Utilizing Reading to Treat Aphasia After Stroke or Head Injury

Aphasia, an acquired communication disorder that affects verbal and written language abilities, often follows stroke or head injury. Speech-language pathologists (SLPs) worldwide employ an assortment of strategies to rehabilitate affected individuals, providing a gateway to improved communication and enhanced quality of life. An often-underutilized but potent approach in this realm is employing reading as a therapeutic medium to address aphasia.

A substantial number of studies support the merit of utilizing reading interventions in treating aphasia. One such study found that reading therapy can result in improvements in word retrieval, fluency, and sentence construction (1: Rohde et al., 2018). However, the applicability of reading in aphasia therapy depends significantly on understanding and adopting effective, actionable strategies.

Strategy 1: Scaffolded Reading Therapy (SRT)

Step 1: Begin with texts that interest the client, ensuring they are at an appropriate difficulty level.

Step 2: The SLP reads aloud while the client follows visually.

Step 3: Engage in guided repetition where the client reads after the SLP.

Step 4: Discuss the content, encouraging the client to express understanding and thoughts.

Strategy 2: Visual Orthographic Training (VOT)

Step 1: Introduce the client to common and functionally relevant words in written form.

Step 2: Employ various visualization strategies, like flashcards, to reinforce word recognition.

Step 3: Engage in activities that require recognizing and selecting the trained words.

Step 4: Progressively introduce these words in reading and writing activities (2: Beeson et al., 2003).

Strategy 3: Melodic Reading Therapy (MRT)

Drawing inspiration from melodic intonation therapy (MIT) (3: Sparks, Helm, & Albert, 1974), MRT leverages melody and rhythm in reading tasks.

Step 1: Select a short, meaningful phrase from a text.

Step 2: Intone the phrase in a melodic and rhythmic pattern.

Step 3: Have the client listen, observe, and eventually mimic the melodic reading.

Strategy 4: Dual-Task Training (DTT)

DTT is built on the premise that engaging in two concurrent activities enhances cognitive and linguistic processing (4: Maher et al., 2006).

Step 1: Introduce a reading task paired with a secondary activity, such as tapping a rhythm.

Step 2: Gradually increase the complexity of the secondary task to challenge cognitive resources.

Step 3: Regularly assess and adapt tasks to align with the client’s progress.

Strategy 5: Written Verb Network Strengthening Treatment (VNeST)

Step 1: Present a verb and have the client generate related sentences in written form.

Step 2: Discuss and rectify any incorrect sentence structures.

Step 3: Engage in repetition and recycling of the constructed sentences in reading exercises (5: Edmonds, Nadeau, & Kiran, 2009).

Benefits and Considerations

The utilization of reading as a therapeutic medium fosters linguistic processing, facilitating reconnection and strengthening of neural pathways compromised due to stroke or injury. Through consistent practice, clients can rebuild vocabulary, enhance comprehension, and improve verbal expression, thereby navigating daily communicative challenges more adeptly (6: Fridriksson, 2010).

However, implementing reading-based interventions necessitates considering the client’s individual characteristics, such as their pre-morbid reading abilities, interests, and current linguistic capacities. A study by Lacey, Stilla, and Sathian (2012) emphasizes the importance of customizing interventions, recognizing that each client brings a unique profile to the therapeutic setting (7).

Conclusion

Exploiting reading as a mechanism to treat aphasia opens avenues for enhancing language and communication skills following a stroke or head injury. By adopting tailored, evidence-based strategies, SLPs can harness the power of written words, offering clients a viable pathway to regain communicative competence.

References:

  1. Rohde, A., Worrall, L., & Godecke, E. (2018). The impact of aphasia on healthcare costs in the first year post-stroke. Aphasiology, 32(3), 290-303.
  2. Beeson, P. M., & Egnor, H. (2006). Combining treatment for written and spoken naming. Journal of Rehabilitation Research & Development, 43(3), 391.
  3. Sparks, R. W., Helm, N. A., & Albert, M. L. (1974). Aphasia rehabilitation resulting from melodic intonation therapy. Cortex, 10(4), 303-316.
  4. Maher, L. M., Kendall, D., Swearengin, J. A., Rodriguez, A., Leon, S. A., Pingel, K., … & Rothi, L. J. G. (2006). A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. Journal of the International Neuropsychological Society, 12(6), 843-852.
  5. Edmonds, L. A., Nadeau, S. E., & Kiran, S. (2009). Effect of Verb Network Strengthening Treatment (VNeST) on Lexical Retrieval of Content Words in Sentences in Persons with Aphasia. Aphasiology, 23(3), 402-424.
  6. Fridriksson, J. (2010). Preservation and modulation of specific left hemisphere regions is vital for treated recovery from anomia in stroke. Journal of Neuroscience, 30(35), 11558-11564.
  7. Lacey, E. H., Stilla, R., & Sathian, K. (2012). Metaphor comprehension and text processing in post-stroke aphasia. NeuroImage: Clinical, 2, 550-563.
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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