SWITCH!: Therapy Board Game Targeting Expressive Modality
Switching in Aphasia
Krystal Peralta, MS and Marjorie Nicholas, PhD
Abstract
Generalization of trained communication modalities (e.g
speaking, writing, drawing, using a communication book) is
one of the ultimate objectives in aphasia therapy. Several
researchers have purported that in order to achieve this
goal, isolated training of each modality is not sufficient for
successful carryover. In fact, a range of executive
functions are necessary for functional use of multi-modal
communication in the community setting and therefore must
be considered when implementing functionally based
speech-language therapy. The SWITCH! aphasia therapy
board game specifically targets cognitive flexibility by
having the individual with aphasia engage in an interactive
game that requires multimodality expression.
Board Game Development
When developing the game board, pieces, and target
stimuli, the following were considered:
• Target stimuli: all target items should be able to be easily
communicated across multiple modalities and also be
functional for many individuals.
• Fine motor abilities: developing game pieces and target
cards that can be manipulated by clients with decreased
fine motor abilities.
• Aesthetics: color scheme and lines should not be visually
distracting.
• SWITCH! provides a structured interaction between two communication
partners by having them take turns in expressing a particular message. Four
color-coded modality cards may be implemented to visually enforce the act of
switching. These include visual prompts to gesture, draw or write, speak, or
use an alternative communication device (if appropriate).
Modality Queue
• Each player selects a
set of modality cards
based on their
expressive capabilities
and places them in a
modality queue (see
above). A Modality card
is turned over when the
player has attempted to
convey a particular
message.
Introduction and Background
• SWITCH! was developed under the hypothesis that many
individuals with aphasia may have decreased abilities in
executive functioning which negatively impact successful
carryover of learned communication skills. Executive
functioning skills may include initiating, planning, as well as
monitoring communicative attempts and feedback in order to
determine whether the message was understood In addition.
Like impaired linguistic processes, impaired executive
functioning functions can also be treated in the clinical
setting.. This has spurred several researchers into exploring
executive functioning treatment in aphasia.
Sample stimulus cards
• 36 single unit target
stimulus items are displayed
on playing cards that include
pictures of objects (e.g.
comb, car, book), people
and animals (e.g. boy, girl,
dog), and descriptors (e.g.
angry, married, small). For
each turn, a player
communicates a target item
while the other guesses.
Sample response card
• If the player’s communicative attempt fails, the expectation is that he/she will
switch to another modality in order to repair the failure. If the player fails to
switch after their communication partner provides verbal (“I don’t understand) or
nonverbal feedback (head shake), a bell will then be used to explicitly signal that
the attempt has failed.
• The act of switching to another modality, despite the possibility of leading to
another failed communicative attempt, is still rewarded by having the player
move an extra space for each switch on the game board.
• SWITCH! primarily targets cognitive flexibility, an
important executive function necessary for individuals to
switch to another communication modality in order to repair a
failed communication attempt.
• The board game allows the client to take a “journey
through the brain” and practice multi-modal communication in
an interactive game format. Candidates are clients that use
at least more than one modality for communication.
How to Play
Clinical Observation Trials
• Clinical trial use of SWITCH is ongoing in two Boston
area clinics with people who have aphasia
• Modifications to the game rules and stimuli will be made
after these trials are complete
ASHA Convention,
Boston MA
November 2007
• Two playing levels:
Beginner Level: the player is expected to express the target item using all
modalities on the queue, before their partner guesses.
Pro Level: the player may use any modality to express the target item, and is
expected to switch when their attempt has failed. The object of the game is to
reach the last space and be titled Switch Master.