A Bird's Eye View: The Past and Future of Activity-Focused Treatment

Abstract

Throughout her career, Audrey Holland advocated for persons with aphasia, urging clinicians and others to view each person in the context of their needs and desires in navigating daily life. In this article, we acknowledge her ideas about functional treatment, and consider their influence on contemporary, activity-focused aphasia treatment. Three criteria define activity-focused treatment: (1) activity-specific goals, (2) personally relevant targets, and (3) near-real-life practice settings. Elements of treatment design, activities, and outcome measurement described here exemplify Audrey's beliefs in person-centered clinical aphasiology. Operationalizing treatment elements and designing a context as close to real life as possible are clinical actions that support these beliefs. Activity-focused treatment and other life participation approaches have often been relegated to the last phase of treatment; following Audrey's example, we advocate beginning with activity-focused treatment based on a client's communication needs and desires. Activity-focused treatment benefits persons with aphasia, their families, clinicians, and other stakeholders by presenting outcomes that reflect communication change in a real-life context and that are individually relevant. Such outcomes foster an individual's inclusion in their communication environments, respect the WHO platform of functional treatment, and prepare a clinician to present outcome data relevant to that individual.

Keywords

activity-focused treatment - aphasia - skill acquisition theory - treatment outcome - functional communication

Disclosure

The authors have declared that no competing financial or nonfinancial interests existed at the time of publication.

Publikationsverlauf

Artikel online veröffentlicht:
29. Juli 2024

• References

• American Speech-Language-Hearing Association. (2016). Scope of Practice in Speech-Language Pathology [Scope of Practice]. Available from www.asha.org/policy/
• American Speech-Language-Hearing Association. (n.d.a). Modes of Service Delivery for Speech-Language Pathology. https://www.asha.org/practice/reimbursement/modes-of-service-delivery-for-speech-language-pathology
• American Speech-Language-Hearing Association. (n.d.b) ASHA Practice Portal. https://www.asha.org/practice-portal/
• Anderson, J. R., Bothell, D., Byrne, M. D., Douglass, S., Lebiere, C., & Qin, Y. (2004). An integrated theory of the mind. Psychological Review, 111, 1036–1060
• Aydinbek, C. (2022). Contributions of cognitive theory to the problem of automatization of grammatical structures in teaching foreign language. Educational Research Review, 17(4), 131–137.
• Avent, J., Patterson, J., Lu, A., & Small, K. (2009). Reciprocal scaffolding treatment: a person with aphasia as clinical teacher. Aphasiology, 23(1), 110–119
• Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91–97
• Beaulieu, C. L., Peng, J., Hade, E. M., Montgomery, E., Gilchrist, K., Corrigan, J. D., Horn, S. D., & Bogner, J. (2021). Quasi-contextualized speech treatment in traumatic brain injury inpatient rehabilitation: effects on outcomes during the first year after discharge. The Journal of Head Trauma Rehabilitation, 36(5), E312–E321
• Biel, M., Enclade, H., Richardson, A., Guerrero, A., & Patterson, J. (2022). Motivation theory and practice in aphasia rehabilitation: a scoping review. American Journal of Speech-Language Pathology, 31(5S), 2421–2443
• Biel, M., & Haley, K. L. (2023). Motivation in aphasia treatment: Self-determination theory applied to the FOURC model. American Journal of Speech-Language Pathology, 32(3), 1016–1036
• Bogner, J., Dijkers, M., Hade, E. M., Beaulieu, C., Montgomery, E., Giuffrida, C., Timpson, M., Peng, J., Gilchrist, K., Lash, A., Hammond, F. M., Horn, S. D., & Corrigan, J. D. (2019). Contextualized treatment in traumatic brain injury inpatient rehabilitation: effects on outcomes during the first year after discharge. Archives of Physical Medicine and Rehabilitation, 100(10), 1810–1817
• Boyle, M. (2011). Discourse treatment for word retrieval impairment in aphasia: the story so far. Aphasiology, 25(11), 1308–1326
• Boyle, M. (2020). Choosing discourse outcome measures to assess clinical change. Seminars in Speech and Language, 41(1), 1–9
• Breitenstein, C., Hilari, K., Menahemi-Falkov, M. L., Rose, M., Wallace, S. J., Brady, M. C., Hillis, A. E., Kiran, S., Szflarski, J. P., Tippett, D. C., Visch-Brink, E., & Willmes, K. (2023). Operationalising treatment success in aphasia rehabilitation. Aphasiology, 37(11), 1693–1732
• Brogan, E., Ciccone, N., & Godecke, E. (2019). Treatment fidelity in aphasia randomised controlled trials. Aphasiology, 33(7), 759–779
• Cavanaugh, R., Kravetz, C., Jarold, L., Quique, Y., Turner, R., & Evans, W. S. (2021). Is there a research–practice dosage gap in aphasia rehabilitation? American Journal of Speech-Language Pathology, 30(5), 2115–2129
• Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons Mackie, N. (2000). Life participation approach to aphasia: a statement of values for the future. ASHA Leader, 5(3), 4–6
• Cherney, L. R., DeDe, G., Hoover, E. L., Murray, L., Obermeyer, J., & Pompon, R. H. (2022). Applying the Rehabilitation Treatment Specification System to functional communication treatment approaches for aphasia. Archives of Physical Medicine and Rehabilitation, 103, 599–609
• Cherney, L. R., & Van Vuuren, S. (2022). Complexity and feedback during script training in aphasia: a feasibility study. Archives of Physical Medicine and Rehabilitation, 103(7S), S205–S214
• Cohen, M. L., & Hula, W. D. (2020). Patient-reported outcomes and evidence-based practice in speech-language pathology. American Journal of Speech-Language Pathology, 29(1), 357–370
• Conlon, E. L., Braun, E. J., Babbitt, E. M., & Cherney, L. R. (2020). Treatment fidelity procedures for an aphasia intervention within a randomized controlled trial: design, feasibility, and results. American Journal of Speech-Language Pathology, 29(1S), 412–424
• Coppens, P., & Patterson, J. P. (2017). Generalization in aphasiology: What are the best strategies? In: P. Coppens & J. P. Patterns (Eds.), Aphasia Rehabilitation: Clinical Challenges (pp. 205–248). Jones & Bartlett Learning
• Crosson, B., Rodriguez, A. D., Copland, D., Fridriksson, J., Krishnamurthy, L. C., Meinzer, M., Raymer, A. M., Krishnamurthy, V., & Leff, A. P. (2019). Neuroplasticity and aphasia treatments: new approaches for an old problem. Journal of Neurology, Neurosurgery, and Psychiatry, 90, 1147–1155
• DeKeyser, R. (2020). Skill acquisition theory. In: B. Van Patten, G. D., Keating, & S. Wulff (Eds.), Theories of Skill Acquisition: An Introduction (3rd ed.). Routledge
• Dietz, A., Knollman-Porter, K., Hux, K., Toth, K., & Brown, B. (2014). Supported reading comprehension for people with aphasia: visual and linguistic supports. Journal of Medical Speech-Language Pathology, 21(4), 319–331
• Dipper, L., Marshall, J., Boyle, M., Hersh, D., Botting, N., & Cruice, M. (2021). Creating a theoretical framework to underpin discourse assessment and intervention in aphasia. Brain Sciences, 11, 183
• Dipper, L., Carragher, M., & Whitworth, A. (2023). Interventions Targeting Spoken Discourse in Aphasia. In: A. P. H. Kong (Eds.), Spoken Discourse Impairments in the Neurogenic Populations. Cham, Switzerland: Springer
• Doedens, W. J., & Meteyard, L. (2022). What is functional communication? A theoretical framework for real-world communication applied to aphasia rehabilitation. Neuropsychology Review, 32, 937–973
• Duncan, E. S., & Small, S. L. (2018). Changes in dynamic resting state network connectivity following aphasia therapy. Brain Imaging and Behavior, 12(4), 1141–1149
• Elman, R. J., & Bernstein-Ellis, E. (1995). What is functional? American Journal of Speech-Language Pathology, 4(4), 115–117
• Fridriksson, J., Holland, A. L., Beeson, P., & Mo rrow, L. (2005). Spaced retrieval treatment of anomia. Aphasiology, 19(2), 99–109
• Gili, T., Fiori, V., De Pasquale, G., Sabatini, U., Caltagirone, C., & Marangolo, P. (2017). Right sensory-motor functional networks subserve action observation therapy in aphasia. Brain Imaging and Behavior, 11(5), 1397–1411
• Gravier, M. L., Dickey, M. W., Hula, W. D., Evans, W. S., Owens, R. L., Winans-Mitrik, R. L., & Doyle, P. J. (2018). What matters in semantic feature analysis: practice-related predictors of treatment response in aphasia. American Journal of Speech-Language Pathology, 27, 438–453
• Haley, K. L., Womack, J., Helm-Estabrooks, N., Lovette, B., & Goff, R. (2013). Supporting autonomy for people with aphasia: use of the Life Interests and Values (LIV) Cards. Topics in Stroke Rehabilitation, 20(1), 22–35
• Hart, T., Dijkers, M. P., Whyte, J., Turkstra, L. S., Zanca, J. M., Packel, A., Van Stan, J. H., Ferraro, M., & Chen, C. (2019). A theory-driven system for the specification of rehabilitation treatments. Archives of Physical Medicine and Rehabilitation, 100(1), 172–180
• Heath, C., Conroy, P., Pellegrini, I., & Bruehl, S. (2023). Investigating the neural basis of post-stroke aphasia therapy; a systematic review of neuroscience-based therapy studies. Aphasiology, 37(9), 1508–1532
• Heilemann, C., Best, W., Johnson, F., Beckley, F., Edwards, S., Maxim, J., & Beeke, S. (2014). Investigating treatment fidelity in a conversation-based aphasia therapy. Aphasie und verwandte Gebiete/Aphasie et domaines associés, 37(2), 14–26
• Hickey, E., Bourgeois, M., & Olswang, L. (2004). Effects of training volunteers to converse with nursing home residents with aphasia. Aphasiology, 18(5–7), 625–637
• Hinckley, J. (2014). Facilitating life participation in severe aphasia with limited treatment time. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 3, 89–99
• Hinckley, J. (2017). Selecting, combining, and bundling different therapy approaches. In: P. Coppens & J. P. Patterson (Eds.), Aphasia Rehabilitation: Clinical Challenges. (pp. 331–354). Jones & Bartlett
• Hinckley, J., & Carr, T. (2005). Comparing the outcomes of intensive and non-intensive context-based aphasia treatment. Aphasiology, 19(10–11), 965–974
• Hinckley, J. J., & Douglas, N. F. (2013). Treatment fidelity: its importance and reported frequency in aphasia treatment studies. American Journal of Speech-Language Pathology, 22, S279–S284
• Hinckley, J. J., Patterson, J. P., & Carr, T. H. (2001). Differential effects of context- and skill-based treatment approaches: preliminary findings. Aphasiology, 15(5), 463–476
• Hinckley, J., Patterson, J., & Karidas, S. (submitted). A functional multitasking assessment for aphasia: the catalog ordering task.
• Hinckley, J., & Sanchez, L. (2023). Treatment time and treatment selection in aphasia: a preliminary study using vignettes. American Journal of Speech-Language Pathology, 32(5S), 2430–2443
• Holland, A. L. (1980). Communicative Abilities in Daily Living (CADL): A Test of Functional Communication for Aphasic Adults. Baltimore: University Park Press
• Holland, A. (1982a, June 6–10). Remarks on observing aphasic people [Conference Session]. Clinical Aphasiology Conference, Oshkosh, WI, United States. http://aphasiology.pitt.edu/749/
• Holland, A. L. (1982b). Observing functional communication of aphasic adults. The Journal of Speech and Hearing Disorders, 47(1), 50–56
• Holland, A. L. (1999). Communication Activities of Daily Living (2nd ed.). Austin, TX: Pro-Ed
• Holland, A. L. (2011). Developing and using scripts in the treatment of aphasia, apraxia of speech, and TBI. SpeechPathology.com. Accessed July 5, 2024 at: https://www.speechpathology.com/articles/developing-and-using-scripts-in-1673
• Holland, A. L., Halper, A. S., & Cherney, L. R. (2010). Tell me your story: analysis of script topics selected by persons with aphasia. American Journal of Speech-Language Pathology, 19, 198–203
• Hopper, T., Holland, A., & Rewega, M. (2002). Conversational coaching: treatment outcomes and future directions. Aphasiology, 16, 745–761
• Kagan, A. (1998). Supported conversation for adults with aphasia: methods and resources for training conversation partners. Aphasiology, 12(9), 816–830
• Kagan, A., & Simmons-Mackie, N. (2007). Beginning with the end: outcome-driven assessment and intervention with life participation in mind. Topics in Language Disorders, 27(4), 309–317
• 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), 258–280
• Kamhi, A. G. (2019). Speech-language development as proceduralization and skill learning: implications for assessment and intervention. Journal of Communication Disorders, 82, 105918
• Kaye, R. C., & Cherney, L. R. (2016). Script templates: a practical approach to script training in aphasia. Topics in Language Disorders, 36(2), 136–153
• Kiran, S., & Thompson, C. K. (2003). The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality. Journal of Speech, Language, and Hearing Research: JSLHR, 46(3), 608–622
• Kiran, S., & Thompson, C. K. (2019). Neuroplasticity of language networks in aphasia: advances, updates, and future challenges. Frontiers in Neurology, 10, 295
• Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research: JSLHR, 51(1), S225–S239
• Lambert, C. (2024). Practice in task-based language teaching. In: Y. Suzuki (Ed.), Practice and Automatization in Second Language Research: Perspectives from Skill Acquisition Theory and Cognitive Psychology. Routledge
• Lock, S., Wilkinson, R., Bryan, K., Maxim, J., Edmundson, A., Bruce, C., & Moir, D. (2001). Supporting partners of people with aphasia in relationships and conversation (SPPARC). International Journal of Language & Communication Disorders, 36(Suppl), 25–30
• Logan, G. D. (2002). An instance theory of attention and memory. Psychological Review, 109, 376–400
• Luria, A. R. (1970). Traumatic Aphasia: Its Syndromes, Psychology and Treatment. The Hague & Paris: Mouton
• Marchina, S., Norton, A., & Schlaug, G. (2023). Effects of melodic intonation therapy in patients with chronic nonfluent aphasia. Annals of the New York Academy of Sciences, 1519, 173–185
• Martin, N., Thompson, C. K., & Worrall, L. (2007). Aphasia Rehabilitation: The Impairment and Its Consequences. Plural Publishing
• Mayer, J. F., Madden, E. B., Mozeiko, J., Murray, L. L., Patterson, J. P., Purdy, M., Sandberg, C. W., & Wallace, S. E. (2024). Generalization in aphasia treatment: a tutorial for speech-language pathologists. American Journal of Speech-Language Pathology, 33(1), 57–73
• Melton, A., & Bourgeois, M. (2005). Training compensatory memory strategies via the telephone for persons with TBI. Aphasiology, 19(3–5), 353–364
• Miller, W. R., & Rollnick, S. (2023). Motivational Interviewing (4th ed.). Guilford Press
• Mis, R., & Giovannetti, T. (2022). Similarities between cognitive models of language production and everyday functioning: Implications for development of interventions for functional difficulties. Topics in Cognitive Science, 14(2), 295–310
• Nickels, L., Best, W., & Howard, D. (2015). Optimising the ingredients for evaluation of the effects of intervention. Aphasiology, 29(5), 619–643
• Rose, M. L., Ali, M., Elders, A., Godwin, J., Karachalia Sandri, A., Williams, L. J., ... & Brady, M. C. (2018). Tidier descriptions of speech and language therapy interventions for people with aphasia; consensus from the RELEASE collaboration. Aphasiology, 32(Suppl 1), 183–186
• Ryan, R. M., & Deci, E. L. (2017). Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness (1st ed.). New York: The Guilford Press
• Sarno, M. T. (1969). The Functional Communication Profile, manual of directions. New York: Institute of Rehabilitation Medicine, New York University Medical Center, (Rehabilitation Monograph 42)
• Sato, M. (2024). Skill learning theories and language teaching. In: Y. Suzuki (Ed.), Practice and Automatization in Second Language Research: Perspectives from Skill Acquisition Theory and Cognitive Psychology. New York: Routledge
• Schuell, H., Jenkins, J. J., & Jimenez-Pabon, E. (1964). Aphasia in Adults: Diagnosis, Prognosis and Treatment. New York: Harper & Row
• Shill, M. A. (1979). Motivational factors in aphasia therapy: research suggestions. Journal of Communication Disorders, 12(6), 503–517
• Simmons-Mackie, N. (2001). Social approaches to aphasia. In: R. Chapey (Ed.), Language Intervention Strategies in Aphasia. Williams & Wilkins
• Stark, B. C., Dutta, M., Murray, L. L., Fromm, D., Bryant, L., Harmon, T. G., Ramage, A. E., & Roberts, A. C. (2021). Spoken discourse assessment and analysis in aphasia: an international survey of current practices. Journal of Speech, Language, and Hearing Research: JSLHR, 64(11), 4366–4389
• Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10(2), 349–367
• Suzuki, Y., & Elgort, I. (2024). Measuring automaticity in second language comprehension: A methodological synthesis of experimental tasks over three decades (1990–2021). In: Y. Suzuki (Ed.), Practice and Automatization in Second Language Research: Perspectives from Skill Acquisition Theory and Cognitive Psychology. New York: Routledge
• Suzuki, Y. (2024). Introduction: Practice and automatization in a second language. In: Y. Suzuki (Ed.), Practice and Automatization in Second Language Research: Perspectives from Skill Acquisition Theory and Cognitive Psychology. New York: Routledge
• Taylor, M. L. (1965). A measurement of functional communication in aphasia. Archives of Physical Medicine and Rehabilitation, 46, 101–107.
• Thompson, C. K. (1989). Generalization in the treatment of aphasia. In: L. McReynolds & J. Spradlin (Eds.), Generalization Strategies in the Treatment of Communication (pp. 82–115). B. C. Decker
• Truijens, F., Zühlke-van Hulzen, L., & Vanheule, S. (2019). To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment. Journal of Clinical Psychology, 75(3), 329–343
• Vanderploeg, R. D., Collins, R. C., Sigford, B., Date, E., Schwab, K., Warden, D., & the Defense and Veterans Brain Injury Center Veterans Health Administration study planning group. (2006). Practical and theoretical considerations in designing rehabilitation trials: The DVBIC cognitive-didactic versus functional-experiential treatment study experience. The Journal of Head Trauma Rehabilitation, 21(2), 179–193
• Vanderploeg, R. D., Schwab, K., Walker, W. C., Fraser, J. A., Sigford, B. J., Date, E. S., Scott, S. G., Curtiss, G., Salazar, A. M., Warden, D. L., & the Defense and Veterans Brain Injury Center Study Group. (2008). Rehabilitation of traumatic brain injury in active duty military personnel and veterans: defense and Veterans Brain Injury Center randomized controlled trial of two rehabilitation approaches. Archives of Physical Medicine and Rehabilitation, 89(12), 2227–2238
• van de Sandt-Koenderman, M. W. M. E., Mendez Orellana, C. P., van der Meulen, I., Smits, M., & Ribbers, G. M. (2016). Language lateralisation after Melodic Intonation Therapy: an fMRI study in subacute and chronic aphasia. Aphasiology, 32(7), 765–783
• Voss, P., Thomas, M. E., Cisneros-Franco, J. M., & de Villers-Sidani, É. (2017). Dynamic brains and the changing rules of neuroplasticity: implications for learning and recovery. Frontiers in Psychology, 8, 1657
• Wallace, S. J., Worrall, L., Rose, T., Le Dorze, G., Cruice, M., Isaksen, J., Kong, A. P. H., Simmons-Mackie, N., Scarinci, N., & Gauvreau, C. A. (2017). Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF. Disability and Rehabilitation, 39(14), 1364–1379
• Webster, J., Whitworth, A., & Morris, J. (2015). Is it time to stop “fishing”? A review of generalisation following aphasia intervention. Aphasiology, 29(11), 1240–1264
• Wepman, J. M. (1953). A conceptual model for the processes involved in recovery from aphasia. The Journal of Speech and Hearing Disorders, 18(1), 4–13
• World Health Organization. (2001). The International Classification of Functioning, Disability and Health (ICF). Geneva: WHO. Accessed July 5, 2024 at: http://www.who.int/classifications/icf/en