Copyright: Rehabilitation Institute of Chicago
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EM Babbitt 4/4/2016
Aphasia Interventions:
Partner Training &
Treatment Intensity
DISCLOSURES

Iowa Conference on Communicative Disorders
April 7, 2016

Edie Babbitt, M.Ed., CCC-SLP,
Board Certified-ANCDS

Rehabilitation Institute of Chicago
Center for Aphasia Research and Treatment
www.ric.org/aphasia
Director, Leora R. Cherney, PhD, CCC-SLP,
Board Certified-ANCDS
Topics today:
 Life
Participation Approach to
Aphasia
 Neuroplasticity
Principles
Conversation for Adults
with Aphasia
 Intensity
 Intensive
using Computer Programs
Comprehensive Aphasia
Programs - Outcomes
Ms. Babbitt received an honorarium
for this presentation.
Ms. Babbitt does not have any
relevant nonfinancial relationships
to disclose.
RIC – Center for Aphasia Research &
Treatment

& Intensity
 Supported
Ms. Babbitt receives a salary from
the Rehabilitation Institute of
Chicago.
Develop, Implement, and Promote rehabilitation
practices that:
 enhance
communication skills of individuals living
with aphasia




 facilitate
engagement in life activities
Engages community in special interest groups supported
by SLPs and trained volunteers
Conducts clinical studies to establish the efficacy and
effectiveness of aphasia treatments
Provides aphasia treatment in the Intensive Aphasia
Program
Educates staff on the techniques of Supported
Conversation for Adults with aphasia
Life Participation Approach to
Aphasia

Life Participation
Approach to Aphasia
Edoardo Matania (1847–1929)

Theoretical Foundation
 ASHA

http://www.asha.org/public/speech/disorders/LPAA/
Resources for Clinicians
 Aphasia Access

http://www.aphasiaaccess.org/
1
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Social Practice Principles
 Equalizing
social relations
 Creating
authentic involvement
 Creating
engaging experiences
 Establishing
user control
Byng & Duchan
(2005)
EM Babbitt 4/4/2016
World Health Organization:
International Classification
of Functioning
Main Health
Condition
Environmental
Factors
Impairments - Body,
Structure, Function
Personal Factors
Participation
Restrictions
Activity Limitations
Principles of Neural
Plasticity
Living with
Aphasia:
Framework
for Outcome
Measurement
(A-FROM)
Wikimedia commons
Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008).
Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258280.
Neural Plasticity is:



The adaptive capacity of the central
nervous system
The mechanism by which the brain
encodes experiences and learns new
behaviors
Living with
Aphasia:
Framework
for Outcome
Measurement
(A-FROM)
The mechanism by which the damaged
brain “relearns” lost behavior in response
to rehabilitation
Kleim & Jones, 2008
Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008).
Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258280.
2
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Principles of ExperienceDependent Neural Plasticity

Use it or lose it

Use it and improve it

Specificity

Repetition matters

Intensity matters

EM Babbitt 4/4/2016
Principles of ExperienceDependent Neural Plasticity
Failure to use specific functions can lead to functional degradation

Training that uses specific function can lead to an enhancement

The nature of the training experience dictates the nature of the
plasticity

Induction of plasticity requires sufficient repetition

Induction of plasticity requires sufficient training intensity

Time matters

Salience matters

Age matters

Transference

Interference
Kleim & Jones, 2008

Different forms of plasticity occur at different times during
training

The training experience must be sufficiently salient to induce
plasticity

Training induced plasticity occurs more readily in younger brains

Plasticity in response to one training experience can enhance the
acquisition of similar behaviors

Plasticity in response to one experience can interfere with the
acquisition of other behaviors
Kleim & Jones, 2008
Intensity of Aphasia
Treatment


Robey (1998)

Meta-analysis of aphasia Tx:
larger effect sizes with
treatment 2 hrs per week or
greater



Bhogal et al. (2003)

5 studies with positive
treatment effect

5 studies with negative
treatment effect

8.8 hrs/wk for 11.2 wks

2 hrs/wk for 22.9 wks
Cherney, Patterson,
Raymer et al. (2008)

6 studies with 68
participants
Regardless of treatment
type, more treatment
over a restricted time
appears better
Cherney, Patterson,
Raymer (2011)


5 additional studies
Equivocal results
Cumulative Intervention Intensity
• Dose Form - task in which teaching episode occurs
100
60
3
12
wks
• Dose – # of therapeutic client acts per session
• Session Duration – in minutes
• Session Frequency – times per week
• Total Intervention Duration (weeks/month)
• Cumulative Intervention Intensity
• 100 trials X 3x a week X 12 weeks =
• 3600 productions of target skill
Warren, Fey, Yoder 2007
Therapeutic Intensity Ratio
• Intensiveness (massed vs distributed)
3
• Total # hours Tx per week
40 • Maximum # hrs Tx per week
• Treatment Intensity Ratio
• 3 ÷ 40 = 7.5%

Patient characteristics

Paradoxical Results


Components of Treatment
Wikimedia commons
Supported Conversation Techniques for
Persons with Aphasia
Desired outcomes vs Workplace limitations
Babbitt, Worrall, Cherney (2015) Baker (2012)
3
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EM Babbitt 4/4/2016
ORLA®: Oral Reading for
Language in Aphasia
Living with Aphasia:
Framework for Outcome
Measurement (A-FROM)
Supported by grants H133G010098, H133G060055
& H133G040269
from the National Institute on Disability and
Rehabilitation Research,
Department of Education
PI: L.R. Cherney
Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008).
Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258280.
Oral Reading for Language in
Aphasia (ORLA®)
Living with
Aphasia:
Framework
for Outcome
Measurement
(A-FROM)

Sentences and paragraphs repeatedly read aloud, first in
unison with the clinician and then independently
Theoretical Background



Based on neuropsychological models of reading
Improve reading comprehension by providing practice in
grapheme-to-phoneme conversion
As oral reading becomes more fluent and automatic, the
reader can focus on comprehension
(Cherney et al.,1986, 1995, 2010a,2010b)
Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008).
Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258280.
ORLA® – Key Elements





Oral reading is systematically applied in
programmed format
Focuses on connected discourse
Permits modeling of more natural speech
Allows practice on a variety of grammatical
structures
Graded based on stimuli length and reading level
Wikimedia Commons
4
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
Stimulation approach
 Multimodal
 Responses
 Incorrect
repetition of stimuli
not forced or corrected
responses followed by further
stimulation i.e. correct responses are
modeled

Consistent with Principles of Learning Theory
 Active participation by the learner
 Repetitive practice in the overlearning of
skills
 Use of meaningful materials that are graded
in difficulty
EM Babbitt 4/4/2016
ORLA® Procedure
 SLP
sits opposite patient
 SLP reads stimulus aloud to patient
1.
SLP reads stimulus aloud to
patient, both point to each word
2.
Both read aloud together, Pt
points to each word (2x)
SLP adjusts rate and volume
ORLA® Procedure cont.
3.
4.
5.
SLP states a word for patient to
identify – 2x or one word from each line
or sentence
SLP points to word for patient to
read out loud - 2x or one word from
each line or sentence
1.
Baseline
Testing
2.
Pre-Treatment
Testing
Treatment:
24 sessions
of ORLA
3.
Post-Treatment
Testing
4.
Maintenance
Assessment
Patient reads stimulus aloud
SLP reads aloud with patient as needed
5
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Conclusions
 C-ORLA®
may be efficacious for people with chronic
nonfluent aphasia
Over a 6-week period, there was a trend for greater
language improvement with increased intensity and
amount of therapy

After 24 treatment sessions, there was a trend towards
greater improvement when sessions scheduled less
intensively

EM Babbitt 4/4/2016
Summary Trends
 Severe
aphasia
 Greatest
improvements in reading
comprehension
 Moderate
 Greatest
aphasia
improvements in discourse
production
 Mild-moderate
 Greatest
aphasia
improvements in written
expression and discourse production
Cherney 2010b
Conclusions


Cross-modal improvements consistent
with previous findings when ORLA
given by SLP or via computer with
avatar
Tx delivered over internet with SLP
oversight may be an efficacious and
cost effective option
AphasiaScripts®
Supported by Grant H133B031127 from the National
Institute on Disability and Rehabilitation Research,
Department of Education
PI: L.R. Cherney
Living with
Aphasia:
Framework
for Outcome
Measurement
(A-FROM)
Case Study - ROMJI












Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008).
Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258280.

Introduction at Aphasia Conference
Welcome lords, ladies, gentlemen, and honored guests.
My name is Jim R
I had a stroke eight years ago.
And like many of you, I have aphasia.
Living with aphasia can be a challenge.
But stop, look around, we are in this together.
I may have trouble finding the words I want to say.
But I still have my sense of humor.
That reminds me of a joke.
Before you criticize someone, walk a mile in their
shoes.
That way, when you criticize them,
You’re a mile away and you have their shoes!
Thank you and enjoy the wonderful day ahead.
6
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Background
Scripts guide and facilitate identification of
participants and actions involved in social
situations
 Script knowledge includes:
 understanding

 remembering
 recalling
 the
temporal organization of events in routine
activities
 Script knowledge is not seriously compromised by
aphasia for mild to moderate language deficits

A
sequence of sentences that a
person typically speaks in routine
communication situations
 Examples
 Ordering
 Making
 Talking
pizza over the phone
a doctor’s appointment
with friends and family
Cued Massed Practice
Instance Theory of Automatization

Automatic processing is fast, effortless,
autonomous, and unavailable to conscious
awareness

Automaticity of skills achieved by retrieving
memories of complete, context-bound, skilled
performance
Memories are formed with repeated exposures
to a consistent task (ie – repetition and
practice)
(Logan, 1988)
AphasiaScripts® Incorporates…
 Complete
What is a Script?
(Armus et al, 1989; Lojeck-Osiejuk, 1996)
Script Training Rationale

EM Babbitt 4/4/2016
meaningful
segments vs single words
 Relevant discourse
 Communication partner
 Consistent practice
 Intensive practice

Provides maximum support to facilitate
accurate production; support is gradually
decreased

Intensive repetitive practice accomplishes
automatization of script production

Whole task, massed practice and drill can be
accomplished by using repeated oral reading

Cost effectiveness can be achieved with use of
computers
AphasiaScripts®
 Computer
program providing
practice in conversational script
training
Uses
an animated agent with
visible speech
Allows
repeated and consistent
practice of an individualized
conversational script
7
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EM Babbitt 4/4/2016
Case Study: Jim R
Case Study – Jim R
68 year old male
 8 years post-stroke
 Moderate Broca’s aphasia
 WAB AQ 85.3
 Scripts





My name is Jim R
I had a stroke eight years ago.

Living with aphasia can be a challenge.


Dialogue about a Mediterranean cruise

Before you criticize someone, walk a mile in their shoes.



Creating Scripts

Considerations
 Identifying
patient’s communication needs
and interests for topics
 Type
of script (dialogue or monologue)
 Number
and length of conversational turns
 Grammatical
 Vocabulary
complexity
selection






Conversation starters
Dinner conversation with friends
 Ordering in a restaurant, pizza on the phone
 Talking to family (in person or on the phone)

That reminds me of a joke.
That way, when you criticize them,
You’re a mile away and you have their shoes!
Thank you and enjoy the wonderful day ahead.
Types of Communication
Situations

Script Topics
But stop, look around, we are in this together.
I may have trouble finding the words I want to say.
But I still have my sense of humor.

Dialogue about family and interests
And like many of you, I have aphasia.


Monologue: Introduction to the Midwest
Aphasia Conference
Welcome lords, ladies, gentlemen, and honored guests.


Visit exhibitions,
museums, libraries

Go to restaurants

Go to the movies,
theaters, concerts, plays

Go shopping

Play with or help
children or grandchildren
Visit friends or relatives
Talk to sales people in
stores
Severe Apraxia
of Speech



Talk on the phone to
friends and family
Make appointments over
the phone
Order over the phone
Tell stories and jokes
Discuss finances with
banker, accountant,
lawyer
Ask for directions
Discuss your health with
your doctor
Wernicke’s
Aphasia


Siblings, Parents, Kids, Grandkids, Nieces/Nephews

Giving a testimonial in church
Telling jokes
Stroke and Aphasia story
Favorite vacation/travel
Well known family stories from the past

Starbucks orders




8
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EM Babbitt 4/4/2016
Moderate Broca’s Mild Broca’s
Aphasia
Aphasia
AphasiaScripts® Research Team
Rehabilitation Institute of Chicago
 Leora R. Cherney, PhD, CCC-SLP, BC-NCD
 Edie Babbitt, MEd, CCC-SLP
 Rosalind Hurwitz, MA, CCC-SLP
 Jaime Lee, MA, CCC-SLP
 Rosalind Kaye, PhD
 Center for Spoken Language Research
 Ron Cole, PhD
 Sarel Van Vuuren, PhD
 Nattawut Ngampatipatpong, MS
 Consultant
 Audrey L. Holland, PhD. CCC-SLP, BC-NCD

Living with
Aphasia:
Framework
for Outcome
Measurement
(A-FROM)
AphasiaScripts® Summary
 Why
use scripts?
 Instance Theory of
Automatization
 Massed Practice
 Contextually-based
 Individualized Material
What is Intensive Comprehensive
Aphasia Therapy?
Definition of ICAP

Combination of therapy approaches







Individual
Group
Technology
Family Education
High Intensity
Cohort of participants in a defined amount of time
Targets all areas of ICF
RIC’s Intensive Comprehensive
Aphasia Program (ICAP)
What is a day like?
1
1
hour CILT
hour Reading/Writing
session
1
hour computer session
hour conversation group
2 hours of Individual
Treatment
1
Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008).
Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258280.
9
Copyright: Rehabilitation Institute of Chicago
Do Not Copy Without Permission
EM Babbitt 4/4/2016
Evidence-Based Treatments
Sample
Schedule

ASHA – Practice Portal

ANCDS: Academy of Neurologic Communication
 http://www.asha.org/practice-portal/
Disorders and Sciences – Practice Guidelines
 http://www.ancds.org/index.php/practice-guidelines-
9#Aphasia

SpeechBITE – Speech Pathology Database for Best
Interventions and Treatment Efficacy
 http://speechbite.com/
Principles of Constraint Induced
Language Therapy (CILT)
Forced verbal response required
 Compensatory strategies prohibited
 Intensive therapy schedule
 Shaping verbal responses

 Words/short
 Then
phrases
longer phrases/sentences
 Barrier
games
selected for each individual;
responses predetermined
 Pictures
CILT Treatment Examples

Severe Apraxia of Speech:

Moderate Broca’s Aphasia:

Mild Broca’s Aphasia:
 Visual
cueing and choral productions
 Interest-based
 Complex
stimuli, cueing as needed
language tasks
 Wernicke’s Aphasia:
 Auditory
comprehension
Pulvermuller et al, 2001
Why treat writing ?




Consider cognitive processes involved in
comprehension and production of spoken and written
words.
If one process is significantly impaired by aphasia, can
we use alternate process to enhance communication?
Orthographic representations may be better preserved
or more amenable to treatment than phonological
representations.
Motor control for writing may be more preserved.
(Beeson, 2003)
Conversation Group
Treatment




Multimodal
communication

Supported
communication

Goals may be:

Use of technology
 Initiate

Expect participants with
aphasia to initiate,
interact with each other
NOT didactic
SLP is NOT the “leader”
SLP is the “facilitator”
 Repair,
ask for
clarification
 Use
multimodal
strategies
10
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Individual Session
Treatments
EM Babbitt 4/4/2016

Treatments by Modality
Verbal Expression





RIC’s Intensive Aphasia
Program Outcome
Social Perspective:
Stakeholder Views
Behavioral Perspective:
Language & Participation
Changes
Semantic Feature
Analysis
Phonological
Feature Analysis
Response
Elaboration
Treatment
Melodic Intonation
Therapy
Reading Comprehension


Auditory Comprehension

Verb Treatments


TUF

V-nest



Kendall’s Phonological
Approach
CATE
Apraxia of Speech Drills
Gesture + Verbal
Multiple Oral Rereading
 Phase
 Phase
1: Retrospective Data Analysis
2: Stakeholder Perspectives
Clinical
Persons
 Phase
Staff
with Aphasia & Family
Members
3: Neuroplastic changes
Biological Perspective:
Neuroplastic Changes
Theory behind
Outcomes Measurement
Why is it important to
evaluate ICAPs?




Increase in number of intensive comprehensive
aphasia programs (ICAPs) in US and abroad
Unique model of therapy delivery
Funded by individuals
Bottom line questions:


Are ICAPs effective and cost effective?
Will services be reimbursed by insurance in the
future?
 Donabedian
described factors
that are important in health
care quality assurance:
Structure
Process
Outcomes
Rose, et al in press 2013
11
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Structure: Attributes of settings in which
care occurs
• Material Resources, Facilities, Equipment,
Money
• Human Resources, Personnel, Administration
EM Babbitt 4/4/2016
Current ICAP outcomes


Process: What is actually done in giving and
receiving care
Includes clinical treatment outcomes and research studies

Babbitt, Worrall, & Cherney (2015)

Winans-Mitrik, Hula, Dickey, Schumacher, Swoyer, & Doyle (2014)

• Provider/Patient activities in delivering/receiving
care
• Content of Care, Treatment Planning
• Delivery of Care (frequency/duration of visits)



Outcomes: Effects of structure and care on the
health status of patients and populations
• Improving patient's knowledge, changing behavior
• Changes in satisfaction with care and effects on
health care utilization
• Changes in measures of cognitive/physical function
Currently, 8 published papers about outcomes from ICAPs




Babbitt, Worrall, & Cherney (in press)
Persad & Wozniak (2013)
Hinckley & Craig (1998)
Dignam, Rodriquez, & Copland (2015)
Rodriquez, Worrall, Brown, Grohn, McKinnon, Pearson, et al (2013)
Code, Torney, Gildea-Howardine, & Willmes (2010)
Should we expect to see improvements in all areas for all participants?
Is improvement based on factors such as severity, type of aphasia,
time-post-onset?
Phase 1
Possible Factors Influencing
Outcomes
Measurable Factors

Program Characteristics
(or Process)




Number of tasks in
session
Number of hours per
day/week
Type of therapy
administered
Personal characteristics

Severity, etiology,
location of stroke,
size of lesion
Difficult Factors to Measure

Individual motivation

Family support




Expectations for
recovery
Pre-stroke language &
cognition networks
Social Perspective:
Stakeholder Views
BDNF and ApoE ԑ4
Biological Perspective:
Neuroplastic Changes
Clinician interpersonal
and therapeutic skills
Phase 1: Retrospective Data
Analysis


Questions
Do 1st time participants show improvements on the
following types of outcome measures:



Impairment measures?
Participation measures?

Patient reported? Care-giver reported?
What variables impact recovery?



Behavioral Perspective:
Language & Participation
Changes
Does time post-onset impact the amount of improvements
on pre-post measures?
Does severity of aphasia impact the amount of
improvement on pre-post measures?
Participant inclusion

12 cohort sessions

Total number of participants = 114


Sept 2008 to April 2014
83 first time participants included in data
analysis
1
unable to complete pre & post
testing due to severity of cognitivecommunicative deficits
Does type of aphasia impact the amount of improvement
on pre-post measures?
12
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Impairment Measures

Western Aphasia
Battery R
Aphasia Quotient
 Language Quotient
 Cortical Quotient


Boston Naming Test
Participation Measures:
Patient and Family
Reported Outcomes



ASHA Quality of
Communicative Life (ASHA
QCL)
EM Babbitt 4/4/2016
Phase 1: Regression Analysis



Determine whether any variable or combination can predict
improvement and develop a model
Based on WAB R AQ change score
Communication Confidence
Rating Scale for Aphasia
(CCRSA)

Person with Aphasia
Caregiver
Social Perspective:
Stakeholder Views




University research setting



Variety of # of years of experience, number of times
participating in intensive programs
Severity: Initial WAB R AQ
Naming ability: Boston Naming Test
Cognitive Measure: WAB R subtest Raven’s Progressive Matrixes
Confidence: CCRSA
Only AGE was significant for predicting who would achieve > = 5
Could NOT determine a model of variables that contribute to
improvements
Phase 2: Stakeholder
Perspectives
 Phase
2a: Clinician Perspectives
 Phase
2b: Perspectives of
Persons with Aphasia & Family
Members
Methods

Graneheim & Lundman (2004) to guide
analysis of interviews
 Read
through interview multiple times
 Chunked
into meaning units
 Condensed
Veteran’s hospital
All clinicians approached agreed to be interviewed
Months post-onset (MPO)
Results – Only AGE and MPO showed significant difference between
the groups
Seven clinicians from 3 locations
Non-profit rehab hospital
Type of aphasia: Non-fluent & Fluent

Phenomenological Approach – describing one’s lived
experience



Biological Perspective:
Neuroplastic Changes
Phase 2a: Clinician
Perspectives
Age


Behavioral Perspective:
Language & Participation
Changes



Phase 2
Categorized into Responders (>= 5) and Non-Responders (< 5)

Communicative
Effectiveness Index (CETI)


Factors/Variables


 Essence
meaning units
of thought
Interviews re-read for support for main
themes
Reliability check
13
Copyright: Rehabilitation Institute of Chicago
Do Not Copy Without Permission
Intensive Therapy
Model
Learning &
Support
Intensive
Comprehensive
Aphasia Programs
Rewards
Hard work but rewards outweigh challenges
Ability to go indepth
Different view of
aphasia therapy
Seeing Progress
Relationships
EM Babbitt 4/4/2016
Learning more
about diagnosis &
treatment
Learning
evidence based
treatments
Factors in Job
Satisfaction


Support from
other
staff/mentors

Between persons
with aphasia

Between family
members


Clinicans and
PWA/Fam
Members
Challenges
Time
Patient
Characteristics



Potential for professional development
Specialized skill training
Can health care providers re-create specific functions of
ICAP to provide services that enhance patient progress
and clinician job satisfaction?
Babbitt EM, Worrall LE, Cherney LR. (2013). Clinician
perspectives of an intensive comprehensive aphasia
program. Topics in Stroke Rehabilitation, 20(5), 398408.
RELATIONSHIPS








Interacting with clients, therapeutic
relationships
Support & collegiality from team
work/mentors
Helping people, making a difference
Learning/expanding knowledge base
ICAPs seem to
support these
factors




Limited effectiveness due to
client characteristics
Lack of opportunity for
professional development
Scheduling/heavy workload
ICAPs seem to
overcome
these factors
Returning to
typical clinical
setting
Discussion – Clinical
Implications

Variety in work
Factors leading to
Lack of Job
Satisfaction
"Sort of like you are in a life boat“
"like going away to college where you get a bond, all in the
same boat”
"Everybody has a story... listening to those stories you not
only bond with them… great empathy for their situation."
"never interacted with anybody" with aphasia
Phase 2: Participants &
Families
Purposeful sampling from April and Oct 2014 sessions
12 Participants, 10 Family members
 6 spouses
 1 daughter
 3 parents (Mom & Dad for 1 participant)
 3 Females, 9 males
 Range of aphasia severity levels and different types
 7 non-fluent
 5 fluent/anomic


ENVIRONMENT



"You know it's like the people I like I like.”
“We had a good laugh at a lot of those things”
“These guys are funny, it’s everybody, that’s like ‘well what
do you think?’”

“Would have been nice to have a little more contact with
the various families.”

"It's more intimate. We have this family room where we
connect which we don't have that with the other kinds of
therapies my husband has access to"
"Family room... that's really where you got all of the
stories...
Family education sessions "allowed for relationships and
learning to happen"
"He really liked going there, an office, similar to what he
used to do for work. Get dressed up, go downtown. You go
to work, you do your thing. That was really good and it
made you feel like this was this was more what my normal
life used to be."
“Family room was too small”
14
Copyright: Rehabilitation Institute of Chicago
Do Not Copy Without Permission
INTENSITY









EM Babbitt 4/4/2016
OUTCOMES
"In-depth, challenging, hard"

"Every day… very keeping keep keep keep (snapping
fingers).
“Fast paced”
“It was fun but very grueling.”
"Other speech therapy more broad, not specific"
"Well it was different. That one was 1-2 and there was
10“ (comparing to previous therapy)
"Was this was a higher level in terms of intensity and
work? No doubt."
"It was work to him and he needed work, this work"
“Oh my God yes. Tired tired.”






"Awesome, Grow, Challenge brain, excited, happening
"But here more words. Oh my gosh. different.”
“He speaks in more complete sentences. Before it was just
a word or two "
"It's accelerated… I might have made the same process but
it might take a lot longer.“
“Speed at which I can think is slower than it used to be,
getting better now”
"Started walking all over without his cane… making a lot of
physical progress."
"More confident, fine on his own, talks to people in
restaurants, went to local bar, talked to two strangers and
the bartenders."
Phase 3
RELATIONSHIPS
INTENSITY
Social Perspective:
Stakeholder Views
OUTCOMES
Behavioral Perspective:
Language & Participation
Changes
Biological Perspective:
Neuroplastic Changes
ENVIRONMENT
Research Question


Are there changes in specific
language areas of the brain after
participation in a 4 week intensive
aphasia program?
Present a case study of one participant
who demonstrated significant
improvement on a behavioral reading
measure and increased BOLD
activation on semantic judgment task
Protocol
• fMRI scan
• Language
• & Cognition testing
Pre-testing
ICAP
• 4 weeks
intensive
aphasia
therapy
• fMRI scan
• Language
• & Cognition testing
Post-testing
15
Copyright: Rehabilitation Institute of Chicago
Do Not Copy Without Permission
Boat
Ship
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EM Babbitt 4/4/2016
Future Directions
 Comparing
to standard care
 Cost-benefit
analysis
Referrals?
Please contact us at:
Phone: (312) 238-6163
email: [email protected] or [email protected]
RIC Center for Aphasia Research & Treatment
345 E Superior St. #1353
Chicago IL 60611
web: ric.org/aphasia
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