Post on 06-Feb-2018
Approaches to Therapy in Progressive Aphasia
Cathleen Taylor
Speech PathologistWar Memorial Hospital9369 0212taylorc@sesiahs.health.nsw.gov.au
progressive non- fluent aphasia (PNFA)
Frontotemporal lobar degeneration (FTLD)
frontotemporal dementia (FTD),
semantic dementia.
Semantic Dementia
•Semantic components of language are affected. (Hodges, 1999)
•Fluent (Mesulam, 1982)
Progressive Non Fluent Aphasia (PNFA)
Phonological (sounds) and syntactic components (sentence order and structure) of language are affected. (Hodges, 2001)
Non fluent
Anomia
Phonemic paraphasias(sound errors in speech e.g. 'gat' for 'cat')
Agrammatism
Hesitant, effortful speech
Loss of fluency
(Neary et al 1998)
apple
Semantic System
Phonological input lexicon
Visual representation
Graphemic input lexicon
Sound to letterconversion
Letter to sound conversion
GraphemicOutputlexicon
Phonological Output lexicon
/æp l/
Single word processingmodel Adapted fromKay, Lesser & Coltheart (1996) Aphasiology,10,159-215.
Case History 154 yo maleUniversity graduate level education, lawyerDriving, surfing , all personal ADLsNo reported changes to behaviour or personality2 yr h/o deterioration of speech and language skills.
Symptoms: case 1Effortful, groping speech productionAnomia, (circumlocutes)Phonological errorsInitial sound and whole word repetitionsResults in overall slowed speech rate ~110-150 SPM ( norm 160 -190)Syntactical errorsHigh level comprehension difficulties, eg logicogrammatical relations
Case History 258 yo maleGraduate and post graduate level education, now retiredDriving, golf, all personal ADLsSome reported changes to behaviour2 yr h/o deterioration of speech and language skills
Symptoms: case 2“Stuttering”: speech rate ~120-150SPM with ~10% syllables stuttered.AnomiaPhonemic errorsSyntactical errorsHigh level comprehension difficulties, eglogico grammatical relations
Case History 348 yo femaleNESB with 20+yr ho of fluent English ( verbal and literate)All personal ADLs, some cooking, cleaning etc but with some home help, using public transport independentlyLabile5-6yr h/o speech and language deterioration
Symptoms: case 3
severe oral apraxiaunable to perform oral mmts to commandunable to consistently phonate - non verbal
Mild oro pharyngeal dysphagia…MBS resultsUsing written language, and sms to communicate.
AssessmentComprehensive communication Ax can assist DxAx should identify level of breakdown in language processing and therefore guide different approaches to Tx (Hillis and Carramazza, 1994)Individuals with progressive language impairments are under referred for speech pathology services.(Taylor et al, in print)
Treatment
•Intervention is relevant
•Evidence in literature for effectiveness of intervention
•Full disclosure to individual and significant other.
•Collaborative decision making and goal setting.
TherapiesImpairment Based InterventionsSemantic RxNaming/word retrieval RxWord finding strategiesFluency RxNumerous others
Participation Facilitation InterventionsTeaching total communication techniquesAlternative and Augmentative Communication: life books, portfolios, memory wallets, communication books, ID cards, lists,maps
Treatment case 3
Appropriate AAC-pen & paper, SMS, electronic voice output, picture baseResponsive vs generative; issue of adynamiaDysphagia mx
Review
Communication needs changeOngoing Dysphagia Mx53% of individuals described were reviewed (Taylor et al in press)
Education/ SupportEducation programs; individual and group: enhancing communicationAustralia specific information, web, printedAustralian Aphasia Association
Enhancing Communication
Supporting Partners of People with Aphasia in Relationships & Conversation(Lock, Wilkinson & Bryan, 2001)
Errors of meaning
Four weeks ago….
No…. four days ago
Semantic paraphasias
Solution: Perhaps let errors go. Clarify by giving a choice of two or a verifying question.
Word finding difficulties
Solution =Give more timeBinary choiceClarify with questions
I saw…oh you know….that one….who goes there….ohhh…
Getting stuck on the same ideaThe taxi comes at 4
The taxi comes at 4
That’s fine.
Don’t forget Roger’s
coming to dinner.
Solution: Pause. Introduce new content in a way that doesn’t require response.
Preventing problems From Occurring
Prepare the environmentGain attention before beginning-a gentle touch, an “alerter”
References and Bibliography:Access Economics. (2005). Dementia Estimates and Projections: Australian States and
Territories. Access Economics Pty Ltd. for Alzheimer’s Australia.
Brodaty, H. (2006). Dementia in Australia Now. Plenary session address at The Hammond Care Group’s 6th Biennial International Dementia Conference, Sydney, Australia 29-30 June 2006.
Croot, K. Communication Disruptions in Dementia of the Alzheimer Type and Primary Progressive Aphasia: Impairment-, and Activity/Participation-based Interventions. Speech Pathology Australia Neurology Focus day, Sydney, November 09, 2002
Croot, K., & Nickels, L. (in press). Impairment and Activity/Participation directed Interventions in progressive language impairment: Clinical and Theoretical issues. Aphasiology, accepted for publication August 20th, 2007.
Duffy, J.R. & Petersen, R.C. (1992). Primary progressive aphasia. Aphasiology,6(1) 1-15.
Garrard P.; Hodges J. R. Semantic dementia: implications for the neural basis of language and meaning Aphasiology, Volume 13, Number 8, 1 August 1999 , pp. 609-623(15)
Graham,K.S., Patterson, K.H & Hodges, J.R. (1999). Relearning and subsequent forgetting of semantic category exemplars in a case of semantic dementia. Neuropsychology, 13(3), 359-380.
McNeil, M.R., Small, S.L., Masterton, R.J. & Fossett, T.R.D. (1995). Behavioural and pharmacological treatment of lexical-semantic defictis in a single patient with primary progressive aphasia. American Journal of Speech-Language Pathology, 4, 76-87
Murray, L (1998). Longitudinal treatment of primary progressive aphasia: A case study. [Peer Reviewed Journal] Aphasiology. Vol 12(7-8) Jul-Aug 1998, 651-672. Taylor & Francis, United Kingdom
Ratnavalli E. Brayne C. Dawson K. Hodges JR. The prevalence of frontotemporal dementia.[see comment]. [Journal Article] Neurology. 58(11):1615-21, 2002 Jun 1
Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, et al . Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998;51:1546-54.
Rogers & Alarcon (1999). Characteristics and management of primary progressive aphasia. ASHA Special Interest Division Neurophysiology and Neurogenic Speech and Language Disorders, 9(4), 12-26
Schneider, S.L., Thompson, C.K., & Luring, B. (1996). Effects of verbal plus gestural matrix on sentence production in a patient with primary progressive aphasia. Aphasiology, 10(3), 297-317.
References and Bibliography:
Schwartz MF, Marin OS, Saffran EM. Dissociations of language function in dementia: a case study. Brain Lang 1979; 7: 277–306
Snowden JS, Neary D, Mann DMA. Fronto-Temporal Lobar Degeneration. Fronto-Temporal Dementia, Progressive Aphasia, Semantic Dementia. London: Churchill Livingstone, 1996.
Taylor, C., Kingma, R., Croot, K. & Nickels, L. (in press). Speech pathology services for primary progressive aphasia: Exploring an emerging area of practice. Aphasiology, accepted for publication August 20th, 2007.
Westbury & Bub (1997) Primary Progressive Aphasia: A review of 112 cases. Brain and Language, 60(3) 381-406