ouc IN ALTVA,

AUTONOMOUS
U.A. UNIVERSITY OF CHILE

FACULTY OF HEALTH SCIENCES

COURSE OF PHONE AUDIOLOGY

EVALUATION
AND
TREATMENT FOR
APHASI
AS
Name: Camila Ortega Soto
Boarding center: Hospital M. H.
Angol
Date: 05/22/2018
Teacher: Carolina
Fernández
 Aphasia
It is a language disorder as a result of a
injury to the brain areas that control its emission and
understanding, as its components (Semantic,
phonological, morphological and syntactic), however
Depending on the location of the injury, these
components may be damaged or preserved.

(Estabrooks & A, 2005)

 Apha
sia
Exam
review

Treatment.

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 Assessment
V Identify the existence of a problem
V Find the processes that are compromised.
V Provide a diagnosis
V Specify the type of aphasia and plan language rehabilitation.
V Determine the severity of the disorder.
V Establish a differential diagnosis
V Describe verbal (oral and written) and non-verbal
communicative behavior.
V Determine the factors that facilitate language recovery
V Provide a forecast
• Document changes.

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 ASSESSMENT

V Boston Test (H. Goodglassy Kaplan, 1996)

V Porch Communication Skills Index “PICA” (Porch, 1981)
V Language protocol for aphasic patients (González, 2000)
V BETA. Battery for the evaluation of aphasic disorders Cuetos,
González (2009)
V The Brief Aphasia Assessment (EBA)
V Test for evaluation of aphasias “MEMORIZA”
V Minnesota Test for the differential diagnosis of aphasia
• western aphasia battery

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 BOSTON TEST FOR THE
DIAGNOSIS OF APHASIA (H.
Goodglass and Kaplan, 1996)

> Exclusive language skills exam

> It is a test specifically designed to assess the ability to name visual stimuli .

> The task consists of naming each of the 60 pictures, presented in order of
increasing difficulty, in a maximum time of 20 seconds.

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 The exploration is divided into two
scales: LISTENING
WRITTE AND
COMPREHENSION
N AREAS:
EVALUATION

Oral
production

Comprehensi
on
Production
auditory
of the
language Understanding
written of
written
INCLUD language
ES
Speech Characteristics Profile and Severity Scale
 Boston test for the diagnosis of aphasia.
Short format
I- TALK ABOUT CONVERSATION AND
EXHIBITION A -Simple social responses B -Free conversation C -
Description of a picture D- Narrative speech
(Comics)

SEVERITY SCALE AND PROFILE IN APHASIA

II- LISTENING COMPREHENSION A- word comprehension (D. of words)
B - orders
C - complex ideational material
III - ORAL EXPRESSION
A - Articulatory agility B- automated sequences C -
Repetition
D - Denomination

IV - READING
A - Basic symbolic recognition
B -Pair No.
B - Word Identification
C - Phonetics
D - Reading aloud f - Reading comprehension

V - WRITING A -Mechanics of writing

B -Basic coding skills 9

C - Written designation of drawing

D - Narrative writing
Communication skills index
Porch “PICA” (Porch, 1981)

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> It contains 18 subtests, each verbal, 8 of them with 10 items, 4 of them
gestural and 6 graphic.

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Minnesota test for the differential WESTERN Aphasia Battery
diagnosis of aphasia

Hearing disorders Evaluates verbal comprehension, oral

expression, naming, repetition, praxis and
Visual and reading disorders constructive skills
Speech and language disorders
Visuomotor and writing disorders.
Disorders of numerical relationships. Usefulness of diagnosis and treatment of
aphasia.

The results will place the aphasic patient

in one of the 5 recovery prognosis groups Many of the items taken from the
that the author proposes. Boston test.
__
__

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 It allows you to explore all the
processes involved in language
BETin all its modalities, both oral
and written, and both in
A comprehension and production.

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 BETA: is made up of 30 tests
6 blocks of five tests each.
1. Oral comprehension.

Objective: evaluate all the processes involved in the

understanding of words, from the identification of
phonemes to semantic processes through
V Phoneme discrimination
V Auditory lexical decision
V Word-picture pairing
V Word repetition
• Repetition of pseudowords

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2. Oral production. Aim :
Analyze oral production, from lexical-semantic processes to purely
phonological ones, through:
- Naming drawings of objects
- Naming stock drawings
- Naming famous people - Naming definitions
- Verbal fluency
3. Semantics. Aim :
evaluate purely semantic processes through the use of drawings and
words, through
:- Semantic association
- Object-action association
- Definition-word pairing
- Synonym Matching
- Point out the different

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4. Reading. Aim:
evaluate the components of the reading system (letter identification,
orthographic lexicon, grapheme-phoneme conversion mechanism, etc.),
through
:- Letter naming
- Visual lexical decision
- Matching word drawing
- Reading high and low frequency words
- Reading pseudowords
5. Writing. Aim :
evaluate the writing of both regular words and spelling
arbitrary, through
: - Point to the letter
- Written naming of objects
- Copy from uppercase to lowercase
- Dictation of words arbitrary spelling
- Pseudoword dictation

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• 6. Prayers. Aim:
• evaluate the comprehension and production of
sentences, through:
V - Spoken sentence-drawing pairing
V - Written sentence-drawing pairing
V - Sentence comprehension
V - Digit Test
• - Description of a sheet

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 LANGUAGE EVALUATION FOR
APHASIC PATIENTS (R. GONZÁLEZ, 2000)

Degrees and
Severities
0-1: Severe
2-3: Moderate
4-5: Mild

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 MINI APHASIA EVALUATION
PROTOCOL (R. González, 2000 )
• 1- EXPRESSIVE LANGUAGE
1.1 Speech
1.1 Oral speech
1.1.1 Oral fluency:

- Melodic line (intonation) - Phrase length

- Articulatory agility
1.1.2 Content
1.1.3 Paraphasias
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1.1.4 grammatical form

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1.2 . automatic language
1.2.1 numbers (1-10)
1.2.2 . Days
1.3 repeated language
1.3.1 . Words (10)
1.3.2 . Phrases (5)
1.4 Denominative language (Plates)
1.4.1 . Objects
1.4.2 . Actions
1.5 Fluency
1.5.1 Semantic fluency (1min)
1.5.2 Phonemic fluency (3min)

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2- COMPREHENSIVE LANGUAGE
2.1 Auditory recognition
2.1.1. objects
2.1.2. Actions
2.2 Token Test
2.1.2. Part I
2.1.3. Part II
2.1.4. Part III
2.1.5. Part IV

2.3 Comprehensive discourse (reading of

Andeanism) 2
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3- SPELLING
3.1. oral spelling
3.2. Oral spelling comprehension

4- WRITING
4.1. . Automatic writing
4.2. Dictation (Words – Phrases)
4.3. Copy (Words-Phrases)
4.4. Descriptive writing (Plate 1 of the Boston test)

5- READING (What sheet corresponds to this word?)

6-ORAL READING (Words and Sentences)

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7- WRITTEN CALCULATION (Addition, subtraction,
multiplication and division)
8- VISUAL (visual-visual pairing)
9- COPY OF FIGURE
10- PANTOMIME (Understanding and Expression of Pantomime)
11- COMMUNICATIVE PROFILE

TYPE I Talkative Active(+Initiator/

+Responder).
TYPE II Talkative Passive(-
Initiator/+Responder).
TYPE III Talkative No
Communicative (+Initiator/-
Responder).
TYPE IV Talkative Inactive(-Initiator/-
UNDERSTANDING AND SPOKEN EXPRESSION
a) COMPREHENSION
b) REPETITION
c) DENOMINATION
d) SPEAKS
UNDERSTANDING AND WRITTEN EXPRESSION
e) READING
f) WRITING
OTHER FUNCTIONS TO BE EXPLORED WITH THE TEST
g) ATTENTION, ANALYSIS AND PHONEMIC SYNTHESIS
h) MEMORY
i) PRAXIA
16-Orophonatory praxia (imitation of a mouth movement made by the interviewer)
COMPLEMENTARY BEHAVIORAL EVALUATION
 Aphasia Treatment
The treatment to be implemented will depend on many factors: the
degree and state of the person's disease, the cause of the brain
damage, the area of the brain that was damaged, the degree of brain
injury, and the age and health of the individual. Additional factors
include motivation, the tendency to use one hand more than the
other, and educational level.

Therapy for overcoming aphasia focuses on improving an individual's

ability to communicate using the person's remaining communication
abilities, restoring language abilities to the extent possible,
compensating for language problems, and learning other methods to
overcome aphasia. communicate.
 The goals of aphasia treatment are:

Reintegrate or remediate the aphasic's ability to speak,

understand, read and write
Help the person with aphasia develop strategies that
compensate or minimize language problems
Locate the associated psychological problems that
compromise the quality of life of the aphasic person and their
family members.
Help family and loved ones get involved in communicating
with him.
THERAPEUTIC PROGRAMS
TO IMPROVE EXPRESSION
VERBAL
1) Therapy to work
perseverations:
 Candidates: Moderate listening
comprehension
preserved, ability to name by
confrontation.

Variables that
induce Establish a breaks and
perseveration stop when distractions
control enter a
new homework
Increase of
the Hide answers
conduct previous
perseverative
 Specific strategies for
treatment program
aphasic perseveration:

Time Prayer
gesture help Drawing
interval descriptive

Sentence Aid
Graphic help oral reading
to phonemic
complete

speak or sing
Repetition
in unison
intonation therapy
melodic
 Candidates: No right hemisphere involvement,
poorly articulated non-fluent speech, when singing
familiar songs there is no articulatory difficulty, poor
repetition, preserved listening comprehension, good
attention.

Level º2: from Level º3: from

Level 1: from
humming to humming to
humming to
spontaneous spontaneous
spontaneous
response, taps the response, sung
response
patient speech
3) Syntactic production program for
aphasia.
 Candidates: agrammatic oral production (with
omissions), preserved listening comprehension,
good attention and memory and understands
objectives
of the program.

TestA: requires that the

patient completes a stimulus
with the help of a model like
answer to a question

Test B: requires that the

patient completes a history
using the intended stimulus
without benefiting from the model
 4) Voluntary control of
involuntary productions
 Sequence of activities
• Reading aloud towards naming by confrontation.
THERAPEUTIC PROGRAMS FOR
IMPROVE EXPRESSION
VERBAL
 5) Visual action therapy
• Candidates: Left hemisphere lesion, severe (global) aphasia
with limited ability to communicate. Moderate to severe oral
and limb apraxia. Ability to produce spontaneous, alert,
cooperative and motivated gestures with good attention.
Step 1) * Match objects and drawings
- Place objects on the drawings
- Place the drawings on the objects
- Point out the objects
- Point out the drawings
Step 2) Training in the use of objects
Step 3) Demonstration of the action images.
Step 4) Execution of the action images orders
Step 5) Pantomime demonstration
Step 6) Pantomime recognition
Step 7) Production of pantomimes
Step 8) Demonstration of hidden object representation
Step 9) Production of gestures for hidden objects
Steps 1-9 use: Real objects; drawings of objects; action images
Steps 5-9 to use: Use only action images
Steps 5-9 use only the drawings of the objects
6) Drawing program
communicative
 Candidates: Inability to communicate the
desired information through speech or
writing, ability to use marker and copy
one-dimensional forms, preserved visual memory,
good visual attention capacity.
Steps:
1)Basic semantic/conceptual knowledge
2)Knowledge of the properties related to the color of
objects
3)Recognize objects of various shapes
4)Copy geometric shapes
5)Complete drawings with omitted external and internal
features.
6)Draw objects with characteristic shapes from memory
7)Draw objects on command from stored representations.
8)Draw objects within established categories
9)Creating drawings: animals and means of transportation
10) Draw scenes with vignettes
7) Therapy with anagrams, copies and
memory
Candidates: Aphasia, agraphia, difficulty writing, reading
comprehension for isolated words, partial knowledge of
word forms, visual memory.
 Steps:

2)Writing of 3)Select and 4)Second attempt

stimulus with write with of denomination
anagrams and anagrams and by confrontation
copy copy written
of the word a word
8) Communicative approaches
augmentative and alternative
Candidates: Global aphasia, significant disorder in verbal
expression, significant disorder in listening
comprehension.
 Method:

Phase 1: Phase 3: Use

Phase 2:
Learning the of method
Creation of
mechanisms outside the
sentences.
CAA clinical setting.
 PROGRAMS
THERAPEUTICS FOR
IMPROVE UNDERSTANDING
AUDITORY
9) Treatment for aphasia
Wernicke
 Steps

2) Reading aloud 4) Understanding

1) Reading high 3) Repetition auditory
comprehe
nsion • Read out • Repeat • Correctly
Match a the select the
loud
word words pictorial
the stimuli
written in only representation
letters with of a group of
the six for each
help of word, after
the hearing the
drawin word uttered
g by the
therapist
(without the
help of written
stimuli)
 10) A cognitive approach to
increase listening comprehension
• Candidates: Good alertness and stamina without signs of
notable fatigue, moderate to severe auditory comprehension
deficit, cognitive problems, good visual perceptual ability,
adequate basic graphomotor abilities, good ability to work
independently on homework assignments .
 Therapeutic tasks:
• Attention tasks
• Conceptual knowledge tasks (leftover drawings, size-weight
judgment)
• Presentation of tasks and cognitive approach scoring to increase
listening comprehension
• Assignment of work to do at home.
 Ardila, A. (2006). THE APHASIAS.
Helm-Estabrooks, A. (2005). Manual of aphasia and aphasia therapy. Buenos Aires. Panamericana Medical Editorial.
Ardilla, A., Huidor, C., & Mendoza, V. (2012). A basic neuropsychological assessment battery. Neuropsychology,

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