Evaluation and Treatment

EVALUATION

First, I spend time on the phone and/or e-mail, usually with a Helper.  A Helper is often a family member of a Person with aphasia.  The Helper tells me about the aphasic person’s path so far.  The Helper asks me questions.  This time can be lengthy, and is not billed.  You will speak with me, and not an intake clerk.  This initial interview allows me to focus the evaluation when we meet.

Next, the evaluation usually takes 1 to 2 hours.  I find out what the client can do, can’t do, and points in between.  I find out what activities are important to the Person and which are important to the Helper (yes, I know, a Helper is a person too).  Because I am traditionally trained, I write a diagnostic phrase and a severity level, and then flesh it out with details.

Finally, the Person with aphasia and Helper and I work out goals:  what do you want to do that you can’t do now, or can’t do easily.  Examples:  e-mail to grown children,  relay a phone message, pay the bills, say your own name.

TREATMENT

Two poles have characterized aphasia treatment over the past 70 years or so:  1) improve the speech output in the therapy session and 2) allow the Person to function better, via alternative communication techniques.  We’ll call these philosophies Get Over Aphasia and Live With Aphasia.

Neither approach in isolation is ideal.  (They also can affect each other in a virtuous cycle.)  The speech improvements seen with the clinician do not tend to carry over “automagically” into real life.  And the Person who points contentedly to a picture of a cup of coffee, who might have had the potential to say “coffee,” has lost an opportunity.

I firmly believe the aphasia clinician needs to offer both approaches, although not necessarily on a 50-50 basis for any given client.

But beware the therapist who offers only drills in the therapy room and also beware the therapist who aims only to make you a happier aphasic person.  Above all, beware the clinician who guarantees specific outcomes.  With human brains, nothing is guaranteed.

Now for the good news:  speech therapy “works.”  In the sense that people with aphasia, after therapy, can 1) communicate more easily, or 2) with more complexity, or 3) in a more typical, less disordered fashion — or all three.  These improvements in function are distinct from the “spontaneous recovery” that typify the phase of early healing of the brain.  People with aphasia make gains years and years after the initial injury.

Speech therapy for aphasia is labor intensive.  All things being equal, the more treatment you get the greater your function.  However, because we would rather be swimming or playing with the dog or puttering in the garage or doing our life, rather than participating in therapy, the onus is on the clinician to make treatment as effective and as efficient as possible.  To this end I assign homework and train Helpers.

Whatever you can or want to do, from one session a month to 5 sessions a week, I can do.

I do have a front-loaded bias:  I prefer to get a Person and a Helper started, do therapy intensively, then fade meetings…with more and more time in between and more and more independently completed activities.

WESTBOROUGH APHASIA GROUP – for support and practice

We meet the second Tuesday of each month from 11:30 am to 12:45 pm. We meet at Congregation B’Nai Shalom, 117 East Main Street, Westborough, MA.

Family and friends are welcome. People from all towns are invited. There is no charge. Affiliated with the National Aphasia Association.

2017 dates are:
January 10
February 14
March 14
April 4* (first Tuesday in month)
May 9
June 13
July 11
August 8
September 12
October 10
November 14
December 12