Intensive Communication Group for people with Aphasia (ICGA)
Contents
The Cogneuro Model
pg.4-5
Listening pathway
pg.6-7
Speaking pathway
pg.8-9
Reading pathway
pg.10-11
Writing pathway
pg.12-13
Strategies to help understanding
pg.14
Strategies to encourage expression
pg.15
React2.com
pg.16
Apps and software
pg. 17
Resources
pg.18-19
This booklet was written and produced by Sarah Chedburn and Heather Ridley with support from other students fon clinical placement with the Intensive Communication Group for People with Aphasia project held at Queen Margaret University June 2013.
The Cog-neuro Model · The cog-neuro model is used by Speech and Language Therapists to pin-point areas of strengths and difficulty for each individual client. · The model represents how language is typically processed in the brain. There are many stages in the processing of language, which are each controlled by different parts of the brain. · Language is all processed in the left-side of the brain. People with aphasia can sometimes still sing because singing is processed in the right-side of the brain. · The top half of the model represents the input of language. Sensory information (e.g. hearing and seeing) goes into the brain and is decoded for understanding. · The bottom half of the model represents information coming from the brain and being expressed either by speaking or writing. · An impairment can occur anywhere on the model. Depending on where the impairment is, a person may have several impairments on the same pathway and/or impairments on multiple pathways.
Listening
When we hear: · The ears pick up sound and send the information to the brain.
· The brain sorts out whether it is hearing speech or environmental noises (e.g. hearing the word “cat” vs. a door slamming). It also identifies individual sounds (e.g. “k” vs. “t”).
· If we are hearing speech, the information travels to the language centres of the brain. We compare what we are hearing to our store of spoken words to determine if it is a word that we know.
· Once the word has been identified, the information goes to our store of meanings and tells us what the word means (e.g. “cat” is a four legged, furry animal that says “meow”).
If there is a breakdown with: · the ear: the person experiences hearing loss.
· recognition of speech: The person’s hearing is fine and would pass a hearing test but would find it difficult to make sense of speech sounds.
· store of spoken words: The person knows that it is speech but it find it difficult to recognise words (a bit like hearing a foreign language).
· store of meanings: The person knows the word but has difficulty accessing its meaning.
Speaking
When we speak: · We have to first decide what to say and access the dictionary of meanings · We then have to go to the word list and found out how to pronounce the word · Commands are then sent to the muscles controlling the lips, tongue, mouth and voice box · This results in speech
If there is a breakdown with: · The store of meanings: - May not be able to say the word at all (anomia) - May select a word with a similar meaning (e.g. cat—dog) (semantic paraphasia) · The store of spoken words: - May not be able to say the word at all (anomia) - May select a word that sounds similar (e.g. cat—cap) (phonemic paraphasia) - May say a nonsense word (neologism/jargon) · The muscle command - May have difficulty coordinating the muscles involved in speech (apraxia/dyspraxia)
- May have a weakness in the nerves controlling the muscles involved in speech (dysarthria)
Reading
When we read: · the eyes pick up on visual information and send the information to the brain · the brain recognises what it sees as writing and identifies the letters (e.g. c-a-t). · we then have to go to the store of written words and find out if it is a word that we know. · once the word has been identified, the information goes to our store of meanings and tells us what the word means (e.g. “cat” is a four legged, furry animal that says “meow”). If there is a breakdown with: · the eyes: the person may experience visual impairments. · recognition of letters: The person can see fine but has difficulty identifying letters. · store of written words: The person can identify the letters but has difficulty recognising the word. · store of meanings: The person recognises the words but has difficulty accessing its meaning.
Depending on where the breakdown is: · a person may be able to read and understand but unable to read aloud · a person may be able to read aloud but not understand what they are reading.
Writing
When we write: · we have to first decide what to say and access the dictionary of meanings · we then have to go to the word list and found out how the word is written · commands are then sent to the muscles controlling the hand · this results in writing
If there is a breakdown with: · the store of meanings: - May not be able to write at all - May write a word that is similar in meaning · the store of written words: - May not be able to write at all - May write a word that looks similar - May write a nonsense word · the muscle command: - May have difficulty coordinating the muscles involved in writing (apraxia/dyspraxia)
Strategies to help understanding Some people with aphasia find it easier to understand when:
· people slow down their talking
· people simplify their sentences where possible e.g. instead of: “Before you leave the house, could you please find the time to do the dishes?” Say: “Please do the dish before you leave”.
· people gesture and point in addition to speaking
· they can see the speaker’s mouth
Strategies to encourage expression You can encourage someone with aphasia to express themselves by: · giving them time to talk · if struggling to find a word, ask them to describe the item e.g. Cup = you drink out of it, kept in the kitchen etc. · if struggling, ask them to write it down or type on a communication aid (e.g. iPad, alphabet chart etc.) · if struggling, ask the person to gesture the item e.g. Computer = gesture typing · if struggling, ask them to draw the item · giving the first sound of the word if you think you know what they want to say · asking the person a yes/no question e.g. Is it something you eat? · asking the person two choices e.g. Do you mean Lisa or Julie?
N.B. Everyone has different strengths and difficulties. Some strategies will work better than others.
React2.com · React2.com is an online-based interactive speech and language therapy tool for people suffering from communication difficulties.
· All group members have free access until the end of July.
· The different sections of the programme help strengthen the pathways in the brain. Auditory Processing tasks targets the listening pathway Visual Processing tasks target the reading and seeing pathways Semantics tasks help strengthen the store of meaning (used in all pathways) Memory and Sequencing tasks (using several pathways) Life skills tasks target all input pathways (listening, seeing, reading) in everyday situations.
· During the ICGA programme, some clients also used React2 to strengthen the output pathways by either saying the answer or writing the answer down rather than clicking on the screen.
· For more information please see: www.react2.com
Apps and software These are some commonly used apps (applications) as well as programmes for aphasia:
Proloquo2Go Symbols you press which ‘speak’ the word Can make sentences and phrases Keyboard setting can predict what you are typing and can ‘speak’ the word, phrase or sentence Speech therapist can advise or it can be purchased individually
Speak It! Keyboard allows you to type the words and then ‘speak it’ aloud Requires good literacy
Can store the words, phrases and sentences to save you typing each time
IT Resources Information about AAC www.communicationmatters.org.uk/about-aac Keycomm Lothian Region only Contact/referrals are made by your Speech Therapist Useful information on the website www.keycomm.weebly.com Select Downloads along the top Select Information sheets at the bottom Select Ideas for using devices Scaffolding interaction · Gives some ideas and phrases for having a conversation · These can be copied into the iPad if useful Considerations for uses of AAC
Information sheets Select Programming Devices Programming prologquo2Go · Gives a step by step guide to add buttons to the app Scottish Centre of Technology for the Communication Impaired (SCTCI) Provides service to: Borders and Forth Valley Contact/referrals are made by your Speech Therapist
Group Resources Chest Heart & Stroke Scotland (CHSS): www.chss.org.uk Tel: 0131 225 6963 Groups throughout Scotland Connect: www.ukconnect.org The Stroke and Aphasia Handbook Better Conversations Stroke Talk Different Strokes www.differentstrokes.co.uk For younger people Speakability www.speakability.org.uk Groups in Edinburgh and Forth Valley
The Stroke Association www.stroke.org.uk Headway www.headway.org.uk Groups in Edinburgh, Falkirk, Dumfries and Galloway Exercise www.exerciseafterstroke.org.uk www.edinburghleisure.co.uk
