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Sunday, September 6, 2009

Aphasia In-Service Training

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By Justin Zarb

A few weeks ago I put together some materials for an in-service training on aphasia. I wanted to share it for those who are looking for an in-service to perform, or for those who would like to learn a little more about it.

Understanding and Working with Aphasia

Presented By: Justin Zarb

Aphasia: Quick Fact Sheet

Who Gets Aphasia and What Causes It?

  • By far the most common cause of aphasia is stroke. However, any disease or injury that damages brain tissue can cause aphasia (head injury, aneurysm, brain tumors). It is estimated that about 20% of individuals who suffer a stroke will also incur a serious loss of speech and language.

What is Aphasia?

  • Aphasia is a total or partial loss of the ability to communicate whether through listening and understanding, speaking, gesturing, reading, or writing.

When Does Aphasia Onset? When Does Aphasia Get Treated?

  • Within hours of recovering from a stroke, aphasia will usually become evident if there has been sufficient brain damage. Sometimes the aphasia will be hard to detect if it is a non-oral form such as reading, writing, or gesturing. A trained speech pathologist should perform an evaluation for the stroke victim.
  • Treatment for aphasia can begin immediately with speech therapy. If therapy is available, almost all aphasic patients will improve their use of language. Some individuals who are very impaired in the first few days can go on to a full (of almost full) recovery within a few months. Typically, therapy only produces results within the first 12 months after the onset of aphasia.

Where In the Brain Does the Damage Occur?

  • Each individual’s stroke or incident will affect different parts of the brain, and therefore affect different parts of one’s communication. For instance, the left frontal lobe of the brain controls one’s ability to form complete sentences. More often than not, many parts of one’s brain are affected by a stroke and there is a mixture of their abilities that are affected. Additionally, multiple strokes over a period of time can cause new aphasic symptoms for an individual.

Why Is Aphasia Important to Learn About?

  • Imagine trying to help an individual walk if you didn’t understand how their prosthetic leg functioned. The better you understand the tools and abilities the individual has to work with, along with the limitations facing them, the better you will be in helping them communicate and you communicate with them.

A Guide for Communicating with an Aphasic Person

  • Respect: Treat the person as a mature, responsible adult. Do not make the mistake of equating speech ability to one’s intelligence. Giving someone respect will improve their confidence in their abilities.
  • Normalize: Talk in your natural voice, this will also help the person feel dignified. Only use a low-tone voice or other adaptation if you know the person also has a hearing loss.
  • Be Patient: Give the aphasic person time to respond. Remember, they are re-learning a complex system of communication and will only improve if given the opportunity to practice.
  • Observe: Look for any cues that the person understands what you said, or knows what they are trying to say. If the person seems to not understand, try repeating and then rephrasing your request.
  • Adapt: If the person is having difficulty verbalizing, try using a pencil and paper. Communication boards may also work well for some individuals. Don’t forget that gesturing can also be a great communication tool for you and for them!
  • Control the Environment: Try conversing in a quiet setting, turn down or off any radios, televisions, fans, or air conditioners that make talking more difficult.
  • Be Honest: If you did not understand the person, do not pretend that you did. Simply tell the person you are not sure what they are saying. If there is not time to keep trying, tell the person you’ll try again later.
  • Have a Good Attitude: Enjoy the exchange with the person, inject humor into the situation if appropriate to keep things light-hearted. This can help the person feel that they are not solely responsible for the failure in communication, but that it is a mutual discussion where both parties are learning one another.
  • Ask for Help!: It is okay to ask the person what method of communication works best. Paper? Gestures? Yes/No questioning?
  • Be a Guide: Establish a topic at the beginning of a conversation. Stay on one topic at a time. Give the person fair warning if you need to change the topic. If in a group, try to make sure only one person is speaking at a time.
  • Set Them Up For Success: Simplify long, complex directions. Avoid abstract questions in favor of Yes/No questions. (Are you having a good day? Instead of, How are you doing today?) Pick topics that you know the person is likely to respond well too.
  • Look and Listen: Make eye contact to let them know you are engaged in communication with them. Listen to all the words and try to piece together what they are trying to say. Ask follow-up questions to clarify their meaning, and let them know when you do understand!
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3 comments:

  1. I disagree with the statement that therapy produces results only within the first twelve months after the onset of aphasia. Research has shown that the spontaneous recovery period (time after the stroke in which new neural connections are being made and damage repaired without therapy) can last up to two years. Speech therapy can continue to make a difference even years after the onset of aphasia. The majority of people with aphasia who participate in research studies are persons with chronic aphasia (more than 6 months duration) and there are numerous articles showing that continued treatment can be beneficial. I operate an intensive aphasia program (6 week program) and I can tell you that we have had clients who are over 14 years post onset show great improvements in their speech, reading, comprehension, and writing. Making such a limiting statement leaves persons with aphasia believing that there is nothing else they can do to help themselves recover. Additionally, there was a statement to the effect that persons with a very severe aphasia within the first few days can get markedly improved within a few months. This is certainly within the realm of possibilities, but recovery takes time, motivation, and lots of practice. It can be done!

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  2. I am Adam Miller and I happen to agree with you. It so happens that I have aphasia but I got it from aneurysm. There was two vein bleeds. About 9 years and I am still improving.

    For the 1st 3 months I couldn't talk at all. The next 5 years were difficult. The past four years I have been improved tremulously.

    I am a web designer and I did http://www.aphasianyc.org.

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  3. Great discussion on the onset and treatment of aphasia. Our company is creating a web-platform that will connect Speech Language Pathologists with individuals in need of therapy. This platform will help address the nationwide shortage of SLPs while improving access and reducing cost. Please visit our website, we would love to hear your comments:
    http://presencetelecare.com/

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