Treatment Strategies for Primary Progressive Aphasia

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Primary Progressive Aphasia may be described as a form of frontotemporal dementia in which a gradual worsening of the speech has had an insidious onset. In other words, the person has trouble speaking and thinking of words but it is difficult to pin down when the problem started. In our treatment program we train the caregiver and the patient to be active participants. Here is part of a typical plan of treatment:

1. Therapy - Since every person with aphasia is different, his/her specific needs should be addressed
   a.Make sure that the patient uses a relaxed breath flow for speech support so that his/her mental resources are freed for word recall and sentence production.
   
   b.If the patient has difficulty with voicing in terms of starting phonation [ voicing ] or loudness or changing pitch for intonation, address his/her ability to let the breath support turn on the voice and make intonation changes in a sentence or on vowels. Have him/her say a short sentence and then change the word that is stressed [ How ARE you? HOW are you? How are YOU? ]. Using this relaxed voice, work on word recall in natural exchanges such as the Sentence Patterning Drill. The patient answers questions that you ask using information you gave. Gradually increase the length and complexity of the exchanges see www.aphasiatoolbox.com for the drill and materials.
   
   c.Play commercial games that encourage semantic [ meaning ] facilitation and lexical [ words ] activation. Examples are Tribond [www.boardgamecentral.com/games/tribond.html ] and Scrabble. Have the patient say aloud the words in simple sentences.
   
   d.Avoid overuse of imitation, serial and/or external cuing [ for example avoid, "Say this after me.", " Say the days of the week", or "You write with a ____ ." ]. Instead, find ways for the patient to work from his/her own memory and thoughts. Use words or sentences in conversation as often as possible for carryover into the real world of speaking. Whenever possible work in sentences encouraging natural rhythm and flow.
   
   e.Work on verbal working memory [ VWM ] by saying aloud a short sentence for the patient [ "I walk around "], then have him/her repeat the sentence then say aloud the sentence in alphabetical order [ around I walk ] then the original then backward [ around walk I ] then original then in order according to length of words [ I walk around ] then the original then say every other word [ I around ] etc. This encourages the patient to maintain alternating attention skills and VWM both of which are critical cognitive underpinnings.
   
   
2. AAC/Technolgy - Consider investigating the use of augmentative/alternative communication technology early [ Lingraphica at www.aphasia.com for example ] while the patient is able to communicate more effectively and is able to record his/her voice for future use.
   
   
3. Pragmatics - Work on pragmatic problems. Patients may anticipate difficulty responding so they may struggle early and try to get a "running star to talk" . Make sure they take conversational turns, truly listening and then responding from his/her own memory and thought patterns.