Aphasia

What is Aphasia? Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain- most typically, the left hemisphere. Aphasia involves carrying degrees of impairment in four primary areas.

• Spoken language expression
• Spoken language comprehension
• Written expression
• Reading comprehension

Assessment: 

1. “Hello Mrs/Mrs. _____, I’m _____ a speech language pathologist. I’d like to see how you are doing today.”
2. Small talk to elicit the patient’s “best” discourse sample

• Phrase length
• Syntax
• Paraphasia
• Prosody
• Articulation errors

3. Assess auditory comprehension from simple to complex. Use relatable tasks or objects that can be found in the environment.

• Pull up your chair
• Hand me the pen
• Turn off the TV
• Fold the paper in half, before you give it to me

4. Assess Naming

• Confrontational: “What’s this?” as you point to an object or picture
• Generative: “Name 5 types of fruits. Name the members of your family.”

5. Assess Repetition

• Start with single words and increase to phrases: “Repeat after me”

6. Do you have any questions for me?

Classification of Aphasia

Treatment Hierarchies

SEMANTIC CUEING HIERARCHY: If the patient does not accurately respond, provide feedback “No- but we are getting closer. Let’s buy something else.”

1. Picture is presented: “What’s this?”
2. Picture is presented with a verbal description of the target: “This is something that we ____. What’s this?”
3. Pictures are presented with semantically non-related sentence completion: “Let’s go to the store and buy a ____.”
4. Picture is presented with semantically loaded sentence completion
5. Picture is presented with verbal model: “Repeat after me:___”

PHONOLOGICAL CUEING HIERARCHY

1. Picture is presented: “What’s this?”
2. Picture is presented along with a NON-word rhyme: “It rhymes with ____.”
3. Picture is presented along with the first sound cue: “It starts with ___.”
4. Picture is presented along with a NON word rhyme cue and sound cue: “It rhymes with ___ and starts with ___.”
5. Picture is presented with a verbal model: “This is a ___.  Say ___.”

Treatment

SEMANTIC FEATURE ANALYSIS

MELODIC INTONATION

Candidacy includes:

• Have damage to only the left hemisphere
• Demonstrates good auditory comprehension
• Non-fluent speech
• Poor repetition of single words

During the first stages, stimuli should be no longer than 4 syllables and gradually work to 5+ syllables. Make it functional by choosing target words that the patient will utilize in their everyday life. Only 2-4 musical notes are to be used and should resemble natural prosody. Write down the words and phrases in length and underline the naturally emphasized words.

Auditory Comprehension Hierarchy

1. Point to one object
2. Point to object by function
3. Point in sequence to two objects by function
4. Point in sequence to two objects by name
5. Point to one object spelled by examiner
6. Point to one object described by examiner with 3 descriptors
7. Follow one-verb instruction
8. Point in sequence to three common objects by name
9. Point in sequence to three common objects by function
10. Carry out two object location instructions
11. Carry out, in sequence, two verb instruction
12. Carry out, in sequence, two verb instructions with time constraints
13. Carry out three verb instruction
14. Correctly selecting the pictorial representation of the word from a group of six upon hearing the word spoken by the clinician

COMMUNICATION STRATEGIES FOR APHASIA

• Simplify language by using short, simple sentences.
• Maintain a natural conversational manner appropriate for an adult.
• Minimize distractions like radio/TV when possible.
• Ask yes/no questions or give choices.
• Use gestures while using verbal communication. Pause to assess understanding.