Transcript Methods of SLT Intervention

Speech and Language Therapy
Methods of Intervention
The Patient’s Journey through
Acute, Rehabilitation and into
Long-term Care
Overview of Our Service
ACUTE PHASE
Weeks 0 - 6
REHABILITATION
PHASE
Weeks 6 - 24
LONG TERM CARE
6 months – 10 years + post stroke
Hospital Based – Day Hospital or Ward
Out - Patient
Identifying Needs to Develop
Intervention Methods
Giving
Information
Assessment
And
Hypothesis
Living with
Aphasia
Person With
Aphasia
Training
And
Courses
Conversation
Groups
Individual
Therapy
Counselling
And
Support
Acute Phase Needs –
Patient, Family and Therapist
1. Establish current and pre-morbid
communication skills
2. Establish baseline communication skills
3. Give information about Aphasia
4. Identify ward based communication needs
5. Provide counselling and support
Acute Phase Methods
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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
Rehabilitation Phase Needs –
Patient, Family and Therapist
1. Assessment of specific impairment needs
2. Ongoing information giving and updates
3. Building communication links and skills with
family and friends
4. Setting individual therapy goals
5. Implementing individual and group therapy
6. Developing ward based communication skills
7. Ongoing counselling and support
Rehabilitation Methods
Direct Methods
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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
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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
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
person’s 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.
Long Term Care Needs –
Patient, Family and Therapist
1. Making therapy functional and relevant
2. Developing sense of self awareness and
self identity
3. Preparing patient for Living with Aphasia
4. Developing autonomy and independence
5. Ongoing support and training courses
Long Term Care Methods
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Direct Methods
Conversation Groups (weekly)
Patient Focus Group (weekly)
Living with Aphasia Group
(weekly)
1:1 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
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 patient’s 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 James’s 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.
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