Aphasia commonly results in word-finding difficulties which can range from mild to severe. Word-finding problems are sometimes referred to as “the tip of the tongue syndrome”. The person knows what they want to say but they cannot find the word. There are a range of treatment approaches for word-finding difficulties including errorless learning (listen and repeat), the hierarchy of cueing and semantic feature analysis.
Semantic Feature Analysis
In a previous blog post we explained how Semantic Feature Analysis (SFA) works. Research tell us that this approach can help individuals with aphasia improve the ability to name pictured items.
The Semantic Feature Analysis approach is also very useful for teaching the ‘talk around the word’ strategy. Having difficulty finding a word in conversation can be very frustrating and it frequently results in a communication breakdown. If the person describes the word effectively, then the other person will realise the word they have been trying to find and the conversation can continue.
Some individuals are naturally good at talking around words when they get stuck but others will halt and get increasingly frustrated. We therefore need to not only teach but also practice the strategy of talking around words (using the semantic feature analysis questions).
Please note that this works best for people with aphasia who have mild to moderate aphasia.
Use Pictured Objects
The first step involves learning to effectively describe pictured items.
Choose a picture
Initially prompt the person to answer each question e.g. “What type of thing is it?, What do you do with it? etc” .
At a later stage, see if they can begin to describe the pictured items spontaneously without answering the questions.
Note the number of times they described a word using the cues and how many times they were able to describe a word spontaneously.
Also note how accurate their descriptions were. Could you easily tell what they were describing?
Present the individual with a picture and ask them to tell you as much about the picture as they can. Tell them that if they cannot find a word, they need to try to talk around it. Encourage them to use a prompt sheet which has the semantic feature analysis questions on it. Tally each of the following:
the number of times they have difficulty finding a word
the number of times they spontaneously self-cue and talk around the word
the number of times you have to remind them to talk around the word and use the prompt sheet.
The pictures could be interesting ones from a newspaper or magazine or an app such as Inference Pics. You could also ask the person to bring in personal photos such as those taken on family vacations.
Choosing pictures that the person is more interested in will likely elicit much more language so also consider their personal interests when choosing materials.
Sample Prompt Sheet
Appearance: What does it look like?
Category: What type of thing is it?
Function: What do you do with it?
Location: Where do you find it?
Extra: What else do you know about it?
Talk about topics that are of high personal relevance for the individual. For example, ask them about their hobbies, their family, their house. Remind them to use the prompt sheet to help them to describe words if they have difficulty. Tally as before.
Story Recall Using Animated Silent Videos
Play a video for the individual and ask them to tell you the story in their own words. Remind them to use the prompt sheet to help them to describe words if they have difficulty. Tally as before.
Using videos such as Pixar shorts is ideal for this task as the individual can watch the video and then recall what happened in their own words. They don’t have to listen, comprehend or remember what was said as the videos are silent. They can simply focus on talking and describing words.
Ask the person questions to elicit personal stories. For example you could ask them to tell you about previous jobs, places where they have lived, their wedding day, the first time they went on a plane. Encourage them to self-cue if they cannot find a word. Tally as before.
Note that talking about past events and telling personal stories can present an extra cognitive challenge as the person will need to remember and plan the order of what they are saying.
Thanks for reading! Stay tuned for a future blog post on narrative therapy and the different types of discourse.