National Aphasia Association Newsletter
Volume 11, Number 1 Spring 1999
Aphasia Therapy Research Update
by Anthony J. Velez, M.D. and Martin L. Albert, M.D.This column, which will be published periodically in the NAA Newsletter, will summarize current research activity focusing on promising new approaches to aphasia therapy around the country and around the world.
Current research is focusing on two key themes in treating people with aphasia: (1) the need to tailor the approach to the individual patient and to a specific aphasic sign or symptom; and (2) to bring family and other members of the social support system into the therapeutic process.
To tailor treatment, it’s helpful to understand the underlying problems that may be causing the specific symptoms. One discipline that may assist in both analyzing and treating aphasia is cognitive neuropsychology (a branch of psychology concerned with mental processes, including memory and language). The goal of this approach is to sift out and understand which portion of the patient’s language process is impaired, then to formulate treatment approaches based on the specific impairment. This approach has been proven effective in a range of aphasic difficulties, but perhaps is best illustrated in the treatment of anomia (inability to use or understand words denoting objects). In aphasia, word retrieval is often impaired, but the underlying cause for the anomia may vary across patients. Tailoring treatment to a proposed cause of deficit may result in successful outcomes.
For example, Ochipa and colleagues in a recent paper (Neurophysiology and Neurogenic Speech and Language Disorders, 1998) reported on their treatment of a young man with anomia with seven, twice-daily administrations, of a 30-minute tailored treatment program. The patient demonstrated a substantial increase in naming (from 20-35% to 100%). Not only did he improve in naming the words that were the primary focus of the treatment, he also showed an increase in oral and written naming for words that weren’t part of the study, and was able to maintain a high level of accuracy in naming these words some two weeks after treatment.
Another example is the new “modular treatments” approach to the rehabilitation of aphasia presented by Schwartz, Fink, and Saffran (Neuropsychological Rehabilitation, 1995). First they analyze the “component symptoms” of their patients who show symptoms of agrammatism (inability to use words in grammatical sequence). Then they develop a series of specific treatment approaches for each of the disturbed components, based on psychological theory of language development. Each of these targeted treatments becomes the “module” or a piece of a complete rehabilitation program. In this report and others, they document their patients’ improvement, especially in persons with the most severe form of agrammatism.
When treating aphasia, the therapist must look at the whole person, addressing not just the language deficit, but also the personal and social issues associated with the communication disorder. Lyon and colleagues tackle this issue in a novel aphasia treatment plan called Communication Partners (Aphasiology, 1997). At the core of this treatment program is the desire to restore a sense of direction and control to both the patient and the caregiver. This is achieved through involvement of a community volunteer who aids and accompanies the person with aphasia, in activities of his or her choosing, within the home and/or community. Although patients’ test results in regaining language skills varies, all participants (caregivers, patients, and partners alike) have noted improvement in the patient’s sense of well-being and in functional communication.
One of the exciting new directions in aphasia rehabilitation is in the field of computer-aided therapy. A particular strength of this approach is the accessibility and variability of tasks made possible by the computer. Uses range from simple reading response tasks aimed at reconditioning language in afflicted patients to creative communication systems such as C-VIC (Computerized visual communication, Baker, Nature, 1975; Weinrich, Journal of Neurolinguistics, 1991) which offers severely aphasic patients a computerized symbol system as an alternative to spoken language.
A recent re-analysis of a computerized written naming rehabilitation program by Deloche and colleagues revealed global improvements in both untrained items and untreated oral naming (writing and speaking words not in the program; Journal of Communication Disorders, 1997). Another study, by Katz and Wertz (Journal of Speech, Language and Hearing Research, 1997), illustrated the effectiveness of computer-provided reading activities on language performance in patients with chronic aphasia. Of the 55 aphasic adults included in the study, significant improvement over the 26-week course occurred on 5 of the language measures used to assess communication ability. No improvement was noted in subjects given no treatment at all.
The reach of aphasia seldom ends within the domain of language, as our ability to communicate shapes our perception of self and our ability to interact with friends and loved ones. Any treatment which improves the ability to communicate, thereby enhancing an aphasic person’s overall well-being, should be considered by the therapist.
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