Broca's aphasia

Intervention
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INTERVENTION

In some instances an individual will completely recover from Broca’s aphasia without treatment. When treatment is necessary, the most common treatment is therapy designed to improve an individual's ability to communicate by helping the person to use remaining abilities, to restore language abilities as much as possible, to compensate for language problems, and to learn other methods of communicating. 

 

The primary treatment for most causes of Broca’s aphasia is speech therapy, which is begun as soon as the patient's condition allows. There are no drugs available to cure or treat Broca’s aphasia. The speech therapist works with the patient to strengthen his or her remaining language skills and to find ways to compensate for the skills that have been lost. Techniques might include exercising the facial muscles, repetition of words, using flash cards to improve memory of object names, using pictures of objects and activities to communicate with others, completing reading and writing exercises in workbooks, and using computer programs to aid in speech, hearing, and reading comprehension, as well as recall.

 

Recovery from aphasia depends upon the severity of the brain injury. More than half of the patients who have symptoms of aphasia after a stroke, infection, head injury, or as a result of a brain tumor will recover. While people who are left handed are more likely to develop aphasia after a brain injury, they tend to recover more fully. This is because they have language centers on the right and left side of the brain so language abilities can be recovered from either side. Surgery is only used to treat the cause of aphasia, such as to reduce pressure from a brain tumor or to reduce swelling from head trauma.

 

The following intervention techniques may be helpful in working with a patient who is suffering from Broca’s Aphasia:

 

 

  1. Confluent, effortful. halting, and uneven speech.
    1. Tap foot, hands or use metronome to create pace and maintain fluency.
    2. Relaxation may help with overdone effort.
    3. Taking a deep breath before speaking may help to relax speech muscles.
  2.  Limited verbal output, short phrases, and short sentences.
    1. Expand the patient’s utterances.
    2. Work on word retrieval.
    3. Use words meaningful to the patient.
    4. Use imitation. The clinician starts with short phrases and sentences and gradually expands the length.
  3. Misarticulated and distorted sounds.
    1. Articulation Therapy stressing placement for sounds.
    2. Opening mouth wider
    3. Reducing rate of speech
    4. Use of short sentences.
  4. Agrammatical or telegraphic speech, which is very often limited to nouns and verbs. Omissions of conjunctions, articles, and prepositions are also noted.
    1. Build on what the patient uses by adding to their utterances.
    2. Imitating the speech of clinician. Start with short sentences and gradually add to the length.
  5. Impaired repetition of words and sentences, especially the grammatical elements of a sentence. 
    1. Start with repetition of words.
    2. Progress to 2 word phrases.
    3. Progress to three word sentences and beyond when ready.
    4. Start slow and work toward normal speech rhythm.
    5. Imitation is easiest.
    6. Story completion
    7. Answering questions from a story or picture.
    8. Describing a picture.
    9. Sentence completion.
  6. Impaired naming, especially confrontation naming. 
    1. Require patient to name pictures or objects.
    2. Provide prompts and cues to lead patient in the direction of the intended word. These cues may include: the first sound of the word, sentence completion, it rhymes with, function, location, word spelled out loud, and synonym/antonym.
    3. Choose words that are useful to the patient.
    4. Work on carryover by giving the caretaker a list of words that were worked on with success in the therapy session as well as techniques used for elicitation.
    5. Work on categories, associations, word combinations.
    6. Use pictures that have meaning to the patient. Family picture albums can help with important names.
  7. Better auditory comprehension of spoken language than production.
    1. Work on production techniques addressed previously.
    2. MIT therapy.
  8. Difficulty understanding syntactic structures.
    1. Use pictures showing syntactic structures.
    2. Act out sentences and stories.
    3. Use gestures.
  9. Poor oral reading and poor comprehension of material read.
    1. Start with short stories that have a lot of pictures.
    2. Use materials that have meaning to the patient-for instance, a church bulletin from their church, a grocery add from the paper, a letter from a friend, the horoscope, a section of the paper that they are interested in, a greeting card, etc.
    3. Ask questions while as they are reading to reinforce meaning.
  10. Writing problems, which are characterized by slow and laborious writing full of spelling errors and letter omissions. 
    1. Use techniques as you would for a beginning writer. Depending on the level that the patient is functioning, pointing out letters that the clinician sounds out sounding may be the beginning point. After that is mastered, tracing letters, copying letters and then writing letters should be performed. Then the clinician spells words letter by letter, says words and the patient writes them and copies structured sentences. Finally, the patient writes sentences to dictation and writes sentences using words from the clinician.
    2. Teach survival writing skills. These include: signing forms, writing shopping lists, writing checks, writing notes to friends in cards or letters.
    3. Practice drills with words used for the above purposes.
  11. Monotonous speech
    1. Practice intonation
    2. Tape record patient’s speech for feedback
    3. Singing therapy.
    4. Imitating the clinician.
    5. Exaggerating inflections.
  12. Apraxia of speech

            a.   Develop volitional vocalization with a small repertoire of vowels and

                  consonant-vowel combinations.

            b.  Use drawings to show placements of sounds.

            c.   Use progressive approximation. Make sounds out of sounds that they        

                  are able to produce.

            d.   Use phonetic contrasts.

            e.   Imitation may not be helpful. Usually if the patient imitates, the

                  communication has little meaning to them.

f.        Repetition drills for sounds, words, phrases and sentences. Start with sounds.

g.       Use of an alternative communication device may be helpful.

h.       Neurobehavioral reorganization approaches to treatment can be taught, such as the use of gestures and melodic intonation therapy.

i.         Many repetitions are needed to stabilize newly acquired responses and make them automatic.

j.        Intensive treatment is required and should consist of massed practice over a long time.

k.      Treatment of prosody should accompany articulation treatment.

                  l.     Contrastive stress drills.

 

  1. Dysarthria
    1. Respiration exercises may be needed.
    2. Sensory stimulation.
    3. Muscle strengthening.
    4. Modification of muscle tone. Progressive relaxation, shaking and chewing exercises, biofeedback.
    5. Posture and speaking position.
    6. Adjust utterance length to match the patient’s respiratory capacity.
    7. Contrastive stress drills. The clinician says a sentence and then asks a question with exaggerated stress.
    8. Articulation therapy.
    9. Prosody activities.

 

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