Aphasia Rehabilitation Unplugged: Impairment and functional approaches

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Aphasia Rehabilitation Unplugged Impairment and
functional approaches

• Jacqueline Hinckley, David Howard, Nadine Martin,
  Cynthia Thompson, Nina Simmons-Mackie, Linda
  Worrall Audrey Holland

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Background

• This presentation grew out of concerns raised by
  Dr. Anna Basso
  
• Essentially, is there a unifying theory that
  underlies treatment for aphasia?
  
• If so, what is that theory?
• If not, why not?

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The Lerici meetings

• Dr. Basso hosted two meetings at her home in
  Lerici, Italy
  
• Goal of the meetings
• To resolve the issue of a theory of aphasia
  treatment
  

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Dedication

• These talks are dedicated to Anna Basso, whose
  retirement is being celebrated this month in
  Bologna, Italy

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First meeting participants

• Anna Basso
• Argye Hillis
• Jacqueline Hinckley
• Nancy Helm-Estabrooks
• David Howard
• Walter Huber
• Linda Garcia
• Linda Worrall
• Alfonso Caramazza
• Margaret Forbes
• Audrey Holland

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Second meeting participants

• Anna Basso
• Argye Hillis
• Nadine Martin
• Steve Nadeau
• David Howard
• Walter Huber
• Linda Garcia
• Linda Worrall
• Cynthia Thompson
• Nina Simmons-Mackie
• Audrey Holland

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Meeting one vs Meeting two

• Group recognized vast differences in approaches
• Approaches seemed to have two themes
• Working directly with impairments
• Working with the consequences of these
  impairments
  
• Agreed to disagree

• If at first you dont succeed..
• Goal
• To seek common ground
• Still no theory of therapy, but.
• We learned much from each other

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The outcome..

• Recognized that these important participants
  respect each others opinions
  
• Agreed that none of us knows the answers to
  questions such as
  
• What is the BEST therapy?
• Where does it happen?
• How can insure that my family member receives it?

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And finally

• A growing recognition that indeed, there probably
  is NO ONE Theory of Therapy.
  
• INSTEAD, there are (possibly ) MANY such
  theories.
  
• In my view, competing, viable, data-producing,
  mini-theories result in
  
• A vibrant profession!

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Growing to the point of asking questions such as

• Are some approaches more useful at some points in
  the recovery spectrum than at other points?
  
• Are some approaches more appropriate for some
  individuals than for others?
  
• Are some approaches more appropriate for some
  problems in aphasia than for others?
  
• And many more

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The Lerici groups have been productive.

• We have individually pursued these topics in our
  own work
  
• We have collaborated and continue to talk
• We have conducted a similar session, with
  somewhat different speakers and topics at the
  World Federation of Neurology, Cognitive
  Language Disorders Section in Buenos Aires,
  Argentina
• We have recently published a book
• Aphasia Rehabilitation The Impairment Its
  Consequences (N. Martin, C. Thompson L.
  Worrall, editors)
  

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Our very useful exercise

• Describe individuals with varying aphasic
  symptomatology
  
• Have two clinicians discuss how they would treat
  each individual
  
• One clinician committed more strongly to
  impairment approaches
  
• The other committed more strongly to approaches
  aimed at the consequences of the aphasia on life
  activities and participation in society
  
• Look for resulting convergences and divergences

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Todays presentation will

• Illustrate that process by describing three
  individuals with aphasia
  
• A person with anomic aphasia
• A person with nonfluent aphasia
• A person with global aphasia
• Discuss treatment plans for each of them that
  reflects
  
• An impairment based approach
• A consequence based approach

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This symposium will

• Hopefully, delineate common ground for the
  treatment of aphasia
  
• Clarify treatment approaches
• Heal the rift that sometimes separates clinicians
  who encamp at one or the other end of the
  impairment-consequences spectrum.

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Order of presentation

• Anomic aphasia
• Impairment -based approach--Nadine Martin
• Consequences approach--Jacqueline Hinckley
• Nonfluent aphasia
• Impairment-based approach--Cynthia Thompson
• Consequences approach--Linda Worrall
• Global aphasia
• Impairment based approach--David Howard
• Consequences approach--Nina Simmons-Mackie

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• Each presentation will end with a discussion of
  ways in which the approaches converge and
  diverge
  
• Then, at the VERY END, we will have a general
  discussion among panelists, and time for your
  questions.
  

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Before I relinquish the podium to my colleagues

• Probably all well-done therapy makes a
  difference
  
• Should be grounded in a defensible theory,
  nonetheless
  
• We need to think together about our goals
• Speech or communicating
• Talking vs getting a message across
• Living successfully with aphasia,