Archive | externship RSS feed for this section

Aphasia therapy

26 May

APHASIA!

If you’re working with adults you’re PROBABLY working on aphasia. There are maaany types of aphasia. If you use the WAB, which there is a good case you will, then you will give your patients any one of eight aphasia diagnoses (Broca’s, Wernicke’s, Transcortical Motor, Transcortical Sensory, Global, Isolation, Conduction, Anomic). Most aphasias  be classified as fluent (receptive) or non-fluent (expressive). And there are other aphasias out there like primary progressive, alexia, agraphia etc. AND the way you classify aphasia will depend on your “theory” of aphasia.

I say all of this, but really you won’t see “pure” aphasias often – I would say many are mixed. You’ll see patients with a variety of difficulties that manifest themselves in all sorts of exciting ways.

AND QUITE FRANKLY – sometimes the diagnosis is SORTA irrelevant. To me – I’m not treating a diagnosis. I’m treating the issue. Just because someone has Broca’s aphasia doesn’t necessarily mean that the treatments typically used for Broca’s aphasia will work for this patient.

So what do you do with these patients – who may have difficulty speaking, understanding, reading, writing, spelling and a plethora of other troublesome word related tasks?

I’ll try to narrow it down a bit.

The patients I saw MOST OFTEN were having difficulty with word finding. I’ve had one patient with global aphasia and one patient with Wernicke’s. My externship had a very cool “Evidence Based Aphasia Clinic” which analyzed the aphasic characteristics of patients enrolled in the clinic, and then looked at EVIDENCE BASED protocols for treating aphasias. WHICH IS SO SMART. Everyone should do this. Not just with aphasia. With all things. One day I’d like to have at least one legit journal article printed off that explains why I do what I do with each kind of disorder that I focus on.

Back to what I was saying – What do we do with these patients? With a global aphasia you’ll likely be trying to find some kind of multi-modality communication system that will be consistently and appropriately utilized in the patient’s life. These are tough patients but you’ll find a way to communicate. One of my most favorite patients had global aphasia. She was the sassiest.

Wernicke’s? Wernicke’s aphasia is really cool. There is a Treatment for Wernicke’s Aphasia which works, but is extremely tedious and exhausting for EVERYBODY. Be sure to break up your sessions if you attempt it. The idea is you put out six photos (of 12 photos total) of everyday photos and first – hand the patient a card with a word on it. The patient matches the word to the picture. The patient then reads the word or verbally identifies the picture. The patient then repeats the word after you. Then you ask the patient to identify the picture with just a verbal cue. There is no scaffolding or cueing, but obviously for training purposes and for success purposes you’ll want to cue and prompt as necessary at the beginning. When I find the source for this I’ll share it – I’m not sure where I hid it. You can also do Response Elaboration Training, Cloze Procedures, Melodic Intonation Therapy, and I’m sure a number of other procedures.

And the biggie – word finding. This is going to change with each patient. I really enjoy category naming and teaching HOW to do this efficiently. I think often we say to a patient “Name all of the animals you can!” and then they have a hard time and we write down how many they got and then we tell them to name some other things. THIS IS NOT GOOD THERAPY.

Teach, don’t test, people.

So some ways we can deal with naming and word finding is to do semantic mapping tasks and semantic feature analysis. You can TEACH patients how to categorize by really thinking about how our brain works. How is our brain organized? Do we just have a jumble of animals in our brain all willy nilly? If someone asked YOU to name as many animals as you could what would you do? I often tell patients to subcategorize. Tell me animals, but first tell me farm animals, then zoo, pets, woodland, ocean, flying, etc. Tell me vegetables but envision yourself at the grocery store. And also consider – are you asking the patient to name CONCRETE items or ABSTRACT? Example time. Concrete: Animals. Abstract: Red things. Our brain is not organized by color.

Other tasks for word finding: synonym and antonym generation. And not just ONE word. Tell the patient to think of THREE antonyms. This gives you a good idea of where they are as far as what is difficult and what sorts of scaffolding is required. Can you give a patient a FIM score without really pushing them and figuring out what is hard? (No.)

Unscrambling tasks. Idiom defining.  Homonym explanation. Word defining. Seriously – ask a patient with a word finding disorder to define the word “tree”. Try that one. I really recommend the WALC books and Cognitive Reorganization if you work with aphasia often.

Now, I’m going to do the last edit of my thesis because I’ve been…not doing it.

NP: Anna Begins – Counting Crows

PS – if you Google just the word “WALC” you get this website. Lolz.

Advertisements

Memory Therapy

21 May

I don’t know about you guys, but I felt like in many of my SLP classes I learned a lot of “textbook knowledge.” Meaning it’s good info to know and it’ll help me pass the Praxis, but beyond that it’s sort of useless. For example, in aphasia we learned the symptoms of aphasia and the different classifications of aphasia and how to evaluate aphasia. But three months ago if I was presented with a person with aphasia and someone said “TREAT THEM!” I’d be all, “Oh Dear Mother of God.” The knowledge isn’t super practical sometimes.

Which is why externships and clinic are important.

Anyway, I thought I’d take some time to break down some of my favorite areas to work on in the adult realm. Today I thought I’d go over,

MEMORY

As SLPs we address cognition which is an umbrella term for: orientation, memory, attention, problem solving, reasoning, initiation etc. Executive functioning overall. You’ll find often that OTs work on this as well.

Memory is an umbrella as well, since there are so many types of memory. Short term, long term, delayed, procedural, working, autobiographical, muscle, semantic and so forth. And memory has many steps. Your brain has to absorb the info, it has to code it, store it, and make it available for retrieval.

Generally, what I worked on most often was working memory and training patients to compensate for short term memory loss. There are a few agreed upon tricks of the trade and I’ll share them with you now.

1. Teach your patients to associate. This is most often used in the case of remembering new names. I always give my patients the example, “My name is Sam. I am a Speech therapist. And I’m a Student.” Lots of /s/. You could also use physical traits or personality. Like “Democratic Diana” or “Tall Tina.” You can make an association between new information and something you already know like, “My niece’s name is Sam and your name is Sam so I’ll remember you” (I never get how this works but patients always do this as their example.)

2. Repeat repeat repeat. If you want to memorize a list, a phone number, a poem, song lyrics – whatever – what do you do? You say it or do it over and over until you can do it without prompts. If a patient can’t remember what month it is – tell them during your session. A lot. And write it down. Several places. Repetition and rehearsal are great tools for committing something to memory.

3. Visualize it. This is good for prospective memory because you imagine yourself calling the doctor at 3 PM, or you imagine yourself turning on the TV to watch your favorite show. It’s like a little movie in your mind. A way to train visualization is to give a patient a list of words and have them make a story out of the words. Sometimes patients don’t really get it and will just combine a bunch of unrelated sentences. You want to encourage the story to have flow and be related, though it can be really silly. So if the list of words is:

Sock. Keys. Pink. Word. Chair.

They might say something like, “I’m wearing socks. I have keys in my purse. My favorite color is pink. Chair is a word.”

This is beneficial to no one. You want a story like, “I put on my sock but couldn’t find the other. So I got my keys and unlocked my pink car, so I could go buy a new pair. When I got home, I said a curse word because my sock was under the chair.

They’ll say the story to themselves a few times and then you remove the list from their line of vision. Ask them to verbalize or write the list immediately. Then ask again 20 minutes later.

4. Grouping. Which is one we all do a lot anyway – putting like things together. So if you’re making a grocery list, put the meats, dairy, dessert, veggies on the list together so it makes sense. Also then if you forget the list at home you have a better chance of remembering if you had categories.

5. Writing things down. Putting new activities into a planner. Writing notes on your day. Keeping a pad of paper by the phone. Reviewing the day with someone. Writing on a calendar. However you want to do it. But you’re more likely to retain something if you’ve put it on paper. A lot of patients physically can’t do this, so encourage their families or caregivers to help them.

You’ll also want to encourage your patients to make changes in their home environment so it’s more conducive to memory. Like keeping everything in a specific place everyday. Labeling drawers. Using a pill organizer. Using external aids like alarms and calendars. Whatever is going to make their life a little easier.

Working memory is something I really enjoy therapizing and that is just the retention and manipulation of information. So doing things like numbers reversed, or unscrambling letters into words when provided verbally. If you have a patient who has visual impairment these are good tasks to get them settled into therapy and get that brain moving. It’s a challenge for me too!

NP: Memory