performance and knowlegde/experience

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2
Q

Why are client priorities important in treatment?

A

-Increased tx progess
-Increased tx satisfaction
-Aphasia threatens their roles and autonomy: so give them information and seek their input
-The greatest impairment may not be the most salient, make sure it is what the client wants to work on

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3
Q

What components of the clients performance influence tx expectations

A

-individuals neurologic, cognitive, metacognitive, and language profile

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4
Q

What 3 key information pieces obtained from assessment help to determine reasonable tx expectations

A

-What the client can do independently (tx reinforcer)
-What the client can do with support (tx targets)
-What the client can’t do

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5
Q

5 components of treatment goals

A
  1. Reflect the individuals personal priorities
  2. Written in operational language, easily understood by others
  3. Easily measurable for clear and objective determination and report of treatment response
  4. Logical and practical progression from STG to LTG
  5. Emphasize the communication activity
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6
Q

What is progress monitoring

A

Continuously evaluating and revising of goals as appropriate
Assessment is an ongoing process

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7
Q

3 reasons for documentation of treatment services

A
  1. pragmatically more important than therapy
  2. Proves services took place (if not documented, it didnt happen)
  3. Shows expertise- explains and justifies reasoning for services and activities
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8
Q

ASHA Documentation guidelines

A
  1. Use terminology reflecting technical knowledge
  2. Indicate rational/function, type, and complexity of activity
  3. Report objective (quantitative data) showing progress towards measureable goal
  4. Explain any modifications and give reasoning
  5. Specify feedback and/or training and client response
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9
Q

How may group tx be beneficial at the individual level

A

sense of family support
Feeling understood
Community
learn from others
Socialization

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10
Q

How may group tx be non-beneficial at the individual level

A

May lead to being discouraged
Less individualized
Less structure
individuals may not benefit as much
Less attention to individual
Inconsistent attendance

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11
Q

How may group tx be non-beneficial at the healthcare level

A

Meeting insurance requirements
Third party payer
Communication is targeted indirectly

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12
Q

Cons of group therapy

A

Harder to take data
Finding a common activity for alls interests
Inclusion of all participants
Creating equal opportunity for everyone
Less structure

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13
Q

Considerations for composing group therapy

A

Etiology
Symptomology
Severity
Age
Gender
Family in groups (good and bad)
Standards for participation
Pragmatic skills
Social behaviors
Attendance
Dischanging

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14
Q

Tips for composing group therapy sessions

A

-Know patient and family members needs, abilities, etc.
-Get family members to fill out questionare about client
-Get a sense of pre-morbid level of funtioning
-Ignore undesireable behaviors and reinforce positve behaviors
-Redirect undesirable behaviors
-Praise any level of participation
-Acknowledge and validate frustrations

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15
Q

3 Types of group tx Programs

A
  1. Communication based
  2. Psychosocial based
  3. Transactional based
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16
Q

What are communication based group tx programs

A

Procedural discourse tasks
-Facilitate language in a social setting
-Improve narrative procedural discourse
-Improve content of narrative and procedural discourse
-Improve functional communication in selected roles

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17
Q

What are psychosocial based group tx programs

A

emphasis on a team
NOT individualized

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18
Q

What are transactional based group tx programs

A

Facilitate discharge planning for patient and movement from one setting to another
(rehab team to long-term care)
Leader: social worker or case worker

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19
Q

What would be examples of story based tx activities

A

Pictionary
Acting out scenarios
Guess that word
Show and tell
Charades

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20
Q

What would be examples of arts based activities

A

Building structures
Baking
Cooking
Directions
Planning
Blueprints

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21
Q

Considerations when selecting documentation instrument for group therapy

A

-Group tx goals and objectives
-Amount of time needed
-Frequency and duration of group tx
-Examiner skill
-State/company/billing insurance requirements

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22
Q

Examples of documentation

A

-Standardized tests
-Measures of quantifying verbal output (frequency of initiated conversation, response time, level of engagement, accuracy of message)
-Qualitative measures
-Psychosocial measures
-Task specific measures of information exchange
-Type of communication acts
-Satisfactory levels
-Communication acts profile (children)

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23
Q

Examples of qualitative information that can be measured in group tx

A

-degree of communication burden assumed by conversational partner
-communication modality
-Self ratings
-list of augmentative strategies used
-list of compensatory efforts used
-psychosocial measures

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24
Q

Examples of psychosocial measures

A

Mood scales
Well being scales
Affect balance scales
Interactive communication scales
Self ratings

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25
3 types of communication acts
1. Assertive: agreeing with others 2. Responsive: answering others 3. Imitative: copying others
26
8 specific intervention techniques
1. multiple modality teaching 2. Providing feedback 3. check for comprehension 4. Share the leadership role 5. Scaffolding 6. promote generalization 7. compensatory 8. Various communciation methods
27
Define communication
-Information exchange between listener and speaker -Participants use meaningful mode of communication with set of symbols -Feedback occurs, which makes the communication participation equal
28
Purpose of varying stimulation in tx
To add or decrease difficulty level Want to minimize failures and maximize performance/success
29
Standardized test for measuring auditory verbal comprehension
Token test
30
Standardized test for measuring naming
Boston naming test
31
Standardized test for measuring reading
1. Gray Oral Reading Test 2. Reading Comprehension Battery for Aphasia
32
Standardized test for measuring language
1. Western Battery Aphasia 2. Boston Diagnostic Aphasia Examination
33
Standardized test for measuring writing
None that measure only writing
34
Standardized test for measuring repetition
None that measure only repetition
35
4 biomedical approaches for aphasia
1. Pharmacotherapy 2. Transcranial Magnetic stimulation 3. Stem cell transplantation 4. Nerve cell stimulation
36
Biomedical approaches help to understand?
The neural basis of language
37
Define pharmacotherapy for aphasia
Manipulation of the brains neurotransmitters (chemical substances that allow electrical messages to be sent from one nerve cell to another)
38
List some of the neurotransmitters shown to be effective for pharmacotherapy
1. Dopamine 2. Acetylcholine/Cholinergic 3. Amphetamines 4. Bromocriptine 5. Dopaminergic 6. GABA
39
GABA and cholinergic have been shown to be effective with what type of aphasia?
Fluent aphasia
40
Amphetamines, Bromocriptine, and dopaminergic have been studied in what type of aphasia?
Nonfluent aphasia (only amphetamines and bromocriptine are effective)
41
Pharmacotherapy have been shown to be effective for?
Mild to moderate aphasia, but not severe aphasia (evidence from not well-designed studies- case studies)
42
What is transcranial magnetic stimulation
Noninvasive procedure using magnetic fields to create electrical currents in discrete brain areas This increases or decreases the excitability of neurons in the affected area that lasts beyond the duration of the stimulus itself
43
Differentiate between slow and fast runs of magnetic stimuli
Slow runs decrease cortical excitability Fast runs increase cortical excitability
44
What are some compensatory/alternative approaches to Aphasia Tx
Yoga Meditation Mindfulness meditation Nature based therapy approaches
45
What are the 3 nature based therapies
1. Horticultural therapy 2. ANimal assisted therapy 3. Natural environment therapy
46
What did the times say about meditation? Why
Meditation should be treated more seriously like medication because it can be beneficial to a variety of areas: Depression Anxiety Cognitive functions Immune function Stress Sleep Cancer Self-compassion
47
Mindfulness meditation targets what
Divided attention Increased attention and awareness Improved relaxation Increases cortical thickness
48
Physiologic and cognitive benefits shown with mindfulness meditation
1. Physiologic- increase parasympathetic (calming) activity & decrease sympathetic activity (fight or flight) 2. Cognitive- attention benefits
49
What compensatory/alternative approach has been shown to have bio-psychosocial benefits in stroke survivors
Yoga
50
Yoga has had what 3 effects in stroke survivors
1. Improved language abilities (spontaneous sleep and fluency naming) 2. Improved visual attention (reaction time, perceptual tracking, and simple/alternate sequencing) 3. Decreased levels of anxiety and depression
51
Describe horticulture therapy
Therapeutic effects of cultivating plants
52
What is animal assisted therapy
Use of animals to individuals improve: socially emotionally cognitive functioning motivation
53
What is natural environmental therapy
Exposure to natural environment can improve patients experience and health outcomes Aimed at improving healing, reducing medicine use, shorten hospitalization, and decrease anxiety/stress
54
What is agnosia?
-Sensation without perception= sensory acuity being WNL, with inability to recognize/identify sensory stimuli -Modality specific -Rare
55
Define visual agnosia
Failure to respond appropriately to visually presented stimuli Visual sensory processing, language, and intellectual functioning are intact/preserved
56
Define auditory agnosia
Problems with the recognition of sounds, while hearing acuity is 100& WNL
57
Apperaceptive visual agnosia
Inability to match, draw, or point to objects
58
Apperceptive visual agnosia deficits are possibly due to?
Simultanagnosia
59
Lesion site associated with Apperceptive visual agnosia
Striate area- visual sensory area in occupital lobe Peristriate area- areas surrounding striate areaa
60
Define associative visual agnosia
Inability to identify objects Able to copy (drawings) or match sample objects
61
Associative visual agnosia is affected by what effect?
Stimulus abstraction Line drawings < picture or objects
62
4 types of associative visual agnosia
-Object agnosia -Color agnosia -Prosopagnosia -Alexia
63
What is object agnosia
Difficulty with object identification
64
What is color agnosia
Inability to identify/differentiate between colors
65
What is prosopagnosia
Face blindness Inability to recognize familiar faces They can recognize identifying characteristics of individuals (eye color, hair style, clothing, nose)
66
What is alexia
Acquired reading disorder Difficulty with letter identification
67
2 types of alexia
Peripheral and central alexia
68
which alexia type affects early stages of reading processes and includes difficulty with perceiving the wirtten word
Peripheral alexia
69
What is central alexia
Affects later stages of reading process Impairment in lexical and sublexical processing
70
Pure word agnosia
Difficulty recognizing/understanding spoken words Environmental (non-speech) sounds, reading, writing, and speaking abilities intact
71
How would a person with auditory comprehension deficit may differ from pure word deafness during a repetition task
AC would be able to repetite the words even tho unable to comprehend the words Pure word deafness would be able to perceive the sound, but not recognize it inorder to repeat
72
When listening to music, what may pure word deafness hear
Melody Without words
73
What is auditory sound agnosia
Difficulty recognizing enviornmental sounds Speech reception is normal
74
What is cortical deafness
Inability to recognize any auditory sounds All other language areas are unaffected
75
Which type of auditory agnosia often report feeling deaf
Cortical deafness
76
What is cortical auditory agnosia
A subset of cortical deafness Able to recognize background noise, but unable to recognize auditory sounds Feel like something is happening in the background
77
What is amusia
Difficulty recognizing/discriminating characteristics of music, while being able to hear lyrics/words within a song
78
What musical characteristics would someone with amusia not be able to discriminate
Pitch Harmony Timbre Intensity Rhythm
79
What is agraphia
Acquired writing difficulty
80
2 approaches to evaluating agnosia
1. neurologic model- Agraphia is the core, and the other disorder is associated with agraphia 2. Neuropsychological (Cognitive) approach- agraphia exists as a result of a processing deficit or peripheral deficit
81
What is linguistic agraphia
A problem in processing results in writing deficit (agraphia)
82
What is peripheral agraphia
Any peripheral (outside) deficit that results in a writing deficit
83
What peripheral deficits could cause agraphia
-mobility issue (ALS, cerebral palsy, paralysis) -Vision (blindness, visual neglect) -Attention deficit
84
When assessing agraphia, which writing level should writing be assessed?
Paragraph, sentence, and word level
85
2 types of writing tasks used to assess agraphia
1. spontaneous writing task 2. Dictated stimuli writing task
86
Instructing someone to write regular words, pseudowords, irregular words would be considered
Dictated stimuli task
87
Give an example of a spontaneous writing task
-Write what you did yesterday -Write a story about a past experience
88
What is the best way to assess writing
Spontaneous writing task
89
What are 2 approaches used in treating agraphia
1. Phonological Treatment Approach 2. Copy and recall treatment
90
What is the phonological treatment approach for agraphia
Hierarchy to improve writing - letter sound association -key word -picture identification -copy key word
91
What is CART
Retrains writing by looking at the word, progressing to spontaneous writing
92
3 interactive treatments for agraphia
1. Train phonological skills 2. Lexical checks 3. Electronic devices

Aphasia (4 decks)

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