Elizabeth Learnard & Kendrah Marchi0ndo

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1 Elizabeth Learnard & Kendrah Marchi0ndo

2 Definition A treatment approach that employs strong, controlled, and intensive auditory stimulation of the impaired symbol system as the primary tool to facilitate and maximize the patient s reorganization and recovery of language. (Chapey, 2008)

3 Background Understanding the Auditory Stimulation Approach Virtually all approaches for treatment of aphasia involve auditory stimulation of some kind Stimulation approach encompasses all other approaches to aphasia treatment Key symptom in aphasia impaired ability to retrieve and use the language code across modalities Stimulation approach is not teaching or reteaching language (Chapey, 2008; Schuell et al. 1964)

4 Rationale All people with aphasia have some deficits in their auditory comprehension (Chapey, 2008; Schuell et al. 1964; Schuell 1955)

5 Individuals for whom the approach is appropriate The severity of aphasia will influence the nature of stimulation and the treatment program Patients with severe aphasia (global) Other deficits that may co-exist with aphasia (apraxia of speech, dysarthria) may impact the outcome of a auditory stimulation treatment program (Chapey, 2008; Schuell et al. 1964; Schuell 1955)

6 General Philosophy Treatment must be tailored to the individual patient Diagnosis is crucial Treatment must be relevant Schuell et al. (as cited in Chapey, 2008) stated that treatment should be logically related to beliefs about the nature of aphasia (Chapey, 2008; Schuell et al. 1964)

7 General Principles Intensive auditory stimulation should be used Stimulus must be adequate Repetitive material should be used Each stimulus should elicit a response Responses should be elicited, not forced or corrected A maximum number of responses should be elicited (Chapey, 2008)

8 General Principles cont. Feedback should be provided when it appears to be beneficial Treatment should be systematic and planned Sessions should begin with relatively easy tasks, proceeding to more difficult Abundant and varied materials should be used New materials should be extensions of familiar materials and procedures (Chapey, 2008)

9 Suggestions for Intervention Structure of Stimulation Weak evidence Auditory Perceptual Clarity (Volume and Noise) Conversation vs Headphones Increasing Volume vs Decreasing Background Noise Nonlinguistic Visuperceptual Clarity Realistic, color pictures are best Less ambiguity is best Linguistic Visuoperceptual Clarity Print vs. Script Method of Delivery Face-to-face presentation is best Discriminability Semantic & phonemic differences (Chapey, 2008)

10 Suggestions for Intervention cont. Combining Sensory Modalities Best practice Research supports visual stimuli increased reaction times of pt s Stimulus Repetition Maximal, minimal, and no stimulus repetition Rate and Pause Slow rate and longer pauses are best Length and Redundancy Accounting for memory deficits Cues, Prompts and Prestimulation Maximum stimulation is best according to Schuell (1964) Frequency and Meaningfulness High frequency and terms meaningful to the client are best (Chapey, 2008)

11 Suggestions for Intervention cont. Abstractness Less abstract the content, the better Part of Speech and Semantic Word Category Grammar and Syntax Context Stress Appropriate stress and emphasis is important Order of Difficulty Presenting simpler pictures first improves performance on difficult images later (Chapey, 2008)

12 Pattern of Auditory Deficit Slow Rise Time Noise Buildup Retention Deficit Information Capacity Deficit (Chapey, 2008)

13 Clinician Feedback Stimulus itself facilitates the patient s accurate response (Schuell et al. 1964; Schuell 1955)

14 Efficacy of the Auditory Stimulation Approach This approach has probably been more extensively studied than any other approach treatment Robey (1998) found that the Schuell-Wepman- Darley Stimulation (SWDM) Approach was the only treatment approach reported in a relatively large number of studies (Chapey, 2008; Robey 1998)

15 Strengths Evidence-based Hierarchically based principles Principles that can be modified and used with any patient with aphasia

16 Weaknesses No clear procedure for implementation Unclear what stage of therapy this treatment should be used for Does not discuss generalization specifically Could the combination of multiple modalities overstimulate the patient?

17 Criterion for Acceptable Performance: Brookshire and LaPointe (as cited in Chapey, 2008) suggest target behavior criterion of 90% accuracy

18 Sequencing Steps in the Treatment Program Where to Start? Schuell et. al (1964) suggests starting at the level where language breaks down

19 Sample Therapy Procedures Point-To Tasks Following Directions Yes/No Questions and Sentence Verification Response Switching Repetition Tasks Sentence/Phrase completion Verbal Association Answering Wh-Questions Retelling Conversational Tasks Reading Writing (Chapey, 2008)

20 Sample Goals Long Term Goal: Pt will follow spoken directions of increasing complexity at 90% accuracy with min cues Short Term Goal #1: Pt will follow spoken simple two unit commands using high frequency words at 90% accuracy with min cues. Short Term Goal #2: Pt will follow spoken simple two unit commands using low frequency words at 90% accuracy with min cues. Short Term Goal #3: Pt will follow spoken complex two unit commands using high frequency words at 90% accuracy with min cues. Long Term Goal: Pt will name functional objects at will with 90% accuracy given minimum cues. Short Term Goal #1: Pt will name pictures with 90% accuracy given min cues.

21 Data Collection Long Term Goal #1 Commands Number of repetitions requested Level of Cuing Notes Point to the spoon Min Mod Max Point to the cup Min Mod Max Point to the chair Min Mod Max Point to the pencil and the cup Min Mod Max Put the pencil in the cup Min Mod Max Put the cup in your lap Min Mod Max Min Mod Max Min Mod Max Min Mod Max Min Mod Max Min Mod Max

22 Data Collection Long Term Goal #2 Independently (accurately naming Minimum Cue Moderate Cue (The clinician Maximum Cue (Clinician increases pictures without aid) (Using a prompt sheet or provides a phonemic or other cue) cuing to modeling or delayed circumlocution strategies) imitation)

23 References Chapey, R. (2008).Schuell's stimulation approach to rehabilitation.in Language intervention strategies in aphasia and related neurogenic communication disorders (5th ed., pp ). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Schuell, H., Carroll, V., & Street, B. S. (1955).Clinical treatment of aphasia.journal of Speech and Hearing Disorders, 20, Schuell, H., Jenkins, J. J., & Jimenez-Pabon, E. (1964).Techniques and Materials for Treatment of Aphasia. In Aphasia in adults: diagnosis, prognosis, and treatment (pp ). New York, London, & Evanston: Hoeber. Robey, R. (1998).A meta-analysis of clinical outcomes in the treatment of aphasia.journal of Speech, Language and Hearing Research. 41,

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