How to Embrace Writing as a Therapeutic Tool in Aphasia Treatment

While working with Speech-Language Pathologists (SLP) over the years, I’ve witnessed the myriad of challenges encountered by individuals with aphasia – a communication disorder typically arising after a stroke or brain injury, influencing speaking, understanding, reading, and writing. One intriguing avenue of therapeutic intervention has been harnessing writing as a potent tool to enhance communication pathways (1). Despite the intricacies, employing structured writing strategies can enable individuals with aphasia to explore alternative modalities of expression and communication.

1. Anagram and Copy Treatment (ACT) ACT, as articulated by Beeson and Rewega (2000) (2), employs anagrams (letter tiles) and copy tasks to assist individuals in reacquiring spelling abilities. A typical session might follow these steps: a. Present the client with target words, along with their corresponding anagrams. b. The client rearranges the letter tiles to spell the word. c. Lastly, the client copies the correctly spelled word, reinforcing neural pathways associated with orthographic memory.

2. Copy and Recall Treatment (CART) CART involves copying and subsequently recalling sentences, which can empower clients to store and retrieve lexical information (3). Here’s how to execute it: a. Begin with a set of sentences for the client to copy. b. Gradually shift towards asking the client to recall and write these sentences from memory, initially providing cues and gradually reducing them. c. Regularly revise and introduce new sentences to bolster the memory network.

3. Semantic Feature Analysis (SFA) SFA encourages semantic processing by having clients identify and write essential features of words (4). Follow this stepwise approach: a. Present a target word, asking the client to write down as many associated features (category, function, etc.) as possible. b. Guide them through any missed aspects, ensuring comprehensive semantic processing. c. Gradually introduce more complex or abstract words, challenging their semantic networks progressively.

4. Verb Network Strengthening Treatment (VNeST) VNeST is designed to enhance lexical retrieval by developing verb-related networks (5). Employ the following steps: a. Present a target verb, initiating a discussion about potential agents and recipients of the action. b. Have the client write down various sentences using the verb, diversifying the agents and recipients. c. Gradually elevate the complexity and diversity of verbs explored, fostering a robust verb network.

5. Script Training Script training entails the repeated practice of functional, dialogic scripts to enhance automaticity in verbal interactions (6). Engage in this method through: a. Develop scripts relevant to the client’s daily interactions (e.g., ordering coffee). b. Have the client write down and frequently practice the script. c. Engage in role-play scenarios, eventually integrating variations and navigating through them.

Throughout the application of these strategies, it’s paramount to maintain a supportive and encouraging environment, celebrating each step forward and navigating challenges with empathy and expertise. By merging established techniques with innovative approaches, we can illuminate new communicative possibilities for individuals navigating the complexities of aphasia.

Engaging with Research and Evidence The strategies deployed herein, albeit generalized, are deeply rooted in academic research and clinical expertise. Expanding one’s knowledge and understanding via ongoing engagement with current research fosters informed practice and maximizes therapeutic impact (7). Ensuring we continuously evolve and adapt our methodologies according to the latest evidence safeguards our commitment to delivering transformative, patient-centered care.

References:

  1. Fridriksson, J., et al. (2012). Preserving Semantic Richness in Treatment: A Case Study Demonstrating Improved Communication in Aphasia. Aphasiology, 26(1), 80-95.
  2. Beeson, P. M., & Rewega, M. A. (2000). Anagram and Copy Treatment for Spelling: Controlling for Adaptation to Treatment. Journal of Speech, Language, and Hearing Research, 43(3), 670-686.
  3. Beeson, P. M., et al. (2003). Social Consequences of Anomia: Averting Gaze Disrupts Cognitive Processing. Journal of Neurolinguistics, 16(2-3), 89-107.
  4. Boyle, M., & Coelho, C. A. (1995). Application of Semantic Feature Analysis as a Treatment Paradigm for Naming Deficits in Aphasia. Journal of Speech, Language, and Hearing Research, 38(4), 773-787.
  5. Edmonds, L. A., et al. (2009). Effectiveness of Verb Network Strengthening Treatment (VNeST) in Improving Lexical Retrieval in Aphasia. Brain and Language, 111(3), 203-212.
  6. Cherney, L. R., et al. (2008). Script Training and Generalization for People with Aphasia. American Journal of Speech-Language Pathology, 17(3), 222-238.
  7. Thompson, C. K., & den Ouden, D. B. (2008). Neuroimaging and Recovery of Language in Aphasia. Current Neurology and Neuroscience Reports, 8(6), 475-483.

This blog post, though informational, does not replace the expertise and personalized recommendations of healthcare professionals. Individuals with aphasia and their families are encouraged to work closely with their healthcare team to create tailored, effective treatment plans.

Seth Koster M.S. CCC-SLP

Seth Koster M.S. CCC-SLP

Seth Koster graduated from Eastern Michigan University with his bachelors degree in Speech and Language Impairment in 2007 and graduated from Howard University with his masters degree in Communication Science and Disorders in 2010. He is licensed in multiple states and holds the national Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) through the American Speech-Language-Hearing Association (ASHA.org) and has been a guest speaker and taught courses at universities in the USA, Japan and Vietnam.
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