Motor Speech Disorders Language Disorders Management

2.  Apraxia of speech, also known as verbal apraxia
or dyspraxia, is a motor speech disorder in which
a person has trouble saying what he or she wants
to say correctly and consistently. It is not due to
weakness or paralysis of the speech muscles (the
muscles of the face, tongue, and lips). The
severity of apraxia of speech can range from mild
to severe.

3.  a disorder in carrying out or learning complex
movements that cannot be accounted for by
elementary disturbances of strength, coordination,
sensation, comprehension, or attention" (Strub &
Black 1981).
 a group of phonological disorders resulting from
disruption of central sensorimotor processes
that interfere with motor learning for speech...
Paralysis or weakness might be present, but is not
sufficient to account for the nature and severity of
the observed speech disorder" (Crary 1984).

4.  Motor Planning/Programming Disorders:
inability to group and sequence the relevant
muscle with respect to each other
-apraxia of speech (AOS) – acquired and
developmental
 Motor Execution Disorders: deficits in
physiology and movement abilities of muscles
-dysarthria – acquired and developmental

5.  Salient characteristics of this disorder is the same
as acquired AOS
 Considerable delay in speech production, limited
sound inventory, unintelligibility, and progress
slowly in speech therapy
 Causes are not well understood; some research
points to hereditary component, not clear there
is specific neurological damage
 Some cases caused by stroke or traumatic brain
injury

6.  Inability to transform an intact linguistic
representation into coordinated movements of
the articulators.
 Characteristics: slow speech, sound distortions,
prolonged durations of sounds, reduced prosody,
consistent errors within an utterance, difficulties
initiating speech, groping of articulators.
 Caused by neurological damage to the left frontal
cortex surrounding Broca’s Area – due to stroke,
brain injuries, illness, and infections..

7.  Professionals consider how the disorder affects
the individual’s life to determine the impairment
and the course for treatment.
 Assessment of motor speech disorders( apraxia,
dysarthria etc) should include measures of non
speech oral motor skills and should isolate
particular motor subsystems to determine
impairment.

8.  Perceptual measures – perceptual judgments of
intelligibility, accuracy, and speed of speech
production (most common).
 Acoustic measures – visual representation of the
speech sound wave (e.g., spectogram) for more
detailed and objective view of speech problems.
 Physiologic measures – measurement of
physiologic aspects of speech motor system not
easily perceived otherwise (e.g., muscle
strength).

9.  To evaluate child's condition, child's speech-
language pathologist, reviews child's symptoms
and medical history, conducts an examination of
the muscles used for speech, and examines how
the child produces speech sounds, words and
phrases.
 Child's speech-language pathologist will also
assess child's language skills, such as his or her
vocabulary, sentence structure and ability to
understand speech.

10.  It's important to identify whether child shows
symptoms of CAS, because CAS is treated
differently from other speech disorders. Children
with CAS also may have other communication
problems.
 It can sometimes be difficult to diagnose CAS,
especially when a child speaks very little or has
difficulty interacting with the speech-language
pathologist.

11. A Very Young Child
 Does not coo or babble as an infant
 First words are late, and they may be missing
sounds
 Only a few different consonant and vowel sounds
 Problems combining sounds; may show long
pauses between sounds
 Simplifies words by replacing difficult sounds
with easier ones or by deleting difficult sounds
(although all children do this, the child with
apraxia of speech does so more often)
 May have problems eating

12. An Older Child
 Makes inconsistent sound errors that are not the
result of immaturity
 Can understand language much better than he or
she can talk
 Has difficulty imitating speech, but imitated
speech is more clear than spontaneous speech
 May appear to be groping when attempting to
produce sounds or to coordinate the lips, tongue,
and jaw for purposeful movement

13.  Has more difficulty saying longer words or
phrases clearly than shorter ones
 Appears to have more difficulty when he or she is
anxious
 Is hard to understand, especially for an
unfamiliar listener
 Sounds choppy, monotonous, or stresses the
wrong syllable or word

14. Potential Other Problems
 Delayed language development
 Other expressive language problems like word order
confusions and word recall
 Difficulties with fine motor movement/coordination
 Over sensitive (hypersensitive) or under sensitive
(hyposensitive) in their mouths (e.g., may not like
tooth brushing or crunchy foods, may not be able to
identify an object in their mouth through touch)
 Children with CAS or other speech problems may
have problems when learning to read, spell, and
write

15.  Several tests help determine if childhood apraxia
of speech (CAS) is present and rule out or
identify other problems that may be affecting
child's ability to speak. The specific tasks
conducted during the evaluation depend on
child's age, ability to cooperate and the severity
of the speech problem.
 Diagnosis of CAS isn't based on any single test or
observation. It depends on the pattern of
problems that are seen.

16.  Tests may include:
 Hearing tests: to determine if hearing problems
could be contributing child's speech problems.
 Oral-motor assessment: Child's SLP will
examine child's lips, tongue, jaw and palate for
structural problems, such as tongue-tie or a cleft
palate, or other problems, such as low muscle
tone (low muscle tone usually isn't associated
with CAS, but it may be a sign of other
conditions). Child's SLP will observe how the
child moves his or her lips, tongue and jaw in
activities such as blowing, smiling, and kissing.

17.  Speech evaluation: Child's ability to say sounds,
words and sentences will be observed during
play or other activities.
 Child may be asked to name pictures to see if he
or she has difficulty making specific sounds or
speaking certain words or syllables.
 Child's speech-language pathologist may evaluate
child's coordination and smoothness of
movement in speech during speech tasks.

18.  To evaluate child's coordination of movement in
speech, child may asked to repeat syllables such
as "pa-ta-ka" or say words such as "buttercup."
 If child can produce sentences, child's speech-
language pathologist will observe child's melody
and rhythm of speech, such as how he or she
stresses syllables and words.
 Child's speech-language pathologist may help
child be more accurate by providing cues, such as
saying the word or sound more slowly or
providing touch cues to his or her face.

19.  Acquired apraxia of speech (AOS) is a treatable
neurologic, sensorimotor speech disorder.
 The primary clinical characteristics considered
necessary for the diagnosis of AOS include:
1) a slow rate of speech resulting in lengthened
sound segments and intersegment duration.
2) speech-sound errors such as sound distortions
and/or distorted sound substitutions,

20. 3) errors that are relatively consistent in type
(i.e., distortion) and location (i.e., within a word).
4) disturbed prosody.
5) Other speech behaviors that frequently occur
with AOS include articulatory groping,
perseverative errors, increased errors with
increased word length, and speech initiation
difficulties.

21.  The severity of AOS varies from minor sound
distortions to an inability to produce speech.
 Stroke is the most frequent etiology resulting in
AOS. AOS is linked to cortical and/or subcortical
damage in the language-dominant hemisphere of
the brain.
 Although AOS is most often associated with a
neurological event of sudden onset, progressive
apraxia of speech has been reported in
individuals with a diagnosis of motor neuron
disease

22.  Treatment focuses on (re)learning motor aspects
of speech production, which requires acquisition,
retention, and generalization
 Acquisition: temporary improvements during
treatment
 Retention: lasting performance enhancements
 Generalization: improvements in either related but
untrained behaviors (response) or in targeted
behaviors in different contexts, tasks, or settings
(stimulus).

23.  Use of nonspeech tasks (e.g., pursing the lips,
smiling, moving the tongue) in assessment does
not mean that nonspeech tasks should be used in
treatment
 Little research supports “oral motor activities” to
strengthen the articulators or improve their
movements
 Focusing on more complex targets results in
greater learning than focusing on simpler targets

24. Primary Strategies: Two Approaches
 Improve impaired subsystem – focus on specific
functions in relevant speech tasks
 e.g., improve respiratory support for speech
 Compensatory strategies
… for the affected individual
… for the environment
… for the communication partners

25.  Important indicator of treatment effectiveness is
generalization
 Speech production in other tasks and with
different conversational partners should be
included the routine assessment process

26.  Pre-practice considerations – several conditions
should be considered and discussed prior to
treatment:
-memory
-attention
-motivation
-goal setting
-establishing a reference of correctness

27.  Modifying inhalation (e.g., increasing duration of
air intake)
 Modifying exhalation (e.g., vowel prolongation)
 Improving inhalation/exhalation relationship
 Increasing respiratory flexibility (e.g., producing
words with a variety of stress patterns)
 blishing respiratory support (e.g., making a
postural adjustments)

28.  Improving voice quality (e.g., postural
adjustments, relaxation therapy)
 Controlling vocal folds to enhance naturalness of
speech

29.  Improvement of strength and control of velo-
pharyngeal port (e.g., practicing nasal vs. oral
airflow patterns)
 Might be necessary to use a palatal lift – a device
that helps raise the velum – depending on
severity of subsystem impairment

30.  Focus the patient’s attention to the accuracy,
range, and direction of movement during speech
 Feedback from the clinician can include
articulatory placement cues (e.g., modeling
speech production)

31.  Prosody involves manipulation of three factors:
loudness, pitch, and duration
 Each of these factors should be focused on during
treatment
 Approaches to reducing the rate of speech:
-rigid control techniques
-non-rigid control techniques

33. Definition of Aphasia:
 A disorder of language that is neurogenic (caused
by brain disease or injury), which involves the
symbolic use of sound (i.e. Language in the
meaningful sense of the word). Is not due to
deafness or motor-paralysis, mental retardation
etc.

35.  Dysarthria – poor articulation of speech due to
slurring or fragmentation of the sound structure
of speech. Is a motor problem due to poor
coordination of breathing and speech muscles.
Cause slurred speech and staccato speech.
 Apraxia – disorders of skilled movements. Can
include symbolic movements. Cause by left
parietal lesions. Some apraxias particularly
affect the ability to speak, e.g Buco-facial apraxia.

36. Aphasia
Fluent
Aphasias
Wernicke’s
Aphasia
Anomic
Aphasia
Conduction
Aphasia
Non-fluent
Aphasia
Broca’s
Aphasia
Global and
mixed
Aphasia

37. 1.Wernicke’s Aphasia:
 Can’t comprehend,
can’t repeat, can speak spontaneously
 Spontaneous speech is
however not normal.
 Is fluent, but is paraphasic, semantically paraphasic
in particular. In extreme cases, word salad.
 Make a particular type of literal paraphasic errors
(neologism – make up new words, predominantly by
putting old words together - Jargon aphasia.
 Not always entirely aware that they are not making
sense, because their comprehension is impaired.
 Lesion site: left primary projection cortex
(Wernicke’s area).

38.  Comprehension and Production is still relatively intact
 Repetition is impaired – sound images received by
Wernicke’s area can not be transmitted forward to
Broca’s area to be produced
 However, spontaneous output is also not normal
 Is paraphasic, but predominantly of literal type. This
takes a particular form in that they will approximate
the word closer and closer and sometimes they will
get there
 Lesion site: Posterior temporal lobe or insular cortex
(track of fibres (white matter) that connects Broca’s
& Wernicke’s area (arcuate fasciculus)

39.  Is a condition in which the patient has problems
finding the right word
 Patients often resort to elaborate
circumlocutions
 E.g. for “doll” – they may say “solid
representation of a baby”
 Analysis of this disorder has been the primary
basis for proposing an auditory output lexicon
 Distinction between semantic anomia and word
selection anomia.

40.  Semantic anomia: Patient has problems finding
words because of a semantic disturbance – make
semantic errors
 In word selection anomia the semantic input
appears intact (since these patients can
understand what people are saying to them) and
the defect lies within the phonological output
lexicon itself.

41.  Disruption to links between Wernicke’s area and the
concept centre
 Unable to comprehend, but still able to produce and
to repeat
 Circumlocutory – go around words. Leave out
concrete words, but full of connectives
 Speech is fluent, but empty of meaning
 Severe word-finding difficulties, specifically for
concrete words and nouns - Use phrases like “thing a
ma jig” and “you know what”
 Pathology: Alzheimer’s patients in the 2nd stage of
disease.
 Lesion: From Wernicke’s upwards towards parietal
lobe.

42. 1. Broca’s Aphasia:
 Speech out-put problems.
 Output is non-fluent, not only
i.t.o. few words per minute (i.e. less than 60), but also
in terms of short phrase length which leaves out
connecting words and overemphasises of nouns.
This leads to telegramatism.
 Effortful and halting speech.
 Lesion site: Just in front of motor area – Broca’s area:
i.e. Posterior part of the inferior frontal convulsion.
 Same difficulties usually extend to written language.

43.  Due to damage to fibres linking the concept
centre with Broca’s area.
 Non-fluent speech output.
 Tend to say very little, lack of initiation of speech.
 Paucity of spontaneous output.
 Can repeat.
 Often has a compulsion to repeat back what is
heard – echolalia.
 Lesion: Damage is to fibres that lead to Broca’s
area. Is not always in transcortical area, lesion
may also be in supplementary motor area.

44.  Poor production and comprehension.
 Damage to both Wernicke’s and Broca’s area
 Often a stroke may initially be cause a global
aphasia and then recover to a Broca’s or
Wernicke’s aphasia.
 Mixed Transcortical Aphasia :
 Affect both transcortical motor and transcortical
sensory fibres.
 Caused by watershed infractions of middle
cerebral area (thus speech area is isolated).
 Can repeat, but can’t understand or produce.
 Repeat quite a lot – echolalia.

45.  Word-finding difficulties: difficulty finding the
particular word you are looking for, seen in the
patient’s spontaneous speech.
 Paraphasia (next to speech): distortions in
speech output.
 Semantic paraphasias: say a word that is
meaningfully related to the word you want to say.
E.g. “whiskey” when you want to say “wine”.
 Literal paraphasias: is phonologically different
from the word you want to say. E.g. “broddel”
instead of “bottle”.

46.  Alexia: aphasia for written language (can’t
comprehend).
 Dyslexia: milder form of the above.
 Agraphia: disorder of writing, can’t produce
(write) language.
You can have an Alexia/agraphia without aphasia.
But you should not find an aphasia without an
alexia/agraphia.

48.  To determine the presence of communication
impairment:
 Severity and type of impairment
 Determine the individual’s strengths and weaknesses
 To identify exacerbating factors:
 Vision and hearing
 Agnosias (recognition deficits) in various modalities
 Deficits in proprioception or praxis
 Affective (mood) disorders
 Effects of medications
 To identify intervention goals.

49.  To assess potential for future recovery
(prognosis).
 To monitor change – e.g. spontaneous recovery,
treatment efficacy.
 To evaluate maintenance of treatment gains.
 To define factors that facilitate comprehension,
production and use of language.
 To establish a working relationship with client
and significant others.

50. Cognitive
Recognition,
understanding, memory,
attention, reasoning
ability
communicative/
Pragmatic
Turntaking, topic initiation
and maintenance, repairs,
speech acts produced,
nonverbal aspects
Linguistic
Auditory
comprehension,
language production
(form and content)

51.  Organised, goal directed evaluation of the
components of communication.
 Evaluation of communicative interactions within
family/social unit.
 Their role in larger unit of society.
 Carried out to determine how strengths fortified
and weaknesses modified.

52.  Before to start…
 Gain information and form initial hypotheses
from:
 Initial referral
 Verbal information
 Medical notes
 Remember introductions and endings.
 Why you are there, what you want to do, why it was
useful, what happens next.

53.  What to assess:
 speech fluency
 speech output
 auditory comprehension
 repetition
 naming
 written output
 reading comprehension
 drawing
 gesture
 facial expression
 awareness of deficit
 NOT all at once! Be sensitive to client’s medical /
cognitive / emotional state

54.  For each aspect of communication:
 What the individual is able to do?
 Where does the task break down?
 language production: Single words  short phrases 
sentence  2-3 sentences  paragraph  monologue
 conversation
 Auditory comprehension: Single words  yes/no
questions  sequential commands  non-sequential
commands

55.  Manipulate the structure you provide for the task
 Unstructured (no control or interference)
 Moderately structured (retell a story, describe a picture
or a sequence of activities)
 Highly structured (sentence completion, object
naming)
 Be systematic
 Check hearing and visual perception first
 Assess language comprehension before language
production
 Writing and calculation later

57.  Auditory comprehension
 Answer closed  open questions
 Point to objects / pictures named by the examiner
 Follow spoken directions
 Answer questions about spoken discourse
 Speech
 Recitation
 Object / picture naming
 Phrase or sentence completion
 Phrase / sentence repetition
 Produce single sentences  longer utterances

58.  Reading
 Match pictures, letters, geometric forms
 Match printed words to pictures
 Read aloud: numbers, letters, words, phrases
 Answer written questions
 Silent reading / comprehension – answer questions
about a written test
 Writing
 Copy letters, numbers, shapes, words
 Write to dictation – letters, numbers, words, sentences
 Write a paragraph / written narrative

59.  Acute
 Boston Naming Test
 Bedside Evaluation Screening Test (BEST)
 Western Aphasia Battery
 Chronic
 BDAE (subtests)
 PALPA
 Pyramids and Palm Trees
 Minnesota Test for Differential Diagnosis of Aphasia
 Porch Index of Communicative Ability (PICA)
 Comprehensive Aphasia Test (CAT)

60.  The Boston Naming Test (BNT), introduced in 1983
by Drs. ,Edith Kaplan, Harold Goodglass and Sandra
Weintraub, is a widely used neuropsychological
assessment tool to measure confrontational word
retrieval in individuals with aphasia or other
language disturbance caused by stroke, Alzheimer's
disease, or other dementing disorder.
 A common and debilitating feature is Anomic
aphasia, an impairment in the ability to name
objects. The BNT contains 60 line drawings graded in
difficulty. Patients with anomia often have greater
difficulties with the naming of not only difficult and
low frequency objects but also easy and high
frequency objects

61.  The 60-item BNT is widely used.
 The examiner begins with Item 1 and continues
through Item 60, unless the patient is in distress or
refuses to continue.
 The patient is told to tell the examiner the name of
each picture and is given about 20 seconds to
respond for each trial. The examiner writes down the
patient’s responses in detail, using codes.
 If the patient fails to give the correct response, the
examiner at her or his discretion may give the
patient a phonemic cue, which is the initial sound of
the target word.

62.  After the patient completes the test, the examiner
scores each item + or – according to the response
coding and scoring procedures.
Brain Areas Associated with Naming:
 The classically known language areas
are Broca’s and Wernicke’s areas in the frontal and
temporal lobes, respectively, of the left hemisphere.
 Additional areas that are activated for language
processes are outside those areas in the left
hemisphere—especially anterior to Broca’s area- as
well as in right hemisphere regions.
 Naming tasks seem to be associated with the left
triangularis in the frontal lobe and superior
temporal-lobe regions.

63.  The BEST is designed to administrate in 30
minutes. It requires that the patient being
examined be able to sit up in bed and maintain
eye contact with examiner.
 The test’s name and its stated purpose points
directly towards its use as an alternative to
reaching decisions based just upon clinical
interactions at the “beside”.

64.  The BEST-2 comprises seven sub test:
1. Conversational expression
2. Object Naming
3. Object Description
4. Sentence Repetition
5. Pointing to Objects
6. Pointing to the Parts of Picture
7. Reading
For most subtests a question and answer format is
used to obtain responses which may be verbal or
gestural.

65.  Performance on each subtest can range up to raw
score of 30, with lower score indicating a more
poor performance.
 A total score represents the sum of scores across
the subtest set.
 In a review of the test, Morales commented that
the BEST-2 scoring system is “easy and well
explained” and that its manual is well
“organized”.

66.  The Western Aphasia Battery (Shewan & Kertesz,
1980) was designed to provide a means of
evaluating the major clinical aspects of language
function: content, fluency, auditory
comprehension, repetition and naming plus
reading, writing and calculation. In addition to
the nonverbal skills of drawing, block design and
praxis are evaluated.
 The scoring provides two main totals, in addition
to the subscale scores.

67.  These are the Aphasia Quotient (AQ) score and
Cortical Quotient (CQ) score.
 AQ can essentially be thought of as a measure of
language ability.
 CQ is a more general measure of intellectual
ability and includes all the subscales.

68.  BDAE is a test used to evaluate adults suspected
of having aphasia, and is currently in its third
edition. It was created by Harold Goodglass
and Edith Kaplan.
 The Boston Diagnostic Aphasia Examination is a
comprehensive, multifactorial battery designed
to evaluate a broad range of language
impairments that often arise as a consequence of
organic brain dysfunction.

69.  PALPA has been designed as a comprehensive
psycholinguistic assessment of language
processing in adult acquired aphasia.
 PALPA is a set of resource materials enabling the
user to select language tasks that can be tailored
to the investigation of an individual patient's
impaired and intact abilities.
 The materials consist of sixty rigorously
controlled tests of components of language
structure such as orthography and phonology,
word and picture semantics and morphology and
syntax.

70.  Assess pt strengths and weaknesses in all
language modalities
 Designed to determine where language
performance breaks down in each modality and
provides information about deficit
 Oldest test
 6 hours to administer
 48 subtests
 No classification information
 Not used much any more

71.  This test determines the degree to which a
subject can access meaning from pictures and
words.
 Information from the test will enable the tester to
establish whether a subject’s difficulty in naming
or pointing to a named picture is due to a
difficulty in retrieving semantic information from
pictures, or a difficulty in retrieving semantic
information from words, or, in the case of a
naming failure, a difficulty in retrieving the
appropriate spoken form of the word.

72.  Six different versions of the test are possible by
using either pictures, written or spoken words to
change the modality of stimulus or response
items.
 The pattern of results can be used to build up a
picture of the subject’s ability to access semantic
and conceptual information, and so to indicate
whether a subject has a central, modality-
independent impairment to semantic knowledge,
or whether there are modality-specific
difficulties in access to semantics.

73.  The test is therefore ideal for theoretically
motivated testing of picture and word
comprehension in subjects with aphasia, visual
agnosia and general semantic impairment (as in
many subjects with Alzheimer’s disease).
 The test is short and easily administered, and
provides essential information for evaluation of
semantic disorders, and may help in the design of
appropriate rehabilitation programmes.

74.  Have to have 80 hours of training to administer
this test
 Good thing- multidimensional scoring system
 Provides accurate and reliable measure of pt
performance and a prognostic statement of what
changes in performance can be expected

75.  CAT was created by Kate Swinburn, Gillian Porter
and David Howard. The CAT is a new test for
people who have acquired aphasia, the
impairment of language ability.
 The comprehensive assessment can be
completed over one or two sessions.
 The test contains a cognitive screening, a
language battery and a disability questionnaire.

76.  The cognitive section assesses people’s abilities
across a wide range of tasks that can impact
rehabilitation.
 Forming the main body of the test, the language
battery provides a profile of performance across all
modalities of language
production and comprehension.
 The disability questionnaire explores the practical,
psychological, and social impact of impairment from
the perspective of the person living with aphasia. The
disability questionnaire is optional.

77.  The tests make use of simple procedures such as
lexical decision, repetition and picture naming
and have been designed to assess spoken and
written input and output modalities.
 Each test is also accompanied by detailed
instructions of how and why it was constructed,
how to use it, and by presenter's forms and
marking sheets.

78.  Not language per se – performance, pragmatics
 Communication skills in everyday life
 Example: CADL-2 (Communicative Activities in
Daily Living)
 Provides a snapshot of functional communication
skills using a variety of simulated communication
activities
 Involves people reading timetables, menus;
pretending to go to doctor, shopping; making a
phone call; writing a shopping list
 For people with aphasia, HI, dementia,
intellectual impairment, hearing impairment

79.  Spontaneous recovery: decelerating curve.
 Maximum recovery 1-3m
 Flattening out 6-7m
 Little/no spontaneous recovery after 1yr – plateau
(Basso 1992 Benson and Ardila 1996 in Chapey 2008)
 Prognosis: TBI better than stroke, haemorrhagic better
than infarction.
(Lesser and Milroy 1993)

80.  Treatment is delivered by qualified
professionals.
 Global aphasics are excluded.
 Content, intensity, duration and
timing of treatment are appropriate.
 Sensitive and reliable measures are
used to track changes.

81.  Approaches that assume the brain can
relearn what has been lost/skills can be re-
accessed.
 Approaches that assume lost language
functions not recoverable. Therapy aimed
at “getting around the problem”.

82.  WHO International classification of Functioning,
Disability and Health (2002).
 Body functions and structures i.e. impairments
of brain.
 Activity i.e. ability to make a phone call, read a
menu.
 Participation i.e. pursuit and enjoyment of real
life goals e.g. volunteering/getting a job.

83.  Timing:
 Generally, delaying treatment has not been
conclusively demonstrated to have any effects on
eventual outcome; but it likely does have effects on the
patient and their family.
 Candidacy:
 Some patients have very mild impairments and recover
spontaneously.
 Some are so severely impaired that they cannot
benefit.
 Some refuse, lack motivation, can’t travel.

84.  Use assessment results.
 Use discussion with client (where
possible) and family.
 Set long and short term goals.
 Consider design of task, the
psycholinguistic nature of stimuli selected,
modality of material, type of facilitation
given, duration and intensity of therapy.

85. closing the gap
What person
can do
cannot do
does do
What person
needs to do
wants to do

86.  Arrange the steps in order of difficulty:
 To draw well defined single items
 to command (draw an apple)
 therapy tasks include drawing basic shape, then differentiating
items from one another on visual features (e.g.. apple vs.
orange)
 based on function (draw something you wear) –
extending from objects to actions
 based on gesture (may or may not incorporate the verb
function from above) (e.g. gesture a banana; gesture a
shovel)
 in whole and parts (involves semantic breakdown)
 within a category/ generative drawing
 from memory
 To draw well defined single events
 from stimulus pictures
 from part of stimulus
 from memory

87.  to draw single items communicatively
 to draw single events communicatively
 therapy tasks will involve encouraging Pt to be aware of the
conversation partner’s needs, focusing on issues such as listening
to the other person’s guesses, conveying one piece of information
at a time.
 to draw communicatively in conversation with SLT
 therapy tasks will include drawing ‘answers’ to questions – e.g.
what did you do on the weekend?
 to draw communicatively in conversation with wife
 therapy tasks will include working with wife to assist her to
develop interpretation strategies, such as ‘homing-in’ questions;
asking for details; adding to the drawings; writing key words to
check; recapping what she knows about the drawing every few
minutes.

88.  Simple  more complex
 Less demanding  more demanding
 More support  less support
 E.g. cuing hierarchy for anomia:
Imitation
First sound / syllable
Sentence completion
Word spelled aloud
Rhyme
Synonym / antonym
Function / location
Superordinate
 Make hierarchies personal

89.  The primary objective in treatment of aphasia is to
increase communication. What the aphasic patient
wants is to recover enough language to get on with
his life.”
 Usually will not be complete recovery of language
and communicative function.
 Treatment may enhance recovery, but recovery will
stop.
 Identify strengths and weaknesses; use the strengths
to compensate for the weaknesses; help the aphasic
person to be an effective communicator in spite of
their language deficits.
 Generalization – recovery must not be limited to the
treatment room.
 Generalization does not just happen – it must be
planned for, worked towards, tested for.