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Functional Approaches to Aphasia Flashcards

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1
Q

What is a functional approach

A

assessment or treatment focusing on the person’s ability to function in daily life following brain damage

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2
Q

what questions does functional assessment aim to answer? (4)

A

How is functional performance affected by the impairments associated with the disorder?

How can the person function now, despite the impairments?

How can the person function within everyday contexts (this can include assessment and intervention which includes Eg family members or friends of the person affected)?

How can intervention be targeted directly on improving function?

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3
Q

what is another type of assessment/intervention that is not a functional approach?

A

impairment approach

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4
Q

what are the 3 main functional approaches

A

Communication-focused

Psychosocial-focused

Interaction-focused

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5
Q

reference for the classification of 3 functional approaches

A

Wilkinson, 2015

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6
Q

what does communication-focused assessment focus on?

A

Focus is on transfer of information (transactional aspects of communication)

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7
Q

what did Holland, 1977 find?

A

PWA can communicate better than they talk

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8
Q

what do PWA use to overcome communication barriers?

A

compensatory strategies

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9
Q

what are compensatory strategies

A

spontaneously acquired and systematically employed, to overcome a communication barrier in an effort to meet both transactional and interactional communicative goals’

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10
Q

reference for compensatory strategies?

A

Simmons-Mackie & Damico, 1997

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11
Q

3 types of compensatory strategy

A

circumlocutions

idiosyncratic use of language

non-verbal

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12
Q

3 types of NV compensatory strategy

A

drawing

writing

gesture

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13
Q

reference for drawing

A

Sacchett et. al., 1999

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14
Q

3 points about drawing as a CS

A

Useful for more severe PWA

Integrated into intervention with SLT also using it.

SOs report using it increasingly post-intervention

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15
Q

reference for writing

A

Garrett et. al., 1989

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16
Q

how is writing used as a CS

A

write whole or part of a word

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17
Q

negative of using writing as a CS + reference

A

Involves certain loss of interactional functions such as eye gaze, facial expression, prosody (Wilkinson et. al., 2011)

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18
Q

who gestures more - PWA or typical speakers

A

PWA

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19
Q

how does gesture differ across diff aphasia types?

A

People with different forms of aphasia show different patterns of gesture use on the whole

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20
Q

how do people with BA use gesture differently to people with WA + reference

A

Broca-type PWA use more ‘meaning-laden gestures’ such as iconic gestures and pantomime, while Wernicke-type PWA rely particularly on metaphoric gestures and beats (Sekine et al., 2013)

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21
Q

reference for PWBA relying most on gesture

A

Ozturk & Özçalışkan, 2024

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22
Q

reference for targeting gesture use with PWA can be successful

A

Rose et. al., 2013

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23
Q

summary of communication-focused intervention

A

Encourages multimodal communication (PWA has to convey a message to a listener that is unknown to the listener) and involves SLT prompting PWA to use all modes of communication

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24
Q

examples of communication-focused intervention

A

PACE

Conversational Coaching

APPUTE

Compensatory strategy focus

Communication Partner Training

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25
reference for PACE
Davis, 2005
26
what is PACE
Popular in 80s and 90s Involves PWA conveying content of a set of pictures to an SLT
27
reference for conversational coaching
Hopper et. al., 2002
28
what is conversational coaching
Similar to PACE PWA has to convey videoed stories to SO SO is part of the therapy session, SLT coaches them both
29
reference for APPUTE
Nykanen et. al., 2013
30
what is APPUTE
Similar to conversational coaching More formalised, greater involvement of SO, SLT takes more active role
31
reference for CPT
Simmons-Mackie et. al., 2010
32
what is CPT?
Improves how the non-aphasiac communication partner communicates with PWA Can also focus on interactional and psychosocial issues covered by other 2 approaches
33
when did the psychosocial approach gain popularity
since 1990s
34
what does psychosocial-focused assessment focus on? + reference
Interested in how aphasia affects the social self (Brumfitt, 1993; Shadden, 2005)
35
36
what elements of social self are included in psychosocial focused assessment
face displays of competence PWAs participation QoL anything emphasised in social model of disability
37
reference for face
Goffman
38
reference for displays of competence
Kagan et. al., 2001
39
reference for PWAs participation
Davidson et. al., 2008
40
reference for QoL
Hilari et. al., 2010
41
what are the emotional impacts of aphasia + references
Aphasia can cause increased levels of stress and depression for both the PWA and the SO/carer (Hilari et al, 2010) Dar & Biran (2024): ‘Spouses of PWA face an emotionally taxing journey, with communication impairment reshaping marital dynamics'
42
3 psychosocial-focused interventions
counselling supported conversation communication partner scheme
43
reference for counselling
Brumfitt, 2000
44
challenges of counselling for PWA
counselling services based around talk - not aphasia friendly poor NHS provision
45
reference for supported conversation
Kagan et. al., 2001
46
aims of supported conversation
Aims to improve the psychosocial well-being of the PWA  Training volunteers at an aphasia centre to improve their interactions with PWA PWA can communicate better and better display underlying competence
47
reference for communication partner scheme
McVicker et. al., 2009
48
aims and method of CPS
Aims to improve the psychosocial well-being of the PWA  Similar to SC  Volunteers visit people at home instead
49
when did interaction-focused approach first emerge
since 1990s
50
what does intervention-focused assessment use
conversation analysis
51
reference for CA
Sidnell & Stivers, 2013
52
methodology for CA
1) Record naturally occurring conversations 2) View recording; select and transcribe parts that seem relevant 3) Analyse to investigate the norms of conversation and how the participants are following the norms (or not)
53
areas that CA focuses on (5)
Turns (e.g. turn construction, turn-taking) Actions (questioning, answering, requesting, teasing etc) Sequences of actions (question-> answer; request-> granting or declining) Repair (self vs. other repair initiation and repair completion) Topic (how it is initiated and maintained)
54
what is repair?
 interactional practices by which participants identify and deal with troubles in speaking, hearing and understanding
55
2 types of repair
Repair-initiation  Repair-completion can be both self or other
56
what is self-initiated repair
where speaker indicates there is a trouble with his/her own talk typically indicated by a) a pause indicating word search or b) a cut-off of a word being produced.  Most common in typical conversation, speaker is successful in repairing trouble quickly. (self-initiated, self-repair)
57
what is other-initiated repair
typically occur in turn following trouble source turn and are often used to display a problem of hearing or understanding. Normally will trigger a self-repair attempt from initial speaker which is usually successful (other-initiated self-repair)
58
what is self-initiated other repair
Sometimes, the speaker may not be the one who initiates repair perhaps due to inability to find the word needed for repair (self-initiated, other-repair)
59
2 features of aphasia that disrupt turn-taking
word searches agrammatism
60
which types of aphasia are word searches most prominent in?
occur in all aphasias but especially fluent types e.g. anomic
61
how do word seacrhes disrupt the progressivity of turns
word searches lead to frequent self-initiations of repair and the PWA may have difficulty achieving self-repair. Repairs may end up as self-initiated other-repair or abandoned repairs.
62
which types of aphasia is agrammatism most common in?
symptom of Broca-type, non-fluent aphasia
63
how does agrammatism disrupt the progressivity of SEQUENCES of turns
leads to other-initiations of repair when the listener doesn’t understand. Other-initiations can be more frequent with PWA than in typical conversations which slows the conversation
64
why does disruption to progressivity of turns matter?
ince the norm for conversation has a ‘preference for progressivity’, the difficulty in progressing draws unwanted attention to speaker and reason for difficulty.
65
66
why does disruption to progressivity of sequences of turns matter?
The expectation is that a speaker will design their turns to be best understood by their listener. Other-initiations of repair can highlight that this expectation has not been met, drawing unwanted attention to the reason for the lack of understandability.
67
what is adaptation in aphasic conversation?
PWA and their SOs find novel ways to talk and communicate = adaptation
68
why is adaptation in aphasic conversation important?
Lessens occurrence of repair which would occur if they attempted to speak like they did pre-aphasia
69
name a type of adaptation in aphasic conversation
enactment
70
reference for enactment
Wilkinson et. al., 2010
71
define enactment
a type of adaptation, where the PWA ‘acts out’ an event rather than describing it. Normally made up of quotations and use of gesture
72
features of interaction-based intervention (3) + reference
Lock et. al., 2001 Naturally occurring conversations between PWA and SO is the basis for pre-intervention baseline/planning and for post-intervention evaluation SOs are typically targeted in the intervention (can be only SO and not PWA but often targets them together) Intervention focuses on reduction/elimination of unhelpful adaptations (particularly by the SO) as well as promoting new interactional adaptive behaviours between PWA and SO

LCCA Exam Revision (7 decks)

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