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Describe the difference between habilitation and rehabilitation. Please given an example of each

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Habilitation Focus is on teaching a skill that is not there and has never been there (learning for the first time) Ex: Teaching someone to use an AAC device when they've never used one before

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Rehabilitation

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Relearning something already known Ex: Teaching someone to initiate conversation like they did prior

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How does remediation differ from the other two categories of treatment? Please give examples of each category of treatment

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Remediation: strengthening area of weakness ex: Compensation & Counseling

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Compensation

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Working around problem areas Ex:

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Counseling

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Helping the person cope with things they cannot change EX: Client is frustrated that they are perseverating, you can help them cope by speaking to them and teaching them strategies to cope with this issue.

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What are the advantages of canned approaches to remediation? What are the disadvantages?

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Advantages: Give clinicians directions Starting points for new/inexperienced clinicians Good efficacy Materials often provided

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Disadvantages of Canned approaches

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Boring May not meet client/clinician needs May not account for cultural diversity may not be founded on a good model

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What is the purpose of minting low error rate in therapy?

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Errors should be kept at a minimum We learn through practice; therefore, if we practice errors, we learn errors. This is taken to its furthest degrees in errorless learning approaches. Errorless learning: strive to keep error rate at zero and do not allow client to make errors. They take a most to least hierarchal approach

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Discuss three ways to increase the complexity of a task. Give an example of each

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Semantic Change level of vocabulary for same meaning Syntactic Change tenses Saliency Easier to use familiar concepts Phonemic Single consonants easier than clusters

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Discuss three methods of fading cues, and given an example for each

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Decreasing the intensity of the cue Increasing time since the cue Increasing interference since the cue

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Decreasing the intensity of the cue

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From "Dave" to "Day" to "D" - less information Lower the volume of the cue

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Increasing time since the cue

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Having the person repeat, then adding a time count (3 seconds) before they can repeat delayed imitation

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Increasing interference since the cue

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Saying something after the cue Give the cue, "now you say it" - adds interference

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Why is the didactic method less popular than other methods for treatment of aphasia

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Have not been shown to have a large amount of efficacy Re-teaching language does not work

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What is a good structure for a session, in terms of difficulty. Why?

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1) Start with something easier for client so they aren't discouraged from the start 2) Increase difficulty of the task to challenge the client 3) End with something easier to give sense of accomplishment It's good to build up on skills and you don't want the client to get stuck on having given an incorrect answer at the beginning (i.e. perseveration) because then it's harder to get them back to being successful in the session

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Melodic Intonation Therapy is a program that would be helpful for aphasic patients with which strength and weaknesses? What is the goal

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Helpful for patients with non-fluen aphasia and AOS Moderately preserved auditory comprehension Poor repetition Poor articulated speech Motivated, emotionally stable, good attention span

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MIT goal

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Uses hand-tapping, humming, and repetition of common phrases together to increase speech production Uses right hemisphere to process the prosody of propositional language

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What is the method for Response Elaboration Training? What is the goal? Please given an example of an exchange between a clinician and client, using the program

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Goal: increase verbal output in a less constraint induced manner Increasing length and content by combining successive client responses, model for client repetition, and prompts for more information (verbal or non-verbal)

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RET example

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When showing client a picture "Tell me whatever this reminds you of" Client: "sweeping" - yes, thats right, "the man is sweeping" Client: "wife mad" - why is the wife mad? Client: "man sweeping, wife mad" - that's good, now try "the man is sweeping the floor because his wife is mad" Repetition

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What is the goal of voluntary control for involuntary utterance program

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Goal: Brings stereotypes into more productive usage, especially where some may not get productive use of single words/phrases and build vocabulary

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What skills does a patient require in order to benefit from the communicate drawing program? what is the goal?

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Uses clients drawing skills Goal: Increase visual attention skills

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Candidates for CDP

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-Relatively intact visual memory -Good visual attention skills -Ability to use a pen to copy one-dimensional shapes -Inability to communicate desired substantive info. through either speech or writing

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What is the goals of Visual Action Therapy? What is a disadvantage of this program

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Uses a visual system to address the aphasia Goal: this program is done in silence- severely aphasic patients are taught to use arm, hand, gestures to represent objects

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VAT disadvantages

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Generalization of effects not seen to untreated but similar behaviors needs more research for use with global aphasia

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What are the four principles for using the PACE program? What is the goal

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Goal: Make communication as natural as possible Useful for all types of aphasia

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Four principles of PACE

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Client can use any modality they want to convey the message It's a conversation: equal opportunities to exchange and receive messages Information between client and clinician is novel Gives feedback based on communication adequacy, rather than production adequacy

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Discuss contextual vs. decontextual treatment. What are the relative merits of each?

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Contextual: Not about skill building little generalization The context is the physical and social situation of the communication Less about strengthening the sill, more about using the strengthened skill in different environments

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Decontextual

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Skill based therapy results in generalization less improvement in the specific context

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Measuring outcomes of research and for therapy can be performed at the impairment level, activity level, and participation level. Discuss the differences between these measures

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Impairment level Change in level of impairment Level that we see as a score on an examination

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Activity level

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Change in ability to perform activities

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Participation level

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Change in ability to participate in social roles after stroke

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Treating anomia via the cognitive neuropsychological approach involves restitutive treatment and substitutive treatment. What is the difference between these types of treatment?

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Restitutive treatments Semantic treatments: Semantic comprehension tasks Phonological treatments

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Substitutive treatment

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Circumvent impaired lexical system or find alternative means of retrieving words through other cognitive mechanisms Working around the deficits Compensation techniques

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Name and describe two types of semantic restitutive treatment and two types of phonological restitutive treatment

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Semantic restitutive treatments 1) Semantic restitutive treatments 2) Phonological restitutive treatments

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Semantic restitutive treatments

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Semantic Restitutive treatments: Strengthening semantics to improve word retrieval Giving the person pictures to sort, word to picture matching

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Semantic restitutive treatments

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Contextual Priming: Modified semantic comprehension Sees a field of pictures related semantically, phonologically, or unrelated - word to picture matching

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phonological restitutive treatment

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Phonological question tasks Ask the person questions about the words phonology Ex: Does cat rhyme with bat

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phonological restitutive treatment

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Phonological choice task: Does party start with /p/ or /k/

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Describe how and why you would use a semantic matrix with a client (HOW)

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How: Client describes objects by their features: group, use, properties, location, and association

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WHY

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To strengthen their association with a given word or object so they can pull form all they know about it to be able to retrieve and say it

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When would you use a most to least cuing hierarch and when would you use a least to most cuing hierarchy

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Most to least When teaching someone a completely new skill or something you don't expect them to know Provide more support in beg. then fade

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Least to most

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During rehabilitation, teaching them a skill that was previously mastered If task is too hard, they will become fur started and it will go right over their head

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Describe three strategies to reduce perseveration

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Describe the purpose of each task at its start to reduct stuck in set perseveration Bring the perseveration to their attention so they know to look for it Forced delay in response so the client will have time and possibly not make the error

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Describe the hierarchy of tasks for improving writing skills, from the most basic to the most difficult

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1) trace (delay trace to copy) 2) copy (model) 3) delay copy (copy word, turn over the paper and copy without the direct model) 4) fill in missing letters (i.e. B_d --- for bed) 5) written fill in the blank sentences (i.e. you write with a _____") 6) split a compound words into parts 7) Provide blanks indicating the number and letters in a word 8) say the next letter 9) repeat the word for the client 10) use spoken language to describe the word (i.e. "you can write it")

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Describe constraint-induced language therapy. Name a canned approach that falls into the category of constraint-induced language therapy and a treatment that does not fall into that category

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Came from CIPT Physical Therapy -If the person has weakness on the right side and you put an object in front of them, they will pick it up with their left hand How will they become stronger on the weak side if they don't use it?

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CIT in language therapy

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The client is forced to use the weak modality and a specific type of response so they get better at that type instead of going around it If you can't think of the word and you talk around it and use a gesture for it, draw it- you aren't getting better at saying the word If you are doing therapy where you HAVE to say the word, you will get better at it

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CIT therapy examples

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MIT: Constraint induced language therapy Response Elaboration Therapy: less constraint induced

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How do we address deficit areas for patients with transcortical aphasics with good repetition, when this repetition does not necessarily help them produce better proposition language?

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the tx targets are the same as for Broca's word-finding, agrammatism, phrase length, prosody, written expression BUT repetition is not seen as a viable tx tool- instead using oral reading, sentence fill-ins, semantic cues

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Name 5 recommendation to give to family/staff regarding how to speak to the patient with global aphasia

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Keep topics concrete Use short, direct language Speak in adult talk Let client know communication is about to start Speak slow and clear

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What are some goals you might address for the patient with global aphasia

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improving auditory comprehension improving production of simple, unequivocal gestures Ensuring a small, basic core of communicative intention can be conveyed in one or a combination of modalities

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Name give types of cues you might use to improve your patients auditory comprehension

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Increasing alert Repeating the stimulus Shorten the stimuli Use prosody to emphasize portions Use visual cues to supplement

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Name 5 types of cues you might use to help your patient retrieve a word

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Synonyms and antonyms Rhyming words Spelling the word Phonemic cues Repetition

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Discuss two challenges that may arise in group therapy

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Lack of motivation Lack of focus

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Describe one way that a clinician would consider the impact of neurochemistry on treatment and how the clinician would manipulate treatment to increase that impact

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Since the prefrontal cortex is strongly affected by dopamine Dopamine may impact the cognitive function involving the prefrontal cortex, including working memory, attention, decision making Dopamine responds to novelty

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