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Friday, September 6, 2013

ASHA Leader: More Than Words, Multimodal Communication in Aphasia

Just a the entire article HERE.

The whole communication picture

In our research, we hypothesize that some people with aphasia may struggle to use alternative communication modalities because of their inability to switch among them. That is, when talking doesn't work, the person with aphasia is not able to switch to using gestures, despite being able to use gestures in structured situations. To help clients overcome this, we've developed Multimodal Communication Treatment,* an instructional technique designed to boost alternative modality use.

MCT's goal is to make verbal and nonverbal representations of a concept more automatic, facilitating switching among modalities. The technique promotes integration of nonverbal and verbal communication through simultaneous instruction: We instruct clients in speaking, gesturing, pointing, drawing or writing of a single concept before moving on to another one. We take care to preserve instruction in spoken expression to ease potential anxiety about it being sacrificed for instruction in alternative modalities...

Steps to moving beyond words

Clearly, studies of MCT's principles, elements and benefits are preliminary and we need further research. But we believe its basic tenets can benefit people with aphasia when incorporated into practice. In short, these are:
  1. Assessment should guide intervention.Before beginning treatment, we assess clients to target the most effective modalities and involve clients and family members in their selection. For example, one person we worked with was a painter before his stroke, so we incorporated drawing into his intervention program. In assessing patients, we also consider limb apraxia and handedness, which could affect writing, drawing and gesturing. If a person can't functionally model a gesture,he or she will certainly never try using it outside of treatment. For example, gesturing the words "writing" or "pencil" may be difficult for some people who struggle with fine-motor movements. When a patient can use only one hand, we sometimes emphasize using one-handed gestures rather than two-handed gestures.We also suggest assessing clients' semantic abilities—using, for example, the Pyramids and Palm Trees and subtests of the Psycholinguistic Assessment of Language Processing in Aphasia—because intervention combining both semantic and multimodal treatment may best help some clients.
  2. Treatment should aid integration of verbal and nonverbal representations.Instead of instructing clients in, say, using gesture for a number of concepts before moving on to instruction in writing or drawing, clinicians instruct clients to integrate multiple modalities for a single concept. For example, when providing instruction on the word "cat," a clinician would encourage the person with aphasia to practice gesturing, drawing, writing and saying the word before providing instruction in another concept. Including spoken expression in this instruction increases the likelihood that clients will use other modalities when words fail. It also helps assure clients and families that spoken expression is not forgotten.
  3. Treatment should support comprehension.Many patients with aphasia benefit from augmented input or the simultaneous presentation of other modalities with spoken expression. Augmented input can help them understand instructions and perform treatment tasks. For example, we found that using photographs, written keywords and gestures helped a client understand directions and effectively perform a role-playing activity.
  4. Treatment should integrate existing evidence.Whenever possible, we incorporate evidence about how best to instruct people to learn particular modalities. For example, instruction in written expression may follow steps similar to those in PĂ©lagie Beeson and colleagues' Copy and Recall Treatment protocol for providing instruction in written expression. The CART protocol provides structured modeling and opportunities for imitation.

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