Aphasia therapy

26 May


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.

this is a long one. sorry boutcha.

21 Oct

I’ve had a request to post a lil’ about getting into graduate school. I’m giving a presentation next week to NSSLHA about this topic so I’m all ready to go! (ADDENDUM: I don’t know anything about using CSDCAS so don’t ask me!)

I’ll try to do this in steps so you can check things off as you go.

1. Make a list of schools you’re interested in and a pros and cons list if you have more than…six. I went to a presentation by Donald Asher my senior year and he said six was a good number. 2 reach, 2 safe, 2 middle of the road.

2. Once you have that list, make a check list for each school‘s requirements. Schools are weird, they can’t all just have a uniform manner in which they accept applications. Different deadlines, different costs, different expectations, different requirements. BE VERY CAREFUL HERE. If you eff it up, you’re OUT.

3. Compile. Get it together. Make a resume/Curriculum Vitae. Write a personal statement (I’ll blog a different time about writing a personal statement). Get your references in line. Start requesting transcripts yesterday.

4. Send in your actual application and fee as soon as possible. That way you’ll be on file and they’ll have a safe place to keep your stuff. The actual application shouldn’t be hard to do – it’s just the general things they need to know about you.

5. Ask people for recommendations as early as humanly possible. Schools vary on how many recommendations you need, but expect about three. I’d try to get them from people in your major who can write you STRONG letters of recommendation. Ask in person – “Would you be willing to write me a strong letter of recommendation for graduate school?”

6. Make the life of your recommender EASY. Give them a folder with everything they need in it. Supply your CV, your transcripts, your personal statement. Some schools may have a specific form they want your recommender to fill out, some may have an online survey, some just want a letter. Provide an addressed and stamped envelope and tell them the specifics about that letter. Some schools want YOU to mail it with all of your other stuff, but many want your recommender to seal it and sign it on the seal and mail it themselves. Once again, be very careful here, get it right the first time.

7. Also on that note, your school may require that you fill out a “waiver of rights” so recommenders may talk freely about your grades. Provide each person with a waiver about each school.

8. Transcripts suck. They take forever, they cost money, they never go to the right place. It’s a disaster so get started early. And remember to get transcripts from every school you attended – even if you did dual credit your junior year of high school through the community college.

9. Get your resume/CV together and edited by EVERYONE. You don’t want to look like a dummy with typos. And if your GPA isn’t AWESOME feel free to just mention the last 60 hours. (I mean, if they specifically ask your GPA, tell them, but on your resume you can put “3.45/4.00 last 60 hours”).

10. FOLLOW UP ON YOUR LETTERS OF REC. Ugh. Okay. This is the worst but it has to happen. Sometimes it is Christmas break, you gave all of your stuff to your recommender in October, and you get an email from your schools saying “We have two of three letters of recommendation” – sometimes they tell you who they’ve gotten them from. So it’s easy to narrow it down. You must hunt that person down and kindly, gently, nudge them to write that letter. They’ve likely just forgotten because they’re crazy busy just like you – they appreciate the reminder even if you feel awkward doing it. ON THAT NOTE – when you hand them the folders with all of the stuff they need – label that folder “YOUR NAME, The date you provided them with the folder, and the school it is for” – some people just do one folder for all their schools but I made an individual folder for each school and each professor.

11. Oh, and you can ask the same professor to write you multiple letters. And tell them which school you REALLY want. Professors want to help you, I promise.

12. Right, right, right before the deadline CALL the school and MAKE SURE they have received EVERYTHING. You might feel like you’re bugging them, but you’ll feel better once you do it. Especially if you applied to several schools. I’ve seen it happen where it is two days before the deadline and someone finds out a school never got their transcript. (Usually a school will accept an unofficial transcript until a real one gets to them – just FYI)

13. Once it is all said and done, you’ll start receiving notice in the mail (may go to your parents’ home) after spring break. And rejections come first. So if you haven’t heard from your number one school and it is early April don’t stress yet.

14. After that, write your thanks-you’s to the people who wrote your recommendations. Literally write them. On thank you cards. In pen. I waited until I got my decisions from schools because I didn’t want them to think I was sucking up to them (even though I sucked up to them all of the time any way because I am a suck up.)

15. If you get into multiple schools you’ll need to pick a school and write an acceptance letter by the date they give you. You’ll also have to write refusal letters. You can Google how to do that.

The end. If you want to know more about the types of graduate schools to apply to I wrote this last spring: for the chitlins

NP: Conor Maynard – Marvin’s Room (gorgeous. gorgeous. gorgeous cover.)

Thanks ASHA!

19 Aug

Well I am just tickled pink! I will be one of the three ASHA bloggers for the 2011 Convention in November. So keep your eyes peeled for more information about my ASHA-adventures. Be sure if you have the Twitter to follow me @slweathersby and follow ASHA  @ASHAWeb.

Also I just submitted my ASHA-blogging-agreement thing and this was the submission response: