Aphasia Treatment
The purpose of the aphasia treatment is to try to restructure and reorganize the loss of language the patients are suffering from, through various treatments and personalized trainings. The importance of assessing the language in the entire life is emphasized, instead of assessing the language inside a room. In this sense, spontaneous development of language skills by the patients gained significance, rather than the reactions the patients give to the stimulants they are provided with.
There is a great variety of treatment approaches. The first one is the behavior modification covering the efforts to increase the reaction given by the patient through samples ranging from easy to difficult. Nevertheless, the cognitive approach put forward by Schuell et al. (1964) aims to increase the quality of the language behavior by providing dense verbal stimulants for a long time. In the later years, there were attempts to develop the cognitive approach through new methods, such as the “different thinking treatment” , which emphasizes the requirement of producing various creative thoughts for each stimulant by means of method like showing the patient an object and expecting them to make different remarks regarding the use of that object, in addition to the “multi-modal approach” where the stimulant is constantly changed, in contrast to that method.
The “programmed stimulation approach” is another treatment method developed in 1990 by LaPoint, aiming to use the behavior modification and cognitive approach simultaneously. In this method, the stimulant ranges from easy to difficult, and the patient is expected to give different answers. The melodic intonation therapy and visual action therapy being used in global aphasias are also taken into consideration for this method.
The method of treatment known as the “Pragmatic Approach” aims to increase the communication with the patient in a social setting, especially in the circle of the patient. PACE (promoting aphasic’s communicative effectiveness, the most broadly-accepted treatment method today, also includes the joint participation of the therapist and the patient in the treatment. As distinct from other treatment methods, there is an exchange of information here, and the desired channel of communication can be used freely. Picture cards, real objects or the computer media can be freely chosen as stimulants.
In another approach developed in recent years (solution focused aphasia therapy), it is aimed to train the patient’s relatives on the treatment of aphasia. This treatment method is probably the one being used the most today.
There are also some studies carried out on what type of stimulants and clues should be given to the patient, regardless of the method being used. The clue given to the patient may be phonologically or semantically similar to the word. For instance, for a patient trying to find out the word “table”, the word “safe” is of phonological similarity, and the word “chair” of semantical similarity. Although there are authors claiming that the ones of phonological similarity are more effective, there is no complete consensus on this matter. Some studies indicate that the most important criterion is the age when the information is acquired, rather than the clue in remembering the word.
Although dopamine agonists, piracetam (Nootropil), amphetamines and donepezil (Aricept) are used within the scope of pharmacological treatment, the recent 2001 Cochrane compilation published on this issue states that the controlled studies concerning the effectiveness of the drugs were not adequate. Mortality rates in the patients taking these drugs are stated in the studies conducted. Although these results seem statistically meaningless, the need for further researches regarding the reliability of the drugs is emphasized. As a result, the aforementioned rehabilitation approaches are the ones that are acknowledged the most in the treatment of aphasia.
