Question
During aphasia group therapy, do you use phonemic cues when addressing word-finding difficulties?
Answer
This question initially arose during a recent online presentation on use of group therapy that is consistent with a social approach to aphasia (Vickers, 2010). In his excellent overview of treatment of aphasia, Brookshire (2007) points out that aphasia groups may have different purposes; e.g., psychosocial or life participation groups versus language stimulation groups. The first two modes are consistent with a social approach to aphasia therapy that focuses on natural interaction in conversation (Simmons-Mackie, 2001). In a language stimulation group therapy mode, leaders might pursue providing more structured experiences that aim to help reduce impairments. The use of cueing hierarchies for treatment of anomia in individual therapy has been well described (Brookshire, 2007). Depending on the structure, purpose, and setting of the group, a clinician might choose to work with cueing of word retrieval through various cueing strategies or tasks. However, a group structured this way does not capture the essence of true conversation.
This answer considers the question about use of phonemic cueing in the context of aphasia groups offered by leaders who embrace a more social approach to aphasia where interaction is the focus. Rather than trying to improve word retrieval in a specific group member through phonemic cueing, the group leader seeks to create an atmosphere that leads to spontaneous and possibly multi modal communication. The focus is on overall success of communication versus retrieval of a specific word verbally (Bernstein-Ellis & Elman, 1999). If a person with aphasia (PWA) is unable to retrieve an exact word in conversation during group therapy, it does not have to prevent communication. If the group leader stops the flow of conversation to use phonemic cueing with an individual member, he or she has now moved from being engaged in listening, to facilitating or correcting the speaker. At this point, there is no longer an authentic exchange.
To encourage the flow of communication when an individual with aphasia is struggling in a group therapy setting, I use active listening and reflection or paraphrasing of ideas that I understand through all the communication channels that I observe the PWA using. I find that using these methods assures the speaker with aphasia that their overall content is understood, and encourages further communication through any means possible. If a speaker strongly wants to get a certain idea across and is frustrated, it is helpful to both model and ask for the use of multi modal communication, such as gesturing, drawing or writing. Another option is to ask limited alternative questions or use written choices (Garrett & Beukelman, 1992). It can be even more powerful if the leader asks the other members of the group to try to help their peer by asking questions of their own if they are able. All of these methods may lead a given member to retrieval of the desired content. Finally, I am a strong believer in the judicious use of a strategy Oelschlaeger (1999) has termed the use of "enter the word search" to assist the speaker. According to Oeschlaeger's research, a listener with shared experiences and context with the speaker with aphasia may be able to assist during moments of communication breakdown by offering the speaker a "candidate word" when given a direct or indirect invitation to "participate in the word search". If the word is the one that the speaker had in mind, he or she may take that word, incorporate it into the utterance, and then continue with the thought.
This Ask the Expert was taken from the course entitled: A Social Networks Approach to Aphasia: Group Therapy and Communication Partner Training presented by Candace Vickers, Ph.D., CCC-SLP.
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Dr. Candace Vickers is the author of Communication Recovery: Group Conversation Activities for Adults (1998). In 1994 she created and initiated the Communication Recovery groups, which use trained communication partners in groups for persons with aphasia at St. Jude Medical Center. Candace has 30 years experience in treatment of aphasia and other neurogenic communication disorders and has been a National Aphasia Association State Representative for the last ten years. Candace is an adjunct faculty member at both Chapman University in Orange and California State University, Fullerton in Southern California.