Vol. 20 • Issue 22 • Page 10
The field of speech-language pathology has known for some time that outcomes are improved for adults with chronic aphasia when therapy is intensive, typically defined in the research as nine or more hours per week. The University of Michigan Aphasia Program (UMAP) creates an environment of success for this patient population with a combination of individual and group therapy delivered on an intensive schedule targeting multimodal forms of communication that include training with assistive software, along with education and support for caregivers.
Beginning in January 2011, UMAP will build on its clinical experience, client feedback, and what the research says to maximize the therapeutic experience for clients and their families. Sessions will coincide with each month of the year, and clients can opt for additional weeks at any time.
A full-time client receives 25 hours of speech-language therapy each week. Music and art therapy, caregiver education seminars and support group, and social-recreational activities complete the weekly package of 30 hours of structured activities.
Each client is assigned to a team of speech-language pathologists. The client's primary clinician coordinates the goals and serves as the point person for the family and client regarding questions, goals and progress.
Each day clients receive two hours of individual therapy designed to target their specific goals, which are developed from baseline testing and initial conversations with the client and family. As appropriate, goals target all areas of communication: listening, speaking, reading, writing, memory, cognition, and use of gestures.
Group therapy is an important component of the UMAP therapy regimen. As speech-language pathologists, we are well aware of the dynamic nature of communication. Clients receive two hours of group therapy daily to support the use of newly learned behaviors targeted during individual therapy into more naturalistic contexts.
This supportive context for communication is vitally important. Our client may be the only person in his or her community with aphasia. Re-learning communication skills in an environment with others who have aphasia helps reduce some of the stress and increases hope. Our clients push each other to try new ways of communicating, and they reinforce one another's successes. The exuberance in the group when someone accomplishes a communicative task is uplifting for all involved!
Technology has opened up the world for people with communication disorders. UMAP computer lab is held daily to further support individual goals. Under the guidance of a speech-language pathologist, a client uses state-of-the-art software programs that target verbal production, listening, reading comprehension, spelling, memory and writing. Clients also receive training on communicating via e-mail, searching the Web, and using assistive devices such as a Kindle or personal palm pilot.
Group music and art therapy are integral parts of the weekly package. Communication goals are supported in each of these environments. Some clients opt for individual music or art therapy as well. Under the direction of professionals in those fields, clients learn new ways to express themselves. Many discover latent talents in these areas. Their artwork is displayed around the building, and at the end of each session we are treated to a musical performance that is guaranteed to lift spirits.
Caregivers are also learning. They attend therapy sessions to learn how to best communicate with their loved one. Speech-language pathologists may facilitate conversational coaching with the client and caregiver. Weekly educational seminars conducted by speech-language pathologists cover such topics as specifics about aphasia, how to enhance recovery, and how to design an intensive treatment program at home. In addition, a weekly psychosocial support group led by a social worker provides a supportive environment for caregivers to talk about their shared experiences as they adjust to living with someone who has aphasia.
Weekly social-recreational activities comprise another important component of the program. Under the guidance of a recreation therapist, clients and family members attend a weekly Dinner Club at local restaurants as another supportive context for communication. Prior to the evening, the menu is reviewed, dinner choices are discussed, and practice sessions for ordering are conducted. Surrounded by others with aphasia and their family members, clients work hard to place their order and communicate with waitstaff. These experiences further enhance the UMAP goal to strengthen communication skills so clients are better equipped when they return home.
Weekly trips to venues around town provide opportunities for clients to get out in public and use newly learned communication skills. Depending on the interests of the group, we may go to a concert, a sporting event, a farmer's market, or activities such as bowling or golf.
The intensive therapy regimen of UMAP, coupled with a supportive environment and immersion in using language in natural contexts, creates a life-changing experience for adults with chronic aphasia and their families.
Mimi Block is Clinical Services manager at the University of Michigan Aphasia Program. She can be contacted at firstname.lastname@example.org.