Chapter 16
The chapter discusses the treatment of right hemisphere disorders (RHD), including coarse coding, suppression, social cognition deficits, prosody, discourse, pragmatics, reading and writing, and cognition. The authors have analyzed the use of evidence-based practice, âfocusing treatment,â and patient involvement in treatment procedures. While self-awareness is crucial in treatment, implicit training can improve behaviors, but caregivers must adjust their perceptions to accommodate patients who do not recognize their deficits.
Nevertheless, patients can go through an awareness-training program using any of the three main approaches: procedural treatment, caregiver education, and individual awareness-enhancing method. Most of the treatments used on coarse coding can be applied to several other related disorders. The deficit-oriented treatment is receiving approval for its effectiveness in RHDs. It is implicit rather than direct, has a remediation focus, and is delivered via auditory modality. Metalinguistic is another effective treatment that is direct, but patients must be provided with compensatory aids.
- Quote: âOther evidence has supported three approaches for memory training âŠ: the use of external memory aids, acquisition of particular skills or information, and varied instructional methodsâ (Tompkins & Scott, 2013, p. 358).
- Question: What are the strengths and weaknesses of each of these memory-training approaches? When would you use each?
Chapter 17
Traumatic brain injury (TBI) varies from mild to severe and results from falls, accidents, sports, and other injuries to the head. The injury could be open with a visible wound from outside or closed caused by a blunt blow. Recovery mechanisms of TBI rely on brain plasticity and are linked to neurobehavioral outcomes after recovery. There are two phases of recovery: acute, which utilizes the Rancho Los Amigos (RLA) scale, and subacute, moving from acute to post-acute rehabilitation.
If the patient has achieved recovery to RLA Stage VI, a neurobehavioral assessment is conducted to identify weaknesses and strengths, guide the choice of compensatory and remedial strategies, and enhance goal development. The evaluation process must be a team effort and target both short and long-term memory. Cognitive rehabilitation must strive for effortless behavior, capitalize on implicit processes, and be person-centered. Some instructional approaches for this treatment include spaced retrieval therapy (SRT), positive routines, and metacognitive and direct instruction.
- Quote: âCategorization and decision-making problems are also evident during this phase of recovery as well as problems in social cognition and pragmaticsâ (Constantinidou & Kennedy, 2013, p. 370).
- Question: What is the name of the recovery phase mentioned here? Describe other characteristics of a patient in this phase of recovery.
Chapter 19
Patients with acquired apraxia of speech (AoS) âknowâ words and their sounds but experience difficulties with actual specification and parametersâ movement coordination to produce sound strings. Clinical assessments seek to differentiate apraxic, dysarthric, and paraphrastic speech breakdown. The commonly used materials and tasks include speech motor examination, diadochokinetic activities, and repeated trials. Van der Merweâs speech output model includes three stages: premotor, motor planning, and motor programming.
There are lesion sites associated with AoS, such as the insular region. Evidence-based treatment methods for AoS include articulatory-kinematic, instrumental feedback, gestural, and rate and rhythm control approaches. These treatment methods require practice variability and organization, feedback administration, and complex practice stimuli. There are other treatment approaches categorized as functions, such as augmentative and alternative communication (AAC). Finally, conversational techniques may be utilized for better conversation abilities, such as through pseudoconversations.
- Quote: âAoS has been distinguished on the one hand from dysarthria (deemed a neuromuscular problem of speech) and on the other from phonemic paraphasiaâ (Miller & Wambaugh, 2013, p. 433).
- Question: What are these distinctions?
References
Constantinidou, F. & Kennedy, M. (2013). Traumatic brain injury in adults. In I. Papathanasiou, P. Coppens, & C. Potagas (Eds), Aphasia and related neurogenic communication disorders (pp. 364-398). Jones & Bartlett Learning.
Miller, N. & Wambaugh, J. (2013). Acquired Apraxia of speech. In I. Papathanasiou, P. Coppens, & C. Potagas (Eds), Aphasia and related neurogenic communication disorders (pp. 431-458). Jones & Bartlett Learning.
Tompkins, C., A. & Scott, A., G. (2013). Treatment of right hemisphere disorders. In I. Papathanasiou, P. Coppens, & C. Potagas (Eds), Aphasia and related neurogenic communication disorders (pp. 345-364). Jones & Bartlett Learning.