There are all kinds of physical therapy techniques that are used to deal with a number of physical and mental traumas. Did you know that there is physical therapy for a brain trauma that causes the person to not be able to speak, write, or understand language? Well, there is! Damage to specific areas of the brain cause aphasia. Speech-language pathologists treat this with different types of aphasia physical therapy. Below, we will talk about what aphasia physical therapy consists of, specific therapy techniques, and how these can help patients. So, let’s jump right in!
An Overview of Aphasia
Before we can get into the different therapies, let’s look at what Aphasia is. Simply put, aphasia is the loss of the ability to understand or express speech, verbally or written, that is caused by damage to the brain. Aphasia manifests in two ways.
The first form of aphasia is known as Broca’s aphasia. Damage to Broca’s area of the brain impacts expressive aspects of spoken and written language. Partial loss of the ability to produce language, both verbally and written, characterizes this type of aphasia. The comprehension of language is still present, but the patient will have broken speech and seem to put a lot of effort into their words.
The second form of aphasia is called Wernicke’s aphasia. Just like Broca’s, this aphasia is named after the area of the brain that is damaged. So, this form is caused by damage to…you guessed it! Wernicke’s area of the brain. Damage to this area results in deficits in the comprehension of language, meaning that the patient will have trouble understanding things when spoken to or reading.
Now that we know the different types of aphasia, let’s look at how physical therapy can help a patient with this condition.
What is Aphasia Physical Therapy?
Aphasia physical therapy techniques help improve a patient’s ability to speak and understand language. There are two general categories that therapists use when treating a patient; impairment-based therapy and communication-based therapy.
Impairment-based therapy is aimed at improving language functions for the patient. These therapy techniques consist of procedures in which the therapist stimulates specific listening, speaking, and writing skills.
On the other hand, communication-based therapy, also known as consequence-based therapy, is used to enhance communication by any means. It is also used to encourage support from caregivers. With this type of therapy, the therapist uses techniques that consist of natural interactions involving real-life communication challenges for the patient.
Within both of these categories, there are also specific therapies that the therapist can use and switch between. Let’s take a look at some of these!
Specific Impairment-Based Therapies
Here we will focus on two main impairment-based aphasia physical therapies; Constraint-Induced Therapy (CIT) and Melodic Intonation Therapy (MIT).
Constraint-Induced Therapy (CIT)
This type of aphasia physical therapy has three treatment principles: constraint, forced use, and massed practice.
In general, constraint means to avoid compensation by tying down the good limb. In regard to aphasia, constraint then refers to avoiding the use of strategies such as gesturing, writing, drawing, or any way of communicating other than talking. Next, forced use refers to the use of the impaired limb. So, with CIT and aphasia, forced use means communicating only by talking. Last, massed practice means to require the constraint and forced use every day, all day. When it comes to aphasia, massed practice refers to therapy that occurs for two to four hours every day.
Overall, with this practice, the therapist constrains a patient’s gestures in order to direct them to use their impaired spoken language. By forcing them to use the broken speech, therapists believe that the patient’s impaired language will improve over time.
Melodic Intonation Therapy (MIT)
The idea that some people with aphasia “sing it better, than say it” is the basis for this type of aphasia physical therapy. Basically, during therapy, the individual performs a series of steps in which they practice an artificially melodic production of sentences.
Therapists use MIT with people that have an expressive type of aphasia and have retained a good comprehension of language. People with better melodic intonation that still lack normal conversational skills are great candidates for this type of therapy.
During therapy sessions, the therapist encourages the patient to hum. From there, the therapist will then have them sing words or phrases that they find hard to recall while tapping out a rhythm. Therapists attest to the success of this therapy because the part of the brain that recalls music is different from the part that deals with spoken language. In other words, MIT teaches the patient an alternative way to recall phrases.
Specific Communication-Based Therapies
With communication-based therapy, the therapist is focusing on helping the patient convey messages and feelings with alternative means of communicating in conversation. These aphasia physical therapies include PACE Therapy, conversation coaching, and supported conversation.
PACE Therapy (Promoting Aphasics’ Communicative Effectiveness)
PACE Therapy helps improve the patient’s conversational skills. It is a variation of the basic picture-naming drill. But it introduces elements of conversation into the mix.
The therapist and the individual with aphasia take turns being the message sender or receiver. The speaker hides the picture prompts for the conversational messages from the listener. The speaker will then use their choice of modalities to convey messages and so on.
Conversation Coaching
Conversation coaching aims to increase the patient’s communicative confidence through the practice of scripted conversations and communication strategies. Designed to teach both verbal and nonverbal communication strategies to the patient and their main communication partner, this therapy works on both ends. Drawing, gestures, cueing, confirming information, and summarizing information are all strategies within conversation coaching. Knowing these, the individual and their partner choose strategies and then practice them in the scripted conversations.
Supported Conversation
Now, we will discuss the last type of aphasia physical therapy on our list: supported conversation. Just like conversation coaching, supported conversation therapy helps enhance a patient’s communicative confidence. Unlike conversation coaching, support groups tend to use this type of therapy. It emphasizes the importance of partner training, and opportunities for social interaction. Thus, individuals interact with trained volunteers using scripted or “scaffolded” conversations.
According to ASHA.org, supported conversation therapy has three principles:
- Teaching strategies to partners can improve functional communication
- Communication is a dynamic process; tools and services for the person with aphasia must reflect this dynamic process
- Communication includes social interaction and the exchange of information and ideas; therapists emphasize social interaction
How These Therapies Help the Patient
Now that you know a few of the different types of aphasia physical therapy, it is essential to look at how they help the patient. There are three main ways in which these therapies can help an individual with aphasia.
Simply, aphasia physical therapy helps to:
- Restore as much speech and language as possible
- Allow the individual to communicate to the best of their ability
- Find alternative ways of communicating
All in all, there are so many different types of aphasia physical therapy. These are just a few that can help an individual with aphasia be able to comprehend language and communicate effectively again. But remember, therapy won’t always stay the same. As the person improves, their therapy should change to meet their needs.
Have you had any experiences with aphasia and any physical therapy techniques that can help? Tell us about your experiences below…
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