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Thursday, October 21, 2010

BCAT - The Viking Module 10-21-10


Brain Compatible Aphasia Treatment Program - Module 1
The www.aphasiatoolbox.com Brain Compatible Aphasia Treatment Program (BCAT) takes advantage of the powerful recovery and re-connective potential of brain plasticity.  BCAT brings together the best of aphasia research, neuroscience, learning theory and the clinical expertise of our speech/language pathologists (SLP). We blend this combination with the determination and effort or the person with aphasia using our innovative techniques and tools to achieve his/her goals.  To view some examples of our client's outcomes visit http://www.aphasiatoolbox.com/?q=accomplishments .

BCAT consists of 15 component treatment modules, 61 guiding treatment principles, 88 unique treatment protocols (sets of activities with specific goals) with accompanying materials; and 2 software programs with over 500 stimulus sets.

The component treatment modules include:
1.    The Viking Module for Apraxia
2.    Phoneticize for thinking in sounds
3.    The AphasiaPhonics Module for phonological elements of aphasia
4.    The Lexical -- Semantic Module for word recall anomia
5.    The Speaking in Sentences Module for syntactic reconnection
6.    The Prosody Module for sentence intonation, word stress and phrasal timing
7.    Keyboarding for alexia, agraphia and screen literacy
8.    The Numerology Module for cardinal and ordinal numbers and concepts
9.    The Speech Acts Module for intent and communicative responsiveness
10. The Pragmatics Module for Language In Action
11. The Cognitive Underpinnings Module for memory, attention and mental resource allocation
12. The Morphing Module for morphological difficulties
13. The Reading Module for Acquired Alexia
14.  The Movement Module for Limb Apraxia
15.  Groups for per engagement, practice and support


For more information visit http://www.aphasiatoolbox.com/?q=bcat or contact us at 724.494.2534 or email information@aphasiatoolbox.com .

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This is the first in a series of newsletters that will explain in more detail each of the component modules of our Brain Compatible Aphasia Treatment Program (BCAT) pronouns.  Our first topic is the Viking Module for Apraxia. 
When one of our clients with aphasia also experiences the effects of apraxia (motor programming problems) on his/her speech, we begin his/her treatment in our vocal-oral physical training center.  We have built a treatment module that truly approaches apraxia as a movement disorder focusing on motor skills 1.   

The clinical goals for the Viking Module are:
1.    Disassociate jaw and vocal fold neural controls
2.    Increase metapraxia, the knowledge and awareness of apraxia and movement patterns 2
3.    Improve deliberate control of vocal fold action (voicing, phonation)
4.    Establish effective use of proprioceptive feedback, the ability to focus on the sense of position and location and orientation and movement of the body and its parts  3
5.    Establish presyllabic and preprosodic skills
6.    Establish the effective production of vowels primarily in relation to jaw position and as the building blocks for syllables
7.    Simplify the client's movement patterns
8.    Establish syllables as the building blocks for speech motor programming

Wambaugh,et. Al., (2006) offered the following definition of apraxia, "Acquired apraxia of speech (AOS) is a neurogenic speech disorder that is characterized by erroneous production of speech sounds; reduced rate of speech; increased time in transitioning between sounds, syllables, and words; and disordered prosody" 4. Recognizing that this definition would do little to assist the client's appreciation of what needs to happen therapeutically, we utilize a visual definition of apraxia and its relationship to aphasia and connected speech production.   Formative assessment is a key clinical management tool used by our speech/language pathologists (SLP) during apraxia treatment.  Formative assessment of the client's needs occurs minute-by-minute, day-by-day resulting in a fluid, responsive plan of treatment.  In other words, the module continually develops in response to the client's progress in and reaction to this movement-centered treatment and practice. This approach can be in sharp contrast to less frequent treatment adjustments provided when intermittent, formal testing is employed. 

In the Viking module, prioritizing targets for treatment is critical.  At times, this means downplaying voicing errors (e.g., t/d) or postponing work on consonants while emphasizing work in syllables as a primary treatment target 5 or incorporation of rhythm at treatment onset.  It seems that the great majority of traditional apraxia treatment approaches target segmental, single phoneme units (e.g., consonant sounds), or use imitation ("Watch me.") and external cueing (mirrors, recordings, placement) as key treatment techniques.  In contrast, we focus on the client working from his/her own memory and thought for movement patterns, as well as a focus on his/her own internal feedback and control (proprioceptive feedback).  From the very beginning, the Viking Module focuses on the client reconnecting motor control in his/her own brain. 

As with our treatment modules for aphasia, a guiding principle for this work on apraxia is:
·      Ensure that the client knows where to place his/her mental focus.
·      Make sure that the client acts on that focus.
·      Have the client effectively and efficiently move to next point of focus.
Effective use of this principle has consistently resulted in a fading away of perseverative utterances (repetitive production of speech sounds that have no meaning such as: thatathatathat; cocococococ;  yesthankyouyesthankyou ) as clients begin to differentiate their movements and speech output.  Once effective motor control has been reconnected, bridging treatment activities to speech sounds, syllables, and sentences in connected and propositional speech becomes much less difficult.

While we are working on apraxia that affects the jaw, mouth and voice, we also work on apraxia affecting motor control of the arm/hand control (The Movement Module for Limb Apraxia).  This allows us to:
·      begin to address keyboarding and screen literacy skills
·      work on any asymbolia (impairment in understanding and using symbols)
·      facilitate the client's metapraxia
·      help the client improve independent therapeutic efforts by recognizing shared elements of the effects of apraxia on various motor functions of the body
·      Establish a purposeful, functional communication modality (pointing; gesturing; yes-no head nod-shake)



The specific elements of the Viking Module for Apraxia include:

a.    The Visual Definition of Aphasia
b.    Viking - concepts
c.     The basic Viking -- pulsing syllables
                                               i.     Modeled
                                             ii.     Independent on request
d.    Durational Viking -- Stretching Vowels
e.    Intoned Viking
f.      Viking with an Attitude
g.    Rhythmed Viking
h.    Scatpraxia: yes-no-delicious
i.      Scatpraxia: vowels
j.      Scatpraxia: varied vowels
k.     Scatpraxia: bringing in the consonants
l.      Vowels
                                               i.     Jaw positions
                                             ii.     Around the Mouth
                                            iii.     The Elevator: Alternating Vowels
                                            iv.     Vowel Sequences From Memory
                                              v.     Continuous Phonation -- Dipthongs
                                            vi.     Blend Sounds into Words
                                           vii.     V to VC words
                                         viii.     Alternate / h / -vowels
m.  Vowels Become Pronouns
n.    Oral-Motor Coordination Module -- addressing naturalness of syllable structure and its supra-syllabic features
o.    Sound Embedded Verbs
                                               i.     Oral Motor Coordination
                                             ii.     Men's Basic Bootcamp
                                            iii.     Coaches

For an explanation of apraxia and its treatment geared more toward consumers, contact us at 724.494.2534 or email information@aphasiatoolbox.com .

1 Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17, 277-298.

2 Heilman, Kenneth, and Gonzalez Rothi, Leslie, Apraxia -- The Dana Guide, http://www.dana.org/news/brainhealth/detail.aspx?id=9772, March 2007

3 Georgopoulos, Aposotlos, Movement, Balance, and Coordination -- the Dana Guide, http://www.dana.org/news/brainhealth/detail.aspx?id=10070 , November 2007

4 Wambaugh, Julie, Duffy, Joseph, McNeil, Malcolm, Robin, Donald, and Rogers, Margaret,  Treatment guidelines for acquired apraxia of speech: a synthesis and evaluation of the evidence.(ANCDS Bulletin Board)(Academy of Neurologic Communication Disorders and Sciences )
Journal of Medical Speech - Language Pathology | June 01, 2006

5 Ziegler, Wolfram, Aichert, Ingrid, and Staiger, Anja, Syllable- and Rhythm Based Approaches to Apraxia of Speech, Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 20 59-66 October 2010
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