Table of Contents

What do people with aphasia want to be able to say? A content analysis of words identified as personally relevant by people with aphasia

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Associated Data

The data set underlying this paper is provided within the Supporting Information files. Some fields have been redacted due to concerns of participant confidentiality. Requests for the complete data set may be made to the corresponding author.

Abstract

Background

Word finding is a common difficulty for people with aphasia. Targeting words that are relevant to the individual could maximise the usefulness and impact of word finding therapy.

To provide insights into words that people with aphasia perceive to be personally relevant.

Methods and procedures

100 people with aphasia were each asked to identify 100 words that would be particularly important for them to be able to say. Two speech and language therapist researchers conducted a quantitative content analysis of the words selected. The words were coded into a framework of topics and subtopics. The frequency with which different words and topics were selected was then calculated.

Outcomes and results

100 participants representing 20 areas of the United Kingdom ranged in age from 23 to 85 years. Word finding difficulties ranged from mild to severe. The sample of 9999 words selected for practice included 3095 different words in 27 topics. The majority of words selected (79.4%) were from the topics ‘food and drink’ (30.6%), ‘nature and gardening’ (10.3%), ‘entertainment’ (9.4%), ‘places’ (7.3%), ‘people’ (6.7%), ‘house’ (6.5%), ‘clothes’ (5.2%) and ‘travel’ (3.5%). The 100 words types chosen with the greatest frequency were identified. These account for 27 percent of the 9999 words chosen by the participants.

Discussion

Personally relevant vocabulary is unique to each individual and is likely to contain specific or specialist words for which material needs to be individually prepared. However there is some commonality in the words chosen by people with aphasia. This could inform pre-prepared materials for use in word finding therapy from which personally relevant words could be selected for practice.

Introduction

Approximately a third of people have aphasia after a stroke. Aphasia affects different domains of language including understanding spoken language, reading, writing and speaking to varying degrees. Word retrieval difficulties are common to the majority of people with aphasia and contribute to making communication difficult and frustrating. Consequently speech and language therapy often focusses on word finding with the aim of increasing the ability to retrieve words in everyday communication, to improve verbal interactions and reduce frustration [1].

Therapy approaches for the retrieval of single words are often subdivided into phonological therapies and semantic therapies. Phonological therapies may use word repetition, phonemic cueing or orthographic (written whole word or letter) cueing. Semantic therapy techniques usually focus on word to picture matching or describing the properties of a target word, for example what it does or what it is used for. Cues and descriptions can be provided by the therapist to prompt word retrieval, or the individual can be encouraged to self-cue [2]. Cues are often presented in a hierarchy of difficulty until the participant retrieves the word successfully, starting with a phonemic cue and building up to presenting the whole word to be repeated [3]. Intensive language action therapy (previously known as Constraint Induced Aphasia Therapy) targets the use of words to make requests in increasingly complex phrases and sentences. This moves beyond word retrieval in isolation to word retrieval in functional language tasks [4,5]. Word finding interventions have been delivered during face to face treatment sessions with a speech and language therapist using table top/paper based therapy materials and within specialist computer therapy programs and apps [6–8]. Common to all therapy techniques and modes of delivery is the use of pictures and written words/letters as stimuli for word retrieval.

Therapy has been shown to be effective for words used within therapy sessions (treated items). For example, Best et al 2013 showed 15/16 participants improved retrieval of treated items in a cueing hierarchy therapy delivered face to face [3]. Palmer et al (2012) showed improvement of treated items in 10 out of 15 participants following a self-managed computer word finding therapy in a pilot study using the StepbyStep program [8,9]. Speech and language therapists deliver therapy with the intention of having an impact on the individual’s everyday communication outside of therapy. This assumes generalisation of the word finding improvements seen in therapy. Generalisation encompasses two key ideas. The first is that words learned in therapy are used in everyday functional communication situations and that following therapy the experience of communicating is improved. Best et al (2008) found an improvement in both word finding and patient rated activity levels using the Communication Disability Profile [10] following impairment based word finding therapy [1]. During interviews with participants and carers of participants who had used StepbyStep computer word finding therapy, participants gave examples of using words learned in therapy in everyday functional communication contexts. In addition participants and carers described an increased confidence to participate in social situations where communication is required [11]. The second meaning of generalisation is that the word finding improvement shown for words treated in therapy is also shown for untreated items. In a review of word finding studies Nickel et al 2002 showed that approximately one in four people with aphasia generalised improved word finding of treated items in therapy to untreated items [2]. More recently, Best et al 2013 also showed that whilst 15/16 participants improved naming of treated items, 4/16 (1 in 4) improved retrieval of untreated items by more than four percent [3]. Common to all four participants who showed generalisation to untreated words was that their word finding difficulties were phonological in nature. Those with semantic difficulties or mixed semantic and phonological difficulties did not generalise to untreated items [3].

Best et al (2013) highlight the importance of using functionally relevant words in therapy for people with aphasia for whom therapy does not always generalise well to untreated items [3]. Neuroplasticity theories describe the process by which re-learning of skills occur following brain damage. They provide further support for treatment of words that are of particular interest or use to an individual by identifying salience as an important factor in treatment success [12]. In other words, meaningful learning environments or materials may enhance re-learning. Participants and carers who took part in the pilot CACTUS study which focussed on practising personally relevant words, highlighted that making sure that the practice material was of interest to them was motivating [11].

To maximise the impact of word finding therapy on the lives of people with aphasia, it is important to, ensure that words selected for use in therapy are of personal relevance to the individual being treated. Preparing a bespoke set of picture material for each individual can be time consuming and therapists often rely on pre-prepared colour flashcards or libraries of images within computer programs or apps. In order for these pre-prepared resources to be of maximum use to therapists, they need to contain pictures of words that people with aphasia commonly identify as being of personal relevance to learn. But what do people with aphasia see as relevant?

In the Big CACTUS trial of computerised word finding therapy all participants with aphasia were asked to select 100 words that they thought would be particularly useful for them to be able to say. They were then randomised to computer therapy with the StepbyStep program for 6 months, an attention control group (completion of puzzle books), or usual care [13]. A picture was found to represent each word chosen in order to provide stimuli for baseline and outcome word finding tests and, if randomised to the computer therapy group, to provide stimuli for the treatment of the 100 words for the six month intervention period. This study analysed the words chosen by 100 participants in the Big CACTUS trial to provide insights into what people with aphasia perceive to be personally/functionally relevant.

The study answers two questions: 1) What are the topics that people with aphasia are interested in talking about? 2) What are the most common words and topics selected for practice by people with aphasia?

Methods and materials

Design

A quantitative content analysis was used to analyse lists of personally relevant words generated by 100 people with aphasia. Analysis followed the six stages of content analysis proposed by List (2007) [14]: 1) selecting content for analysis, 2) identifying the units of content, 3) preparing content for coding, 4) coding content, 5) counting and weighting, 6) drawing conclusions.

Participants

People with aphasia post stroke were recruited to the Big CACTUS trial from twenty National Health Service (NHS) trusts across the United Kingdom (UK) [13]. Participants were included if they were aged over 18 years; had a diagnosis of stroke at least four months prior to randomisation; had a diagnosis of aphasia subsequent to stroke; were able to retrieve 10–90 percent of words on the Comprehensive Aphasia Test Naming Objects subtest [15]; were able to perform a simple matching task in the StepbyStep computer program with at least 50 percent accuracy; and were able to repeat at least 50 percent of words in a StepbyStep repetition task. Participants were excluded if they had another pre-morbid speech and language disorder caused by a neurological deficit other than stroke; required treatment for a language other than English; were currently using the StepbyStep computer program or other computer speech therapy aimed at word retrieval/naming.

Recruitment was carried out by speech and language therapists trained by the Big CACTUS research team. The Consent Support Tool [16] was used to ensure informed consent was taken where possible. When a potential participant did not demonstrate capacity to provide consent, their inclusion was enabled by a signed consultee declaration of belief that their friend or relative would like to participate. See Big CACTUS protocol [13] for further details. The study protocol was approved by Leeds West National Health Service research ethics committee [reference 13/YH/0377]. Additional approval was granted for Scotland by the Scotland A research ethics committee [reference 14/SS/0023].

Procedure for selecting personally relevant words

After participants had consented to the Big CACTUS study, the speech and language therapists asked them to choose 100 words that they would find useful to be able to say. They were given time to think about this with their families. In addition, 18 picture cards were designed to show participants possible topic areas to prompt them to think about what was important to them. The cards were informed by topics chosen in the pilot CACTUS study [8] and the content of the StepbyStep program library [9]. Once a set of 100 words had been chosen they were grouped according to words related to the same topic of interest and entered onto a central electronic project database. Pictures were identified to represent all of the words chosen for each participant to be used in personalised word finding tests for all participants and for therapy for those randomised to the computer therapy group.

Content analysis procedure

The purpose of the analysis was to identify topics of interest to people with aphasia and to identify the most common words and topics selected for therapy by people with aphasia. The analysis was conducted by two speech and language therapy researchers familiar with the StepbyStep word finding therapy and the approach taken to word selection.

Selection of content for analysis: Word lists from the first 100 participants randomised to the Big CACTUS trial were selected for analysis. This number of participants ensured word lists from participants with a range of ages and genders from all 20 areas of the UK participating in Big CACTUS were represented. All words in word lists from the first 100 participants were analysed.

Units of content: Single words or terms made up of two or three words (e.g. ‘cup of tea’) were the units of content in this analysis.

Preparing the content for coding: The words from all 100 participants were listed in one document, S1 File. Terms that contained more than one word were then joined and hyphens and other special characters (such as apostrophes, question marks) were removed to ensure the term was analysed as one unit of content (for example ‘tool-box’ was changed to ‘toolbox’, and ‘cup of tea’ to ‘cupoftea’). Each of the words chosen by each participant was considered as a word token. The SLT researchers classified all the word tokens into word types. All tokens of one word type were labelled with the most frequent token used. For example ‘banana, banana, banana, bananas, bananas’, chosen by five different participants would represent five tokens of the word type ‘banana’. As the most frequent token is ‘banana’ all tokens of this word type were labelled as ‘banana’. Another example is that word tokens ‘tea’ (the drink) and ‘cup of tea’ were classed as one word type ‘cupoftea’. The content was prepared by one research speech and language therapist and checked by the other to identify any omissions such as hyphens left in or tokens of words unaccounted for. The transcript was then imported into NVivo 10 software which was used to present a list of word types and the number of tokens per word type in alphabetical order.

Coding the content: The word types were coded into topics and subtopics forming a hierarchical coding framework in NVivo 10. The two researchers conducted this task until all of the words had been coded. The topics were defined by the researchers who decided what semantic category each word came from (for example ‘dog’ comes from the semantic category ‘animal’). One hundred and fifty three word types (five percent of the sample) were coded by both researchers independently. There was 76 percent agreement between the researchers on this sample. Once the data was all coded the researchers reviewed the coding together. To increase reliability, where the topic was ambiguous, the researchers referred back to the source data to provide context. For example the word ‘lamb’ could be coded as ‘food’ or as ‘animal’. If the source data showed ‘lamb’ was grouped with words such as ‘meat’, ‘chicken’, ‘beef’, it would be coded as food. Where the ambiguity was unresolved it was coded as ‘unable to identify topic’. Once the coding was agreed, the researchers identified where topics could be grouped to form overarching topics and selected labels for the overarching topics which described the content. A third researcher, familiar with the word selection method and content analysis method, was consulted where the two researchers did not reach agreement on a topic grouping or name.

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Counting and weighting: Topic and subtopic labels were added to the original dataset of words chosen by individual participants (in other words each token of a word chosen by an individual participant was labelled with its topic and subtopic). See S1 File. This dataset was then the source for the quantitative analysis of the content which consisted of counts of the number of topics and subtopics and the number of word types in each topic and subtopic for the whole group of 100 participants.

The dataset was then used to identify the proportions of word tokens chosen from each topic by key subgroups and by the group as a whole. Subgroups explored included gender and age. As the total number of participants was 100, they were divided into only two age sub groups based on the frequently used clinical distinction of under 65 years of age or 65 years and over [17]. The percentage of words chosen from each topic was identified for the whole group and for each of the four subgroups (for example, the percentage of words chosen by men, which were from the topic ‘travel’). This enabled similarities and differences to be identified between subgroups. As one percent of the total number of words in the dataset is 100 words and each participant chose 100 words, it is possible that where one percent or fewer words were selected from a topic that these could all have been selected by the same participant. Comparisons were therefore only made for topics comprising more than one percent of the words. The topics were then ranked in order of frequency with which words from them were chosen, from highest to lowest for all subgroups. Box and whisker plots were created for the highest ranking topics to indicate the distribution of words chosen from these topics across participants.

The identification of frequently selected topics gives an indication of what people with aphasia may like to focus on in word finding therapy. However, it does not indicate which words from these topics are likely to be of interest to many patients receiving word finding therapy. To address this, the frequency with which each word type was selected was calculated and presented from highest to lowest. As 100 words were used in a set of therapy words in the treatment study from which these data arose, the 100 words chosen with the greatest frequency are presented in the paper for the group as a whole. Key differences between subgroups are also identified. Where there was more than one word selected with the same frequency in one hundredth place, all of these words were presented.

Results

Participants

Of the 100 participants, 63 were male and 37 were female. Word finding severity was based on the Naming Objects score of the Comprehensive Aphasia Test [15]. Scores of 5/48 to 17/48 were classified as severe, 18/48 to 30/48 as moderate and 31/48 to 43/38 as mild. In this sample 49 of the participants had mild word finding difficulties, 27 had moderate word finding difficulties and 25 had severe word finding difficulties. Participants were aged between 23 and 85 years with a median of 64 years. Fifty two participants were aged less than 65 years and 48 were aged 65 years or above. Table 1 shows the number of participants from each of the 20 areas of the UK involved in the study. The numbers vary depending on the length of time the area had been involved in the Big CACTUS study and the number of participants that had been recruited. S2 File shows demographics for each individual participant.

Table 1

AreaNumber of participants
Ayr1
Belfast5
Cambridgeshire3
Cwm Taf3
Derbyshire6
Dorset3
Glasgow12
Hull8
Newcastle6
Norfolk4
North Lincolnshire5
Northampton4
Northern5
Nottinghamshire3
Plymouth3
Sheffield10
Somerset2
South Bedford12
Sunderland1
Swansea4

Topics and subtopics of words

Three thousand and ninety five (3095) different word types were represented in the sample of words from the first 100 participants. (There were 9,999 words altogether as one participant only had ninety-nine words.) There was insufficient contextual information to categorise 104 of the words (Three percent of the sample). The remaining 97 percent of word types fell into 27 different topics shown in Table 2 . Eighteen of the topics were further divided into subtopics shown in Table 2 . A second level of subtopic was identified for 12 of the 120 subtopics. Eating and drinking out comprised generic names of places to eat out such as ‘restaurant’ or ‘pub’, specific names of places to eat out, and menus. Generic places included ‘city centre and town’ (for example ‘bank’); ‘coastal places’ including ‘beach’ and ‘seaside’; ‘exercises and fitness places’ (such as ‘gym’); ‘health and medical places’ (for example ‘hospital’); ‘public buildings and spaces’ (such as ‘church’) and ‘services’ (for example ‘post office’). Seven of the entertainment subtopics were further subdivided. Arts and crafts included both arts and crafts. Films comprised ‘genres’, ‘mediums’ and ‘modes’ (for example ‘DVD’), ‘production companies’ and ‘specific films’. Non sporting hobby words related to ‘hobbies’, ‘equipment’ used for these hobbies and ‘terminology’ used. Reading was subcategorised into ‘specific reading material’, ‘reference books’ and the ‘medium’ used such as ‘book’ or ‘kindle’. Sport words included those referring to ‘specific sports’, ‘sport equipment’, ‘league or competitions’, ‘players and referees’, ‘sports teams’ and ‘terminology’. Music words included ‘sound equipment’, ‘instruments’, ‘medium ‘of listening to music, ‘genre’, ‘shows’ and ‘songs’. TV words consisted of the category of programs (for example ‘documentary’), ‘channels’, ‘medium’ of watching TV (for example ‘iPad’) and ‘specific names of programs’. In nature and gardening animal words related to ‘types of animals’ and ‘looking after animals’ (for example ‘dog food’). Travel words relating to trips and holidays were subdivided into ‘accommodation’ (for example ‘hotel’), ‘relaxation’ (such as ‘sunbathing’) and the ‘type of trip or holiday’ (for example ‘cruise’). Vehicles included ‘makes’ (for example ‘Ford Focus’), ‘types’ (such as ‘car’) and ‘vehicle parts’(for example ‘engine’). Finally science words were categorised into ‘astrophysics’ (for example ‘telescope’), ‘elements’ (such as ‘hydrogen’), ‘materials’ (such as ‘leather’) and ‘general science words’ (for example ‘evolution’).

Table 2

Topic (Number of word types)Subtopics (Number of word types)
People (488)People’s names (283); Musicians (92); Sports personalities (41); Actors and TV celebrities (23); Relations (15); Fictional characters (13); Royalty (7); Authors (5); Religious figures (5); Comedians (2); Historical figures (2)
Food and drink (447)Food (251); Drink (72); Equipment and utensils (57); a Eating & Drinking out (22); Ingredients (15); Sauces and condiments (14); Types of cuisine (8); Meals of the day (4); Method of cooking (4)
Places (381)Areas in British Isles (156); Places abroad (68); Specific public buildings and spaces in British Isles (56); Generic places (45); a British landmarks (23); Specific roads and addresses in British Isles (14); Landmarks abroad (10); Sports venues (9)
Entertainment (377)a TV (113); a Sport (90); a Films (46); a Music (38); a Art & Crafts (32); Games, toys and puzzles (19) a Non-sporting hobbies (18); a Reading (10); Fitness equipment (6); Dancing styles (5)
Nature and gardening (279)a Animals (146); Trees, plants and flowers (56); Tools and equipment (27); Looking after animals (16); Types of habitat (14); Garden surfaces (5); Boundary markers (3); Outbuildings (3); Outdoor seating (3); Soil and compost (3); Wood (2); Garden activities (1)
House (135)Housework (28); DIY and tools (23); Soft furnishings (22); Furniture (18); Fixtures and fittings (14); Heating and lighting (12); Rooms (11); Types of accommodation (4); Outside the house (3)
Travel (110)a Vehicles (66); a Trips and holidays (15); Public transport, stops or stations (5); Travel documents and baggage (5); Commuting (4); Navigation (4); Roads (3); Fuel and filling up (3); Boating terminology (2); Disability parking (2); Flags (1)
Actions (98)
Work and education (82)Professions (62); Work related words (7); Education (5); Job specific equipment (3); Places of work (3); Companies (2)
Health (69)Body parts (29); Medication (15); Disability and illness (12); Aids (6); Procedures (4); Therapy (2); Tests (1)
Shopping (69)Specific shop names (21); Types of shop (16); Shopping centres and markets (14); Supermarket chains (8); Items associated with shopping (4); Online shopping (3); General places to buy things (2); Brands (1)
Clothes (67)
Money and numbers (60)Numbers (33); Cash amounts (12); Forms of payment (6); Financial products and savings (6); Places to withdraw cash (2); Currency (1)
Maths and science (58)a Science (50); Maths (8)
Time (45)Times (19); Months (12); Days (8); Seasons (3); Calendars and diaries (3)
Personal items (41)Jewellery and cosmetics (28); Items carried around with you (10); Smoking related items (3)
Personal care (34)
Descriptive terms (33)General descriptive terms (19); Colours (14)
Organisations and groups (22)Groups and clubs (8); Support groups (6); Regional and international organisations (5); Group admin processes (3)
Feelings and senses (19)
Weather (17)
Technology and equipment (16)Hardware (8); Accessories (6); Make of equipment (1); Software (1)
Non content words (16)
Communication mediums and modes (12)
Stationery (6)
Events (5)Beer festivals (2); Goods related to celebrations (2); Celebrations (1)
Religion (5)

a Subtopics that were further subdivided

Topics chosen by subgroups

The numbers of word tokens selected from each topic are presented for the whole group and for each gender and age subgroup in Tables ​ Tables3 3 and ​ and4. 4 . The numbers of words chosen per topic are also shown as a percentage of all the words chosen for each subgroup. As there are different numbers of participants in each subgroup, the percentages of words chosen from each topic have been used to compare the subgroups.

Table 3

Number of words chosen by whole group (percentage of all words chosen by whole group)Number of words chosen by women (percentage of all words chosen by women)Number of words chosen by men (percentage of all words chosen by men)
Food and drink3071 (30.7%)1162 (31.4%)1909 (30.3%)
Nature and gardening1024 (10.2%)285 (7.7%)739 (11.7%)
Entertainment937 (9.4%)296 (8%)641 (10.2%)
Places730 (7.3%)235 (6.4%)495 (7.9%)
People671 (6.7%)246 (6.7%)425 (6.7%)
House642 (6.4%)260 (7.0%)382 (6.1%)
Clothes518 (5.2%)278 (7.5%)240 (3.8%)
Travel345 (3.5%)65 (1.7%)283 (4.5%)
Actions231 (2.3%)71 (1.9%)160 (2.5%)
Money and numbers200 (2.0%)110 (3.0%)90 (1.5%)
Personal Care200 (2.0%)111 (3.0%)89 (1.5%)
Shopping196 (2.0%)91 (2.5%)105 (1.7%)
Time190 (1.9%)72 (1.9%)118 (1.9%)
Health167 (1.7%)72 (1.9%)95 (1.5%)
Work and education162 (1.6%)45 (1.2%)117 (1.9%)
Personal items151 (1.5%)101 (2.7%)50 (0.8%)
Other topics564 (5.6%)202 (5.5%)362 (5.7%)
Total9999 (100%)3699 (100%)6300 (100%)

Shading represents a difference off 50% or more between the percentages of words chosen from a topic in each subgroup.

Table 4

TopicNumber of words chosen by whole group (percentage of all words chosen by whole group)Number of words chosen by under65s (percentage of all words chosen by under65s)Number of words chosen by participants 65 and over(percentage of all words chosen by participants 65 and over)
Food and drink3071 (30.7%)1162 (31.4%)1909 (30.3%)
Nature and gardening1024 (10.2%)499 (9.6%)525 (10.9%)
Entertainment937 (9.4%)501 (9.6%)436 (9.1%)
Places730 (7.3%)397 (7.6%)333 (6.9%)
People671 (6.7%)300 (5.8%)371 (7.7%)
House642 (6.4%)347 (6.7%)295 (6.1%)
Clothes518 (5.2%)271 (5.2%)247 (5.1%)
Travel345 (3.5%)209 (4.0%)136 (2.8%)
Actions231 (2.3%)143 (2.8%)88 (1.8%)
Money and numbers200 (2.0%)131 (2.5%)69 (1.4%)
Personal Care200 (2.0%)106 (2.0%)94 (2.0%)
Shopping196 (2.0%)87 (1.7%)109 (2.3%)
Time190 (1.9%)137 (2.6%)53 (1.1%)
Health167 (1.7%)81 (1.6%)86 (1.8%)
Work and education162 (1.6%)68 (1.3%)94 (2.0%)
Personal items151 (1.5%)80 (1.5%)79 (1.5%)
Other topics564 (5.6%)290 (5.6%)274 (5.7%)
Total9999 (100%)5199 (100%)4800 (100%)

Shading represents a difference of 50% or more between the percentages of words chosen from a topic in each subgroup.

Ninety four percent of words were selected from the top 16 topics, with each of these 16 constituting more than one percent of the total number of words. Table 3 shows that of those 16, nine of the topics were chosen with similar frequency by men and women with ‘food and drink’ representing 31 percent of the words chosen by women and 30 percent chosen by men. A greater percentage of words were selected from the topics ‘nature and gardening’ and ‘travel’ by men compared with women. A greater percentage of words from the topics ‘clothes’, ‘money and numbers’, ‘personal care’, ‘shopping’ and ‘personal items’ were chosen by woman compared with men. Table 4 shows that similar percentages of words were selected from each topic by participants under the age of 65 years and those who were aged 65 years or over for 13 of the 16 topics. ‘Travel’, ‘actions’ and ‘time’ were selected more often by those under the age of 65 than those aged 65 years and over.

Table 5 shows the ranking of topics per subgroup from highest to lowest with the highest ranking topic (1) being the topic with the largest percentage of word tokens selected from it and the lowest ranking (16) having the lowest percentage of word tokens selected from it. There was a higher percentage of words selected from the topic ‘food and drink’ than any other topic for all subgroups. ‘Nature and gardening’ and ‘entertainment’ ranked second or third across subgroups. Despite men choosing ‘nature and gardening’ words one and a half times as often as women, this topic still ranked in the top three for women. Although there is some difference in ranking position, Table 4 shows that the top eight ranked topics are ‘food and drink’, ‘nature and gardening’, ‘entertainment’, ‘places’, ‘people’, ‘house’, ‘clothes’ and ‘travel’ for all subgroups. The only exception is ‘travel’ which is not ranked in the top eight for women. The top eight categories represent 79.4 percent of word tokens chosen by the participants. There appears to be greater variation in the ranking of the less frequently chosen topics between subgroups.

Table 5

RankingWhole groupWomenMenunder65 years65 years and above
1Food and DrinkFood and DrinkFood and DrinkFood and DrinkFood and Drink
2Nature and GardeningEntertainmentNature and GardeningEntertainmentNature and Gardening
3EntertainmentNature and GardeningEntertainmentNature and GardeningEntertainment
4PlacesClothesPlacesPlacesPeople
5PeopleHousePeopleHousePlaces
6HousePeopleHousePeopleHouse
7ClothesPlacesTravelClothesClothes
8TravelPersonal careClothesTravelTravel
9ActionsMoney and numbersActionsActionsShopping
10Money and numbersPersonal itemsTimeTimePersonal care
11Personal careShoppingWork and educationMoney and numbersWork and education
12ShoppingTimeShoppingPersonal careActions
13TimeHealthHealthShoppingHealth
14HealthActionsMoney and numbersHealthPersonal items
15Work and educationTravelPersonal carePersonal itemsMoney and numbers
16Personal itemsWork and educationPersonal itemsWork and educationTime

Table 2 shows the number of word types in each topic and Tables ​ Tables3 3 and ​ and4 4 show the number of word tokens selected from each topic. The topics with the highest number of word types ( Table 2 ) and word tokens ( Table 5 ) are similar but there are some differences noted in ranking. This is due to the fact that some topics have many word types each selected only a few times (such as people) whilst others have fewer word types each selected many times (such as clothes). For example the word ‘trousers’ was chosen several times by different participants.

Distribution of words chosen from each topic across participants

Fig 1 shows the distribution of words chosen across participants for the eight highest ranking topics. ‘Food and drink’, from which the highest number of words was chosen, shows a normal distribution across participants. The number of words chosen from this topic was wide ranging from one to 65. For all other topics the median number of words chosen was less than 10 and the boxes are relatively short showing 50 percent of participants chose similar numbers of words from these topics. Not everyone chose words from these topics, however the longer upper whiskers show a spread of up to 37 words chosen from the topic ‘nature and gardening’, 20 to 25 words chosen from ‘entertainment’, ‘places’, ‘people’, ‘house’ and ‘clothes’, and up to 15 words chosen from ‘travel’. ‘Nature and gardening’, ‘entertainment’, ‘places’, ‘people’ and ‘house’ also show outliers (those more than one and a half times the interquartile range above the top of the interquartile range) representing participants who showed particular interest in these topics.

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Words chosen with the greatest frequency

Frequency of selection of each word type is shown in S3 File. Fig 2 illustrates the 102 most frequently selected words (more than one word was selected with the same frequency in one hundredth place). The frequency with which these words were chosen ranged from 18 percent (one in five participants) to 53 percent (one in two participants). This suggests that these words are likely to be chosen by other people with aphasia. Therefore pre-prepared pictures of these words could be used to save therapists time in creating them anew for each new patient. Indeed, these top 102 word types account for 27 percent of the 9999 words chosen by the 100 participants. ‘Coffee’ was chosen with the greatest frequency (58 percent of participants) closely followed by ‘cup of tea’ (53 percent of participants) and ‘water’ (48 percent of participants). The most frequently chosen words come from nine topics, with the majority (61 percent) related to food and drink. All of the topics correspond with the highest ranking topics except ‘people’. Words from the topic ‘people’ do not appear in the 102 most frequently selected words. This is likely to be because the greatest numbers of ‘people’ word types are people’s names which are unique to each individual and need a bespoke picture prepared in each case. For example, the name ‘John’ will represent a different person each time it is selected, requiring a different picture.

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The words selected with the greatest frequency for each subgroup were identified and compared to the 102 words chosen with the greatest frequency by the whole group. Sixty percent of the 102 words were in the 100 (approximately) most frequently selected words for all subgroups. Of the most frequently chosen 51 words (two words were in fiftieth place) from the whole group, 90 percent appear in the 100 (approximately) most frequently selected words for all subgroups. Only five words in the 51 most frequently chosen words for the whole group were not frequently chosen by all subgroups: ‘football’, ‘tennis’ and ‘lawnmower’ were not in the top 100 words chosen by women; ‘washing machine’ was not in the top 100 words chosen by men; and ‘Chinese food’ was not in the top 100 words chosen by participants 65 years and over.

Discussion

Inspired by a need to tailor stimuli for word finding therapy to be relevant to people with aphasia in a bid to maximise the impact of the therapy on their everyday lives, this paper reports on the content analysis of 9999 words selected as relevant by 100 people with aphasia. The sample of participants represents people with all severities of aphasia across a wide age range. The ratio of women to men (37:63) reflects the world-wide gender difference in stroke prevalence statistics [18]. Whereas 26 percent of strokes occur in people under the age of 65 years [17], a higher proportion (54 percent) of the sample in this study was under 65 years of age. This may be accounted for by higher survival rates amongst the younger age group. Additionally younger people may be more interested in participating in a research project involving treatment using a computer from which this cohort of participants was drawn. A subgroup analysis was conducted by age and gender to explore how generalisable the common topics and words from the whole group of participants are to these subgroups.

The words chosen by people with aphasia fell into 27 different topics. A subgroup analysis showed differences in the frequency with which words were selected from some of the topics. Men chose a greater percentage of words about ‘nature and gardening’, and ‘travel’ than women. By contrast women chose a greater percentage of words about ‘clothes’, ‘money and numbers’, ‘personal care’, ‘shopping’, and ‘personal items’ than men. Although the sample of participants in this study contained a greater proportion of under 65 year olds than expected in the stroke population, the percentage of words chosen by under 65 year olds and those 65 years and above was consistent for the majority of topics. Only three topics showed a difference between the age groups. Under 65 year olds chose a greater percentage of words about ‘time’, ‘actions’ and ‘travel’ than those 65 years old and above. Despite these differences between subgroups, the same eight topics are all ranked in the top eight for all subgroups (except for women, where ‘money and numbers’ was in eighth place and ‘travel’ fifteenth). This demonstrates relative consistency between subgroups. For example, although men chose a greater percentage of ‘nature and gardening’ words than women, the topic still ranks highly with both genders, being second for men and third for women. The top eight topics included ‘food and drink’, ‘nature and gardening’, ‘entertainment’, ‘places’, ‘people’, ‘house’, ‘clothes’ and ‘travel’ from which 79.4 percent of the words were selected. Different participants selected different numbers of words from these topics and some topics were of particular interest to a few individuals. However, there was a relatively normal distribution of words chosen from all of the top eight topics across participants.

Goals identified by people with aphasia (Worrall et al 2011) are reflected in these topics [19]. When looking at the frequency of words selected, ‘food and drink’ items were overwhelmingly popular, representing 30 percent or more of words chosen by all subgroups and 61 percent of the most frequently selected 102 words. One of the categories of goals Worrall et al (2011) identified was returning to pre-stroke life and that people with aphasia wanted ‘just to be normal and enjoy life’ [19] (p313). With food being a big part of everyday life and often the source of pleasure and social interaction, the desire to ‘just be normal and enjoy life’ may offer an explanation for the focus on talking about food and drink. Worrall et al (2011) stressed the importance of relationships to people with aphasia and noted that they often wanted to say specific names [19]. Two hundred and eighty three (9.1 percent) of the 3095 different word types selected in this study were names of specific people (excluding celebrities). Worrall et al (2011) also identified social goals including leisure and work as being particularly important once people were home from hospital: ‘it’s communication with other people…in the sense that…just to be talking to a neighbour’ [19] (p315). In addition, they identified the importance of talking about things that are connected to real life. Topics including ‘places’, ‘nature and gardening’, ‘house’, ‘shopping’, ‘clothes’, ‘personal items’, ‘personal care’, ‘health’, ‘weather’, ‘feelings and senses’, and ‘travel’ could all be considered to be ‘real life’ topics that could form the basis for conversation with family, friends and neighbours. The topic of ‘travel’ also contained words related to ‘holidays and trips’ which focus on leisure. One of the largest topics was ‘entertainment’ focussing entirely on leisure pursuits such as sports, hobbies, TV, films and music. Finally, Worrall et al (2011) showed that people with aphasia seek respect by highlighting their premorbid skills and accomplishments [19]. This desire may be represented by the topic ‘work and education’ and the technical and specialist vocabulary selected as words important for people with aphasia to say within several of the topics.

What any given person with aphasia identifies as being relevant personal vocabulary that would help them to meet their communication goals is of course unique to that individual. Therefore the speech and language therapist needs to prepare materials to stimulate the retrieval of a unique set of words for each person. This can be very time consuming if material for each word selected needs to be prepared anew. With the exception of pictures of specific people, which require bespoke preparation for each individual, words which can be represented by a common picture could be prepared in advance and used when requested by a new client. S3 File shows the words in order of the frequency with which they were selected for practice. Therapists could refer to this to decide which words to pre-prepare pictures for. This paper exemplified the 102 words selected with the highest frequency (chosen by between 18 and 58 percent of the whole participant group). It was demonstrated that the majority of these words were chosen with high frequency by all subgroups. These 102 words out of the total 3095 different word types accounted for 27 percent of the 9999 words chosen for practice. If therapists had pre-prepared resources which included these words it is likely that they would have easy access to materials for at least some of the words within an individual patient’s unique therapy set. This could reduce the time associated with preparation of personally relevant therapy material.

Deciding which words to focus on, in therapy for an individual, can be challenging for a number of reasons. People with more severe aphasia may find it difficult to identify or communicate the types of words that would make the most difference for them to be able to say. When a person with aphasia is still in hospital, they won’t yet have experienced the situations or topics of conversation that are difficult and most important for them to address in therapy. Therefore, being aware of words that other people with aphasia have identified as relevant may be a useful starting point to maximise the usefulness of early therapy or to create prompts to help people identify what is most relevant to them.

Limitations of this study and further research: The population studied were people with aphasia at least four months post stroke in the UK with a range of ages, aphasia severities and gender. Additional demographic details which may be relevant such as socio-economic group and ethnic origin are unknown. The subgroup analysis in this paper concentrated on demographics of age and gender. A future analysis could be conducted to explore differences between subgroups based on clinical severity of aphasia. One of the sources to prompt selection of words in this study was the existing large StepbyStep library of words. The large number of food and drink words selected led the authors to question whether this was due to a disproportionate number of food and drink words in the StepbyStep library. However, there were no more food and drink items represented in the library than words in other topic areas. The use of quantitative content analysis identifies categories of words that are important to people with aphasia but does not help us to understand why. The topics were related to goals identified by people with aphasia by Worrall et al (2011) to set them in a context [18]. However further qualitative research needs to be conducted to explore the reasons behind personal relevance of words and the links between the topics and rehabilitation goals.

Conclusion

In conclusion, the study showed that words selected as personally relevant to people with aphasia fell into 27 different topic areas with participants most frequently selecting words from the topic ‘food and drink’. The study identified the frequency with which each word type was selected for practice by participants. The most frequently selected 102 words types accounted for 27 percent of the 9999 words tokens chosen for practice by the 100 participants. If pre-prepared resources contained the frequently selected words identified in this study, it is likely that they would contain some words selected by an individual with aphasia for therapy practice. This would reduce the time required in preparing personally relevant therapy material, facilitating therapy with relevant words to maximise the impact on everyday life.

Diving for people who have disabilities

Diving with people who have disabilities? Contrary to what some people may think, scuba diving is adapted to most disabilities.

Summarized

In short, it enables improve movement and coordination in a way that is much easier than in a terrestrial environment. Such exercises have a positive effect on the respiratory system and blood circulation as a result of learning how to breathe correctly. An individual who takes up diving has got an opportunity to learn and demonstrate independence by taking care of her/his own safety, as well as the safety of her/his companions. Diving encourages you to spend time with other people and, thus, gives an opportunity to be in a group whose members are people without disabilities, as well as people with disabilities, giving the sense of affiliation with a group and responsibility for its members.

Everybody can dive?

A person, who likes to start a course, needs a medical clearance of a doctor. The medical has to tell the scuba diving instructor that the person is fit for diving.

During a course everybody, disabled and abled students, have to meet the same performance requirements. A PADI Scuba Instructor can only certify students as all performance requirements are met for that course.

Some disabled divers will never met the performance requirements for a PADI Scuba Diver Course and/or PADI Open Water Diver Course. But this doesn’t mean that they can’t dive. For the persons who cant meet the performance requirements of a Scuba Diver or Open Water Course, there are other options to dive. Under direct supervision of a PADI/DDI Instructor the disabled person can participate in a PADI Discover Scuba Diving Program, or a DDI Try Dive Program. The difference is that the programs, PADI Discover Scuba Diving and the DDI Try Dive, are not certification levels.

It’s a first time scuba diving experience in a safe environment with a scuba dive instructor. First there will be a theory session, followed up by a pool session. There is an optional dive in the ocean till 12 meters for the divers who are confident enough and the instructor agrees to it.

Oceans 5

Dive centre Oceans 5 Gili Air became in 2014 a Disabled Divers International Instructor Training center. They offers DDI courses for disabled recreational scuba diver as DDI professional courses.

Disabled Divers International

Disabled Divers International (DDI) is a non-profit organization, with the aim to promote, develop and conduct disabled scuba diving training programs for professional and non-professional students. All board members are volunteers, dedicated to promoting and developing disabled scuba diving internationally.

Since its introduction in 2010, DDI has gathered extensive support and recognition within the diving industry and conducted both professional and non-professional programs all around the world. DDI professionals and DDI Dive Centers can now be found in 58 countries with more on the way, enabling disabled diving worldwide.

DDI programs are designed to work in cooperation with existing scuba diving training organizations and their training programs. DDI programs adds a new layer on top of the existing diver training, allowing individuals who would have difficulties fulfilling all requirements and standards to experience diving safely with modifications and enhancements to their training and or equipment.

DDI professional training adds to the diving professional a new set of tools and knowledge to train disabled divers safely and certify their students as a scuba diver, with varied levels of limitations depending on the student’s ability to perform program requirements and standards.

55 Aphasia Treatment Activities

In this post, you’ll find 55 aphasia treatment activities!

The activities are organized by expressive and receptive aphasia. Then further broken down into treatment ideas for severe, moderate, and mild impairments.

You’re welcome to download any of the free printable PDFs on the post. Bookmark this page to use during treatment. Or copy and print the activities.

For hundreds more handouts and worksheets, check out the bestselling Adult Speech Therapy Starter Pack on our shop!

Adult Speech Therapy STARTER PACK Speech-Language image 1

1. Aphasia Support Group

Free Senior happy women watching video online in smartphone Stock Photo

Help patients connect to an aphasia support group. Find a local group through university speech clinics, hospital programs, Facebook Groups, or non-profits.

Try the National Aphasia Associations support group finder (U.S. only).

Or look into an online group such as Virtual Connections.

2. Aphasia Needs Assessment

Complete a needs assessment to understand your patient’s needs and wants better. Use their answers to design person-centered treatments.

Gather a functional vocabulary inventory. Include names of people, pets, places, activities, etc. that are important to the patient.

Use the assessment by Garrett and Beukelman below (click for PDF). Or create your own.

PDF from The University of Nebraska-Lincoln

Expressive Aphasia

3. Teach Expressive Aphasia Strategies

word finding strategies aphasia

Teach patients with expressive aphasia the following word-finding tips. Practice these strategies with the aphasia activities listed below.

1. DESCRIBE IT

  • Who would use it?
  • What does it look like?
  • Where do you find it?
  • When would you use it?
  • Why would you use it?
  • How is it used?

2. SYNONYMS

  • Use a similar word.
  • For example, say “piano” instead of “organ”

3. OPPOSITE WORD

  • Use antonyms, or opposite words.
  • For example, say “not hot” instead of “cold”
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4. GROUP OR CATEGORY

  • Person, place, or thing.
  • Section of the store you’d find it in.

5. FIRST LETTER OR FIRST SOUND

6. GESTURES

Point or act it out.

4. Use Picture Cards

Open the Picture Cards and Picture Descriptions post on your browser. Or sign up to download the Free PDF.

Treatment Approaches

5. Constraint-Induced Language Therapy

constraint-induced therapy aphasia

This is an intensive approach for patients who want to improve verbal speech. Be aware that it discourages any other communication compensations, so it may not be the right fit for some patients.

The 3 Principles of Constraint-Induced Language Therapy:

Only speaking is allowed.

No compensations, including no gestures, writing, or AAC.

6. Semantic Feature Analysis

Semantic Feature Analysis helps a patient find a word (name a picture) by describing semantic features of the word.

These semantic features are: what group it’s part of, what action it does, an associated word, properties of the word, where it’s located, and how to use it.

Use Picture Cards and the Word Web below.

Click to download a free PDF Word Web.

From RecipeSLP.com

7. Phonological Component Analysis

phonological component analysis for aphasia

Phonological Component Analysis helps patients find a word (name a picture) by describing phonological features of the word.

Sound familiar? PCA is modeled after Semantic Feature Analysis. It uses a word web to help patients think of five phonological components of a target picture. These components are: first sound, another word that starts with that first sound, final sound, number of syllables, and rhyming word.

Use Picture Cards and create a Word Web Worksheet (available on our shop).

8. Verb Network Strengthening Treatment

The specific goal of VNeST is to improve word-finding and build sentences.

The therapist presents a verb. The patient then builds a sentence from this verb, filling in the WHO and WHAT.

See Aphasia Treatment Approaches for step-by-step instructions and a free PDF word list.

9. Recruit the Right Hemisphere (Intention Manipulation)

intention manipulation aphasia

Facilitate lateralization of language production to the right brain structures by having a patient complete a complex left-hand movement during a naming task.

Instructions:

    The patient completes a complex left-hand movement. For example, they open the lid of a box and then squeeze a rubber ball.

10. Melodic Intonation Therapy

Instructions:

    Write down a word or phrase. Show it to the patient.

• At this point, the patient is singing, and you are only tapping their left hand (no verbal or oral/facial cueing).

• To intone, the patient may use a sing-song voice. For example, with the word “apple,” the first syllable “ah” will be high-pitched and the second syllable “ple” will be low-pitched.

11. Scripted Conversation

scripted conversation aphasia

With this approach, the therapist helps a patient create scripts that will improve conversations in their daily life. An example is a script to order pizza over the phone.

Instructions:

1. Work with your patient to create 3 scripts that would improve their daily conversations. Each should be useful for your patient and the right level of difficulty.

2. In each script, include lines for both your patient and the conversation partner. For example, if the script is for paying a credit card bill over the phone, write lines for both the patient and the customer service agent.

3. Each script should have 10 turns.

4. During their turn, the patient will respond to what the conversation partner just said.

12. Response Elaboration Training

Pictures in a Book

The goal of Response Elaboration Training is to increase the number of content words that patients with aphasia say during a conversation. Content words are nouns, pronouns, main verbs, adjectives, adverbs, and prepositions.

This approach allows the therapist to follow the patient’s lead.

For example, a therapist may say, “Tell me about this picture,” and ask questions based on the patient’s answer. There are no wrong answers, and the therapist encourages longer utterances with shaping, modeling, and chaining.

13. Treatment of Underlying Form

treatment of underlying form

TUF was created to treat agrammatic aphasia. The goal is to increase syntactic complexity.

Using action pictures and notecards, the therapist helps the patient build sentences.

See Aphasia Treatment Approaches for step-by-step instructions.

14. Promoting Aphasics’ Communication Effectiveness

promoting aphasics communication effectiveness

PACE therapy uses conversations to improve communication.

First, the patient chooses a form of communication (talking, gestures, writing, AAC devices, Pictionary, etc.) Then the therapist and patient take turns conveying messages. Finally, the therapist gives cues and feedback.

Instructions:

    Work on practical messages that matter to the patient. For example, their name, phone number, or ordering at a favorite restaurant.

Severe: Expressive Aphasia Treatment Activities

15. Sing the Alphabet

Print, write, or otherwise have a large-print Alphabet available on one page. Cue your patient to “sing the ABCs” while pointing to each letter.

16. Automatic Phrases

Free Numbers Wall Decor Stock Photo

Print or write the following automatic phrases. Have patients say each of the series aloud, pointing to each number or word as they go.

1 2 3 4 5 6 7 8 9 10

10 20 30 40 50
60 70 80 90 100.

100 200 300 400 500
600 700 800 900 1,000

Monday, Tuesday, Wednesday,
Thursday, Friday, Saturday, Sunday

Spring, Summer, Fall, Winter.

January, February, March, April, May,
June, July, August, September,
October, November, December

17. Object Naming

object naming aphasia

Use physical objects in the environment or the Picture Cards for this activity. Substitute objects as needed. One by one, point to an object and ask the patient, “What is the name of this?”

For example, point to a:

18. Sentence Completion

Ask the patient to complete the sentence. Either read the sentence aloud or have the patient read the sentence. They may say or write the answer, depending on your treatment goals.

    The water is either too hot or too

19. Naming from Description

naming from description aphasia

Ask the patient to name what is being described. Either read the sentences aloud or have the patient read them. They may say or write the answer.

    This animal is black and white, is from China, and eats bamboo.

20. Category Naming

category naming aphasia

Ask the patient to name what category each set of words belongs to. Either read the words aloud or have the patient read them. They may say or write the answer.

    Strawberry, apple, banana, melon

21. Category Members

category members aphasia

Name at least 3 items that belong to each category. Or, name as many items from each category as you can in 1 minute.

ANIMALS

FOODS

PLACES

  • Historical
  • From movies
  • Beaches
  • Beautiful
  • Haunted

ENTERTAINMENT

  • Movies
  • TV Shows
  • Musicians
  • Actors
  • Award shows

HOUSEHOLD OBJECTS

  • Kitchen appliances
  • Bedding
  • Gardening tools
  • Cleaning supplies
  • Home office

22. Rhyming Words

Fill in the blank with the word that is being described. All of the answers rhyme.

23. Letter

aphasia treatment activities

Fill in the blank with the word that is being described. All of the words begin with the same letter.

24. Synonyms

Read each word. Think of a similar word, a word that has the same meaning.

25. Antonyms

antonyms aphasia

Read each word. What is the opposite word? A word with the opposite meaning?

26. Needed Items

free aphasia activities

Name three items you need to…

27. Complete the Series

Free Silver Spoon and Fork on White Textile Stock Photo

What word comes next in each series?

28. Naming Emotions

naming emotions aphasia

How would you feel in the following situations? What emotions would you feel?

Moderate: Expressive Aphasia Treatment Activities

29. Differences Between Words

Free Ceramic Dinnerware Stock Photo

What is the difference between each of these two words? (Provide picture cards as needed)

30. Twenty Questions

twenty questions aphasia

Have your patient guess each word by asking up to 20 questions. Questions must be yes/no.

If they struggle to come up with questions, model the activity: share a word and ask yes/no questions for them.

31. Complete the Sentences

complete the sentence aphasia

Read the following situations and respond as appropriate.

    You’re at a grocery store and a person’s cart is blocking the aisle. You make eye contact and say …

32. Giving Directions

giving directions aphasia activity

“Pretend that I’ve never done these activities before. How do I…?”

33. Definitions

“Pretend that I’m from another planet. “What is (a)….?”

34. Picture Descriptions

Presenting one photo at a time, ask the patient to describe each photo in as much detail as possible.

soccer football picture naming for speech therapy

cow kiss picture description for speech therapy aphasia, motor speech, visual neglect

kids reading picture description for speech therapy aphasia, motor speech, visual neglect

mama bird baby bird nest picture description for speech therapy aphasia, motor speech, visual neglect

Mild: Expressive Aphasia Treatment Activities

35. Conversation Activities for Aphasia (what would you do if…)

conversation activities for aphasia

What would you do if…?

36. Conversations Activities for Aphasia (getting to know you)

conversation activities for aphasia

Answer with as many details as possible.

    What is your favorite sports team and why?

37. Conversations Activities for Aphasia (would you rather…)

Free Trailer Van parked alongside Ocean Stock Photo

Answer with as much detail as possible.

    Live in the city or the countryside? Why?

Receptive Aphasia

38. Teach Receptive Aphasia Strategies

Free Close-Up Shot of a Person Writing on a Paper Stock Photo

Teach patients with receptive aphasia and their caregivers the following strategies.

1. GATHER SUPPLIES

Have a writing surface and utensil ready.

2. WRITE THE MAIN TOPIC

In large letters, write the main topic of your conversation at the top of the writing surface.

  • Example: ‘DOCTOR VISIT’
  • This will be a maximum of 3 words.
  • Capital letters may be easier for your loved one to read.

3. WRITE KEYWORDS.

  • Write down keywords below the main topic.
  • Add bullet points to the left of your keywords.
  • Pause for a moment while your loved one reads.

DOCTOR VISIT
• NEUROLOGY
• WEDNESDAY
• 10 AM

4. COMMUNICATE

  • Say what you want to say. Use short, simple sentences.
  • Avoid “talking down” to your loved one by maintaining your normal speech patterns.

5. ASK QUESTIONS

  • Ask your loved one questions to make sure they understood your message.
  • “Why are you going to the doctor on Wednesday?”
  • “What time is your visit?”
  • “Do I need to say it a different way?”

Treatment Approaches

39. Augmented Input

Free Macro Shot of Pictures Stock Photo

To improve comprehension, the communication partner ‘augments’ or adds visual input to spoken language.

The added visual input can be intermittent or continuous. Pause regularly to check comprehension.

Augmented input can include:

    Written keyword (the main topic, topic changes, key ideas, questions, response choices, etc.)

40. Supported Conversation for Adults with Aphasia (SCA)

With SCA, treatment focuses on the communication partner, not the patient.

The goals are to:

1) Acknowledge the competence of the person with aphasia

2) Help the person with aphasia reveal their competence.

Teach the communication partners the following supportive techniques:

How The Communication Partner Can Acknowledge Competence

  • Use a natural tone of voice
  • Choose adult/complex topics of conversation
  • Express that you know that the patient knows more than they can communicate
  • Attribute communication breakdowns to your own limitations as a communicator
  • Be open when you have to turn to someone else to get information

How T he Communication Partner Can Reveal Competence

  • Use short, simple sentences and visual information (gestures, written keywords, and pictures)
  • Reduce distractions
  • Observe the patient’s non-verbal social cues to help understand their level of comprehension
  • Summarize what you believe the message to be and ask for clarification
  • Ask yes/no questions
  • Ask one question at a time
  • Ask specific questions. For example, “For lunch, I can make a sandwich or soup. Which one do you want?” (versus “What do you want for lunch?” which is too open-ended.)
  • Request more information by asking the patient to gesture, point, write, etc.
  • Give the patient plenty of time to respond

How The Communication Partner Can Verify the Message

Summarize the patient’s message by asking, “Let me make sure I understand” and by:

  • Repeating the message and/or
  • Adding gestures or writing down keywords and/or
  • Expanding what you think they were trying to say and/or
  • Giving a brief summary of longer conversations

Severe: Receptive Aphasia Treatment Activities

41. Body Part Identification

Free Woman In Red Tank Top Smiling Stock Photo

Ask the patient to, “Point to your…”

42. Identify Objects

functional aphasia activities

Ask the patient to “Point to the….” (Skip or substitute objects as needed.)

43. 1-Step Directions

Have a pen and piece of paper ready. If neither is available, substitute any two objects that are easy to pick up, such as a cell phone or book. Ask the patient to:

44. Simple Yes/No Questions

45. Complex Yes/No Questions

aphasia activities for adults

46. Identify Words

Write down a pair of words on a whiteboard, then say one of the words aloud. Ask the patient to point to the word you said. Erase, then write the next pair of words.

47. Identify Phrases

identify phrases aphasia

Write a pair of phrases on a whiteboard. Say one of the phrases aloud. Ask the patient to point to the one you said.

Moderate: Receptive Aphasia Treatment Activities

48. Follow Written Directions #1

Draw or print out the numbers 1, 2, and 3 followed by lines (see example below). Allow plenty of space for your patient to write on each line. Then, ask your patient to read and follow the directions (1-5).

Example:

49. Follow Written Directions #2

Draw or print out the numbers 1, 2, 3, 4, and 5 followed by lines (see example below). Allow plenty of space for your patient to write on each line. Then, ask your patient to read and follow the directions (1-5).

Example:

50. Identify Sentences

Free Photo of Signpost Stock Photo

Write a pair of sentences on a whiteboard. Say one of the sentences aloud. Ask the patient to point to the one you said.

    The second door to the left ………. The second door to the right

51. Paragraphs

Read each paragraph aloud, then ask the related questions.

1. Kim loves rescuing stray cats and dogs. She once found an abandoned cat who had no tail. Kim adopted the cat and named her Misty.

  • What does Kim love to do?
  • Who did she find?
  • What did she name it?

2. After Terrance retired, he began to make clocks in his workshop. He made clocks out of rocks. He made clocks out of pictures. He even made clocks out of crab shells!

  • Where did Terrance make clocks?
  • When did he start making clocks?
  • What did he make clocks out of?

3. Maisy Dobbs is a mystery series about an English detective. After working as a nurse during World War I, Maisy becomes a psychologist. She solves murders using psychology, detective work, and her mysterious intuition. During one case, Maisy must find the psychic who killed a rich man’s wife. Most of the psychics are frauds, but the killer is not. Maisy must outsmart the suspect before she strikes again.

  • Where is Maisy from?
  • How does she solve murders?
  • Who killed the rich man’s wife?

Mild: Receptive Aphasia Treatment Activities

52. Reading

aphasia reading activities

Cue your patient to, “Read the paragraph aloud, then summarize what you read.”

1. Merida is a colonial city on the Yucatán Peninsula of Mexico. It has colorful buildings, hot weather, and friendly people. Merida also has cenotes which are natural, freshwater pools. Both locals and visitors love to swim in their clean, cold waters. But where do cenotes come from? A giant asteroid hit the Yucatán Peninsula 66 million years ago. Scientists believe that the impact created the cenotes. This same asteroid is also thought to have caused the extinction of the dinosaurs!

2. Mindfulness is paying attention to the present moment without judgment. Mindfulness can help people manage their chronic pain. In one study, people who take medication for chronic pain learned mindfulness. Scans of their brain showed that mindfulness decreased activity in their pain centers. By practicing mindfulness every day, some of those people now use less medication! There are many free mindfulness exercises online.

53. Everyday Reading #1

Cue your patient to, “Review the everyday reading material, then answer the questions”:

EVERYDAY READING MATERIAL:

aphasia treatment activities

QUESTIONS:

  1. How much is an Iced Green Tea?
  2. Which item is the most expensive?
  3. Which item is the least expensive?
  4. Much much would all 3 items cost?

54. Reading #2

Cue your patient to, “Review the everyday reading material, then answer the questions”:

EVERYDAY READING MATERIAL:

aphasia activities for adults

QUESTIONS:

  1. Who wrote the card?
  2. Who received the card?
  3. What happened to the person who received the card?
  4. What food was mentioned?

55. Everyday Reading #3

receptive aphasia activities

QUESTIONS:

  1. What type of menu is this?
  2. Which items cost $4?
  3. How much is an Iced Coffee?
  4. How much would a Mocha plus an Irish Coffee cost?
  5. What are the 3 tea options?

Handouts & Worksheets

Aphasia Pack PDF Patient Handouts Worksheets Resources image 1

Adult Speech Therapy STARTER PACK Speech-Language pathology materials

WELCOME!
We are Chung and Miwa.
We aim to be your compassionate mentors (onee-chans).

DISCLAIMER. This website is an educational and informational resource for speech-language therapy professionals. It is not a substitute for working with a speech-language therapy professional. I cannot guarantee the outcome of following the recommendations provided and my statements about the potential outcome are expressions of opinion only. I make no guarantees about the information and recommendations provided herein. By continuing to use this website you acknowledge that I cannot guarantee any particular results, as such outcomes are based on subjective factors that are not within my control. Therefore, following any information or recommendations provided on this website are at your own risk. If you need speech-language therapy advice, you should hire a speech-language therapy professional or other professional. Copyright © 2022 ADULT SPEECH THERAPY | Powered by Astra WordPress Theme

Source https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367780/

Source https://www.oceans5dive.com/blog/diving-disabilities/

Source https://theadultspeechtherapyworkbook.com/55-aphasia-treatment-activities/

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