10/4/2017. Applying the FPP. Strategies and Tactics in the Management of Discourse in Aphasia DISCLOSURE

Transcription

1 Applying the FPP Strategies and Tactics in the Management of Discourse in Aphasia Audrey L. Holland, Ph.D., CCC/SLP, BC-ANCDS HealthSouth Braintree Rehabilitation Hospital 38 th Annual Neurorehabilitation Hospital November 11, 2017 DISCLOSURE Financial Relationship with Carnegie Mellon University Consultant Strategies and Tactics and Aphasia Management Aphasiologists tend to use strategies and tactics almost interchangeably, Particularly in relation to rehabilitation Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat Sun Tzu The Art of War 544 BC-496 BC 1

2 My dear friend and colleague, Nancy Helm-Estabrooks is responsible for some powerful strategies for the treatment of aphasia She refers to them as process approaches, designed to harness neuropsychological strengths into the service of language and communication in aphasia. Here are the most powerful ones in relation to interpersonal communication Melodic Intonation Therapy (MIT) AoS, Syntax, singing & intoning Visual Action Therapy (VAT)- gesture training Back to the drawing boards drawing Others are directed toward less-focused problems Treating Aphasic Perseveration, (TAP); Voluntary Control of Involuntary Utterances (VCIU), Helm Elicited Program for Syntax Stimulation (HELPSS) * all are described in detail in Helm-Estabrooks, Albert, and Nicholas, Pro-ED (2013) The point is that these represent STRATEGIES, with very measurable changes reported on pre and post measures, with generalization to aphasia tests. To the best of my knowledge, their effect on interpersonal communication has not been measured perhaps the FPP could help in that direction? Regardless, these approaches imply TACTICS that follow training on say, gesturing, drawing, etc. & could improve functional communication. But my guess is that practice DURING actual communication is necessary, as is some focused drill work. 2

3 Okay, let s get real. How can we encourage/facilitate/help PWA to use these tactics that FPP has isolated within their repertoires? Being a group-groupie I see these activities as perfect for groups. But all would work for individual sessions as well. Literally, the same format for stimuli as used in the FPP is appropriate Famous places Heroes Breeds of dogs Makes of cars Italian foods Garden tools Difference lies in the required response(s) All participants will have been given the FPP Each participant instructed to respond with strongest tactic. Other members indicate that they got it (using either tactic or verbal response) * The goals of sessions like this group session are to simply practice, in a somewhat naturalistic setting, using strategies to communicate, and getting feedback as to success. 3

4 In individual sessions, the obvious formats are Conversational Coaching Scripting : PACE Example is PACE. Task is to communicate using PWA's most effective strategies (in this case, it is gesture /facial expression ): 1. Clinician prepares a sheet of relevant emoticons for you and him Facial Expressions & Gestures: PACE Each has a copy, PWA & clinician take turns e.g., Clin: A big hairy spider walks across my ipad. Can you guess what I feel? ( Find the emotion. Show me. Do it.) Your turn show me one of the emotions in front of you (Here is where you make sure he knows it's to be shown on HIS face and makes a happy face.) e.g., Clin: "Did you just win the lottery?" (head shake, no) "Did you just become a grandpa?" (head shake yes) etc. SCRIPTING EXAMPLE FPP (kinda). PWA is a talker, her predominant tactic is giving relevant words. She is a football fan. Here is the script: The Steelers beat New England Ben Rothlisberger threw 4 touchdown passes. Pittsburgh fans went wild. How does she communicate that to her husband, who slept thru the whole game? What are the relevant words/concepts? Does order matter? What details can be eliminated? 4

5 Beukelman has pointed out that not only is the world becoming more dependent on reading and writing (if not correctly spelled) for normal communication (witness texting, tweeting. etc). He also pointed out the growing importance of images in normal communication (witness selfies and other image-captures). I recognize the power for some PWA of SGDs and other alternative communication Devices. However, the power of a tablet (e.g., ipad or Samsung Galaxy & a smart phone (e.g.,iphone or LG G6) across the PWA spectrum cannot be overestimated. For example, for the verbal FPP tactics measured: the terms "Paris, tall, iron" fed into Safari brought up BOTH pictures and the words Eiffel tower. The terms dog, hunt, blood brought up the a picture and the word bloodhound. The term moonwalk alone brought up images of Michael Jackson. Obviously, this tactic would probably be easier than drawing, for people who can access related terms, either by talking (Thank you Siriº ), or by writing. OKAY Sleepy Heads, WAKE UP! I am going to show you 4 PWAs in brief segments of their FPPs. I will tell you a bit about each of them including their WAB and their FPP scores. On the basis of what I tell you & what you see: How do they demonstrate what they KNOW, even if they cannot SAY? That is, how will you help them to become part of a conversation? 5

6 Jose Some facts: Jose and Ellen s before-dinner conversation. Ellen: Hard day at work, Jose I am tired let s go out for dinner. How did you spend your day?" Jose gets out his iphone: Ellen: Buy that wheel barrow we needed? Jose: Yeah. Ellen: Did you go anywhere else? Jose gets out his iphone: Ellen: Everything okay out there at the ranch? Jose: Yeah, well...(out comes the iphone ) Ellen: Yikes! Did you kill it? Jose: (laughs) Nah. Ellen: Glad it was you, not me! Joe brings up new picture on iphone. Ellen: Aha, went to watch Manny Jr work out? Jose: Yeah " Ellen; Was he pleased to see his Grandpa there?" Jose: (shrugs) 6

7 Scott some facts Leora some facts Ray some facts 7

8 Rodrigo facts Thanks for Listening! 8