66 y/o, 10 months post stroke, 4 week program, moderate Wernicke’s aphasia
Clients with Wernicke’s aphasia experience phonological (sound) mix-up, so direct treatment is often unsuccessful. Using indirect treatment is the key to improvement of the client’s speech and understanding. After the client has reached a certain level of success, he is then better equipped to have more direct, but still largely contextual, treatment. A writer and teacher before his stroke, he wrote a wonderful guide to inspire other people with aphasia with the help of his spouse during his time at the program.
• His speech was approximately 30% intelligible, though a skilled listener could understand the gist of the message
• No attempt to repair communication breakdowns
• No response to facial or other listener cues showing listener confusion (puzzled facial expressions, etc)
• Decreased auditory comprehension—needed help about 50% of the time using written and spoken assistance to help the listener understand
• Profound reading and writing problems. Even copying single words was very difficult for him
Goal 1: to use other forms of communication to help listener understand
• Initially, he needed maximum help to use gesture to help his speech output
• He began to use strategies he’d been shown and better gestures with moderate assistance
• At the end of therapy, he only needed occasional cues to use other forms of communication when his speech wasn’t helpful
Goal 2: Speak intelligibly and on-target 70% of opportunities
• At first, his speech was tangential (off-topic) and only 30% intelligible
• He wasn’t aware of his errors so he didn’t try to fix them
• By the third week, as his self-monitoring increased, he repaired his speech errors more independently
• At the end of the program, his speech was 72% intelligible
Results for this client may have been even better, but he experienced medical complications the final week of his treatment. He has since received a long series of treatments and is working his way back to his former level day-by-day.
• Formal Evaluation:
He made the most gains in answering yes/no questions (35%), information content in conversation (30%), as well as sentence completion and fluency in conversation, both of which improved by 10%.