Therapy

Myth #1: Using an AAC Communication Device Will Prevent or Slow Natural Speech.

Reality: AAC-specific research shows using an AAC device does not stop or deter the progression or recovery of natural speech.  Recovery is an ongoing process, and active and purposeful engagement by both the person with aphasia and their caregiver is crucial. For many people with aphasia, a communication device is an important component in the ongoing rehabilitation process. The right device can be used to facilitate the use of verbal language and even help to restore a person’s verbal skills so that they can speak for themselves.

Myth #2: Using an AAC Communication Device Will Instantly Fix Everything.

Reality: AAC communication devices will not instantly help the person with aphasia regain their natural speech. Integrating a communication device into everyday life is a process that takes time, patience, practice, and support. But the work is well worth it. Once learned, a communication device can significantly change a person’s life by allowing them to communicate more freely and helping them to regain their relationships and independence.

Myth #3: As Long as I Understand Him or Her, We Don’t Need a Device.

Reality: Caregivers often believe that as long as they understand the person, there’s no need for him or her to have a communication device. But the reality is that other people may not understand what he or she is expressing. As a result, the person can become socially isolated and lose their sense of identity. Communication devices help people with aphasia to more effectively interact with others during everyday activities, like spending time with family, ordering at a restaurant, or visiting the doctor. Even caregivers benefit by not having to communicate on the person’s behalf at all times.

Myth #4: AAC Devices Are Only for People Who Have Long Term Aphasia.

Reality: Research shows that the use of a communication device is more successful when it is introduced early in the recovery process. It can aid in the recovery of speech as well as help the person with aphasia more accurately express their needs in their physical recovery. If a person can express exactly how they feel, both physically and emotionally, they can make progress down the road of recovery even faster.

Some people with aphasia notice that they are able to sing much better than they are able to speak. This is because music uses different areas of the brain than speech. Melodic Intonation Therapy (MIT) takes advantage of this singing ability. It applies musical elements to speech in order to improve language production.

MIT uses the melody and rhythm of speech in an exaggerated way, making speech resemble singing. The speech-language pathologist (SLP) will start with simple phrases. The SLP will demonstrate how the phrase can be “sung” by giving it a melody. The person with aphasia will then practice repeating the phrase, or the SLP and person with aphasia might sing the phrase together. The SLP can provide cues to help if needed. The person with aphasia is often encouraged to tap their finger and slow down speech. As the person with aphasia improves, longer sentences will be used. In addition, the melody will be faded out so that it resembles typical speech.

Traditional MIT used a pre-determined list of words, phrases and sentences. It also suggested that two tones be used. However, SLPs have interpreted MIT in many ways and use it in different forms. There is not a specific melody or intonation that has to be used. The SLP can create the intonation for each phrase. Each phrase will typically have at least two different tones, and the SLP’s vocal tone will rise and fall on certain words. Because of this, MIT will be different from one therapist to the next. Some therapists incorporate other elements of music, such as a musical instrument or using familiar songs.

MIT is usually used for people with non-fluent aphasia. It can be helpful for people with moderate or severe aphasia. One benefit of MIT as applied by most SLPs is that it can be done with any phrase or sentence.

LPAA prioritizes the person with aphasia and their life goals. It is a collaborative model where the person with aphasia, their family, and the speech-language pathologist (SLP) are a team. They identify life participation goals and work together to reach them. With LPAA as a therapeutic mindset, the SLP can address how communication impacts life participation. The SLP can design therapy activities that will help the person with aphasia to engage in activities that are important to them. The primary goal of LPAA is increased life participation and improved quality of life.

LPAA Goes Beyond the Person With Aphasia

The LPAA model also says that the person with aphasia is not the only target of treatment. Anyone who is affected by aphasia (such as family members) are also eligible to receive treatment. In addition, the person’s environment is considered. The SLP might think of ways to change the environment to make participation easier for the person with aphasia. That might mean making an “aphasia-friendly” version of the menu at a favorite restaurant.

The Link Between LPAA and AAC

The principles of LPAA are especially important for people using augmentative and alternative communication (AAC) devices. Some people think AAC devices are just for requesting items or communicating medical information. However, an AAC device is an excellent tool to allow people to participate in activities that are important to them.

For instance, someone’s goal might be to resume attending their weekly card game. The person with aphasia, a family member, and the SLP can work together to think about what they will want to communicate about at the card game. The device can be pre-programmed with phrases, questions and stories to share.

Many aphasia treatments encourage people with aphasia to use alternative means to get their message across. This might include gesturing, drawing, or using augmentative and alternative communication (AAC) devices.

Language action therapy, formerly known as Constraint-Induced Language Therapy (CILT) takes the opposite approach. Language action therapy is an intense treatment choice for people who only want to work on speaking. It is also known as Constraint-Induced Aphasia Therapy. Language action therapy requires the person with aphasia to communicate only by speaking. It does not allow any means of communicating other than verbally.

Three Principles of language action therapy:

• Constraint: avoiding the use of any compensatory strategies (for example, drawing or pointing)
• Forced use: talking is the only means of communication
• Massed practice: therapy must last for a sufficient amount of time

Language action therapy is based on the principles of Constraint-Induced Movement Therapy. This is a type of therapy used by physical therapists for people with limb weakness. It requires that they do not use their good limb at all in order to build the strength of the weak limb. For instance, if someone has weakness in their left arm, the physical therapist might physically constrain the right arm. This forces the person to use their left (weak) arm for everything.

Physical therapists may recommend using language action therapy at all times, that is, not just during a physical therapy session. Because language action therapy is an intense treatment option involving communication, it is not recommended for use all day, every day. It is typically used for a few hours a day, ideally every day.

The goal of language action therapy is improved verbal speech. It is typically used with people who do have some functional verbal speech. People with severe impairments who do not have any verbal speech might experience frustration with this treatment technique.

As with other therapy techniques, there are pros and cons to using CILT. Your speech-language pathologist (SLP) can help decide if it is an appropriate treatment for you or your loved one.

SCA asks the person with aphasia and the communication partner to work together to improve communication. It is a great tool for people who want to learn strategies to help their loved one with aphasia to communicate. SCA is based on the idea that conversation is an important part of life participation. SCA states that the person with aphasia is competent, or knows more than they can say. It trains the communication partner to help the person with aphasia to get and give information.

SCA uses a multi-modal communication approach. This means that it encourages communication in many forms, such as speaking, writing and drawing. Examples of strategies that are taught include:

• Speaking in a normal tone of voice
• Acknowledging communication difficulties and trying to fix them
• Writing key words
• Using drawing or gestures, focusing on one word at a time
• Keeping a written “log” of the conversation that can be reviewed
• Asking yes/no questions to confirm understanding
• Summarizing what the person with aphasia has communicate

SCA training can be helpful for anyone who communicates with a person with aphasia. The techniques can be used in everyday conversation, by anyone. The more people that receive training, the more the person with aphasia will be able to communicate!