Shirley Morganstein, MA CCC-SLP Marilyn Certner Smith, MA CCC-SLP Speaking of Aphasia, LLC Morganstein & Certner-Smith, 20...
Introduction:  TLS Philosophy Morganstein & Certner-Smith, 2011 What ’s TLS?
TLS Definition <ul><li>Thematic language stimulation (TLS) is a  systematic  method of aphasia therapy that employs  thema...
TLS Flow:  A Process <ul><li>Begins with a select group of words, related in meaning. </li></ul><ul><li>Places words in pa...
Role of the  Therapist in TLS <ul><li>Carries the burden of success. </li></ul><ul><li>Provides a link between what the PW...
The Therapist and the PWA <ul><li>Stimulation:  improved language performance. </li></ul><ul><li>Observation during stimul...
TLS:  Elements of the Definition <ul><li>Thematic language stimulation (TLS) is a  systematic  method of aphasia therapy… ...
How is it  systematic? <ul><li>Presents material in hierarchical arrangement </li></ul><ul><ul><li>Best modality first </l...
TLS:  Elements of the Definition <ul><li>… that employs  thematically-related vocabulary  in  multimodality stimulation </...
Thematically-related vocabulary? <ul><li>Meaningful content and personal relevance heighten therapeutic effect via context...
Multimodality stimulation? <ul><li>Language involves  speaking, understanding, reading, and writing.   Schuell (1964)felt ...
TLS:  Elements of the Definition <ul><li>…  targeting  changes in language processing for functional communication. </li><...
Changing processes for functional communication? <ul><li>TLS  hypothesis is that you are changing the way the brain is wor...
Brain Work:  Neurobiological Evidence Morganstein & Certner-Smith, 2011
Animal studies <ul><li>Jenkins et al (1990) found expansion of distal digit representation in monkey brains after sensory ...
Research in Humans:  “The Community of Brain Repair” <ul><li>Constraint-induced therapy in affected upper extremities post...
“ What goes around comes around” <ul><li>1950 ’s:  Schuell’s clinical neurobiology </li></ul><ul><li>1960 ’s:  Programmed ...
The Next Decade: the Brain Redux <ul><li>fMRI :  does therapy change the brain? </li></ul><ul><li>Cortical stimulation: el...
Schuell ’s Neurobiological Stimulation <ul><li>Principle of maximal patient response, achieved by </li></ul><ul><ul><li>Ex...
Schuell ’s Neurobiological  Stimulation <ul><li>Principle of stimulus adequacy, achieved via </li></ul><ul><ul><li>Intensi...
Schuell ’s Neurobiological  Stimulation <ul><li>Systematic and Intense Presentation </li></ul><ul><ul><li>Organized </li><...
Building on Schuell ’s model:  The TLS advantage <ul><li>Use of thematically-related  </li></ul><ul><li>vocabulary, rather...
Building on Schuell ’s model:  The TLS advantage <ul><li>Provides inherent redundancy, depth  </li></ul><ul><li>and breadt...
Research with TLS Morganstein & Certner-Smith, 2011
TLS:  Preliminary Research <ul><li>Defining Success – finding a functional communication measure: content unit analysis pr...
TLS:  Preliminary Research <ul><li>Procedures </li></ul><ul><ul><li>CU analysis (cookie theft picture) </li></ul></ul><ul>...
Morganstein & Certner-Smith, 2011
Beginning with TLS:  Assessment Morganstein & Certner-Smith, 2011
Assessment <ul><li>The PWA ’s preferences for treatment and goals is where is all begins. </li></ul>S.Morganstein & M.Cert...
Assessing at the Impairment Level <ul><li>Determine the severity of the aphasic symptoms </li></ul><ul><li>The type of aph...
Assessment of Impairment  begins.. <ul><li>Evaluates deficits on  </li></ul><ul><li>standardized measures. </li></ul><ul><...
More  Assessment <ul><li>Probes strategies for task success </li></ul><ul><li>Derive information about functional communic...
Assessing the Impairment (Deficit) <ul><li>BDAE </li></ul><ul><li>MTDDA </li></ul><ul><li>WAB </li></ul><ul><li>PICA </li>...
Process Assessment <ul><li>Quality  as well as quantity: </li></ul><ul><ul><li>What is he doing? </li></ul></ul><ul><ul><l...
Assessment beyond  language… <ul><li>The assessment process parameters  beyond language  include: </li></ul><ul><ul><li>Co...
Strategy probes for TLS <ul><li>Aphasia testing using a TLS mindset  requires  strategy probes  </li></ul><ul><ul><li>Nami...
Assessing  conversational  ability and style <ul><li>Assess conversational ability, any way you can </li></ul><ul><ul><li>...
Summary of Assessment <ul><li>Language </li></ul><ul><li>Patient process </li></ul><ul><li>Non-language profile </li></ul>...
Formulating a TLS Unit <ul><li>A TLS Recipe </li></ul>Morganstein & Certner-Smith, 2011
TLS: Creating and Using The TLS Unit <ul><li>Following a culinary metaphor… </li></ul>Morganstein & Certner-Smith, 2011
The TLS Unit:  It ’s About… <ul><li>Knowing </li></ul><ul><li>Selecting </li></ul><ul><li>Developing </li></ul><ul><li>Del...
TLS:  Knowing <ul><li>“ Who am I dining with?” </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Talents & Intere...
TLS: Selecting  <ul><li>Choosing the sandwich: </li></ul><ul><ul><li>Topics that relate to the person ’s  </li></ul></ul><...
TLS:  Creating  <ul><li>Assembling the sandwich </li></ul><ul><ul><li>Select content vocabulary:  8-10 words related seman...
TLS: Delivering  <ul><li>Introductory topical conversation on the theme </li></ul><ul><li>Manipulation of language in a se...
TLS:  Extending  <ul><li>Serve more of the sandwich: </li></ul><ul><ul><li>Extend the theme by adapting and adding exercis...
TLS:  Enhancing:  Metalinguistic Process <ul><li>What just happened here? (reflections on the meal) </li></ul><ul><ul><li>...
TLS: Enhancing  Metalinguistic Process <ul><li>Critiquing the experience: continued </li></ul><ul><ul><li>SLP offers more ...
TLS:  Secrets of a Good Sandwich <ul><li>Maintain a success rate of approximately 80-90% for each selected task. </li></ul...
TLS:  Secrets of a Good Sandwich <ul><li>Make small changes in some aspect of the task each time you repeat it (and do rep...
TLS:  Formatting the Unit <ul><li>The ABC ’s of Exercises </li></ul><ul><li>What to Include </li></ul><ul><li>Creative Com...
Your Turn Morganstein & Certner-Smith, 2011
TLS:  The Exercises Morganstein & Certner-Smith, 2011
Supermarket Unit Core Vocabulary <ul><li>Purpose:  related vocabulary that will provide the core concepts and language of ...
Repetition/Oral Reading <ul><li>Purpose:  controlled speech practice using auditory and/visual input. </li></ul><ul><li>De...
Speech Stimulation/Production <ul><li>Purpose: language stimulation that transitions from cued  contexts to generating nov...
Copying <ul><li>Purpose: writing and spelling practice at a basic level  </li></ul><ul><li>Description: core vocabulary fo...
Categorization <ul><li>Purpose: Identification of the core vocabulary </li></ul><ul><li>Description: vocabulary are random...
Sentence Fill-ins <ul><li>Purpose: reading  comprehension and oral recitation  </li></ul><ul><li>Description: open ended s...
Yes/No Questions <ul><li>Purpose:  Stimulate comprehension visually and/or auditorally. </li></ul><ul><li>Description:  Qu...
Answering questions- multiple choice <ul><li>Purpose:  Facilitates answering simple questions, reading comprehension and o...
Sentence Arrangement <ul><li>Purpose:  Syntactic practice </li></ul><ul><li>Description:  Scrambled sentences are created ...
Sentence Construction <ul><li>Purpose:  Stimulates generating information and  grammar. </li></ul><ul><li>Description:  wo...
Sentence Correction <ul><li>Purpose:  Error identification and correction </li></ul><ul><li>Description: Statements contai...
Reading Paragraphs <ul><li>Purpose: Improve reading comprehension. </li></ul><ul><li>Description: Humorous paragraphs whic...
Conversational Questions <ul><li>Purpose:  Stimulate language that is more functionally based. </li></ul><ul><li>Descripti...
TLS:  Baseball <ul><li>Excerpt from a full session, illustrating use and flow of TLS. </li></ul><ul><li>Is the client ’s c...
<ul><ul><li>Early Recovery </li></ul></ul><ul><li>Clinical  Functional  Psycho/Social  Education </li></ul><ul><li>Manipul...
<ul><ul><li>Middle Recovery </li></ul></ul><ul><li>Clinical  Functional  Psycho/Social  Education </li></ul><ul><li>Finess...
<ul><ul><li>Late Recovery </li></ul></ul><ul><li>Clinical  Functional  Psycho/Social  Education </li></ul><ul><li>Intermit...
Morganstein & Certner-Smith, 2011 Participation in Life Situations Severity of Aphasia Communication and language environm...
Thank you ! Morganstein & Certner-Smith, 2011
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Powerpoint of presentation on Thematic Language Stimulation, an aphasia therapy technique by Shirley Morganstein and Marilyn Certner Smith. Copyrighted material.

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  • Chat a bit about our history and evolution.
  • Will discuss all elements in red one at a time.
  • Will discuss all elements in red one at a time.
  • Tls for oslha unit&vid 2 21-11

    1. 1. Shirley Morganstein, MA CCC-SLP Marilyn Certner Smith, MA CCC-SLP Speaking of Aphasia, LLC Morganstein & Certner-Smith, 2011 Thematic Language Stimulation
    2. 2. Introduction: TLS Philosophy Morganstein & Certner-Smith, 2011 What ’s TLS?
    3. 3. TLS Definition <ul><li>Thematic language stimulation (TLS) is a systematic method of aphasia therapy that employs thematically-related vocabulary in multimodality stimulation , targeting changes in language processing for functional communication. </li></ul>Morganstein & Certner-Smith, 2011
    4. 4. TLS Flow: A Process <ul><li>Begins with a select group of words, related in meaning. </li></ul><ul><li>Places words in particular linguistic contexts. </li></ul><ul><li>Uses words in tasks that employ both input and output modes. </li></ul><ul><li>Targets improvement of underlying language processes for conversational success. </li></ul>Morganstein & Certner-Smith, 2011
    5. 5. Role of the Therapist in TLS <ul><li>Carries the burden of success. </li></ul><ul><li>Provides a link between what the PWA knows and what he shows. </li></ul><ul><li>The neurobiological catalyst. </li></ul>Morganstein & Certner-Smith, 2011
    6. 6. The Therapist and the PWA <ul><li>Stimulation: improved language performance. </li></ul><ul><li>Observation during stimulation: reveals information about underlying processes. </li></ul><ul><li>Awareness of processes: has value in conversational strategy development </li></ul>Morganstein & Certner-Smith, 2011
    7. 7. TLS: Elements of the Definition <ul><li>Thematic language stimulation (TLS) is a systematic method of aphasia therapy… </li></ul>Morganstein & Certner-Smith, 2011
    8. 8. How is it systematic? <ul><li>Presents material in hierarchical arrangement </li></ul><ul><ul><li>Best modality first </li></ul></ul><ul><ul><li>Easiest S-R format first </li></ul></ul><ul><li>The “Alice-in-Wonderland” phenomenon </li></ul>Morganstein & Certner-Smith, 2011 “ Begin at the beginning, continue through the middle, and stop when you come to the end. ”
    9. 9. TLS: Elements of the Definition <ul><li>… that employs thematically-related vocabulary in multimodality stimulation </li></ul>Morganstein & Certner-Smith, 2011
    10. 10. Thematically-related vocabulary? <ul><li>Meaningful content and personal relevance heighten therapeutic effect via contextual language elements. </li></ul><ul><li>Capitalizes on the organizational systems and elements already well-established within the brain, rather than creating new ones. </li></ul>Morganstein & Certner-Smith, 2011
    11. 11. Multimodality stimulation? <ul><li>Language involves speaking, understanding, reading, and writing. Schuell (1964)felt remediation should employ all of these modalities in order to enhance therapeutic effect. </li></ul><ul><ul><li>At the right level in each modality </li></ul></ul><ul><ul><li>In every session </li></ul></ul><ul><ul><li>In a sensible progression of activity and task requirements </li></ul></ul>Morganstein & Certner-Smith, 2011
    12. 12. TLS: Elements of the Definition <ul><li>… targeting changes in language processing for functional communication. </li></ul>Morganstein & Certner-Smith, 2011
    13. 13. Changing processes for functional communication? <ul><li>TLS hypothesis is that you are changing the way the brain is working, by “working the brain”. </li></ul>Morganstein & Certner-Smith, 2011
    14. 14. Brain Work: Neurobiological Evidence Morganstein & Certner-Smith, 2011
    15. 15. Animal studies <ul><li>Jenkins et al (1990) found expansion of distal digit representation in monkey brains after sensory training. </li></ul><ul><li>Kilgard and Merzenich (1998) found changes in the organization of monkey aud cortex with exposure to combination of sound exposure and administration of chemical neurotransmitters. </li></ul>Morganstein & Certner-Smith, 2011
    16. 16. Research in Humans: “The Community of Brain Repair” <ul><li>Constraint-induced therapy in affected upper extremities post CVA. </li></ul><ul><li>BWST in spinal cord injury </li></ul>Morganstein & Certner-Smith, 2011
    17. 17. “ What goes around comes around” <ul><li>1950 ’s: Schuell’s clinical neurobiology </li></ul><ul><li>1960 ’s: Programmed instruction </li></ul><ul><li>1970 ’s: Compensatory Techniques </li></ul><ul><li>1980 ’s: Cognitive and Linguistic techniques </li></ul><ul><li>1990 ’s: Social and Life Participation </li></ul><ul><li>2000 ’s: Renewed neurobiological interest </li></ul>Morganstein & Certner-Smith, 2011
    18. 18. The Next Decade: the Brain Redux <ul><li>fMRI : does therapy change the brain? </li></ul><ul><li>Cortical stimulation: electrocortical stim in conjunction with therapy </li></ul><ul><li>Neurotransmitters in conjunction with tx </li></ul>Morganstein & Certner-Smith, 2011
    19. 19. Schuell ’s Neurobiological Stimulation <ul><li>Principle of maximal patient response, achieved by </li></ul><ul><ul><li>Extending language and materials </li></ul></ul><ul><ul><li>Emphasis on task repetition, re-ordering, adaptation </li></ul></ul><ul><ul><li>Meaningful context </li></ul></ul>Morganstein & Certner-Smith, 2011
    20. 20. Schuell ’s Neurobiological Stimulation <ul><li>Principle of stimulus adequacy, achieved via </li></ul><ul><ul><li>Intensity </li></ul></ul><ul><ul><li>Focus </li></ul></ul><ul><ul><li>Linguistic bombardment </li></ul></ul><ul><ul><li>Multiple presentations </li></ul></ul><ul><ul><li>Varied context </li></ul></ul>Morganstein & Certner-Smith, 2011
    21. 21. Schuell ’s Neurobiological Stimulation <ul><li>Systematic and Intense Presentation </li></ul><ul><ul><li>Organized </li></ul></ul><ul><ul><li>Programmed for success </li></ul></ul><ul><ul><li>Repetition </li></ul></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    22. 22. Building on Schuell ’s model: The TLS advantage <ul><li>Use of thematically-related </li></ul><ul><li>vocabulary, rather than </li></ul><ul><li>isolated high-frequency words. </li></ul><ul><ul><li>Provides a “hook” upon which to </li></ul></ul><ul><ul><li>hang language: natural context. </li></ul></ul><ul><ul><li>Provision of linguistic context allows transition to meaningful conversation. </li></ul></ul>Morganstein & Certner-Smith, 2011
    23. 23. Building on Schuell ’s model: The TLS advantage <ul><li>Provides inherent redundancy, depth </li></ul><ul><li>and breadth . </li></ul><ul><li>Fosters connection with language, with feelings, ideas, history. </li></ul><ul><li>Educational/training component and metacognitive exploration for PWA and/or others </li></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    24. 24. Research with TLS Morganstein & Certner-Smith, 2011
    25. 25. TLS: Preliminary Research <ul><li>Defining Success – finding a functional communication measure: content unit analysis proposed by Yorkston and Beukelman. </li></ul><ul><li>Design Choice – single subject, reversal. </li></ul><ul><li>Subject selection – no significant vision or hearing deficits; able to participate in a 3 week course of 5 day/week therapy. </li></ul>Morganstein & Certner-Smith, 2011
    26. 26. TLS: Preliminary Research <ul><li>Procedures </li></ul><ul><ul><li>CU analysis (cookie theft picture) </li></ul></ul><ul><ul><li>One week in a randomly assigned module </li></ul></ul><ul><ul><li>Repeat CU analysis </li></ul></ul><ul><ul><li>Reversal of module </li></ul></ul><ul><ul><li>Repeat CU analysis </li></ul></ul><ul><ul><li>Reversal of module </li></ul></ul><ul><ul><li>Repeat CU analysis </li></ul></ul>Morganstein & Certner-Smith, 2011
    27. 27. Morganstein & Certner-Smith, 2011
    28. 28. Beginning with TLS: Assessment Morganstein & Certner-Smith, 2011
    29. 29. Assessment <ul><li>The PWA ’s preferences for treatment and goals is where is all begins. </li></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    30. 30. Assessing at the Impairment Level <ul><li>Determine the severity of the aphasic symptoms </li></ul><ul><li>The type of aphasia </li></ul><ul><li>The adequacy of conversation and communication </li></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    31. 31. Assessment of Impairment begins.. <ul><li>Evaluates deficits on </li></ul><ul><li>standardized measures. </li></ul><ul><li>Derives information about patient process during testing </li></ul><ul><ul><li>Less emphasis on the score </li></ul></ul><ul><ul><li>More emphasis on how he got it </li></ul></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    32. 32. More Assessment <ul><li>Probes strategies for task success </li></ul><ul><li>Derive information about functional communication and its enhancement. </li></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    33. 33. Assessing the Impairment (Deficit) <ul><li>BDAE </li></ul><ul><li>MTDDA </li></ul><ul><li>WAB </li></ul><ul><li>PICA </li></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    34. 34. Process Assessment <ul><li>Quality as well as quantity: </li></ul><ul><ul><li>What is he doing? </li></ul></ul><ul><ul><li>How is he doing it? </li></ul></ul><ul><ul><li>Why is he doing it that way? </li></ul></ul><ul><ul><li>What is the time factor? </li></ul></ul><ul><ul><li>Is he using strategies that succeed? That fail? </li></ul></ul>S.Morganstein & M.Certner-Smith “ Batteries are for cars, Not for people. ” Edith Kaplan Morganstein & Certner-Smith, 2011
    35. 35. Assessment beyond language… <ul><li>The assessment process parameters beyond language include: </li></ul><ul><ul><li>Cognition: attention, abstract thinking, </li></ul></ul><ul><ul><li>Behavior: initiation, flexibility, problem solving, etc </li></ul></ul><ul><ul><li>Visual Considerations: hemianopsia, scanning issues, acuity </li></ul></ul><ul><ul><li>Psychological considerations: sense of humor, affect </li></ul></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    36. 36. Strategy probes for TLS <ul><li>Aphasia testing using a TLS mindset requires strategy probes </li></ul><ul><ul><li>Naming/word retrieval (what type of cuing helps, phonemic or semantic?) </li></ul></ul><ul><ul><li>Repetition (does repetition increase linguistic accuracy?) </li></ul></ul><ul><ul><li>Oral reading (does oral reading increase awareness of errors & afford an opportunity for self correction?) </li></ul></ul><ul><ul><li>Etc…… </li></ul></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    37. 37. Assessing conversational ability and style <ul><li>Assess conversational ability, any way you can </li></ul><ul><ul><li>Formal tool: FCP, CADL </li></ul></ul><ul><ul><li>Interview, questionnaire </li></ul></ul><ul><li>Assess transactional process: </li></ul><ul><ul><li>Circumlocution, self-correction, self-cueing </li></ul></ul><ul><li>Assess interaction: </li></ul><ul><ul><li>Drive, social connection, problem-solving, flexibility </li></ul></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    38. 38. Summary of Assessment <ul><li>Language </li></ul><ul><li>Patient process </li></ul><ul><li>Non-language profile </li></ul><ul><li>Task strategies </li></ul><ul><li>Conversation </li></ul>S.Morganstein & M.Certner-Smith Morganstein & Certner-Smith, 2011
    39. 39. Formulating a TLS Unit <ul><li>A TLS Recipe </li></ul>Morganstein & Certner-Smith, 2011
    40. 40. TLS: Creating and Using The TLS Unit <ul><li>Following a culinary metaphor… </li></ul>Morganstein & Certner-Smith, 2011
    41. 41. The TLS Unit: It ’s About… <ul><li>Knowing </li></ul><ul><li>Selecting </li></ul><ul><li>Developing </li></ul><ul><li>Delivering </li></ul><ul><li>Extending </li></ul><ul><li>Enhancing </li></ul>Morganstein & Certner-Smith, 2011
    42. 42. TLS: Knowing <ul><li>“ Who am I dining with?” </li></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Talents & Interests </li></ul></ul><ul><ul><li>Family background </li></ul></ul><ul><ul><li>Insight about the nature of aphasia </li></ul></ul><ul><ul><li>Life priorities </li></ul></ul><ul><ul><li>Style (emotionally open or closed) </li></ul></ul>Morganstein & Certner-Smith, 2011
    43. 43. TLS: Selecting <ul><li>Choosing the sandwich: </li></ul><ul><ul><li>Topics that relate to the person ’s </li></ul></ul><ul><ul><li>interest are always preferred: </li></ul></ul><ul><ul><li>Provides a natural and personal </li></ul></ul><ul><ul><li>connection for treatment. </li></ul></ul><ul><ul><li>Enhances the likelihood of linguistic success since he has better access to information and ideas on “his turf.” </li></ul></ul>Morganstein & Certner-Smith, 2011
    44. 44. TLS: Creating <ul><li>Assembling the sandwich </li></ul><ul><ul><li>Select content vocabulary: 8-10 words related semantically, preferably concrete nouns and verbs. </li></ul></ul><ul><ul><li>Select the exercises to be employed for a course of 5-7 sessions based upon assessment findings. </li></ul></ul><ul><ul><li>Establish a treatment hierarchy for the exercises, progress easier to harder. </li></ul></ul><ul><ul><li>Create (or copy) those exercises to be used. </li></ul></ul>Morganstein & Certner-Smith, 2011
    45. 45. TLS: Delivering <ul><li>Introductory topical conversation on the theme </li></ul><ul><li>Manipulation of language in a series of multimodality tasks </li></ul><ul><li>Return to functional conversation on the theme. </li></ul>Morganstein & Certner-Smith, 2011 Here ’s a TLS Sandwich!
    46. 46. TLS: Extending <ul><li>Serve more of the sandwich: </li></ul><ul><ul><li>Extend the theme by adapting and adding exercises as you go. </li></ul></ul><ul><ul><li>Extend the theme in real, related conversation. </li></ul></ul><ul><ul><li>Extend the theme in supplementary materials (menus, ads, letters, internet articles) </li></ul></ul>Morganstein & Certner-Smith, 2011
    47. 47. TLS: Enhancing: Metalinguistic Process <ul><li>What just happened here? (reflections on the meal) </li></ul><ul><ul><li>SLP internally reflects upon what worked, and modifies what she does next time. </li></ul></ul><ul><ul><li>SLP offers observations to patient about performance in a general sense: </li></ul></ul><ul><ul><ul><li>Gives positive feedback </li></ul></ul></ul><ul><ul><ul><li>Leads toward insight about aphasia (prerequisite for developing strategies) </li></ul></ul></ul>Morganstein & Certner-Smith, 2011
    48. 48. TLS: Enhancing Metalinguistic Process <ul><li>Critiquing the experience: continued </li></ul><ul><ul><li>SLP offers more detailed observations about performance and asks the patient for his discoveries </li></ul></ul><ul><ul><li>Gives positive feedback; transaction & interaction </li></ul></ul><ul><ul><li>Establishes a collaborative relationship in problem solving the treatment outcome. </li></ul></ul><ul><ul><li>Encourages more responsibility and independence in symptom management </li></ul></ul>Morganstein & Certner-Smith, 2011
    49. 49. TLS: Secrets of a Good Sandwich <ul><li>Maintain a success rate of approximately 80-90% for each selected task. </li></ul><ul><li>Present flexibly, shift and roll as needed. </li></ul><ul><li>Recognize task order, decrease choices, change modes. </li></ul><ul><li>Keep patient in the loop: ask for feedback, comments and insights. </li></ul><ul><li>Use humor and emotion whenever feasible; the limbic system is a good stimulator. </li></ul>Morganstein & Certner-Smith, 2011
    50. 50. TLS: Secrets of a Good Sandwich <ul><li>Make small changes in some aspect of the task each time you repeat it (and do repeat it!) </li></ul><ul><li>“ Milk” the linguistic contexts in which the words appear. </li></ul><ul><li>There are no “wrong” responses—merely more opportunities to stimulate </li></ul><ul><li>Include multi-modalities to reap the stimulation benefit. </li></ul>Morganstein & Certner-Smith, 2011
    51. 51. TLS: Formatting the Unit <ul><li>The ABC ’s of Exercises </li></ul><ul><li>What to Include </li></ul><ul><li>Creative Composition </li></ul><ul><li>Building Layers of Language </li></ul><ul><li>Having Fun with Words </li></ul>Morganstein & Certner-Smith, 2011
    52. 52. Your Turn Morganstein & Certner-Smith, 2011
    53. 53. TLS: The Exercises Morganstein & Certner-Smith, 2011
    54. 54. Supermarket Unit Core Vocabulary <ul><li>Purpose: related vocabulary that will provide the core concepts and language of the chosen theme. </li></ul><ul><li>Description: nouns and verbs that are highly predictable and in some cases picturable. </li></ul><ul><li>aisle freezer </li></ul><ul><li>cashier squeeze </li></ul>Morganstein & Certner-Smith, 2011
    55. 55. Repetition/Oral Reading <ul><li>Purpose: controlled speech practice using auditory and/visual input. </li></ul><ul><li>Description: Use a word, phrase, sentence sequence in which core vocabulary items appear as the last word. Patient repeats or reads aloud. </li></ul><ul><li>aisle </li></ul><ul><li>in this aisle </li></ul><ul><li>Sugar is in this aisle. </li></ul><ul><li>squeeze </li></ul><ul><li>squeeze the fruit </li></ul><ul><li>Please don ’t squeeze the fruit. </li></ul>Morganstein & Certner-Smith, 2011
    56. 56. Speech Stimulation/Production <ul><li>Purpose: language stimulation that transitions from cued contexts to generating novel language </li></ul><ul><li>Description: connected sentences for repetition. fill-ins, and answering questions. </li></ul><ul><li>The flour is down this aisle. </li></ul><ul><li>The flour is down this ____. </li></ul><ul><li>Where is the flour? </li></ul><ul><li>What else is in the baking aisle? </li></ul>Morganstein & Certner-Smith, 2011
    57. 57. Copying <ul><li>Purpose: writing and spelling practice at a basic level </li></ul><ul><li>Description: core vocabulary formatted for several writing trials with and without a model. </li></ul><ul><li>aisle freezer </li></ul><ul><li>__________ _________ </li></ul><ul><li>__________ _________ </li></ul><ul><li>__________ _________ </li></ul><ul><li>__________ _________ </li></ul>Morganstein & Certner-Smith, 2011
    58. 58. Categorization <ul><li>Purpose: Identification of the core vocabulary </li></ul><ul><li>Description: vocabulary are randomized in a list with foils provided of varying degrees of complexity. </li></ul><ul><li>aisle elephant </li></ul><ul><li>freedom freezer </li></ul><ul><li>squeeze SUV </li></ul><ul><li>student cashier </li></ul>Morganstein & Certner-Smith, 2011
    59. 59. Sentence Fill-ins <ul><li>Purpose: reading comprehension and oral recitation </li></ul><ul><li>Description: open ended sentences using target vocabulary and foils in a multiple choice format. </li></ul><ul><li>ink aisle over </li></ul><ul><li>I found sugar in the third _________ </li></ul><ul><li> freezer salad butcher </li></ul><ul><li>Get the waffles from the__________ </li></ul>Morganstein & Certner-Smith, 2011
    60. 60. Yes/No Questions <ul><li>Purpose: Stimulate comprehension visually and/or auditorally. </li></ul><ul><li>Description: Questions are formulated with target vocabulary designed to elicit a yes/no response. </li></ul><ul><li> Yes No </li></ul><ul><li>Is the freezer hot? ___ ___ </li></ul><ul><li> Yes No </li></ul><ul><li>Do you squeeze ice cream? ___ ___ </li></ul>Morganstein & Certner-Smith, 2011
    61. 61. Answering questions- multiple choice <ul><li>Purpose: Facilitates answering simple questions, reading comprehension and oral reading. </li></ul><ul><li>Description: Questions with responses in a mult. choice grouping of at least four items. </li></ul><ul><li>squeeze cashier freezer aisle </li></ul><ul><li>Where do you store ice cream? _____ </li></ul><ul><li>What do you do with a melon? ______ </li></ul>Morganstein & Certner-Smith, 2011
    62. 62. Sentence Arrangement <ul><li>Purpose: Syntactic practice </li></ul><ul><li>Description: Scrambled sentences are created for each core vocabulary item. Patient re-orders them. </li></ul><ul><li>I found: </li></ul><ul><li>aisle sugar in this the </li></ul><ul><li>____________________________ </li></ul><ul><li>Give the money: the cashier to </li></ul><ul><li>____________________________ </li></ul>Morganstein & Certner-Smith, 2011
    63. 63. Sentence Construction <ul><li>Purpose: Stimulates generating information and grammar. </li></ul><ul><li>Description: word pairs and word phrases are provided to create statements. </li></ul><ul><li>aisle -narrow down the aisle </li></ul><ul><li>cashier-money a quick cashier </li></ul><ul><li>freezer-turkey in the freezer </li></ul><ul><li>squeeze-Charmin squeeze a little </li></ul>Morganstein & Certner-Smith, 2011
    64. 64. Sentence Correction <ul><li>Purpose: Error identification and correction </li></ul><ul><li>Description: Statements containing core vocabulary item with two errors. </li></ul><ul><li>Errors can be in grammar, misspellings, or incorrect word choice. </li></ul><ul><li>The cashier i f very slow y </li></ul><ul><li>______________________ </li></ul><ul><li>The manager seem me squeeze the plum p s? </li></ul><ul><li>______________________ </li></ul>Morganstein & Certner-Smith, 2011
    65. 65. Reading Paragraphs <ul><li>Purpose: Improve reading comprehension. </li></ul><ul><li>Description: Humorous paragraphs which have the target vocabulary embedded within. Three of four questions are provided pertinent to content. </li></ul><ul><li>I wandered down the organic food aisle </li></ul><ul><li>searching for something interesting and </li></ul><ul><li>healthy. What would I chose, a soybean scone </li></ul><ul><li>or a tofu tamale? I wound up in the freezer </li></ul><ul><li>section where I squeezed a few packages. </li></ul><ul><li>Finally, I chose a pepperoni pizza with pork </li></ul><ul><li>rind crust. The cashier remarked, Dr. Atkins </li></ul><ul><li>would only approve of the pork rinds. ” </li></ul><ul><li>1. What was his final choice? </li></ul><ul><li>A soy bean scone c. pepperoni pizza </li></ul><ul><li>A tofu tamale d. Dr. Atkin ’s bar </li></ul>Morganstein & Certner-Smith, 2011
    66. 66. Conversational Questions <ul><li>Purpose: Stimulate language that is more functionally based. </li></ul><ul><li>Description: Questions designed to elicit conversational responses using core vocabulary items, and related semantic contexts. </li></ul><ul><li>Why shouldn ’t you squeeze the fruit? </li></ul><ul><li>Describe which aisle in the supermarket is your favorite? </li></ul>Morganstein & Certner-Smith, 2011
    67. 67. TLS: Baseball <ul><li>Excerpt from a full session, illustrating use and flow of TLS. </li></ul><ul><li>Is the client ’s conversation better at the end of the session? </li></ul>Morganstein & Certner-Smith, 2011
    68. 68. <ul><ul><li>Early Recovery </li></ul></ul><ul><li>Clinical Functional Psycho/Social Education </li></ul><ul><li>Manipulate Basic communication Support coping with Define Aphasia </li></ul><ul><li>symptoms processes the Trauma How it impacts </li></ul>Morganstein & Certner-Smith, 2011 Life Participation Psycho- social Clinical Functional Education Evolution of Recovery Dialogues
    69. 69. <ul><ul><li>Middle Recovery </li></ul></ul><ul><li>Clinical Functional Psycho/Social Education </li></ul><ul><li>Finesse the Transaction/Interaction Support coping with Problem solve </li></ul><ul><li>symptoms Enhance conversation life changes impact aphasia </li></ul>Morganstein & Certner-Smith, 2011 Life Participation Psycho- social Clinical Education Functional Evolution of Recovery Dialogues
    70. 70. <ul><ul><li>Late Recovery </li></ul></ul><ul><li>Clinical Functional Psycho/Social Education </li></ul><ul><li>Intermittent Transaction/Interaction Promotes living well with aphasia Self-management </li></ul><ul><li>explorations community focused Identity & engagement of LPAA goals </li></ul>Morganstein & Certner-Smith, 2011 Life Participation Clinical Functional Psycho-social Education Evolution of Recovery Dialogues
    71. 71. Morganstein & Certner-Smith, 2011 Participation in Life Situations Severity of Aphasia Communication and language environment Personal identity, attitudes, and feelings LIVING WITH APHASIA Living with Aphasia: Framework for Outcome Measurement (A-FROM) Topics in Language Disorders, Volume 27, No. 4, Dec. 2007 Aura Kagan, The Aphasia Institute
    72. 72. Thank you ! Morganstein & Certner-Smith, 2011
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