Response Elaboration Training (RET) - NSSLHA

Joan C. Payne, Ph.D., ASHA Fellow
Graduate Professor
Department of Communication Sciences and Disorders
Howard University

� Evidence‐Based Practice
� ASHA Code of Ethics
� Cultural Competence in Treatment and
Counseling
� Resources for Caregivers
� Cultural Sensitivity about Functional
Approaches
� Technology for the Cognitive Impaired or
Nonverbal

� Outcome is better if the intensity of therapy
is increased, e.g., a few sessions over a few
days.
� Multiple forms of sensory stimuli increase
therapy effectiveness.
� Difficulty of language exercises should be
gradually increased.

� All studies show that persons with aphasia
make better progress when stimuli are
functionally relevant.
� Treatment activities should be geared to the
communicative demand of the patient’s living
environment.
� If possible, interview the patient about
communicative needs as a baseline for
therapy.

� More attention is given in the literature to
treating mild aphasia.
� More has been written about therapy for the
nonfluent aphasias than for the fluent
aphasias.

� The most widely used approach is the
stimulation, also called traditional therapy
� This approach corresponds to Lubinski’s
(1988) Skills Approach in which standardized
tests are used to determine areas of deficit.
� Clinician builds a therapeutic regimen around
these deficits.

� All efficacy studies agree that patients
improve more with therapy than without,
even during the first six months to a year
after brain injury.

� Step by Step 4.5,
http://www.youtube.com.Watch?v=UfL2yimrC
sQ
� Shows treatment that progresses from easy
to difficult using pictures of common items.

� Cognitive Linguistic Therapy
� Programmed Simulation
� Stimulation‐Facilitation Therapy
� Group Therapy
� PACE (Promoting Aphasic’s Communicative
Effectiveness)
� Melodic Intonation Therapy

� Therapy for Conduction and Anomic Aphasia
� Therapy for Moderate Fluent Aphasia
� Therapy for Severe Aphasia
� Therapy for Right‐Hemisphere Deficits

� Response Elaboration Training (RET)
� Clinician shapes and elaborates spontaneously
produced client utterances rather than targeting
preselected responses.

� Semantic Therapy Program for Naming
� Uses comprehension tasks involving associating
printed words with pictures
� Aids in self‐monitoring for jargon

� Voluntary Control of Involuntary Utterances
� Communication Boards
� Visual Action Therapy
� Effectiveness Approach

� Sequencing tasks
� Selection of critical items of a picture or story
� Visuospatial perception
� Comprehension and production of emotional
tone.
� Limits on speaking time (to avoid digression
and perseveration
� Pragmatics

� Instruction cards for listeners
� Word dictionaries
� Communication books
� Communication wallets
� Communication boards

� Lingraphica : www.aphasia.com
� Dynavox: www.dynavoxtech.com
� GPS for directions
� C‐VIC

� To enable persons with aphasia to increase
participation in desired activities
� To create opportunities for social interaction
through various modes of communication
� Most often used by persons with severe oral‐
motor or expressive impairments
� Most beneficial for mild to moderate aphasia.
� Bourgeoise, et al., (2010). ASHA Leader
� Van de Sandt‐Koenderman, M. (2004) Aphasiology,
18:245‐263.

� There are a variety of approaches to treating
aphasia that have been shown to be effective.
� Treatment must always include the family,
caregivers and/or other persons important to
the patient
� Cultural competence and sensitivity are
important for effective treatment

� Patient’s communicative demands should
always be considered when planning therapy
� The goal of treatment is to help the patient
return as close to the premorbid state as
possible

� There are a variety of assistive devices for the
nonverbal or severely involved aphasia
patient, include speech generative devices,
apps, computer programs, among others.
� Cognitive and language disorders often
coexist and should be treated together.

� Therapy should always be individualized for
the patient and his/her needs and skills.
� Therapy should be gradually increased in
difficulty for maximum effectiveness.

Mr. L., a 70‐year‐old male who is a retired lawyer and
potter, suffered a first‐time left anterior stroke. Since
his stroke, he has regained comprehension skills, but
he is reportedly unclear at times, has word finding
deficits and difficulty with reading. In addition, he
presents with right‐side hemiplegia and a possible
visual field deficit, probably a homonymous
hemianopsia. Results of the Apraxia Battery for Adults
(Dabul), the BDAE, Short Form (Goodglass, et al) and
the Assessment of Language Related Functional
Activities (ALFA: Baines, et al) confirm a moderate
Broca’s aphasia and severe apraxia.

� Mr. L is a good candidate for speech and
language therapy because of a number of
strengths: a premorbid history of good
general health, a supportive family, fairly
intact comprehension, a fair degree of verbal
fluency, an ability to recognize some written
symbols and a high level of motivation.

� Long‐term goal #1: To increase intelligibility by 50%
▪ STG: To decrease struggle on 2‐ and 3‐ syllable words
▪ STG: To decrease perservations in phrases
▪ STG: To increase verbal fluency for automatic speech
� Long‐term goal#2: To increase functional language
by 50%
▪ STG: To increase ability to make change
▪ STG: To increase ability to tell time
▪ STG: To increase ability to recognize dates
▪ STG: To increase ability to recognize and dial own telephone
number

� Long‐term goal #3: To increase oral agility in
verbal expression by 50%
▪ STG: To increase grammatical accuracy in phrases
▪ STG: To increase articulatory accuracy for words of
increasing length
▪ STG: To increase ability to repeat simple words

� Long‐term goal #4: To increase comprehension
for complex information by 50%
▪ STG: To increase comprehension for complex sentences
▪ STG: To increase comprehension for complex
paragraphs
� Long‐term goal #5: To increase oral reading skills
by 50%
▪ STG: To increase ability to read single commonly used
words
▪ STG: To increase ability to read short phrases

� What would you recommend as functionally
relevant activities for Mr. L?
� How would you train his supportive family to
assist in Mr. L’s meeting his long‐term goals?
� What types of reading materials would you
use in treatment for his dyslexia?
� How often would you test to chart progress?
� At what point would you begin to integrate
what he has learned to everyday situations?

� What kinds of low‐ and/or high‐tech devices
or aids would you recommend?
� Would you recommend a support group for
Mr. L and his family? Why or why not?
� Is Mr. L a good candidate for group therapy?
When would you place him in a group, if
appropriate?