What is Aphasia?
- Acquired communication disorder
- Impairs a person’s ability to understand, produce and use language
- May disrupt the ability to generate and use symbol systems. Can affect written, spoken, gestural language, musical notation, telling time, mathematical operations, understanding traffic lights, warning signs, money, playing cards, board games….
Australian Aphasia Association definition:
Aphasia is a language difficulty caused by damage to the brain. People with aphasia may have difficulty with:
- Talking
- Listening (understanding what others say)
- Reading
- Writing
- Using numbers
- Using gestures
CNP of language
Cognitive-neuropsychology of language
Worrall (1999) 5 steps of therapy:
Step 1: Information Gathering and Sharing
Step 2: Collaborative Goal Setting
Step 3: Pretherapy Assessment (i.e., baselining)
Step 4: Therapy
Step 5: Reassessement
Steps are repeated in as many cycles as are required.
Laymans’ definition of ‘language’ production.
The process of message translation. To be able to understand what others are saying and put your thoughts into speech sounds, words and sentences to be understood by others.
-cohort
Conduction aphasia
Disruption to information transmission between Broca’s and Wernicke’s areas
Motor aphasia
Broca’s aphasia
Advantages to a classification system of aphasia (ie Broca’s, Wernicke’s, Anomic, Global etc)
- Diagnostics –> patient gets a label and can ‘explain’ it.
* Simple, clear and concrete.
Disdvantages to a classification system of aphasia (ie Broca’s, Wernicke’s, Anomic, Global etc)
- Not very useful for planning and providing intervention.
- Clients presenting with same kind of aphasia can have very different strengths and weaknesses –> Classifications are not very homogenous
Approaches to aphasia other than classification system?
psycholinguistic and cognitive-neuropsychological approaches
Boxes and arrows
Cognitive-neuropsychological models of cognitive processes usually involve boxes and arrows in various combinations. Boxes represent particular processing centre/type of process. Arrows represent flow of information.
Assumptions of box-and-arrow models:
- Functional modularity
- Anatomical modularity
- Universality of cognitive systems.
- Subtractivity.
Functional modularity:
assumption of box-and-arrow model in cognitive-neuropsychological approach
Modules can operate relatively independently and can thus be independently impaired.
Anatomical modularity:
assumption of box-and-arrow model in cognitive-neuropsychological approach
Modules (or groups of modules) may be localised in distinct areas of the brain.
Universality of cognitive systems:
assumption of box-and-arrow model in cognitive-neuropsychological approach
Every ‘normal’ person will share the same capacity for processing language - although their experiences will vary.
Subtractivity:
assumption of box-and-arrow model in cognitive-neuropsychological approach
Brain damage results in damage to, or loss of cognitive processing components. Damage does not lead to the creation of new processing systems but existing systems can be ‘recruited’ to compensate for lost function.
CNP
Cognitive-neuropsychological
Advantages of the cognitive-neuropsychological (CNP - box and arrows) approach to aphasia?
- Can devise tests that can pinpoint difficulties in different parts of the language processing system (ie difficulty with providing meaning may be due to auditory processing.)
- helps us target intervention because we can work out which areas are damaged and which are intact, to decide whether to target resortation of function or compensation.
Environmental modifications to assist people with aphasia:
PRODUCTS and TECHNOLOGY
- Written material available in accessible formats (simplified sentences, large font, white space, illustrations).
- Assistive listening devices on the wards.
Environmental modifications to assist people with aphasia:
SERVICES, SYSTEMS and POLICIES
- Ensure that any patients with pre-existing communication disabilities are identified on admission.
- Refer clients to advocacy and support organisations.
Environmental modifications to assist people with aphasia:
ATTITUDES
- Providing research evidence to manager/other staff to show that environmental modifications to facilitate communication for patients with communication disabilites is effective and leads to better patient outcomes.
- Improve awareness (talk to hospital staff about aphasia, talk to media…)
Environmental modifications to assist people with aphasia:
SUPPORT AND RELATIONSHIPS
- Providing communication partner training to healthcare providers and loved ones.
- Facilitate group therapy to discuss barriers/faciliators.
Environmental modifications to assist people with aphasia:
NATURAL ENVIRONMENT AND MAN MADE CHANGES TO THE ENVIRONMENT
*Clear signage - colour coded, with pictures as well as words.
How does MMC fit withing the ICF environmental domains?
- PRODUCTS AND TECHNOLOGY: (ipads, phones). AAC boards, alphabet boards, Maccas ordering boards, ipads, phones, text-speech
- NATURAL ENVIRONMENT AND MAN-MADE CHANGES TO THE ENVIRONMENT: signs, picture signs, braille signs
- SUPPORT AND RELATIONSHIPS: (gestures), Sign languages, educating families/friends/educators in how to use MMC and interact appropriately with people using it.
- ATTITUDES: educating others. Being up-to-date with latest MMC technology, workplace training (ie at Maccas), client training.
- SERVICES, SYSTEMS AND POLICIES: Policy of braille signs for public toilets, policy of Maccas ordering boards
