Partner Approaches

Script Training

Origin: In recent years there has been a shift in focus of aphasia treatments to reflect a person's language abilities in everyday interactions.

Rationale

Candidacy

Guidelines

• Variety of types of aphasias and severities
• Studies: Broca's, Conduction, chronic nonfluent aphasias
• Moderately spared comprehension and cognitive difficulties, with significant expressive speech difficulties

• Implementing a social script approach to therapy yielded improvements on accuracy, grammatical productivity, speaking rate, and articulatory fluency
• Studies have also shown improved grammatical morpheme use and, again, increased rate of speech
• Carryover to more functional communication tasks
• Results concluded it was a successful treatment approach. Participants mastered scripts and script productions were judged as more automatized based on naturalness and stability of speech, increased rate and general errorless productions.

• Goals
• Fluency of production for the trained script
• Fluency of independent productions
• Generalization of particular forms to other contexts
• Improve social interaction

(Goldberg, Haley, & Jacks, 2012)

(Youmans, Holland, Muñoz, & Bourgeois, 2005)

(Armstrong, Ciccone, Godecke, & Kok, 2011)

(Hinkley, 2009)

(Hinkley, 2009)

(Youmans et al., 2005)

Reciprocal Scaffolding

Pragmatic Treatment:

Conversational Coaching

Origin: Increase in focus on life participation (Avent, Patterson, Lu, & Small, 2009)

• Core concept of World Health Organization (WHO)
• Supported in more recent research/publications

The life participation approach to aphasia presents a theory and strategy that encourages clinicians to implement treatment that focuses on opportunities for a person with aphasia to engage, or re-engage, in life-enriching activities.

Guidelines

Origin: This treatment was created from the need to improve communication strategies between people with aphasia and their families (Hopper, Holland, & Rewega, 2002).

Core concept of World Health Organization (WHO) pushed for more non-impairment based intervention

Rationale

• Communication Partners
• Expert (PWA) teaches skills to novice.
• Shared learning activities
• e.g. Former baker teaches someone how to make a cupcake
• Goals:
• Improve fluency and content in conversation
• Variety of vocabulary
• Increase content in oral and written language

Candidacy

To train people with aphasia to implement effective communication strategies within their family unit and reduce frustration

Candidacy

(Avent et al., 2009)

(Avent & Austermann, 2003)

(Hinkley, 2009)

• Effective for a number of different types and severities of aphasia.

• Mentioned in the studies: Anomic

Rationale

(Hopper et al., 2002)

This therapy approach can be effective for a variety of aphasia types and severities.

Guidelines

(Avent et al., 2009)

(Avent & Austermann, 2003)

(Hinkley, 2009)

• Genuine, relevant, context dependent interactions that represent goals and participation levels of WHO
• Positive changes for word fluency, correct information units, and variety of words used.
• The re-application of prestroke vocational skills can enhance quality of life and improve language performance.

(Hinkley, 2009)

• Client with Aphasia and spouse are partners
• Clinician is used as a communication coach
• Goals
• Provide alternative communication strategies
• Incorporate verbal and nonverbal strategies
• Teach strategies for response time
• Enhance information exchange
• Encourage writing
• Allow more talking time

(Avent et al., 2009)

(Avent, J., & Austermann, S. 2003)

(Hopper et al., 2002)

Describe the idea you think is best

Mixture of language based treatment with functional, social, life participation focused therapy

Key Points

References

• Partner Approaches have been shown as beneficial for improving communication activities and life participation in PWA when interacting with trained communication partners
• Pragmatic treatment has been shown to increase effective communication and reduce frustration
• Reciprocal scaffolding has been shown to improve fluency, content and vocabulary.
• Script training also improves social interactions
• Overall quality of life improvements
• Advocacy for group therapy to be billable
• Continue research

American Speech-Language-Hearing Association (n.d.). Aphasia (Practice Portal).

Retrieved from www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/.

Armstrong, E., Ciccone, N., Godecke, E. Kok, B. (2011). Monologues and dialogues in

aphasia: Some initial comparisons. Aphasiology, 25(11), 1347-1371. doi: 10.1080/02687038.2011.577204

Avent, J., Patterson, J., Lu, A., & Small, K. (2009). Reciprocal

scaffolding treatment: A person with aphasia as clinical teacher. Aphasiology, 23(1), 110-119. doi:10.1080/02687030802240211

Avent, J., & Austermann, S. (2003). Reciprocal scaffolding: A

context for communication treatment in aphasia. Aphasiology, 17(4), 397.

Brookshire, R. H., & McNeil, M. R. (2015). Introduction to neurogenic communication disorders.

Elsevier Health Sciences.

Goldberg, S., Haley, K. L., & Jacks, A. (2012). Script training and generalization for people with

aphasia. American Journal Of Speech-Language Pathology, 21(3), 222-238 17p. doi:10.1044/1058-0360(2012/11-0056)

Hinckley, J. J. (2009). Conversational treatments: Aphasia [PDF]. Retrieved from http://

www.asha.org/events/convention/handouts/2009/1206_hinkley_jacqueline/

Hopper, T., Holland, A., & Rewega, M. (2002). Conversational coaching: Treatment outcomes and

future directions. Aphasiology, 16(7), 745-761.

Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., & Cherney, L., (2010).

Communication partner training in aphasia: Systematic review. Archives of Physical Medicine and Rehabilitation, 91, 1814-1837.

Wilcox, M. J., & Davis, G. A. (2005). Speech act analysis of aphasic communication in individual

and group settings. Aphasiology, 19(7), 683-690.

Youmans, G., Holland, A., Muñoz, M., & Bourgeois, M. (2005). Script training and automaticity

in two individuals with aphasia. Aphasiology, 19(3-5), 435-450. doi:10.1080/02687030444000877

Script Training Demonstration

• 1. The client and clinician collaboratively determine the type of script that would be most relevant to the client; Monologue or Dialogue

2. Co-construct the targeted script.

• May seek input and help of a close relative or friend

3. Practice the script, using techniques such as phrase repetition and choral reading, until the client is able to produce phrases within the script independently.

4. Have the client independently practice repetitively while monitoring and facilitating as needed.

5. Practice contexts in which the person with aphasia can use the script created.

(Hinkley, 2009)

Cons

Pros

• Individualized
• Functional
• Improves automaticity, fluency, and rate of speech

• Time Constraints
• Frequency of Sessions
• Lee, Kaye, & Cherney (2009), positive correlation between amount of treatment and content with severe aphasia and amount of treatment and rate with less severe aphasia

Reciprocal Scaffolding Demonstration

1. Choose an activity that is relevant to the client.

• For example, teaching science lessons to young children for a former teacher.

2. Embed scaffolding techniques to facilitate communication.

3. Practice doing the activity in order to foster expressive abilities and life participation.

Pros

Cons

• Functional
• Meaningful
• Relevant
• Increases Life Participation
• Level of Motivation
• Individualized, Personal

• Lack of current research
• Could be effected by personality type

(Hinkley, 2009)

Pragmatic Treatment Demonstration

• Clinician and client watch t.v. clip
• Client must communicate a summary of what they watched to their partner
• Clinician, client, and partner choose strategies to help create effective communication
• Clinician, client, and partner identify strengths/weaknesses from interaction
• Client and partner practice communicating information using the identified strategies
• Clinician acts as the coach

(Brookshire, 2015)

Pros

Cons

• Decreases frustration
• Improves communication of information as well as wants/needs
• Strategies can be taught to other family members and friends
• Positively impacts all communication interactions

• Strategies chosen by the specific conversation partner and the person with aphasia
• Might not generalize to all social situations

(Hopper et al., 2002)

(Hopper et al., 2002)

Partner Approaches

• Partner approaches can be defined as interventions that address a person with aphasia who interacts with another individual to support enhancement with their ability to communicate and quality of life ( Wilcox & Davis, 2005).
• Focuses on "interventions directed at people other than the person with aphasia (PWA) with the intent of improving language, communication, participation, and/or well being of the PWA" (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010).

Reciprocal Scaffolding

Script Training

Pragmatic Treatment

Treatment approach in which communication skills are addressed in natural, individualized environments where a person with aphasia takes on the role of an instructor to novices.

This technique allows both parties to demonstrate and reinforce communication strategies during conversations about topics of interest.

With this technique, the clinician and person with aphasia construct a monologue or dialogue pertaining to situations that relate to the person with aphasia and is practiced intensely to support communication.

Treatment approach that focuses on how language is used in social context. It addresses deficits such as turn taking, repair techniques, word choice, nonverbal communication, and conversation rules.

This approach allows clinicians to address speech and language in a natural setting with partnered support.

(American Speech-Language-Hearing Association [ASHA], n.d.)

(ASHA, n.d.)

Partner Approaches

Based on Jim Harvey's speech structures