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Friday, November 13, 2009

Practice Makes Perfect

Practice MakesPerfect; Perfect Practice Makes Normal.

The Importance of Therapeutic Time On Task.

Malcolm Gladwell, in his best selling book Outliers ( #5 New York Times) http://www.nytimes.com/pages/books/bestseller/ , debunks the idea that those who succeed and achieve expertise do so primarily because of talent and potential. He presents an undisputable case for the overwhelming importance of lots and lots of practice. He calls this the 10,000 hour rule. "In fact, researchers have settled on what they believe is the magic number for true expertise, ten thousand hours." Galdwell explains. That was the case for Bobby Fisher in chess, the Beatles in music, and even Bill gates in computing. We propose the same is true for aphasia rehabilitation. Lots and lots of practice using smart activities and innovative tools can help people with aphasia accomplish remarkable things. Recovering the ability to speak is even more important than becoming an expert chess player, musician or computer programmer. People with aphasia, who want to converse again, should be practicing lots and lots everyday.

All too often, the critical nature of independent and/or supported practice is not appreciated sufficiently in traditional aphasia treatment. For example, I reviewed an article in Seminars in Speech and Language ( vol 30, August, 2009 , pp. 174-186, http://www.thieme-connect.de/ejournals/toc/ssl/97930 ) that discussed treatment in bilingual speakers with aphasia. I highly recommend this excellent issue and in particular this fine article. In the article, Katherine Kohnert looked at 13 clinical treatment studies. Of these studies, only 3 (23%) were reported to mention patient practice outside of the clinical setting (#1: 3-5 hours for 6 weeks; #2: 70 minutes a day for 8 weeks; #3: 2 hours a day for 10 days). In the summary table in this article, patient practice was not even addressed by the author. The lack of attention to the importance of patient practice outside of the clinic is noteworthy and, given what we know about the need for hours and hours of practice, troublesome. A cursory examination of other aphasia treatment studies during preparation for this newsletter suggested a consistent laissez-faire clinical attitude toward patient practice in aphasia rehabilitation.

The need for plenty of patient practice has support from many points of view. Common sense tells us, "Practice makes perfect." Educators present clear positions on the need for time on task for effective learning. As Cathy Vetternott proposes in Rethinking Homework, 2009, "Teachers know that learning certain skills require practice to perfect, and often homework is used for practice." Reconnecting skills in aphasia rehabilitation likewise requires lots of practice.

The literature and research on intensive treatment programs for aphasia does demonstrate a strong support for progress supplied by hours of practice in the clinic setting (http://etd.lsu.edu/docs/available/etd-04032008-161153/unrestricted/Cain_thesis.pdf ). How and how much the patient practices, both during formal treatment and when formal treatment ends, is of the utmost importance. Moreover, this practice needs to be done in a focused manner with smart work in a supportive practice culture. The clients we work with online at the Aphasia-Apraxia Treatment CyberClinic average 2:40 hours of practice everyday.

In our next newsletter we will present an amazing case study of what lots of therapeutic time on task (TTOP) using tools and activities can accomplish. We will see how the Aphasia Sight Reader at www.aphasiatoolbox.com affordably provides, in a simple to use manner, unlimited stimuli and practice for speech pathologist, clients and caregivers. No aphasia practice should be without a tool such as this.

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