Peer support helped to increase the pragmatic skills of a teenager who suffered a cardiovascular accident (CVA), as well as her overall motivation and desire to come to therapy.

Lauren, 17, has a history of partial seizures, dating back to when she was 4 years old. In March of 2007, she underwent subdural grid placement surgery for seizures at the Medical Center of Georgia and suffered a CVA. She received treatment at the medical center and later admitted to Children's Healthcare of Atlanta at Scottish Rite, where she received inpatient and outpatient rehabilitation. Speech therapy focused on increasing her memory, comprehension, attending, word-finding, problem-solving and pragmatic skills.

In the fall of 2007, Lauren underwent a speech and language evaluation at the Speech and Hearing Clinic of Valdosta State University (VSU) in Valdosta, GA. Her mother reported that she had difficulty expressing her wants and needs, couldn't find the right words to use, and occasionally had trouble with reading comprehension. The evaluation revealed that Lauren was functioning in the low-average to average range for intelligence, language, fine motor skills, visuo/perceptual skills and visual memory. Her verbal memory was in the borderline to impaired range, and her attention and learning were also considered borderline.

Over the course of four semesters, her therapy focused on tasks to improve problem-solving, attending, word-finding, comprehension, pragmatic and memory skills. Last semester, to address Lauren's pragmatic skills in a more functional manner, a peer was invited to her sessions so she could practice her pragmatic and communication skills. Emily was a senior at a high school across town.

On four out of five occasions during peer therapy sessions, Lauren was to initiate a conversation with a peer about a topic of interest, answer questions appropriately with an on-task response during a conversation with a peer, and discuss and describe current events with a peer, providing appropriate details about each event. A final goal was maintaining a topic of interest during conversational speech with a peer for three to five minutes in structured and unstructured settings.

A variety of procedures were used to address these goals. Activities included structured sessions in the clinic and unstructured activities around campus at the VSU bookstore and University Center. The structured activities included discussions of topics and problematic situations that were posed by the clinicians, as well as planning and completing pages in Lauren's memory scrapbook.

During the unstructured activities, the girls talked while they snacked and took pictures in the University Center and shopped in the bookstore. They discussed topics such as boys, parents, friends, hobbies, spring break plans, jobs and post-graduation plans. A clinician was present at all times to guide Lauren and monitor her progress from one session to the next. Additional activities included text-messaging when Emily was out of town and reviewing problem-solving scenarios for school, work and home.

By the end of the semester, Lauren demonstrated great improvement in her pragmatic and conversational skills, specifically in her ability to initiate conversations, maintain a topic, answer questions with an on-task response, and discuss and describe events in detail. Not only did she meet her goals, she was happy and completely engaged in therapy when Emily was present.

Among the resources used were Word Retrieval Exercises for Adolescents and Adults, by Academic Communication Associates; Everyday Problem Solving: Workbook of Activities for Language and Cognition (WALC-3), by LinguiSystems Inc.; Facilitating Word Recall, by Great Ideas for Teaching Inc.; and Life Skills, by Remedia Publications.

Lora Backes is an assistant professor and clinical supervisor in the Department of Communication Sciences and Disorders at VSU, and Noel Stuckey is a graduate student in the department. For more resources, contact them at lsbackes@valdosta.edu and nvstuckey@valdosta.edu.