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Aphasia Set 6.2 Tx Acute & Global
Aphasia Tx: Intro. acute & global
78
Communication
Graduate
11/05/2011

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Term
How many levels of evidence are there?
(the academy of Neurologic Communication Disorders uses this rating system)
Definition
Class I-IV
Term
Class I
Definition
prospective, randomized, controlled clinical trial; masked outcome assessment in a representative population with qualifiers
Term
Class II
Definition
prospective, matched group cohort study, in a representative population; masked outcome assessment that meets class I criteria OR randomized controlled trial that lacks one criteria for Class I
Term
Class III
Definition
All other controlled trials (including well-defined natural history control subjects or patients serving as own control subjects) in a representative population where outcome assessment is independent of patient treatment
Term
Class IV
Definition
Evidence from UNCONTROLLED studies, case series, case reports, or expert opinion
Term
ANCDS (Academy of Neurologic Communication Disorders & Sciences)Practice Guidelines
Definition
Gives guidelines for various neurogenic disorders. - over 700 Tx studies - meta-analysis - reports appear in Medical Journal of SLPathology
Term
What are some resources for staying CURRENT in the Treatment of Aphasia?
Definition
(textbooks are out of date, 2 yr lag)
1. texts
2. journals
3. conferences
4. workshops/teleconferences/videos
Term
Treatment Effects (4)
Definition
1. Acquisition
2. Response generalization (untrained exemplars of trained behaviors, untrained behaviors)
3. Stimulus generalization
4. Maintenance (withdrawl, follow-up)
Term
Acquisition
Definition
are they learning what you're working on?
are they acquiring the behaviors being treated?
Term
Response Generalization
Definition
1. untrained exemplars of trained behaviors.
2. untrained behaviors (related? what's gonna change together?)
Term
Stimulus Generalization
Definition
can they use what you've trained in DIFFERENT situations?
Term
Maintenance
Definition
1. withdrawal
2. follow-up
Term
Tx efficacy
Definition
effects of treatment provided under IDEAL conditions (clinic almost reaches this)
Term
Tx effectiveness
Definition
effects of treatment under routine conditions
Term
Tx outcomes
Definition
ANY level of measurement
Term
The majority of APHASIA THERAPY is comprised of what two types of approaches?
Definition
1. behavior modification
2. Stimulation-facilitation
Term
Behavior Modification
Theoretical assumption:
Targets of Tx:
Obtaining accurate response:
Tx mechanism:
Number of items in a task:
Feedback:
Definition
Theoretical assumption:
- no assumptions about aphasia
Targets of Tx:
- target a specific behavior
Obtaining accurate response:
- stimulus for particular response (modeling when necessary)
Tx mechanism:
- behavior change through consequence or the clinician's feedback
Number of items in a task:
- restricted number of stimulus items
Feedback:
- upon error or for positive performance
Term
Stimulation-Facilitation
Theoretical assumption:
Targets of Tx:
Obtaining accurate response:
Tx mechanism:
Number of items in a task:
Feedback:
Definition
Theoretical assumption:
- Impaired processes & preserved linguistic knowledge
Targets of Tx:
- Tx impaired processes
Obtaining accurate response:
- behaviors naturally elicited by a stimulus most of the time
Tx mechanism:
- power of a stimulus to elicit a response repeatedly
Number of items in a task:
- Large # of diff stimulus items that may vary from session to session
Feedback upon error:
- restimulation
Term
Linguistic approaches
Definition
Currently popular
- may employ behavioral mod, stimulation-facilitation, or combination of these two approaches
Term
Acute aphasia
Definition
- within hours/days of onset (1-5 days)
- patient may stay on acute medical unit until d/c (discharged)
- patient may transfer to another setting
Term
In the acute phase, what is priority?
Definition
pt's medical issues
Term
Pt should be ____ prior to initiating intervention (for speech)
Definition
medically stable
Term
Spontaneous recovery
Definition
- pt experiences a partial reconstruction of their prior language skills (could be motor skills too)
- can last b/w 6- upwards of 12 months
Contributors to Spon. Recovery:
- diaschisis-reversal (reversal of when things don't work down the line)
- adaptive plasticity
- behavioral compensation
Term
What are the three contributors to Spontaneous Recovery?
Definition
1. Diaschisis-reversal
2. adaptive plasticity
3. behavioral compensation
Term
What are some psychological considerations?
Definition
- pts & fam dealing w/ mortality
- lang probs not first concern after "brush w/ death"
- pt & fam suffer from range of emotions (anxiety, fear, frustration, depression)
- pt may have initial confusion/cognitive deficits, unsure if from CVA or COPING with CVA
Term
When educating Pt & fam, what is it good to do?
Definition
Provide WRITTEN information of what was discussed. Why?
b/c pt & fam may not be able to absorb the info due to what's happened
Term
It's good to know pt's & fam's level of knowledge about CVA.
Depending on severity of pt's CVA, may need to educate family/friends on best way to communicate w/ the pt.
Definition
Pt or Fam's knowledge of CVA may be from family or friend, so circumstances/type of CVA may not apply
Term
Determining assessment tools will likely depend on what?
Definition
The pt's level of severity (mild, moderate, severe impairments)
Term
With Mild-Moderate pts, can administer what formal assessments (if you have enough time)?
Definition
BDAE, ADP, WAB
Term
With a SEVERELY impaired pt what may you need to do?
Definition
administer BRIEF aphasia tests/screens and may need to administer more than once (baseline & progress)
Term
What are some examples of BRIEF FORMAL APHASIA TESTS/SCREENS?
Definition
- Sklar Aphasia Scale
- BEST-2
- Aphasia Language Performance Scales
- Screening versions of:
Examining for aphasia-3
Aphasia Screening test-2
Language Modalities Test for Aphasia
Term
Informal Assessment
Definition
- may be conducted first to determine what formal test to use
- problem: everyone does them differently
- SEVERELY impaired= limited in what can be conducted/assessed
Term
Setting of assessment:
Definition
- determined by facility
- sometimes in pts room
- limit # of ppl in room to avoid distraction ("helping")
Term
Treatment time for acute aphasia may be limited due to:
Definition
- due to being in acute unit
- transfer to another facility
Term
If short Length of stay (LOS) you may only be able to:
Definition
1. education (of CVA etc.)
2. quick assessment
Term
Treatment for Acute Aphaisa is based on _____
Definition
evaluation findings
Term
Amount of Counseling/Education pt & fam receives depends on:
Definition
ability to deal w/ event & new info.
Term
Counseling/Education occurs from ____ onward
Definition
the first meeting w/ pt & fam +
Term
for families to better communicate w/ pt, ___ may be needed.
Definition
Models of communication/interaction w/ pt
Term
To plan for Discharge (d/c):
Definition
team member communication about pt's: status, progress, participation, & prognosis.
- All give input to recommend next level of care (d/c to home, rehab, ECF etc.)
Term
What plays a role in determining the d/c plan for a pt?
Definition
- severity of impairments (communication/physical)
- family support
Term
Questions to consider in determining d/c plan as a team
Definition
1. can pt go home & have home health/outpatient tx? Managed by family at home?
2. Would pt benefit from continued intensive tx? Able to participate and make progress?
3. Is the pt limited in participation/progress/family support?
Term
Upon or After d/c, you should provide next SLP w/ what?
Definition
information regarding what was done (eval/tx)-release of info.
(Don't waste time/money by repeating services)
Term
Global Aphasia
Definition
- is a severe loss of language comprehension with concomitant deficits in expressive aphasia
- 55% of pts in acute phase exhibit global aphasia
Term
Lesion Site & Etiology for Global aphasia
Definition
1. large lesion affecting pre- & post- Rolandic areas (Broca's & Wernicke's)
2. Stroke-MCA
- w/ hemiparesis
- w/o hemiparesis
- Lg. hemorrhagic stroke
Term
What is comprehension like in ppl w/ global aphasia?
Definition
- single word comprehension (functional/common words)
- several isolated areas of relatively preserved comprehension:
personally relevant info
recognition for specific wrd categories
familiar environmental snds
famous personal names (use for positive reinforcement)
Term
What is verbal expression like in pts w/ global aphasia?
Definition
- very limited
- output: stereotypic recurring utterances & speech automatisms
- maintain use of suprasegmental aspects
Term
___ aphasia is the type of aphasia most likely to have cognition impacted
Definition
global
Term
Poorer cognition may lead to impaired ____
Definition
lexical semantic disturbances
Term
Depression following CVA for __ types of apahsia has been unrecognized & under treated
Definition
all
Term
Why have persons w/ Global aphasia been excluded from depression studies?
Definition
b/c of significantly impaired comprehension/expression abilities
Term
Better improvement is demonstrated in ___ than in ___ for ppl w/ global aphasia
Definition
comprehension (better!) expression (worse)
Term
substantial improvement may occur from __-__ mos, but may continue up until __ mo post onset.
Definition
3-6; 12
Term
Global aphasia may evolve into different types (__ - __ evolution across reports)
Definition
0-100%
Term
What are some prognostic factors?
Definition
1. Age (younger better)
2. Hemiparesis (none, better; mild R arm weakness that improved w/in days, better)
3. Alertness/attention (more=better)
4. Language scores:
- PICA (gives prognosis): good Aud. comp, naming=better)
-other aphasia measures: no variability b/w Aud com and other measures=worse; Y/N responses to simple questions=BETTER!
Term
Assessment should...
Definition
- be more than a Dx (diagnosis)
- give pts STRENGTHS & WEAKNESSES
Term
Formal testing should be conducted to sample behaviors across each lang domain
Definition
- but may be inadequate for Tx planning
Term
What is Matrix Assessment?
Definition
- method of systematically assessing basic skills across modalities
- administer at least 5 items per S-R (stimulus-response) relation
- multidimensional scoring suggested
Term
What are prognostic limitations with respect to acute Global aphasia?
Definition
- global aphasia cannot be reliably discriminated
-conflicting findings regarding prognostic indicators
-early intervention appears to be associated with better progress
Term
What are the treatment objectives respect to acute Global aphasia?
Definition
- Tx should be initiated early to facilitate recovery
- Education w/ family & staff to facilitate/enhance communication
Term
What are goal revisions regarding time of intervention of acute global aphasia?
Definition
- varying degrees of improvement across patients
- improvement/evolution to less severe or another aphasia classification
Term
Goal revision
Definition
- due to the dynamic nature of aphasia, early testing in only a measure of the pt's language functioning at a SINGLE POINT in time
[ongoing evaluation/probes will be needed/expected during all phases of treatment]
- Establishing & revising short-term tx goals are inherent principles of aphasia tx
[regardless of when tx is provided, this process will be repeated regularly throughout the term of the pt's rehabilitation regardless of type of aphasia]
Term
What are some realistic goals for the Gobally aphasic patient? (Collins, 1997)
Definition
* IMPROVE AUDITORY COMPREHENSION
* Establish consistent system of yes/no responding
- improving ability to spontaneously produce several written (or verbal) responses/approximations, of functional or salient words of daily living.
- establishing use of several simple gestures
- improving drawing
*ensuring that a small, basic core of communication intentions can be conveyed in one or a combination of modalities
Term
Treatment: Educating Staff & Family
Definition
Guidelines for communicating with the severely aphasic patient:
-simplify
- clue him/her in
-allow time
-guess
-confirm
-be clear
-reduce extraneous variables
-respect (no baby talk)
Term
What are stimulation approaches for Auditory Comprehension?
Definition
1. Matching pictures-pairing real objects to realistic pic to line drawing
2. matching pictures: Eliciting: -responses -differentiated response - appropriate responses -accurate responses
3. Playing cards: based on the observation that global aphasic patients can recognize names with 2 salient features (e.g. queen of hearts)
Term
Stimulation approaches for verbal expression
Definition
- associating meaning with speech movements
- conversational prompting
- voluntary control of involuntary utterances
Term
Associating meaning with speech movements
Definition
1. tasks include: showing fingers, pointing, gesturing, writing, matching, selecting objects to confirm meaning to any successful verbalization
2. auto speech, imitated words/phrases
3. small # of wrds/ gestures, yes/no, greeting phrase, common phrases
Term
Conversational prompting (Wambaugh thinks this is more of a higher level task, a bit too hard)
Definition
-10 conversational levels
-use modeling, expansion & feedback to develop verbal responses in conversational context.
- props and written cues are provided to facilitate verbal expression
-cueing hierarchy is utilized to promote language retrieval
Term
Voluntary control of involuntary utterances
Definition
- purpose is to bring stereotypies into mmore productive usage
- during evaluation/tx-track words used involuntarily & inappropriately (that are consistent)
- for tx, words are trained in sequence at oral reading, confrontation naming & conversation
- goal is to build a vocabulary of 200-300 wrds
Term
Gestural Programs
(Approaches)
Definition
1. Amer-Ind code: best known code, system based on concepts underlying wrds rather than on the wrds themselves
2. visual action therapy: purpose is to utilize gestures to reduce apraxia & improve the pts verbal expression or ability to use symbolic gestures for communication
3. Pantomime
4. Limited manual signs
Term
Gestural Training steps:
Definition
1. Cl gestures & says wrd simultaneously
2. Cl says wrd, cl & pt gesture simultaneously (cl may need to assist w/ gesture)
3. pt imitates gesture
4. pt imitates gesture after delay
5. pt gestures in response to auditory stimulus
6. pt gestures to aud stim after delay
- add written stimulus steps if appropriate
7. pt gestures in response to appropriate stimuli
Term
AAC Approaches (3)
Definition
Preparatory Training
Communication Boards
Computer-Aided Visual Communication (C-VIC)
Lingraphica System
Term
Preparatory Training (an AAC approach)
Definition
-Specific Treatment program for global aphasic pts for the purpose of establishing the necessary skills needed for the iconic/substitutional language system
Term
Communication Boards (an AAC approach)
Definition
- will vary in type and complexity
- Boards include specific items that communicate wants & needs as pts progresses can include other areas of communication
Term
Computer-Aided Visual Communication (C-VIC) [an AAC approach]
Definition
- promising approach to establishing alternative communication in severely impaired patients
Term
Lingraphica System (an AAC approach)
Definition
- Tx program delivered to pts in a laptop computer in tx setting & at home
Term
Drawing
Definition
- drawing has been used for communication as well as strategy for deblocking verbal & written communication
- Back to the Drawing Board
- Other drawing approaches/tx
Term
Future needs for Global aphasia
Definition
- evolution of global aphasia
- refining prognostic indicators
- I.D. relationship b/w site/extent of lesion & global aphasia in outcomes
- outcome info to be used for better management of global aphasic pts
- assessment/Tx specific to globally aphasic pts
- improving communication for globally aphasic pts as well as quality of life. (there's really not much out there)
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