Wednesday, January 10, 2018

Reading :: Language Intervention Strategies in Adult Aphasia, 2ed

Language Intervention Strategies in Adult Aphasia
Edited by Roberta Chapey

I read the second edition of this collection (the link goes to the third edition). This thick book, from 1986, covers several parts: basic and professional considerations; stimulation approaches to therapy; other approaches to therapy; remediation of specific impairments; and remediation of "kindred" or related disorders.

To be honest, I skimmed most of the book. The most interesting chapter for me, and the one I'll examine in this review, is Mark Ylvisaker and Shirley F. Szerkeres' "Management of the Patient with Closed Head Injury" (pp.474-490). I've run into Ylvisaker's work in other places, including a couple of articles and a chapter elsewhere. His approach is Vygotskian, and his focus is on the social environment in which patients recover from injuries. Here, these injuries are characterized as Closed Head Injury (CHI), "in which the primary mechanism of injury is a blunt blow to the head, associated with acceleration/deceleration forces... distinguished from penetrating missile injuries, where the primary damage is focal" (p.474). Elsewhere, Ylvisaker discusses traumatic brain injury (TBI). In both cases, the patients tend to be young men (ex: in motorcycle accidents).

Of interest to me is the focus on compensatory strategies, "simply procedures—sometimes unconventional—that an individual deliberately applies to accomplish a goal" (p.483). These procedures are eventually habituated. They can involve external aids such as logs, alarms, and printed reminders, but they can also involve internal procedures such as mnemonics and structured thinking procedures. Ideal candidates, obviously, "have the metacognitive maturity to think about thinking and other cognitive issues" as well as "adequate attentional resources and ... well-defined neuropsychological strengths on which to base compensatory procedures" (p.483). That is, Ylvisaker and Szerkeres are describing both physical and psychological tools that patients can use to recover functioning—a Vygostkian approach, one that is arguably in a different category from Luria's. They also helpfully include an appendix listing "compensatory strategies for patients with cognitive impairments" (pp.488-490).

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