Conversational Treatments for Aphasia and Dementia by onetwothree4


									             Treatments that Work for Both                   Conversational approaches
                Dementia and Aphasia:
                                                          • Naturally occurring, ecologically valid
                                                            contexts for communication
             Conversational Treatments                    • Purposes are similar for individuals with
                   for Dementia                             aphasia and dementia
                                                            – Opportunity for social interaction
                       Tammy Hopper, PhD, CCC-SLP           – Opportunity to demonstrate preserved
                            Associate Professor               language and cognitive abilities
                       Speech Pathology and Audiology       – Opportunity to practice using communication
                            University of Alberta
                                                              strategies (clients and communication
                         Edmonton, Alberta Canada

             Conversation and individuals
                                                                       Context is key
                   with dementia
                                                          • Create context to reduce demands on
       • Opportunities for social interaction may be
                                                            impaired episodic and working memory
         scarce and often need to be created
                                                            systems, facilitate recognition, stimulate
       • Conversations should be structured to maximize
         positive emotions, language, behaviour &
                                                            spared semantic and procedural memories
         capitalize on spared abilities                   • Multi-sensory input with variety of
       • Focus on conversation groups                       stimuli/props related to topic
         –   Context                                        – Objects
         –   Clinician Strategies                           – Music
         –   Examples                                       – Written and graphic cues in the form of
         –   Evidence                                         memory books (Bourgeois, 2007)

                                                              Reminiscence and dementia:
                Reminiscence therapy
       • An activity/intervention in which individuals    • Reminiscence involves conversations of events
         reflect upon the past in a structured setting      from the individual’s remote past
       • Group RT sessions typically involve props        • Reminiscence Bump: The disproportionately
         to create context                                  higher recall of early-life memories by older
       • The context is related to a theme (e.g.,
                                                          • Reminiscence capitalizes on spared memory
         work, vacations, music, marriage)
                                                            abilities, reveals personal history, and may
       • Facilitator asks questions about the theme         enhance caregiver empathy, facilitating a
         while engaging participants in the props           personhood approach to caring

Hopper, T. ASHA 2009                                                                                        1
         Example reminiscence props                             Group reminiscence session
       • Possible props:                                     • Obtain background information on each
         – Music – from certain eras; favourite singers or     participant
           kinds of music; sing alongs                       • Select props to promote reminiscence (pictures,
         – Aromas – baking bread, mother’s favourite           objects)
           perfume                                           • Introduce the topic (personal or famous events)
         – Pictures – photographs of work environments or    • Group members may also aid each other in
           favorite places                                     sharing of past events
         – Objects – butter churner, old style scales from   • Avoid asking questions that demand detailed
           confectionary store                                 knowledge and recall of times, dates
       • Consider sensory abilities, culture, personal       • Share your own memories but focus on what
         history                                               participants have to say
                                                                                            Adapted fr. Bayles & Tomoeda, 1997

                                                                   Research evidence for group
                Example (Rainbow, 2003)                                   reminiscence
       • Bob often spoke about when he was a
         young man, just starting work, still living         • Kim & colleagues (2006) conducted a
         with his parents                                      systematic review of the evidence and
       • Theme of work was ideal; memories that                outcomes associated with group RT
         gave him the most pleasure were those               • Generally, outcomes were positive and
         about his father’s love of model railways             included maintenance over time in cognitive
       • Props: sound recordings of train whistles,            abilities (memory), improved affect and fewer
         photos of old train stations, signal boxes,           problem behaviours for people with moderate-
         steam trains; old train timetables; loan of           severe AD/other dementias
         model railway from local museum

                  Clinician strategies:                           Other conversational topics
                    question asking                                              (Arkin, 2005)
       • Questions should reduce demands on                  • Pros and Cons: Ask the client what is
         episodic memory – yes/no, choice                      good/bad about selected topics
       • However, to encourage discussion, use                    • Watching television
         open-ended questions that tap into                       • Pantyhose
         semantic memory                                          • Visiting relatives

         – EM: When did you retire?                          • Advice and opinion scenarios: Ask the
         – SM: How do you like retirement?                     individual what s/he thinks about the
         – EM: When did you go to Italy?                       situation you describe and how s/he would
         – SM: What do you think of Italy?
                                                               handle it

Hopper, T. ASHA 2009                                                                                                             2
            Example topics and questions                                  Evidence for open-ended questions
                   (Arkin, 2005)                                                   in conversation
       •   Shoplifting                                                    • Several researchers report positive
       •   Affair                                                           language output and successful
       •   Assisted suicide                                                 communication interactions when using
       •   Mandatory retirement                                             open-ended questions designed to elicit
       •   Marijuana and cancer                                             feelings, opinions and conceptual, factual
           – Your brother is very ill with cancer. His treatment            information (Tappen et al., 1997; Small & Perry,
             makes his feel sick. He can’t eat. Marijuana helps him           2005; Petryk & Hopper, in press)
             feel better, but it is illegal to buy and use. He wants to
             get some. What would you do?
                                                                          • Pair with written and graphic cues to aid in
                                                                            context setting and recall

             The interplay of two types of                                             Connecting strategies
           communication strategies (Small, 2009)                                                         (Small, 2009)

       • Compensatory strategies
                                                                          • Core strategies:
                                                                                – Encourage and invite (rather than ignore)
           – Accommodate to another person’s communication
             challenges by modifying one’s language and the                     – Respect (No patronizing speech, limited
             context of communication (see comprehensive
                                                                                  interruptions, guidance and choice rather
                                                                                  than directives)
             reviews in Bourgeois & Hickey, 2009; Bayles &
             Tomoeda, 2007)                                                     – Validate
                                                                          • Guidelines for Having a Satisfying
       • Relational/Connecting strategies
                                                                            Conversation (Bourgeois, 2007):
                                                                                – Ask permission, guide, redirect, reassure,
           – Reaching out and acknowledging a person’s                            smile & act interested, thank the person
             competence, abilities & sharing experiences together
                                                                                – Do not quiz, do not correct or contradict

            Measuring treatment effects                                                              References
       • Quantitative                                                     •   Arkin (2005). Language enriched exercise for clients with Alzheimer’s disease.
                                                                              Tucson, AZ: Desert Southwest Fitness.
           – Language output: amount and type (# number                   •   Bayles, K. & Tomoeda, C.K. (1997). Improving function in dementia and other
             of words produced; # of on topic statements);                    cognitive-linguistic disorders. Tucson, AZ: Canyonlands Publishing.
                                                                          •   Bayles, K.A., & Tomoeda, C.K. (2007). Cognitive-communication disorders of
           – Pragmatic language – turn taking, initiations                    dementia. San Diego: Plural Publishing.
           – Engagement (Orsulic-Jeras, Judge & Camp, 2000); # of         •   Bourgeois, M. (2007). Memory books and other graphic cuing systems: Practical
                                                                              communication and memory aids for adults with dementia. Baltimore, MD: Health
             times each person participates                                   Professions Press.
                                                                          •   Bourgeois, M.S. & Hickey, E. (2009). Dementia from diagnosis to management: A
                                                                              functional approach. Psychology Press.
       • Qualitative                                                      •   Orsulic-Jeras, S., Judge, K.S., & Camp, C. (2000). Montessori-based activities for
                                                                              long-term care residents with advanced dementia: effects on engagement and affect.
                                                                              The Gerontologist, 40(1), 107-111.
           – Perceptions of affect, nonverbal                             •   Petryk, M. & Hopper, T. (in press). The effects of question type on conversational
             communication (observations, reports from                        discourse in Alzheimer’s disease. Perspectives: Newsletter of the Neurophysiology
                                                                              and Neurogenic Special Interest Division, American Speech-Language-Hearing
             caregivers)                                                      Association.

Hopper, T. ASHA 2009                                                                                                                                               3
        •   Pimentel, J. (in press). Contextual thematic group treatment for individuals with
            dementia. Perspectives: Newsletter of the Neurophysiology and Neurogenic Special
            Interest Division, American Speech-Language-Hearing Association.
        •   Rainbow, A. (2003). The reminiscence skills training handbook. Richmond Hill,
            ON; Speechmark/PsyCan.
        •   Small, J. (May 1, 2009). Communication programs for caregivers. Presentation at
            the 2009 CASLPA Conference, London, Ontario
        •   Small, J., Gutman, G., Makela, S., & Hillhouse, B. (2003). Effectiveness of
            communication strategies used by caregivers of persons with Alzheimer's disease
            during activities of daily living. Journal of Speech, Language, & Hearing Research,
            46, 353-67.
        •   Small, J. & Perry, J. (2005). Do you remember?" How caregivers question their
            spouses who have Alzheimer's disease and the impact on communication. Journal
            of Speech, Language, and Hearing Research, 48(1), 125-136.
        •   Tappen, R. M., Williams-Burgess, C., Edelstein, J., Touhy, T., & Fishman, S.
            (1997). Communicating with individuals with Alzheimer's disease: Examination of
            recommended strategies. Archives of Psychiatric Nursing, 11(5), 249-256.

Hopper, T. ASHA 2009                                                                              4

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