Adult+-+Expressive+Aphasia


 * ﻿﻿ ** **Adult Expressive **** Aphasia: **

==To understand //Expressive Aphasia// we must first know what //Aphasia// is: ==



**What is Aphasia?**

Aphasia is a language disorder that can affect an individual's ability to speak, read, write, and understand.

**What causes Aphasia?**

Aphasia can be caused by brain damage from either a stroke or head injury, and can be a result from a tumor or growth in the brain. The brain damage is usually located in the left hemisphere of the brain. For most people, the left side of the brain houses the main language centers, such as Broca's Area and Wernicke's Area.

**Types of Aphasia:**

There are three general types of Aphasia, all of which present different problems depending on the severity of the injury. 1. Global - affects an individual's ability to speak, read, write, and understand 2. Receptive - where individuals have trouble understanding and reading 3. Expressive - which is the type we will be talking about...

**What is** <span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; line-height: 39px;">**__Expressive__ __Aphasia__?**

<span style="color: #000000; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">Individual's with Expressive Aphasia have trouble with <span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">**speaking** and <span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">**writing**.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">Individuals with this disorder may:

<span style="display: block; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; text-align: left;">﻿﻿- have a difficult time thinking of the words they want to say <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: normal;">- have problems spelling words <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: normal;">- only be able to say one or two words at a time <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; line-height: normal;">- have trouble putting together sentences that make sense <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; line-height: 23px;"><span style="font-family: Helvetica; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">- leave words out of sentences <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; line-height: normal;">- make up words

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: normal;">Expressive Aphasia is also referred to as<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: normal;"> Non-fluent Aphasia, Motor Aphasia and <span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: normal;">Broca's Aphasia.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">Here are a few audio examples of individuals with Expressive Aphasia:

1.http://www.csun.edu/~vcoao0el/de361/de361s52_folder/expAphasia.mov

2.http://www.csun.edu/~vcoao0el/de361/de361s52_folder/expAphasiaR.mov

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">//An Example of Expressive Aphasia:// (n.d.) Retrieved from http://www.csun.edu/~vcoao0el/de361/de361s52_folder/expAphasiamov.html <span style="color: #000000; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; letter-spacing: 2px; line-height: normal;">//Adult aphasia//. (1997). Retrieved from @http://www.asha.org/uploadedFiles/AdultAphasia.pdf <span style="color: #000000; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; letter-spacing: 2px; line-height: normal;">//Aphasia//. (2011). Retrieved from @http://www.asha.org/public/speech/disorders/aphasia.htm
 * Sources:**


 * <span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 25px; line-height: 38px;">__How is Expressive Aphasia diagnosed?__﻿ **

<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 150%;">**Screening Measures:** <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">Typically Screening measures are employed as supplements to neuropsychological testing batteries. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">They signal the presence of an aphasic disorder and may even call attention to its specific characteristics, but they do not provide <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">the fine discriminations of a complete aphasia test battery. These tests do not require technical knowledge of speech pathology for <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">competent administration or interpretation. Some of the tests that are performed to diagnose aphasia are:
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;"><span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">**The Halstead Screening Test** (1984)- This test requires the subject to perform a series of tasks. Such as: name common objects; spell simple words; identify individual numbers and letters; read, write, enunciate, and understand spoken language; identify body parts; calculate simple arithmetic problems; diferentiate between right and left; and copy simple geometric shapes.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">The receptive and expressive components of the test provide an opportunity to judge whether the limiting deficit for a patient is <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">principally receptive or expressive in character. These simple performances, when defective, provide powerful findings that <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">implicate the left or the right cerebral hemisphere. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">To aid the examiner in interpretation, Reitan & Wolfson (1985) have published detailed results regarding the accuracy of <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">pathognomonic signs generated by performances on the screening test. Osgood & Miron (1963) point out that test-retest <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">reliability of responses (in psychometric sense) has never been a hallmark of the responses of the aphasic individual. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">Nevertheless, Reitan (1985) asserts that a single defective performance,when it occurs, is still a valid indication of brain <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">impairment. In addition, the entire protocol, as contrasted with undue emphasis on individual responses, must be considered <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">in evaluating the patient. An older copy of this test can be found in the test file cabinet at the PSC, newer versions <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">are in the neuropsychology lab at the PSC. There are two specific tests to detect aphasia these are:

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;"><span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">**1. Reitan- Indiana Aphasia Screening Test** - <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;">In this test, individuals are presented with a variety of questions and tasks that would <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;"> be easy for someone without impairment. Examples of test items include verbally naming pictures, writing the name of a picture <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;"> without saying the name aloud, reading printed material of increasing length, repeating words stated by the examiner, simple <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;"> arithmetic problems, drawing shapes without lifting the pencil, and placing one hand to an area on the opposite side of the body.

<span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;">2. **Halstead-Wepman Aphasia Screening Test** - It evaluates language-related difficulties, right/left confusion, and <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;"> non-verbal tasks. A typical scoring procedure is not used because this is a screening test; its purpose is to detect possible signs <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;"> of aphasia that may require further evaluation. Subtle language deficits may not be detected.



<span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;">In addition there are other subtests that are included in the Halstead Screening Tests, such as: Category Test, Tactual Performance Test, <span style="font-family: Georgia,'Times New Roman',Times,serif; font-size: 16px; line-height: 26px;">Trail Making Test, Finger Tapping Test, Reitan- Klove Sensory-Perceptual Examination, and Ancillary Tests.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">about a fourth- grade education, and is usually easy for the normal subject though, its use in psychiatric populations has been limited, <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">however, and it is likely that porrer "normal" performance would be found in such groups (Golden 1990). The test has been found <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">sensitive to aphasic disorders that are not apparent upon observation of the patient.
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;"><span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">**The Token Test** (revised-1978)- This test is a simple, easy-to-administer test using a minimum of material. The test requires

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">This test requires 20 tokens, varying in shape (circle and square), size (small-large), and color (red, yellow, green, blue, and white), <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">so that every possible combination is represented. The test has 62 commands, each of which requires the manipulation of, <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">or attention to, one or more of the shapes. For example: one may ask "Touch the green rectangle." In more complex items, the patient <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">might be instructed to "Put the red square under the red circle." If an item is missed initially, it is repeated. If correct the second time, <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">the patient gets full credit. A shorter 39- item of the test was developed by Spreen and Benton (1969). <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">The test is able to discriminate aphasics from normals about 90% of the time (Boller,1968). The test can be found in the neuropsychology <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">lab at the PSC.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">The Token Test for Children Second Edition (TTFC-2)- The approximate price is $ 156.00. It takes 10-15 to be administered. It is mostly <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">used in children from 0-3 to 11-12 years old. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">.

<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 20px; line-height: 29px;">**Aphasia Tests** <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">designed to provide the clinician with a guide approach for evaluating aphasic language disturbances. Eisenson states that <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">results of the examination "enable the clinician to obtain an overall view of the patient's strenghts and weaknesses" as <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">well as determine the "level of ability within a given area of language function." Changes in test performance are taken <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">as indicators of improvement and are considered of value in planning therapy. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">The test is dichotomized into primarily receptive and expressive portions. Within each of these sections, a further division <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">is made between subtests designed to test subsymbolc or low symbolic levels and those tapping higher symbolic levels. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">test adminstration is extremely flexible. The examiner is given the choice of admnistering either the receptive or the <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">expressive portion first; the examiner may also choose to administer all the low-level tests before the higher-level tets. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">More importantly, a variety of stimulus presentations are acceptable. Scoring of the items is on a pass/fail basis, and <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">the axaminer is instructed to indicate the nature of the response on the record form. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Examining for Aphasia is not a standardized test. The author states: "Aphasic patients are characteristically too <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">inconsistent in their responses to permit formal scoring standards to be developed meaningfully." Meaningfully <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">interpretation of a patient's performance thus requires considerable clinical judgement with respect to degree <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">of impairment. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Aphasia Examination was designed to meet three general aims: <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;"> change over time. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;"> 3. Comprehensive assessment of the assets and liabilities of the patient in all areas as a guide to therapy. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;"> The tests is organized into five (5) major sections: <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Interpretation of test results in based upon analysis of the severity rating scale, the rating scale profile of <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">speech characteristics, and the pattern of performance across subtests and modalities after raw scores <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">have been converted to z-scores. Test interpretation is primarily geared toward placing patients into <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">diagnostic categories based on the "classical" anatomical typologies of aphasia. The test's clinical strong <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">points include comprehensiveness, use of standardized data, the ability to distinguish among different <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">patterns of performance, its unique inclusion of scales for measuring qualitative aspects of speech <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">output, and its possible appeal to neuropsychologists and neurologists. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">The administration of this tests takes from 35 to 45 minutes and it was created by Harold Goodglass and Edith Kaplan. <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">This tests is mostly administered in adults. The price of this test is about $ 458.00 for the entire new BDAE- third edition.
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;"><span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">**Examining for Aphasia** (Eisenson, 1954)- One of the first commercially, tests batteries, Examining for Aphasia was
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">**<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Boston Diagnostic Aphasia Examination (BDAE )** (Goodglass & Kaplan, 1972)- The authors state that the Boston
 * 1) <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Diagnosis of presence and type of aphasic syndrome, leading to inferences concerning cerebral localization.
 * 2) <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Measurement of the level of performance over a wide range, for both initial determination and detection of
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Conservational and Expository Speech
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Auditory Comprehension
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Oral Expression
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Understanding Written Language
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">Writing



<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">in Daily Living (CADL) examines how the patient might handle life activities by engaging him/her <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">in role-playing in a series of stimulated situations such as "the doctor's office" or "the grocery store." <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">In keeping with the goal of making the examination naturalistic as possible, the examiner is <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">encouraged to carry out a dual role as examiner/play-acting participant with such props as a toy <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">stethoscope or boxes of packaged soup. Responses are scored on a three-point scale according to <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">their communicative effectiveness, regardless of the modality used (i.e. spoken, written, or <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">gestural responses are al acceptable). The 68 CADL items sample teen categories of behavior, <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">such as "speech acts", "utilizing context," "social convention," and capacity to participate in <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">role-playing. A series of evaluations of CADL performances of 130 aphasic patients <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">demonstrated that this test was sensitive to aphasia, age, and institutionalization, <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">but not sex or social background. The manual provides category patterns for differentiating <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">aphasia types and cut-off scores for identifying aphasics within predominately nonaphasic <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">populations. Self-training procedures for examiners are provided on scoring <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">standardization. This is a 30 minutes tests performed in adults. The cost of the entire CADL second edition <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">is mostly $220.00. <span style="border-collapse: collapse; color: #666666; font-family: verdana; font-size: 11px; line-height: normal;"> <span style="border-collapse: collapse; color: #666666; font-family: verdana; font-size: 11px; line-height: 0px; overflow: hidden;">
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;"><span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px;">**Communicative Abilities in Daily Living** (Holland, 1980)- The Communicative Abilities in


 * Sources**

<span style="background-position: 100% 50%; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px; margin: 0px; padding: 0px 10px 0px 0px;">Neuropsychology Central, 2002. //AphasiaAssessment.// <span style="background-position: 100% 50%; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px; margin: 0px; padding: 0px 10px 0px 0px;">[]
 * <span style="background-position: 100% 50%; color: #000000; cursor: pointer; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; font-weight: normal; line-height: 22px; margin: 0px; padding: 0px 10px 0px 0px;">Enciclopedia of Mental Disorders. 2011. //Halstead Reitan Battery.// http://www.minddisorders.com/Flu-Inv/Halstead-Reitan-Battery.html#ixzz1KHq7MIj3 **

Prod.Ed: An international Publisher.2010.[] <span style="background-position: 100% 50%; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15px; line-height: 22px; margin: 0px; padding: 0px 10px 0px 0px;"> Prod.Ed: An international Publisher.2010. []
 * Prod.Ed: An international Publisher.2010. [] **

__<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 150%;">Theoretical Approaches: __
<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">There are two distinctly different theoretical positions that shape the therapies used to treat expressive aphasia in adults. The first is a //direct approach// in that it stresses targeting the language impairment itself through intervention tasks created specifically to help the patient improve the performance in their linguistic area(s) of challenge. Conversely, the second is an //indirect approach// which stresses the importance of functional and effective communication over the complete restoration of "normal" language skills. This approach encourages the use of alternate forms of communication to help patients "get around" their language deficits rather than targeting them directly. These very different theoretical positions call for equally different interventions involving treatment approaches that best suit the unique goals of each. Some these approaches include various linguistically oriented approaches (primarily semantic or lexical), a Cognitive Therapy Approach, and the Social Approach (group therapy, Aphasia Couples Therapy (ACT), etc.).

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">An example of an indirect approach is the **<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">//Life Participation Approach to Aphasia (LPAA)// ** which aims to enhance the patient's quality of life. In this approach to therapy, the goals are formulated around maintaining participation in life activities that are personally relevant and important to the patient. In this respect, the client is very involved and feels like he or she is in control of their own intervention and their own outcomes (and they are correct). Another underlying principle of the LPAA is the importance of a supportive environment for the person with Aphasia. This is based on the rationale that a supportive environment is crucial to making progress towards therapy goals, regardless of the initial severity level of the diagnosis. Therapy efficacy is rated by patient in terms of degree of happiness in life activities and life in general. Therapies that fall under the category of LPAA include conversation group therapy, self-advocacy work, supported communication, family and couples therapy/training, and communication partners which is explained along with a video example below.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;"><span style="color: #6e306e; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">**//Communication Partners//** is a specific approach which falls under the broad heading of the LPAA. As demonstrated in the video below, this program includes volunteers who are trained in facilitating supported conversation with expressive aphasia patients. These volunteers travel to the patients' houses and converse with them about topics of personal interest (possible topics: vacations they took, things they like and don't like, etc.). This technique is meant to increase a patient's communicative confidence in general and in speaking with new people. Decreasing anxiety over speaking will make a patient less likely to withdraw from social situations, and more likely to continue to part-take in daily activities that require communication with another person. Communication Partners has been found to be effective in improving expressive language abilities, themselves, as well as improving patient satisfaction in quality of life.

media type="youtube" key="tUIr8_QJZ30" height="390" width="640"

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15pt;">**Sources:**
<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">Elman, Roberta J., Rochelle Cohen-Schneider, Kathryn Garrett, and Barbara Shadden. "Aphasia Groups: One Approach Does Not Fit All." (2006). Web. 23 Apr. 2011. <http://www.asha.org/Events/convention/handouts/2006/1033_Elman_Roberta.htm>.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;"><span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">http://www.youtube.com/watc h?v=tUIr8_QJZ30&feature=related

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">LPAA Project Group. (n.d.). Life Participation Approach to Aphasia, A statement of values for the future. In //American Speech-Language-Hearing Association//. Retrieved April 24, 2011, from http://www.asha.org/public/speech/disorders/LPAA.htm

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">Simmons-Mackie, N. Thinking Beyond Language: Intervention for Severe Aphasia. //Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders//, //19//. Retrieved April 24, 2011, from http://div2perspectives.asha.org/cgi/content/abstract/19/1/15

<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15pt;">**Goals for Intervention:**
<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">General goals for intervention of patients diagnosed with expressive aphasia include things like increasing overall communicative effectiveness and regaining or improving expressive language skills.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">Examples of treatment goals for an adult with expressive aphasia under LPAA approach:
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">"Patient will develop functional and effective communication with the nurses that care for them."
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">Beginning stages of therapy
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">"Patient will use functional communication to rejoin the workforce."
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">Later stages of therapy

<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15pt;">**Behavioral Objective:**
<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">An example of a behavioral objective that would coincide with the previous therapy goals might be something like "patient will greet medical staff members when they enter the room 75% of the time."

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 15pt;">**Source:**
<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 13.1pt;">LPAA Project Group. (n.d.). Life Participation Approach to Aphasia, A statement of values for the future. In //American Speech-Language-Hearing Association//. Retrieved April 24, 2011, from http://www.asha.org/public/speech/disorders/LPAA.htm

__<span style="color: #702470; font-family: Tahoma,Geneva,sans-serif; font-size: 1.3em; line-height: 41px; margin: 0px; padding: 5px 0px 0px;">** ﻿Techniques Used in Therapy: ** __

 * **<span style="color: #800080; font-family: Tahoma,Geneva,sans-serif; font-size: 130%;">Recognize The Client's Strengths: **

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 17px; margin: 0px; padding: 0px;">The Bungalow Software series, along with other computer software programs like Parrot Software, Clicker 5, and CHAT software, aid in helping people with ** expressive aphasia ** to learn how to communicate again. These programs aim to drill and practice language as well as give the patient aids for their impaired verbal expression. Most of these cost money, however, a lot of the websites allow for a free trial download. It’s important for the speech-language pathologist to take into consideration how independent their client is, as well as how confident they are with technology. The SLP will help the client with these programs and then as they feel more confident they can do the activities at home without any help. A wife of a man with expressive aphasia quoted, “Between the speech therapists and the Bungalow Software, my husband John is doing so well that he is able to communicate his wants and needs by speech. The speech therapists said that your aphasia therapy software has helped John progress to this level of speech." <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 17px;">
 * <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 130%;">**Give Them Some Extra Time:** Try to be aware that an expressive aphasia sufferer may take longer to answer a question or have a conversation because it takes them longer to retrieve the information from the language centers of their brain.
 * <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 130%;">**Restrict Using Expressions & Signs:** 60% of our communication is non-verbal, but for someone with expressive aphasia they may not easily pick up on the meaning of the non-verbal communication. Therefore it's important to verbalize as much of your conversation as possible.
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 130%;"> **Develop An Answering Pattern:** Yes or no questions are always the easiest to answer for anyone, therefore, for an expressive aphasia sufferer those might be the best questions to start with and from there see what can be worked on.
 * <span style="color: #800080; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 130%;">**Try to Make the Communications Visual:**

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 17px; margin: 0px; padding: 0px;">A **Picture Exchange Communication System** is used most often with A u t i s t i c children, however, someone who is aphasic due to a stroke or a traumatic brain injury can find this technique extremely useful. PECS is an augmentative and alternative communication that uses pictures in place of words. People with expressive aphasia have word retrieval difficulties, therefore, having a technique that allows you to physically see what it is you are trying to say can prove very productive.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 17px; margin: 0px; padding: 0px;">Today our world is full of technological advances, one of which is powered by Apple. This generation is up to the iPhone 4, the iPad, and the iTouch. Each of these devices has the ability to add applications, which are like mini programs. One of the applications is called E xp re __ss__ ive 1.2. This application allows children and adults to sift through a library of pictures ranging from feelings to places to people in order to communicate with the people around them.


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">** Singing Can Improve Word Remembrance ** : From experience I can fully support singing as a wonderful method for remembering because I use jingles and songs to help me study for exams.
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">** Pets Can Be A Method of Therapy: PetsAsTherapy **

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">__**SOURCES:**__
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; line-height: 32px;">Description. (n.d.). In //Expressive//. Retrieved April 20, 2011, from http://www.expressiveapp.com/description/
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">Green, J. L. (2008, January 28). Computer programs for expressive aphasia therapy. In //Speechpathology.com//. Retrieved April 18, 2011, from [|http://www.speechpathology.com/askexpert/display_question.asp?question_id=] 266
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; line-height: 24px;">Improving communication in expressive aphasia sufferers. (2007). In //YGOY//. Retrieved April 27, 2011, from http://speechtherapy.ygoy.com/improving-communication-in-expressive-aphasia-sufferers/
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%; line-height: 32px;">Speech-language therapy for expressive aphasia. (2011, August). In //Bungalow software//. Retrieved April 11, 2011, from http://www.bungalowsoftware.com/aphasia/Expressive-Aphasia-Therapy.asp

<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 29px; line-height: 43px;">What did I observe during my field observations of treatment for Expressive Aphasia?

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">__<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">Angel Nunez: __ During my observations of treatment, I observed different kind of speech and language therapies in places such as hospitals, and schools. Throughout my observations <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 16px; line-height: 23px;">some of the modalities and domains that I observed were: articulation, phonology, voice, morphology and syntax. I had the opportunity to observe individual and group therapies. Also, I did some observation hours in audiology at the Brigham and Women Hospital in which I observed hearing tests. In my opinion, this experience helped me to know better in depth the field and to understand how to do clinical interventions (either speech and language evaluations, therapies,voice therapy and evaluation, hearing tests,and hearing screenings). One of the observations that impacted me the most was when I observed an evaluation of voice in which the clinician performed different activities at a rapid pace. During the first activity the client had to narrate her symptoms in front of a video camera, then she had to read the rainbow passage to analyze client's voice during different English sounds. Then, the clinician performed a hearing screening in which she noticed some discrepancies between the perception of sound in her right ear and the left ear, then she suggested her to go to an audiologist for future assessments. Then, one of the most important parts of the evaluation was when the clinician performed the acoustic and aerodynamic measurements of client's voice to measure its quality. Then, the clinician told the client to do a narrative discourse for one minute to analyze her voice bahavior throughout long utterances. At the end of the session and based on the results of the evaluation, the clinician referred the client to voice therapy starting a week after the day of the evaluation.

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">__<span style="color: #702470; font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">Kelli Wynne: __ During my field observations I came across one older gentleman who had expressive aphasia as a result of a stroke. He had a hard time finding the correct words to use when talking about and describing certain objects, verbs, and pronouns. In the session that I observed with the patient the clinician had a pile of flash cards that had pictures of everyday objects and actions on them. The clinician first went through the pile of pictures asking him to name objects on the flash cards. The second time she had him explain what was happening in each picture. The clinician also worked on association and categories with the patient. She named off three objects and asked the patient to explain the relationship between those three words. Example: Clinician - "fire truck, tomato, blood" Patient's response - " They are all the color red." The clinicians also took this activity one step further and asked him to give a fourth object that would also be found in that group. Therefore, for the previous example the patient's response would be, "strawberry". <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 120%;">media type="youtube" key="CthWEc8CSy0" width="425" height="350"media type="youtube" key="Bk13HLma2CI" width="425" height="350"