Acquired language Disorders

1. Acquired language Disorders aphasia…and

2. important ideas about aphasia aphasia… • …is a symbolic disruption • …is acquired • …involves any or all language modalities • comprehension: auditory, reading, signed/visual • expression: oral, writing, signed/manual • …is not a problem of sensation or intellect

3. Common causes of aphasia CVA TBI tumors infections epilepsy Over 1,000,000 individuals with the US have aphasia - National Aphasia Association

4. describing aphasia Hegde (1998); Brookshire (1997) • various impairments in any/all language modalities • the most commonly observed deficits are in naming and auditory processing • generally describe an the language profile as: • fluent/receptive; • nonfluent/expressive; or • severe or global

5. General symptoms: Bid idea: aphasia treatment focuses on the specific deficit, not the “type” of aphasia • Impairments impacting language use include: • impaired auditory comprehension • anomia: word retrieval/naming difficulty • paraphasias: word or sound substitutions • agrammatism: asyntactic production (or reduced syntax) • reading and writing disruptions

6. the WHO ICF • Functioning and Disability • body functions and structures • activity and participation • Contextual Factors • environmental factors • personal factors

7. Treatment and assessment - Linking the WHO ICF • restorative/process oriented approaches – impairment (body structure/function) • approaches aimed at improving underlying motor or cognitive processes, resulting in generalized improvement in function • skills based/compensory approaches – activity/participation • approaches that train a new skill/behavior -or- alternative method for communicating • however…the distinction of restorative vs. skills based not so clear • participation focused approaches – participation • approaches focused on improved community participation and quality of life

8. Treatment examples Response Elaboration Treatment (RET) Semantic Feature Analysis (SFA)

9. response elaboration training (RET) client profile: variety of aphasia profiles and severities; reduced semantic and/or syntactic content/form result in limited oral expression target: oral discourse  increased content units and length of utterance rationale: combining behavioral techniques of modeling and forward chaining with cognitive stimulation using loose training results in expanded oral expressive output • loose training - uses the client’s response as stimulus

10. RET Protocol: uses simple line drawings important: used modified RET (mRET) for clients with significant apraxia

11. measurement • in session data: • content: number of information units produced (steps 1 and 6) - may vary based on severity of client • possibly grammatical production: number of morphemes, nouns, verbs, and modifiers • outcome measures: • increased MLU in language sample, everyday conversation • measure of impact (e.g., questionnaire, GAS)

12. Semantic Feature Analysis (SFA) client profile: semantic impairment resulting in naming deficit; moderate to severe deficits cause significant difficulty in everyday conversation • errors include semantic substitutionsand failure to name (anomia) • may have a broader semantic deficit target: naming increased content in everyday language; increased ability to say relevant words rationale: • based on concepts of semantic nodes and spreading activation - SFA activates the semantic network around the target word, which may a) increase the likelihood the target can be retrieved, and/or b) strengthen the semantic network (Boyle and Coehlo,1995)

13. RET protocol: • client is shown a picture, asked to name it, then describes it using semantic feature chart • example cues: “you use it for…”, “it’s found in…” • client generates responses and writes answers in boxes around picture

14. measurement • in session data: • number of words named without cues (1 step of protocol) • notes regarding task performance • use a modified SOAP note (current and last session data) and report accuracy on on each set • use information about performance that you collected to assess performance variables (e.g., does she always need help with a particular feature? Does it vary?) • outcome measures • impairment: Boston Naming Test; conversational sample; untrained word probes • activity/participation: self report of increased naming (e.g., fewer communication repairs needed with partner; efficiency; successful phone call, etc.)

15. important ideas • always consider your session data and outcome measurement as separate measures - it is not sufficient to see improvement only on treatment tasks • and measure the real life impact, not just increased accuracy on a test • given client goals, tailor your treatment to the client’s deficit or desired change • Karen can give you information about a variety of interventions - drop by!