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Script Templates: A Practical Approach to Script Training in Aphasia.

ABSTRACT: PURPOSE:Script training for aphasia involves repeated practice of relevant phrases and sentences that, when mastered, can potentially be used in other communicative situations. Although an increasingly popular approach, script development can be time-consuming. We provide a detailed summary of the evidence supporting this approach. We then describe a method in which scripts at various levels of difficulty are created by systematically manipulating readability and grammatical and semantic components. We assess the appropriateness of using these template-based scripts with persons with aphasia of differing severities. METHOD:We evaluated the oral reading performance of eight individuals with chronic non-fluent aphasia on scripts developed from the templates. Scripts were either of high or low difficulty relative to their aphasia severity, and personalized by inserting the participant's town and the name of an acquaintance. Oral reading probes were taken on three separate days within a week and performance within and across participants was examined. RESULTS:Regardless of the participant's aphasia severity, scripts in the low-difficulty condition were read with significantly greater accuracy than scripts in the high-difficulty condition. DISCUSSION:These findings support the use of graded script templates to ensure that appropriately challenging scripts are delivered to persons with aphasia for both clinical practice and research.

SUBMITTER: Kaye RC

PROVIDER: S-EPMC5006751 | biostudies-literature | 2016 Apr-Jun

REPOSITORIES: biostudies-literature

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Script Templates: A Practical Approach to Script Training in Aphasia.

Kaye Rosalind C RC Cherney Leora Reiff LR

Topics in language disorders 20160401 2

<h4>Purpose</h4>Script training for aphasia involves repeated practice of relevant phrases and sentences that, when mastered, can potentially be used in other communicative situations. Although an increasingly popular approach, script development can be time-consuming. We provide a detailed summary of the evidence supporting this approach. We then describe a method in which scripts at various levels of difficulty are created by systematically manipulating readability and grammatical and semantic ...[more]

PMID: 27594730

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Project description:ObjectiveTo explore the effect of complexity and feedback on script training outcomes in aphasia DESIGN: Randomized balanced single-blind 2 × 2 factorial design.SettingFreestanding urban rehabilitation hospital.ParticipantsAdults with fluent and nonfluent aphasia (at least 6 months post onset).InterventionsExperimental treatment was AphasiaScripts, a computer-based script training program. Scripts were 10-turns long and developed at different complexity levels to allow for comparison of high vs low complexity. The program was modified to contrast high vs low feedback conditions during sentence practice. Participants were instructed to practice three 30-minute sessions per day, 6 days per week for 3 weeks.Main outcome measuresGains achieved from baseline in accuracy and rate of production of trained and untrained script sentences at post treatment and at 3-, 6-, and 12-weeks after the end of treatment.ResultsSixteen participants completed the intervention. On the trained script, gains were statistically significant for both accuracy and words per minute at post treatment and 3-, 6-, and 12-week maintenance. Gains on the untrained script were smaller than on the trained script; they were statistically significant only for accuracy at post treatment and 3-week maintenance. Complexity had an influence on accuracy at post-treatment (F1=4.8391, P=.0501) and at maintenance (F1=5.3391, P=.0413). Practicing scripts with high complexity increased accuracy by 11.33% at post treatment and by 9.90% at maintenance compared with scripts with low complexity. Participants with nonfluent aphasia made greater gains than those with fluent aphasia. There was no significant effect of feedback.ConclusionsThis study reinforces script training as a treatment option for aphasia. Results highlight the use of more complex scripts to better promote acquisition and maintenance of script production skills. There is a need for further investigation of these variables with larger samples and with other types of aphasia treatments.

Project description:Limiting or withdrawing nonbeneficial medical care is considered ethically responsible throughout most of critical care and medical ethics literature. Practically, however, setting limits to treatment is often challenging. We review the literature to identify best practices for using the definition of futility as an anchoring concept to aid the ethical practice of ICU clinicians.Data sourcesSource data were obtained from a PubMed literature review.Study selectionEnglish language articles were chosen based on relevance to medical futility ethics, end-of-life care in the ICU, or communication and conflict mitigation strategies.Data extractionIndependent evaluation of selected articles for recurrent content themes as relevant to our clinical case were compared among authors and based on consensus, quantitative and qualitative data from these sources were referenced directly.Data synthesisWhen life-sustaining treatment is unlikely to achieve a meaningful benefit such as symptom improvement, continued care may be discordant with the patient's goals. Institutional and cultural norms, unconscious biases, and difficulty with navigating conflicts all influence how un(comfortable) clinicians feel in setting limits to futile care. Defining futility in light of the patient's goals and values, focusing on outcomes rather than interventions, and being proactive in communication with families are the staples of medically meaningful critical care. Palliative measures should be framed affirmatively, and clinicians should be transparent about the limits of medicine.ConclusionsClinicians have an ethical obligation not to provide futile care. To practice accordingly, we must clearly understand the nature and forms of futility. Armed with this understanding, our discussions with family and surrogates in the ICU should fundamentally comprise 1) eliciting the patient's values and goals, 2) communicating which interventions serve those values and goals and which do not, and 3) offering only those interventions whose likely outcomes are in line with said values and goals.

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Script Templates: A Practical Approach to Script Training in Aphasia.

Publications

Script Templates: A Practical Approach to Script Training in Aphasia.

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