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This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.
Although the most effective means of treating aphasia post stroke has not been determined, several areas of aphasia therapy have proven to be more effective than others. A recent study had determined that intense aphasia therapy over a short period of time has greater impact on recovery than less intense therapy over a longer period of time. Building upon the idea that more is better, this article examines other spects of aphasia therapy that may be combined to facilitate recovery.
In order to develop a useful communication system, a 3-year-old, non-verbal autistic boy was treated for 1 year with a Simultaneous Communication method involving signed and verbal language. As this procedure proved not useful in this case, an adaptation of Melodic Intonation Therapy (signing plus an intoned rather than spoken verbal stimulus) was tried. With this experimental language treatment, the patient produced trained, imitative and, finally, spontaneous intoned verbalizations which generalized to a variety of situations.
A treatment combining semantic feature analysis and semantic priming was carried out on three Cantonese-speaking brain-injured individuals with word-finding difficulties. Two of the participants with mild to moderate semantic impairment demonstrated significant progress on naming performance. Treatment effects also generalised to semantically related and unrelated untrained items. However, only one of these two participants was able to maintain the treatment gain for at least one month after the therapy was completed. The third patient with severe semantic deficits did not benefit from the intervention. The different outcomes of these participants to the same intervention were explained in terms of the nature of the treatment approach, the patients' underlying language deficits, and their level of cognitive abilities.
Aphasia therapy in adults has been established to a larger extent relatively lately in the history of aphasiology, i.e. after its social medical importance had been realized and one of the cardinal problems of neurology solved more satisfactorily--lesion localization by imaging techniques. In order to evaluate the efficiency of aphasia therapy--which is still not quite uncontradicted--it was necessary to acquire sufficient knowledge of the spontaneous recovery process. It takes place--e.g. after stroke--mainly during the first 3 months, coming, as a rule, to a halt during the first year. Longer recovery periods, however, have been described. Next to etiology neurological status, overall health condition, type and severity of aphasia, and time delay between onset of the disease and start of therapy have been ascertained, whereas age and handedness seem to be of minor relevance. If syndrome change occurs the boundary between Broca's and Wernicke's aphasia is not surpassed; this taken apart almost any change from a more severe to a milder form of aphasia is possible. To isolate the therapeutic effect from spontaneous recovery in larger groups is difficult. There are, however, more recent investigations which suggest, that a correctly indicated therapy, which is sufficiently intensive and lasts long enough, will be effective. One of the corner-stones of any therapeutic effort ist adequate stimulation, oriented toward the patients needs and his aphasic syndrome, and taking into account the systemic nature of language and its most important linguistic structural components. Furthermore, a phase-specific and interdisciplinary approach and integration of closely related persons play an important role. We divide the numerous therapeutic techniques into 3 groups: direct or stimulation approach, indirect or circumventory approach, compensatory or alternative strategies approach. Representatives of all 3 groups are presented briefly, e.g. auditory stimulation, divergent semantic intervention, promoting aphasics communicative effectiveness, language enrichment therapy, programmed instruction; then the deblocking method, melodic intonation therapy, imagery, a sample of linguistically oriented methods for the reeducation of syntax, semantics, and phonemics along with special methods for the treatment of alexia and agraphia; finally compensatory techniques like visual communication, visual action therapy, and bliss symbolics. Some particular problems encountered in working with aphasics are addressed. A point is made about the feasibility and profit of lay therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
Developmental aphasia is the most severe form of speech retardation and needs therapeutic intervention. The young age of these children (< 3 years) makes therapy difficult. A specified speech therapy is not possible at this age. Intensive stimulation of verbal communication by the parents is necessary. Therefore we developed a specialized training program for parents. This preparation is very useful for later therapy and should prevent disturbance of interaction between parents and child. We will present our concept.
Specified training for parents of children with developmental aphasia has been offered for several years. We want to guide the parents to a controlled stimulation of speech at home. We asked the former participants about their experiences with this training program. We also studied the realization of the program by parents in everyday life before their children started therapy. The experiences were mainly considered positive, realizing the program did not present difficulties.
This single subject design study examined two models of intervention: Denver Model (which merges behavioral, developmental, and relationship-oriented intervention), and PROMPT (a neuro-developmental approach for speech production disorders). Ten young, nonverbal children with autism were matched in pairs and randomized to treatment. They received 12 1-h weekly sessions of therapy and daily 1-h home intervention delivered by parents. Fidelity criteria were maintained throughout. Eight of the ten children used five or more novel, functional words spontaneously and spoke multiple times per hour by the conclusion of treatment. There were no differences in acquired language skills by intervention group. Initial characteristics of the best responders were mild to moderate symptoms of autism, better motor imitation skills, and emerging joint attention skills.
Holistic (alternative) medical systems and techniques are used so extensively in the United States, it necessitates that health communication researchers include these practices in the corpus of literature. In this essay, I interrogate the terminology that is used to describe holistic medical practice in the United States. There are important distinctions between the use of such terms as holistic and alternative by virtue of the way that the medical systems themselves are constructed and evaluated. I advocate that the terms biomedical and holistic be used to refer to explanatory models and offer additional suggestions for language use throughout the research process. In the article, I conclude with a discussion of the consequences of discursive choices for research and for health care consumers.
OBJECTIVE: Analysis of treatment recommendation given by speech therapists. Evaluation of the language abilities in the examined children and re-examination of those abilities after 12 months. MATERIALS AND METHODS: Thirty-four children, aged between 2.0 and 5.3 years, referred to speech therapists by their General Practitioners because of possible language problems were included in a prospective study. The number of children receiving speech therapy and the number of speech therapy sessions received during 1 year, and the therapy effect on three quantitative language measures were compiled. RESULTS: In 97% of the children referred to a speech therapist, speech therapy was recommended. Most of these children showed average to above-average language scores on standardised tests for sentence development (61%) and language comprehension (79%). In addition, for most children spontaneous speech, as screened by the Groningen Diagnostic Speech Norms, was age-adequate (76%). The children's problems consisted of pronunciation difficulties or periods of stammering. After 12 months for 50% of these children speech therapy was still continued which means that the articulation problems still were present. The mean number of speech therapy sessions was 26.7. The language scores on the three language tests remained relatively stable over the 12-month interval. CONCLUSIONS: In young children pronunciation difficulties often lead to the recommendation for speech therapy. For a large number of children therapy takes more than a year, indicating that speech therapy cannot influence these problems to a great extent. In addition language scores remained relatively stable. Therefore, language problems and especially articulation problems in young children should be reconsidered regarding maturation and normal variations in speech motor development. A 'watchful waiting' approach should be taken more often.
Students with autism present a challenge to the SLP not only because of the severity of their communication disorders, but also because of the great variety of learning styles and social skills. Collaboration- and consultation-based service delivery systems offer an alternative to traditional therapy for these students. This model uses the strength of a team approach and permits strategies for improving communication that are not possible in other environments.
In a mean follow-up duration of 19 months the oral language development of 18 sensorineural hearing-impaired children without multiple handicaps was serially measured at regular intervals (three time points t1 - t3) using the receptive and expressive language scales of the "Münchener Funktionellen Entwicklungsdiagnostik für das 2. und 3. Lebensjahr". Results are presented as developmental quotients (DQ). In case of language retardation the rate of language development is less than one. At t1, the average language development was considerably delayed (DQ receptive: 0.37; DQ expressive: 0.51) and slowly increased over time (receptive: 0.37/0.48/0.55; expressive: 0.51/0.51/0.55) at approximately half the rate of normal hearing children. With the hearing-impairment increasing, the DQs became smaller. Children who were identified as hearing-impaired before the age of 18 months exhibited on average generally greater DQs. A significant impact of speech/language therapy on language development at t3 could not be demonstrated. Finally, the results and health care requirements were discussed.
In a 41-year-old stroke patient with bitemporal brain damage, we found severe signs of auditory agnosia 6 months after onset. Recognition of environmental sounds was extremely impaired when tested in a multiple choice sound-picture matching task, whereas auditory discrimination between sounds and picture identifications by written names was almost undisturbed. In a therapy experiment, we tried to enhance sound recognition via semantic categorization and association, imitation of sound and analysis of auditory features, respectively. The stimulation of conscious auditory analysis proved to be increasingly effective over a 4-week period of therapy. We were able to show that the patient's improvement was not only a simple effect of practicing, but it was stable and carried over to nontrained items.
Following Wepman (1953), the process of recovery from aphasia is seen as involving stimulation, motivation, and facilitation. The most adequate studies of aphasia therapy outcome focus on facilitation to the virtual exclusion of stimulation and motivation, although clinical experience suggests their importance. Motivation includes both the subjective and experiential aspects of the patient's response to aphasic disablement (anxiety, feelings of inadequacy) and the quality of the speech-therapist/patient alliance during the treatment. Retrospective studies utilizing sufficiently improved aphasics and ratings of the patient-therapist alliance are suggested as preliminary means of defining "motivation" in this context more accurately. Research approaches are also outlined which would assess the importance of and interaction between the three factors implicated in recovery for therapeutic outcome.
In this study we analysed the outcome of computer-assisted therapy (CAT) for anomia on eight acute aphasic patients. Since therapy for anomia generally leads to an item-specific effect, the aim of the present study was to investigate whether it is possible to enhance recovery from anomia by increasing the number of treated items. Two periods of five daily written-naming CAT sessions were compared: In one period the CAT included one set of 48 words (single list) and in the other period a double list of 96 items was treated. Seven out of eight patients improved in naming performance for treated items. Overall gains were superior after practising the double list, despite fewer item repetitions. These results suggest that the size of the effect of therapy for anomia depends more on the number of treated items than on the number of repetitions per item. The integration of these results within the framework of studies on intensity is discussed.
AIM: In order to suppress increases in medical costs in Japan, with regard to rehabilitation, it is extremely important to shorten the length of stay at rehabilitation units. Thus, factors related to the length of stay were analyzed in the study. METHODS: The subjects of the study were patients who stayed and left the rehabilitation unit at H hospital in Fukuoka, Japan during the period of May 1, 2003 and December 31, 2004. Of the 236 patients, 167 patients had no missing values with respect to 15 study variables. Thus, these 167 patients were used for analyses. In order to isolate factors related to the length of unit stay, a multiple regression analysis was performed with the length of stay as a dependent variable and other factors as independent variables. RESULTS: Of the 3 types of rehabilitation interventions (i.e., physical, occupational and speech therapies), the quantity of physical therapy was a significant predictor (p< 0.05). CONCLUSION: The findings imply the following. (1) The level of physical activity, which is a target of physical therapy, is used as a criterion for leaving the unit. (2) The three types of rehabilitation interventions highly correlated with one another, and the quantity of physical therapy is greatest. Thus, it is possible that only physical therapy could be isolated as a significant predictor. Since the present finding is based upon patients in a single rehabilitation unit, further studies using patients from multiple facilities is necessary.
Prescription of speech rehabilitation is now an act often performed by pediatricians. We attempt to define the implications of this act by successively describing the specific features of the training of speech specialists, the main childhood disorders for which their help is sought, and the key principals of rehabilitation. We underline the need for an improved clinical definition of learning disabilities in children in order to propose optimal therapeutic strategies.
OBJECTIVE: To examine the effects of bronchopulmonary dysplasia (BPD) and very low birth weight (VLBW) on the cognitive and academic achievement of a large sample of 8-year-old children. METHODS: Infants who were VLBW and had BPD (n = 98) or did not have BPD (n = 75) and term infants (n = 99) were followed prospectively to age 8. Groups were compared on measures assessing 4 broad areas of functioning: intelligence, achievement, gross motor, and attentional skills. Measures included the Wechsler Intelligence Scale for Children III, the Woodcock Johnson Test of Achievement-Revised, the Bruininks-Oseretsky Test of Motor Proficiency, the Tactual Performance Test (spatial memory), and the Continuous Performance Test (attention). School outcomes were assessed by parent and teacher report, as well as from school records. Groups were comparable on socioeconomic status, sex, and race. The total sample of BPD, VLBW, and term children was compared on all outcome measures. In addition, neurologic risk was assessed in the present sample and included the following: intraventricular hemorrhage, echodense lesions, porencephaly, hydrocephalus, ventriculoperitoneal shunt, meningitis, and periventricular leukomalacia. Individual difference analyses were conducted for neurologically intact children in all 3 groups. Finally, treatment effects were examined by comparing BPD children who had received steroids as part of their treatment with BPD children who had not. RESULTS: The BPD group demonstrated deficits compared with VLBW and term children in intelligence; reading, mathematics, and gross motor skills; and special education services. VLBW children differed from term children in all of the above areas, except reading recognition, comprehension, and occupational therapy. Attentional differences were obtained between BPD and term children only. The BPD group (54%) was more likely to be enrolled in special education classes than VLBW (37%) or term children (25%). In addition, more BPD children (20%) achieved full-scale IQ scores <70, in the mental retardation range, compared with either VLBW (11%) or term (3%) children, with all VLBW children significantly more likely than term children to achieve IQs in the subaverage category. After controlling for birth weight and neurologic problems, BPD and/or duration on oxygen predicted lower performance IQ, perceptual organization, full-scale IQ, motor and attentional skills, and special education placement. The qualitative classification of BPD (present or absent) was a significant predictor for lower scores on measures of applied problems; motor skills; and incidence of speech-language, occupational, and physical therapies. Individual difference analyses were performed to ascertain whether differences between the risk groups were primarily attributable to neurologic complications. Even with the neurologically intact sample of BPD and VLBW children, differences between the term comparison group and both the BPD and VLBW groups were found for many outcome measures. When birth weight and neurologic complications were controlled, BPD and severity of BPD were associated with lower performance and full-scale IQ, poorer perceptual organization, attention, and motor skills, as well as lower school achievement and greater participation in special education, including occupational, physical, and speech-language therapies. Treatment protocol may in part be responsible for differences observed in our BPD sample. Steroid and nonsteroid groups of BPD children differed significantly in performance IQ (72.8 vs 84.8) and full-scale IQ (77.0 vs 85.2); perceptual organization (74.0 vs 85.2); Bruininks-Oseretsky Test of Motor Proficiency score (36.6 vs 44.7); and participation in special education (78% vs 48%), occupational therapy (71% vs 44%), and physical therapy (71% vs 41%). In every instance, BPD children who received steroids fared more poorly than BPD children who did not receive steroids. CONCLUSIONS: BPD and duration on oxygen have long-term adverse effects on cognitive and academic achievement above and be beyond the effects of VLBW. The problems that have been identified at 8 years of age highlight the need for continued monitoring of the learning, behavior, and development of BPD children to intervene with children who are at risk for school problems.