Treatment Issues #2 Flashcards Preview

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Flashcards in Treatment Issues #2 Deck (43):

Object Naming Model

Phonological cues are superior

Semantic cues ineffective for patients who know what the word is


Semantic Treatment for Naming

Exercise Semantic Treatment in isolation of word finding

Patients not required to produce direct name

Focus on semantic activation before lexical retrieval

Questionable generalization to untreated items

ex. picture word matching, semantic judgment task


Semantic Feature Analysis

Naming with multiple semantic cues and questions
ex. what is it used for, reminds me of

Completion of phrases and writing answers

Treated/untreated naming improved

No improvement in spontaneous speech


Phonological Treatment for Naming

Lexical cueing to promote phonological structure

No generalization beyond 30 minutes to treated and untreated stimuli


Contextual Priming

Mass repetition to facilitate better naming

Improved naming with questionable generalization

Includes spoken word and picture matching, name repetition, independent naming (delayed repetition)


Verb Network Strengthening Treatment

Promotion of semantic-lexical connection to enhance word production

Verb presentation with nouns, identification of agents and patients


Promoting Aphasics' Communicative Effectiveness (PACE)

Total communication treatment

Focuses on pragmatism (relationship between language and context with reference to participants and roles, social settings, codes)

Additional topics include topic relevance, exchange of new info, initiations, turn taking


PACE Rules

Clinician and patient participate equally

An exchange of new info

A free choice of communication modality

Immediate feedback if message is not received


Constraint-induced Therapy

Intensity/mass practice


Response shaping

Socially imperative for communication

Constrained verbal modality

3-4 hours/day


Principles of Neuroplasticity

Use it or lose it

Mass repetition


Short post-onset time

Therapy done for a large chunk of time every day



PICA-based Treatment

Treat tasks at the fulcrum (middle point of the response continuum)


Content Centered Treatment

Focus on communicative effectiveness

Free choice of communication modality

Reduced emphasis on correctness

Problem solving skills

Improvement in spontaneous communication


Voluntary Control of Involuntary Utterances (VCIU)

We want to focus on getting voluntary control of involuntary utterances

Patient should be able to utter a few selected real words

Goal is to improve verbal output in NF patient with limited to stereotyped utterances


VCIU Treatment Steps

They need to have some ability to utter real words

Ask patient to voluntarily orally read their preserved spoken utterances (swear words)

Move to names of pictures objects and conversational use of words


VCIU Candidates

Speech is limited to a few words

Can match written words to picture


Melodic Intonation Therapy (MIT)

Singing to facilitate expressive language in severely NF patients

Assumption is that brain will reorganize with increased RH participation in case of recovery because musical skills are a RH skill


Basic Principles of MIT

Unison humming and hand tapping

Hand tapping and fading

Gradual progression of length and difficulty

Backing (go back to the previous level where the patient succeeded)

Repetition of correct responses

Use of controlled latencies (3-5 seconds ideal, up to 10 ideal)

Self-monitoring of verbal output

Intensive treatment

Sprechgesang (speech + singing)

Hierarchally structured program


MIT Treatment Steps


Unison singing with fading

Immediate repetition

Response to probe question (what did you say?)


MIT Candidates

Lesion confined to LH (Broca's area)

Good auditory comprehension

No expressive language, good artic. with stereotypic phrases

Desire to recover


Sentence Production Program

Story completion technique to elicit syntactic constructions for agrammatics


Sentence Production Program Candidates

Non-Fluent (Broca's, transcortical motor)


Visual Action Therapy (VAT)

Focus on AAC

Manipulation of objects and cards to follow commands, answer questions, describe events

Items include real objects, pictured objects, and action pictures to demonstrate verbs


VAT Treatment Steps

3 levels and 9 steps each

Step one includes matching objects and pictures, placing objects on pictures, placing pictures on objects, pointing to objects, pointing to pictures


VAT Candidates

Global aphasics with severely restricted receptive and expressive language functions


Recovery in Severe Aphasia

Improvement occurs later than for other aphasia types (6-18 months PO)

Continued improvement probably hinges on activity level, social engagement, and life participation


Steps to Facilitate Participation in a Severe Aphasic

Identify specific activities that are personally meaningful

Identify cognitive abilities

Link cognitive skills with activity and target with evidence based intervention


Communicative Drawing Program

Uses drawing as a facilitator

Stimuli include cartoons, objects and actions, stories

Tools include tracing and copying


Treatment of Aphasic Perseveration (TAP)

Treatment on confrontation naming by a non-perseverative response

Goal of naming 90% of the stimuli with no more than 10% of the items with perseveration


Perseveration types

Stuck in variety (inappropriate maintenance of category of response during new task)

Continuous (response prolongation without interruption)

Recurrent (inappropriate repetition of a previously emitted response after intervening stimulus)

Semantic perseveration (recurrence of a previous semantically related response to a new stimulus, eg pear for apple)

Phonemic carryover (part words or phonemes carried to the next unrelated response)


Frequency of Perseveration

Normal subject: 4% of responses

Fluent aphasics: 18% of verbal responses and 21% of nonverbal responses

NF aphasics: 39% of verbal responses and 19% of nonverbal responses


Specific strategies in TAP

Time interval of 5-10 secs between stimulus/response

Gestural cues; tactile cues


Description sentence

Sentence completion

Graphic cues

Phonemic cue

Oral reading


Unison speech or singing


Symptoms of Wernicke's Aphasia

Presence of speech with lack of awareness

Reduced comprehension


Poor repetition

Their verbal output has very little meaning


Wernicke's Aphasia Treatment Focus

Auditory comprehension

Establishing consistent responses

Incorporating word comprehension task

Directing attention to listening by signal or alarm

Charting communicative failures


Treatment for Expressive Aphasics

Treatment in contexts including naming, concept elaboration, grammaticality judgment, oral reading, copying, writing


American Indian Code

Simple signs for patients with basic communicative needs (not ASL)


Cognitive Treatment

Used to promote recognition and comprehension, registration of new info, generation of logical conclusions and alternatives, elicitation of a variety of responses, elaboration of ideas


Mental Operations

Cognition (problem solving, decision making, task planning)


Thinking (convergent, divergent)


Convergent Thinking

The generation of logical conclusions from given information

Emphasis on achieving conventionally best outcomes

ex. automatic language and focused answers
Lots of things boiled down to 1


Divergent Thinking

Generation of logical alternatives from given info

Emphasis on variety, quantity, and relevance of output from the same source

ex. open ended questions, lists


Evaluative Thinking

Formulation of evaluations in terms of known specifications, such as correctness, completeness, identity, relevance, logical feasibility

Judgmental thinking


Severe Non-Dominant Syndrome Treatment

Treat maladaptive behavior

Modification of environment

Attention to speaker

Maintaining eye contact

Attention to task


Moderate Non-Dominant Syndrome Treatment

Passive orientation (space/person/place/time)

Surrounding awareness (biographical info)

Attentional shift (scanning, cancellation)

General neglect



Mild Non-Dominant Syndrome Treatment

Linguistic subjects (critical vs noncritical info, identification of key points, topic coherence)

Paralinguistic properties (jokes, metaphors)

Cognition (problem solving, abstract reasoning, divergent/convergent)