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Methods of SLT Intervention

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					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
           Living with
                                                            And
            Aphasia
                                                         Hypothesis




                                  Person With
                                    Aphasia
                                                               Training
      Conversation
                                                                 And
        Groups
                                                               Courses




                                                Counselling
                     Individual
                                                   And
                      Therapy
                                                  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
 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                           Indirect Methods

   Use of specific sub-tests, detailed      Carers Evening
    assessments e.g. PALPA, Boston,          Regular patient/therapist/family
    CAT                                       meetings at bedside
   Aphasia Friendly information on          Daily communication diary
    Stroke and Aphasia (CONNECT)             Weekly Case Conferences – close
   Errorless/Errorful learning (BAS)         liaison with MDT
   Narrative therapy (Brody 1994,           Training for families and friends on
    Donald 1998, Byng at al 2000)             therapy techniques
   Colourful Semantics (Bryan 1997)         Training the Trainers – MDT and
   Phonological Awareness Therapy            family
    (Morrison 2001)                          Aphasia and Stroke Information –
   Conversation Groups “Chatter              including PALPA model of language
    Groups”                                   processing
   Individual Communication chart
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
           Direct Methods                   Indirect Methods
   Conversation Groups (weekly)     Carers Focus Group (evening
   Patient Focus Group (weekly)      course)
   Living with Aphasia Group        Training the Trainers (6 week
    (weekly)                          course)
   1:1 Functional therapy (1-2      Carers Evening
    weekly)
   Aphasia Day (6 week course)
   Training the Trainers (6 week
    course)
   Life History Book
          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

				
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