This text-based course is a written transcript of the live event, “Thematic Language Stimulation” presented by Shirley Morganstein and Marilyn Certner Smith, on April 5, 2012.
>> Amy Hansen: It is an honor to introduce Shirley Morganstein and Marilyn Certner Smith who will be speaking to us on “Thematic Language Stimulation.” Shirley Morganstein and Marilyn Certner Smith collaborated together in formulating and developing Thematic Language Stimulation. Their work has been presented at state and ASHA speech and hearing association conventions and is described in chapter 16 of Roberta Chapey’s 2008 edition of Language Intervention Strategies in Adult Aphasia. In 2004, they formed a life participation private practice in New Jersey called Speaking of Aphasia. Since then, they have enjoyed the partnerships formed with their clients in getting back to life as well as the opportunity to teach courses on topics relevant to aphasia. Welcome both Shirley and Marilyn. Thank you so much for sharing your expertise with us today.
>> Shirley Morganstein: Thank you Amy and thank you to all the participants today. Thematic Language Stimulation (TLS) grew out of a relationship, therapeutic and interactional, that Marilyn and I developed during our professional journey for over 35 years. We first met at Rusk Institute for Rehabilitation in New York City, and we wound up having offices right next to each other. This was an environment which was in the golden age of rehab where people were able to share questions and observations very easily as well as ideas about aphasia therapy. We found that we were both creating materials for our patients and began to share that. During 1982, we put together the first edition of Thematic Language Stimulation. Since then, we have developed the system. We have taught it to speech-language pathologists around the country and we do believe that it has potential for a select group of individuals with aphasia. The format for the course today will be strictly didactic and we are hoping it will inspire you to create some thematic language stimulation modules of your own.
Definition of TLS
To understand the thematic language stimulation philosophy, you need to know what it is. Our definition of thematic language stimulation is a systematic method of aphasia therapy that employs thematically-related vocabulary in multimodality stimulation, targeting changes in language processing for functional communication. We will break down this definition for you.
Thematic language stimulation is a systematic method of aphasia therapy. It becomes systematic by arranging the material in a hierarchical manner with the best modality first which is speaking, understanding, reading and writing. We would begin there and work up hierarchically to the ones that are most difficult. Similarly, we use the easiest stimulus response formats first and then work up. It is systematic because of what we call the “Alice in Wonderland phenomenon” which is basically “you begin at the beginning, you continue through the middle, and you stop when you come to the end.” You will see, as we go further, the development of the material is very clear in terms of the progression, and it helps to keep it systematic and not random.
The second element of the definition is that it employs thematically-related vocabulary in multimodality stimulation. Why use thematically-related vocabulary? Meaningful content and personal relevance heighten therapeutic effect and in the context, the themes provide that meaningful content and relevance. We believe that when you take vocabulary that is related thematically, it capitalizes on the organized systems that are within the brain that are already well established. You do not have to create new ones. You have to tap into the ones that are already there. When material is thematic, it makes it so much easier to do that.
Multimodality stimulation really flows from the Schuellian notion that language involves four modalities: speaking, understanding, reading and writing. Schuell (1964) felt that all remediation in aphasia therapy should employ all of these modalities in the same session in order to enhance the therapeutic effect. You do, however, have to be at the right level in each modality and we know that people with aphasia operate very differently across those modalities. In every session, there has to be a sensible progression of activities and task requirements. I think one of the most detrimental aspects of some aphasia therapy is that it is random, unorganized, and not sensible. This puts a cognitive burden on people with aphasia, as they will need to organize what we are giving them to work with.
The fourth element of the definition is that TLS actually targets changes in functional communication. This is a very brave theory to say that the therapy actually impacts functional communication and not necessarily a clinical skill.
Our hypothesis is that you actually change the way the brain is working by working the brain. In order to understand this notion, we will digress and talk about the neurobiological evidence for brain work and how that neurobiological work actually changes the brain.