Speech and Language Therapy Methods of Intervention

1
Speech and Language TherapyMethods of
Intervention

• The Patients Journey through Acute,
  Rehabilitation and into Long-term Care

2
Overview of Our Service
3
Identifying Needs to Develop Intervention Methods
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Acute Phase Needs Patient, Family and Therapist

• Establish current and pre-morbid communication
  skills
• Establish baseline communication skills
• Give information about Aphasia
• Identify ward based communication needs
• Provide counselling and support

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Acute Phase Methods

• Communication History Form
• Meet with family and friends
• Assessment formal/informal (screen)
• Aphasia Information Sheet
• Introduce supported communication, to facilitate
  communication, orientation and understanding
• Liaise with MDT, Medics, Nursing staff
• Provide basic communication chart
• Give SLT contact details

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Rehabilitation Phase Needs Patient, Family and
Therapist

• Assessment of specific impairment needs
• Ongoing information giving and updates
• Building communication links and skills with
  family and friends
• Setting individual therapy goals
• Implementing individual and group therapy
• Developing ward based communication skills
• Ongoing counselling and support

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Rehabilitation Methods

• Direct Methods
• Use of specific sub-tests, detailed assessments
  e.g. PALPA, Boston, CAT
• Aphasia Friendly information on Stroke and
  Aphasia (CONNECT)
• Errorless/Errorful learning (BAS)
• Narrative therapy (Brody 1994, Donald 1998, Byng
  at al 2000)
• Colourful Semantics (Bryan 1997)
• Phonological Awareness Therapy (Morrison 2001)
• Conversation Groups Chatter Groups
• Individual Communication chart

• Indirect Methods
• Carers Evening
• Regular patient/therapist/family meetings at
  bedside
• Daily communication diary
• Weekly Case Conferences close liaison with MDT
• Training for families and friends on therapy
  techniques
• Training the Trainers MDT and family
• Aphasia and Stroke Information including PALPA
  model of language processing

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Rationale for Rehabilitation Methods

• Errorless and Errorful Learning (BAS Conference)
• 120 words collated and divided into three sets.
  Each set comprised 20 verbs and 20 nouns.
  Errorless therapy was used on one set and
  errorful therapy used on the other set. Results
  showed significant therapy effects across both
  therapies. Greater improvements in noun naming
  over verb naming. Errorless took 50 less time
  than errorful, was more engaging, satisfying and
  gives implicit feedback
• Colourful Semantics (Bryan 1997)
• A visual colour coding system of supporting
  development of correct grammatical language
  structure with written words, also used to
  encourage focused word finding skills across a
  set group of nouns and verbs for verbal output.
  Aims to teach the identification of underlying
  thematic roles in written sentences and encourage
  the use of thematic role knowledge to create
  predicate argument structures in written or
  verbal sentences e.g. subject, verb object, or
  subject, verb, location using colour coded
  system. Gives patient back a logical language
  structure and focus and dramatically improved
  word finding and self monitoring skills in fluent
  aphasia.
• Narrative Therapy (Brody 94, Byng at al 00)
• Illness narratives are stories that attempt to
  repair the damage that the illness has done to
  that persons life, attempting to reconstruct the
  future in light of the illness. Different types
  of narratives come through at different stages of
  the persons illness. Narratives take patients
  from the sick role into the health role i.e.
  put the patient in control. They are educative,
  diagnostic and therapeutic.

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Long Term Care Needs Patient, Family and
Therapist

• Making therapy functional and relevant
• Developing sense of self awareness and self
  identity
• Preparing patient for Living with Aphasia
• Developing autonomy and independence
• Ongoing support and training courses

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Long Term Care Methods

• Direct Methods
• Conversation Groups (weekly)
• Patient Focus Group (weekly)
• Living with Aphasia Group (weekly)
• 11 Functional therapy (1-2 weekly)
• Aphasia Day (6 week course)
• Training the Trainers (6 week course)
• Life History Book

• Indirect Methods
• Carers Focus Group (evening course)
• Training the Trainers (6 week course)
• Carers Evening

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Rationale for Long Term Care Methods

• Functional Therapy (Worrall 1999, Addlestone 02)
• The Functional Communication Therapy Planner
  (FCTP) aims to provide the structure for
  therapists to develop, administer and evaluate
  therapy, ensuring the patients needs are at the
  centre. It takes you through the decision-making
  processes involved in providing functional
  communication therapy. It uses a questionnaire to
  obtain information about social networks,
  preferences for conversational topics, their
  perceived pre-morbid communication style and an
  interview to determine communicative needs. It is
  flexible with the severity of the aphasia and
  determines areas to concentrate on in therapy.
• Chatter Groups (Kagan Gailey 93, 98)
• These groups would focus on promoting total
  communication, supported conversation and
  increasing social interaction. Groups look at
  current affairs and topical issues to stimulate
  interaction between members, with the emphasis on
  conversation and getting the message across in a
  relaxed way, highlighting the importance of
  conversation in maintaining psycho-social
  well-being.
• Patient and Carer Focus Groups (Buck 68, Rollin
  00)
• A recent initiative in St Jamess Hospital has
  been to invite patients largely from the Long
  Term Care stage to discuss, share and express
  their opinions on the service they received
  during all phases of their Stroke Care Pathway.
  Therapists act as non-biased facilitators within
  the discussion group. These groups help to
  address the psychosocial aspects of aphasia, not
  just for the individual, but for the family also
  (Buck, 1968). Separate intervention fo family
  members can help target the emotional response,
  change old behaviours and develop a different
  manner of living (Rollin, 2000).
• Living with Aphasia Group (Brumfitt Sheeran
  97)
• This group focuses on encouraging self advocacy
  and independence, with patients taking a lead
  role. It enables patients to share their
  experiences of communication disability in the
  real world and develop methods and strategies
  of managing these. Group work has long been known
  to improve psycho-social well-being in the person
  with aphasia. Group work has included development
  of aphasia friendly leaflets by patients.

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References

• Acute Phase
• Holland, A Fridriksson, J. (2001) Aphasia
  management during the early phases of recovery
  following stroke. American journal of
  speech-language pathology.10 19-28.
• Peach, R. K (2001) Further thoughts
  regarding management of acute aphasia following
  stroke. American journal of speech-language
  pathology. 10 29-36.
• Marshall, R. C (1997). Aphasia
  treatment in the early postonset period Managing
  our resources effectively. American journal of
  speech-language pathology, 6(1), 5-11.
• Rehabilitation Phase
• Byng, S, Pound, C Parr, S (2000) Living with
  Apahsia A Framework for Therapy Interventions.
  In Papathanasiou, I (2000) Acquired Neurogenic
  Communication Disorders A Clinical Perspective.
  London, Whurr.
• Morrison, S (2001) Phonology Resource
  Pack for Adult Aphasia. Speechmark, Bicester.
• Brody, H (1994) My Story is Broken can You
  Help Me Fix It. Medical Ethics and the Joint
  Construction of Narrative. Literature and
  Medicine 13 1 pg 79 92
• Bryan, A (1997) Colouful Semantics. In language
  Disorders in Cghildren and Adults
  Psycholiguistic Approaches to Therapy, edited by
  S, Chiat, J, Law, J, Marshall. London Whurr.
• Long Term Care Phase
• Addlestone, S (2002) The Sourcebook of
  Practical Communication A Programme for
  Conversational Practice and Functional
  Communication Therapy. Speechmark, Bicester, UK
• Brumfitt Sheeran (1997) An Evaluation
  of Short Term Therapy for People with Aphasia.
  Disability and Rehabilitation 19, 6, pg221 230
• Buck (1968)
• Kagan, A Gailey, G (1993) Functional is not
  Enough Training Conversational Partners for
  Aphasic Adults. In A, Holland M, Fords (eds)
  Aphasia Treatment World Perspectives pgs 199
  225, San Diego, Singular Press
• Kagan, A (1999) Supported Conversation for
  Adults with Aphasia Methods and Resources for
  Training Conversational Partners. Apahsiology 12,
  pgs 816 830.
• Rollin, W (2000) Counselling Individuals with
  Communication Disorders. Boston Butterworth
  Heineman.
• Worrall, L (1999) Functional Communication
  Therapy Planner. Winslow Press, Bicester, UK