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Angela Roberts...

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Readings Chapt er15–Schuel l ’ sSt i mul at i onAppr oac ht oRehabi l i t at i onKeyPoi nt s 1.Sc huel l ’ sbel i ef saboutor gani z at i onofl anguageandnat ur eofl anguagebr eak downi naphas i a a.Languagec annotbet houghtofasas i mpl es ens or i mot ordi c hot omyorat hr ees y s t em c or t i c alr el a yi nv ol v i ngr ec ept i on,t r ans mi s s i onandex ec ut i on b.Languagei st her es ul tofady nami ci nt er ac t i onofc ompl exc er ebr al ands ubcor t i cal ac t i vi t i es c .Languagemec hani sm cont ai nsas y s t em ofs t or ed,l ear nedel ement sandr ul es i .Us eandmai nt enanceoft hes eel ement sandr ul esr equi r esdi s c r i mi nat i on, or gani z at i on,s t or age,c ompar i s on,r et r i ev al ,t r ans mi s si onandf eedbac kcont r ol d.Uni di mens i onal ,mul t i modal i t yconc eptofaphas i adoesnotr equi r et hatpat i ent sv ar yal onga s ev er i t yc ont i nuum i .Mos taphasi cpat i ent shav epr obl emsr el at edt oper f or mancef ac t or sr at hert han c ompet enc yf act or s e.Languagepr oc es s esar eac qui r edandor gani z edt hr oughc ompl ex ,i nt er ac t i ngsens or y s y s t emsands ens or i mot orpr oces s es i .Audi t or ypr oces sesar eatt heapexofi nt er ac t i ngs y s t emst hatai di nac qui s i t i on, pr oc ess i ng,cont r ol ofl anguage 2.Sc huel l ’ sc l as s i fi cat i ons y s t em f oraphas i aai medatdes c r i pt i v eandpr edi ct i v eut i l i t ybyc l as s i f y i ng pat i ent sac c or di ngt osev er i t yofl anguagei mpai r ment ,pr es enc eorabs enc eofr el at edsens or yor mot ordefi c i t s ,andpr ognos i s 3.St i mul at i onappr oac h=appr oac ht ot r eat mentt hatempl oy sst r ong,cont r ol l ed,i nt ens i v eaudi t or y s t i mul at i onoft hei mpai r eds y mbol s y s t em ast hepr i mar yt ool t of ac i l i t at eandmax i mi z epat i ent ’ s r eor gani z at i onandr ecov er yofl anguage a.Sev er al i nputmodal i t i esc anbeus ed,butaudi t or ymodal i t yi st hef oundat i onoft hi sappr oac h 4.Thes ev ar i abl esar emos tr el ev antt os t r uct ur i ngs t i mul at i on a.Audi t or yper c ept ualcl ar i t y b.Nonl i ngui s t i cv i s uoper cept ualc l ar i t y c .Li ngui s t i cv i suoper cept ualc l ar i t y d.Met hodofdel i v er yofaudi t or ys t i mul at i on e.Di s c r i mi nabi l i t y f . Combi ni ngs ens or ymodal i t i es g.St i mul usr epet i t i on h.Rat eandpaus e i . Lengt handr edundanc y j . Cues ,pr ompt s ,andpr es t i mul at i on

k .Fr equenc yandmeani ngf ul nes s l . Abs t r act nes s m.Par tofs peec hands emant i cwor dcat egor y n.Gr ammarands y nt ax o.Cont ex t p.St r es s q.Or derofdi ffic ul t y r . Ps y c hol ogi cal andphy s i c al f ac t or s s .Pat t er nofaudi t or ydefi ci t 5.Tr eat ments houl dbegi natl ev el wher el anguagebr eak sdown,ands houl dpr oc eedt hr oughgr adual l y i ncr eas i ngl evel sofdi ffic ul t y 6.Oncet as k sands t i mul i hav ebeenes t abl i s hedandt ar getbehav i or sorr es pons ec har act er i s t i cshav e beeni dent i fi ed,wemus tdet er mi nec r i t er i onf orac cept abl eper f or mance 7.Conc l us i onst hatt her apyf oraphas i ai sgener al l yeffect i v ear ebas edons t udi est hathav eus ed( or pr obabl yus ed)as t i mul at i onappr oac h a.T r eat mentst udi esus i ngas t i mul at i onappr oac har emor ec onc l usi v et hani nc onc l us i v e b.Hasas i gni fi c antpos i t i v eeffec toncommuni c at i onabi l i t yofmanypat i ent swi t haphas i a

Chapt er16–Themat i cLanguageSt i mul at i onTher apy 1.TLS=neur obi ol ogi cappr oac ht os peec handl anguaget her apybas edont het heor yofaphas i a t r eat mentfi r s tpos t ul at edbySc huel l 2.TLSs uc cessdependson. . . a.Ther api stabi l i t yt opr ovi deadequat es t i mul at i on b.Cl i entabi l i t yt ounder s t andandr es pondt oaphas i cs y mpt oms 3.Ther api s t smus tus ecl i ent ’ si nt er es t sandt al ent st ot api nt ot hebes tpos s i bl es ubj ectmat t erf ora s uc ces s f ul out c ome 4.TLSex t endsoutofbas i cs t i mul us r es pons ef or mat si nt ot henat ur alflowofs peak i ngandl i st eni ngi n ac onv er s at i on 5.Theabi l i t yoft het her api s tandc l i entt oex ami nel anguageandcogni t i v eabi l i t i esandmak edec i s i ons abouthowt oi nt egr at et r eat menti sk eyt ous eofTLS Ch.31Mel odi cI nt onat i onTher apy

Ch.10Li f ePar t i c i pat i onAppr oach Cor eVal ues 

Ex pl i c i tgoali senhancementofl i f epar t i c i pat i on

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Al l t hoseaffec t edbyaphasi a( i nc l udi ngf ami l yandc l os eas soc i at es )ar eent i t l edt os er v i ces

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Meas ur esofsucc es si nc l udedoc ument edl i f eenhanc ementc hanges

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Bot hper s onal andenv i r onment al f ac t or sar et ar get sofi nt er v ent i on

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Emphas i si sonav ai l abi l i t yofs er v i c esasneededatal l s t agesofaphasi a

Ch.11Soc i alAppr oac hest oAphas i aI nt er v ent i on 1.Adopt i ngas oc i al model r equi r esaphi l os ophi c als hi f tf r om t r adi t i onal medi c al model appr oac hes 2.As oc i almodeli sbas edont hebel i eft hatcommuni cat i oni sasoc i al ac t ;t hr oughc ommuni c at i onwe c r eat eandex pr es si deas ,i dent i t i es ,l i f eval ues ,andens ur emember s hi pi ns oc i et y . 3.I nasoc i al appr oac h,communi c at i onandps y c hos oc i al f unc t i oni ngar ei ns epar abl e. 4.As oc i alappr oac hf oc us esnotonl yonc ommuni c at i onandl i f epar t i c i pat i onoft hos eaffect edby aphas i a,butal s oont hec ommuni c at i v e,phy s i c al ,soc i al andemot i onalenv i r onment . 5.Longt er m per s onal c ons equencesofaphas i aar et hef oc usofi nt er v ent i on. 6.Tr adi t i onalc l i ni c i anr ol esands er v i c edel i v er ymodel sar el i k el yt oc hangeandex pandwi t ht he adopt i onofsoc i alappr oac hes . 7.Theul t i mat eai m ofas oc i al appr oac hi st oex pandt hel i v i ngofl i f ewi t haphas i a.

Guest Lecture: Gloria Olness Funct i onall i ngui s t i c s :f oc usonl anguageast ool si nat ool boxus edf orc ommuni cat i v egoal s Bas i cr es ear c hbr i dgedt opr ac t i c al ,c l i ni cal appl i cat i ons Di sc our s ef unct i onal i t y–whatdoesi tmeant obef unc t i onal l y c ommuni c at i v ei nev er y dayc ommuni cat i v e set t i ngs

Pes ts t or i esandweat hers t or i esar egr eatc onv er s at i onst ar t er sf oraphas i apat i ent s !

Humanst el l l ot sofst or i es,t hi si showwebondwi t hot her s–“ Homonar r ans ”

Peopl ewi t haphasi at el l s t or i es ,andt heyneedt oc onv eyt hes ef unc t i ons . 

Ref er ent i al f unc t i on–Who,what ,wher e,when o Di ffic ul tf orpeopl ewi t haphasi a,andhi s t or i c al l yemphas i z edal oti naphas i at r eat ment s 

I E,Whenwehol dupapi ct ur e,as kt hem,“ whati st hi s ?”

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“ Somet hi ngwor t ht el l i ng”–I fwegi v epat i ent ss omet hi ngr el ev ant ,i tmak esi tmor e s al i enti nt hei rs y s t em

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Howcanwemak et r eat mentpul l i nt heev al uat i v ef unc t i on/ pr i nc i pl esofsal i enc eand r el ev ance ?Ov er l ayev al uat i v ef unc t i onont ot hes et r eat ment s . . .“ Gi v et hem s omet hi ng t ot al kabout ” 

T ar gets t or ymes s agesi nev al uat i v econt ex t s :Cool l ook i ngpi ct ur es ,pi ct ur es t hatt el l s t or i es–i . e. ,el ephants t eppi ngonacar

o Weus ewor ds ,ges t ur est oc onv eyt hes ef unct i ons o I nanygi v ens t or y ,y oumi ghtc hangehowmanyoft hes e4t hi ngsy oument i onordon’ t ment i on,dependi ngonc ont ex t 

Ev al uat i v ef unc t i on–Addss el ec t i v epr omi nencet opar t soft hes t or y o Maybewhywet el l s t or i esi nt hefir s tpl ac e o Ex ampl esf r om Dr .Ol nes s ’ s t or y 

“ Youwon’ tbel i ev ewhathappened! ”

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“ I ' ml i k eAHHHH! ”“ Youk nowwhaty oudo?”“ Ok ,t r ues t or y ! ”

o Ev al uat i v edev i ces=t ool sweuset oconv eyt heev al uat i v ef unc t i on 

Faci alex pr es s i ons–pr es er v edi npeopl ewi t haphas i a

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Pr os odi cel ement s( pi t c hv ar i at i ons ,r at eofspeec h

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Gest ur es

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Onomat opoei a,v er bal mi mi c r y

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Repet i t i onofcer t ai nwor ds

Cr eat i ngac r i t er i onr ef er enc edas s es s ment–behav i or alobs er v at i onc hec k l i s tt oas s essev al uat i v edev i ces us edbypeopl ewi t haphas i a 

Notanex haus t i v el i s t–r at heral i s tt hatc l i ni c i anscanadaptf ort hei rc l i ent sandt hecont ex t st hey c ommuni c at ei n

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I ns omec ont e x t s( i . e. ,t es t i f y i ngi nc our t ) ,t her ei sahi ghdegr eeofr ef er ent i al c l ar i t yr equi r ed

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Ref er ent i al f unc t i on–r ef er enc et oagent s ,act i vi t i es ,or derofev ent s

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Ev al uat i v ef unc t i on–mar kwhi c hdev i cest heyus e o  Doest heev al uat i v ec ont entmak es ens easawhol e ?

Wh ydoSLPsdodr i l l swi t hc ar ds ? 

I ti seas i ert oc ont r olt het as kandt ak edat a

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I nmedi c almodel s ,f unct i onalc ommuni c at i oni sbas edonwant sandneedsbec aus et hati sal ly ou needt odowheny ouar ei nt hehos pi t al o  Butwhent heyar edi s c har ged,cant heys t i l l communi cat ei nt hatenv i r onment ?

Dr. Hengst’s Lectures Peopl ewi t haphasi aar ebet t eratev al uat i v e;pooratr ef er ent i al f unc t i ons Peopl ewi t hRHDar ebet t eratr ef er ent i al ;pooratev al uat i v ef unct i ons

I nRHDandTBI ,r el ev ance( whatt osaywhen)i sdi sr upt ed

Manyas pect soft her apy–i nt er v ent i onbr oadl y 

Managi ngc as es( i ndi v i dualpat i ent s / f ami l i es)

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Cons ul t at i onandc ol l abor at i v ecar e

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Admi nandbus i nes smanagement

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Cont r i but i ngt ot hefi el d o Et hi c aldec i s i onmak i ng;r esear c h

Whent oi nt er v ene–t i mepost ons et 

Ac ut es t age–ons ett o“ medi c al l ys t abl e”( 35day s)

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Subac ut es t age–medi c al l ys t abl et oendoft r eat ment( 6mont hs )

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Chr oni cst age–r es tofpat i ent ’ sl i f e

Tr eat i ngl anguageandc ommuni c at i ondi s or der s 

Goal s–whatdowet ar get ? o I CF–Whi c huni tdoesourt r eat mentappr oac ht ar get ? 

Bodyst r uc t ur es / f unct i ons 

I ndi v i dualpr oc ess escanbet ar get eds epar at el y

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Boundeddomai n

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Forl anguage,i ti st hel anguagepr oc ess i ngs y s t em i nt hebr ai n

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I fIam wor k i ngonbodys t r uc t ur es / f unc t i ons ,Iwoul dneedt ot ar get ac t i v i t y / par t i c i pat i ons epar at el y

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Ac t i vi t y / par t i c i pat i on 

Di s t r i but edcommuni cat i ons y s t em

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I fIam wor k i ngonac t i v i t y / par t i ci pat i on,Iwoul dex pectbodyst r uc t ur e/ f unct i ons andcont ex tt oc hangeasar es ul tofwor k i ngonac t i v i t y/ par t i c i pat i on

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Cont ext ualf ac t or s 

Ex t er nal env i r onment al

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I nt er nal per s onal

o Hengs tetal ,Thi nv s .Thi ckDes c r i pt i on 

Theor et i c alr at i onal e:Whyandhowdowet ar gett hes egoal s ?What t heor i es / as s umpt i ons / under s t andi ngsgui dey ourdec i s i ons ? o Ther apyt ar get–t heor i esofl anguage,c ommuni c at i on,aphasi a,br ai nor gani z at i onhel pus gui dewhatt ot ar get o Ther apeut i cmec hani s m –t heor i esofdev el opment ,l ear ni ng,neur opl ast i ci t y ,f unct i onal pl as t i c i t yhel pusgui dehowt ot ar get .WhatdoWEdot oi mpr ov ef unc t i oni ng? o Languageasani s ol at edc ogni t i v ebehav i or

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BDAEgr ewoutoft hi sper spect i v e

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Comesf r om neur ops y c hol ogy ,aphasi ol ogy

o Language=v er balbehav i or 

Comesf r om behav i or i sm –l anguagei saf ac etofbehav i or ,notadi st i nc tc ogni t i v e pr oc es s

o Languageus eas“ compet enc e”+“ per f or manc e” 

Comesf r om l i ngui s t i c s

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Languagec ompet ence=i nt act nes sofi nt er nal l anguages y s t em

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Languageper f or manc e=pr agmat i cs ,f unc t i onal l i ngui s t i cs

o Languageasacul t ur al ar t i f ac t ,l anguageus ewi t hi ndi s t r i but edc ommuni c at i on

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Dr .Hengs ts t udi est hi s

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Languagei saf ac etofdi s t r i but edc ommuni cat i on

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Lur i a’ swor k

Cl i ni c i an’ sr ol e o Cogni t i v er ehab 

Tr adi t i onal t r eat ment

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Col l abor at i v e

o Hengs tandDuff,Cl i ni c i ansasCommuni c at i v ePar t ner 

Ser v i cedel i v er yopt i ons–Wher ec an/ s houl dwedot r eat ment ? o Cl i ni cv s .c ommuni t ybas ed o I ndi v i dualv s.gr oupt r eat ment o Si ngl ec l i ni c i anv s .r ehabt eam

4Thi ngsont heboar d 1.Goal s( I CF) 2.Theor i esofWhyandHow 3.Cl i ni c i anr ol e 4.Ser v i cedel i v er yopt i ons

Hi st or yofaphas i at r eat ment 

Pr eWWI o Ver yl i t t l et r eat ment o I nt er es ti nunder s t andi ngbr ai nbehavi orr el at i ons hi ps

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WWI WWI I

o Foc uson“ t eac hi ng”l os tl anguaget or et ur nedv et er ans–r epet i t i onanddr i l l o Penet r at i ngt r auma( f r om abul l et ) f oc ali nj ur y aphas i a o Separ at i ngl anguageandmot orappr oac hes–t her ei sadi ffer enc ebet weenmot ors peec h di s or der sandhi gherc or t i cal l anguagedi s or der s 

WWI I 1970s o Languageasi s ol at edc ogni t i v epr oces s–t xmec hani s mi st ost i mul at eac c es si ngl anguage pr oc es s es 

Hol i st i ct her apy–St i mul at i on/ f ac i l i t at i on

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Modul art her apy–Neoas s oc i at i oni s t s–Bos t ongr oup;needt ounder s t anddi s c r et e modal i t i esassepar at esubpr oces s est hataddt oget hert oc r eat el anguage

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Languagei si nt er r upt ed/ di s r upt ed,notl os t–Needt ogets y s t em abl et oacc es si t agai n,notr et eac hi t

o Language=v er balbehav i or–t xmec hani s mi st oshapeandr ei nf or cebehavi ors opat i entwi l l us ei tmor e 

Behav i or i s m –behav i ormodi fi cat i onappr oac hes

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T r eat menti t s el fl ook ss i mi l art os t i mul at i on

o Languageus easc ompet enc e+per f or manc e–t xmec hani s mi snospec i fi cl ear ni ngt heor y 

Li ngui s t i ct heor i es–pr agmat i c s ,PACE,ps y c hol i ngui st i cs ,neur ol i ngui st i c s

o Languageasc ul t ur al ar t i f ac ti ndi s t r i but edc ommuni c at i on–t xmec hani s mi sunbl oc ki ng, i nt er / i nt r as y s t emi cr eor gani zat i on 

Funct i onalr eor gani z at i on–Lur i a,Hengs t

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I nt egr at esl anguagepr oduc t i onandus e

Di st r i but edcommuni cat i on:c ommuni cat i oni sdi s t r i but edac r os speopl e,r esour ces ,t i me.Notani ndi v i dual sk i l l / abi l i t y ,butr at herapat t er nofi nt er ac t i on.Needt ounder s t andf unc t i onals y s t em/ gr oupt hatpat i enti si n. Hi ghl yemer gent / dy nami c / i nt hemoment .

St i mul at i onappr oac h 

Gener al t ar get s o St i mul at ebr ai n–f ac i l i t at el anguageacc es s i ng o Mai nl yt hr oughaudi t or yc ompr ehens i ondr i l l s

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Theor yofl anguage o Hol i s t i cv i ewofl anguageascompl ex ,i ndi v i s i bl ecogni t i v ef unc t i on o Uni t ar yv i ewofaphas i a–v ar i esonl yi ns ev er i t yandac company i ngs y mpt oms

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I CFt ar get :bodys t r uc t ur e/ f unct i on–l anguageasc ogpr oces s

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Theor yofl ear ni ng:f ac i l i t at eac c essofol di nf o,notnewl ear ni ng

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Cl i ni c i ans :Sc heul l ,Wepman,Dar l ey

Behav i ormodi fi cat i on 

Gener al t ar get s o Languagebehav i or s( notc ogpr oces s es ) o I CF–bodyst r uct ur es / f unct i onsandac t i v i t y

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Theor yofl anguage–v er bal behav i ori snodi ffer entt hanal l humanbehav i or

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Theor yofl ear ni ng o Dr awsonSk i nner ’ swor k o Pr ogr ammedi ns t r uc t i on–shape/ f adeandmemor i z ebehav i or ,s t r es s esmet hodol ogy

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Cl i ni cal :manyc l i ni c i anshav eadopt eds y st emat i c ,pr ogr ammedi ns t r uc t i onappr oac hes

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Res ear c h:poi nt sc ons i s t ent l yt ot hefindi ngt hatpeopl ewi t haphas i ac anl ear n o Butdoest hi sl ear ni nggener al i z e ?I si tmeani ngf ul ?

Sc huel l ’ sSt i mul at i onAppr oacht ot her apy 

Per meat esnewert her api es o Bi gdi ffer encebet weent hi sandnewert r eat ment si st ar gets pec i fi c i t y–newert r eat ment s t ar gett hi ngssepar at el y

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Uni di ment i onal–aphas i ai sagener all anguagedefi ci tt hatcr os s esal l l anguagemodal i t i es

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St i mul at epat i entabi l i t yt oacc es sandus eunder l yi ngpr oc es s es

Summar yoft heDi agnos t i cPr oc es s 1.Whyar ey oubei ngr ef er r ed? a.Us ual l yagener al conc er n( “ Pl eas eev al uat e” )ors t andi ngor der–any onewhohada s t r ok e/ TBIt y pi cal l yget sas t andi ngor derf oras peechev al uat i on 2.Pat i enthi s t or y wor k i ngdi agnos i s .Mat c hs y mpt om s et st oc l i ni c al behav i or alpr ofil es .Doespat i ent hav eat ypi c al orat y pi c alpr es ent at i on? a.Yous us pec tt hi ngsbas edonpat i ent ’ si nj ur y ,ot herr epor t s b.Wehav es t udi edt hec l i ni cal behav i or al pr ofi l es( gener al / cent r alt endenc ypr es ent at i on pat t er ns )offluentandnonfl uentaphas i a,c ogni t i v ecommuni c at i ondi s or der s( RHDandTB CHI ) c .I fpat i enthaspenet r at i ngi nj ur yt ol ef tsi deofbr ai n,s c r eenf oraphas i a

3.Tr ac kpat i entov ert i met oconfi r m orgoagai ns ty ourwor ki ngdi agnos i s

Tr eat mentappr oac hesandmec hani s ms–boundar i esbet weent hes et endt obeper meabl e,andt heymi ght bemi x edt oget her .Asac l i ni c i an,y ouneedt odr awonal l oft hes eappr oac hes . 

Tr adi t i onal appr oac hes :s pec i al i z eds t i mul at i on/ f aci l i t at i on;behav i or al s hapi ng/ r ei nf or c i ng

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Soc i alappr oac hes :t r ai ni ngcomm.par t ner s ,r educ i ngs oc i al bar r i er s

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Ac t i v i t y bas edappr oaches :aut hent i cact i v i t i es ,c ol l abor at i v eappr oac hes o Aut hent i cac t i v i t i es=ac t i v i t i esofev er ydayl i f e o SumaandMar t ha’ swor kf al l si nt ot hi scat egor y

Cl i ni c i an’ sr ol e 

Di r ect or

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Par t ner

Ser v i cedel i v er yopt i ons 

Cl i ni cs et t i ng

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Communi t ybas ed

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I ndi v i dualorgr oup

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Si ngl ecl i ni c i anort eams

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I nc l udesf ami l yandcommuni t ymember s

WWI I 1970sappr oac hest oaphasi at her apy 

Tr adi t i onal appr oac hes o St i mul at i onf ac i l i t at i on–Schuel l 

Schuel l ’ suni t ar yv i ewofl anguageandaphas i a:l anguagei sonesol i t ar ymodul e/ uni ti n t hebr ai n

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I fpat i enthaspur eaphas i a,Sc huel l s ay st heys houl dbepr oduci ngandunder s t andi ng l anguageatt hes amel ev elac r os sal lmodal i t i es .I fnot ,t hent heyhav es omet hi ngel s e i naddi t i ont oaphas i a.

o Behav i ormod...