John, a 50 year-old man with aphasia, wanted to find out more about intensive aphasia treatment for himself. "I've been told I have a high level of aphasia. I talked to a speech therapist and she told me that intensive therapy wouldn't work for me".
Believe it or not, I've heard this a few times from other clients. At first, I became frustrated. There is a lot of misinformation out there about aphasia and intensive treatment. If someone has never worked in an intensive aphasia program, then they really can't say one way or the other what's possible. It's a great disservice to clients to block possible avenues of treatment due to lack of knowledge. The reality is that if someone could still benefit from any aphasia therapy, then he/she can benefit from some level of intensive treatment. It's frustrating to hear that clients aren't getting treatment because "no one knows how to work with me".
I told John that, of all the people with aphasia, those with a "high-level" may need intensive aphasia treatment the most. Here's why:
- Most people with high-level aphasia are young enough that they want to return to work. And not just any type of work—typically it's the pre-stroke profession. What's keeping them from working? Aphasia. What's keeping them from getting back to work faster? They are getting little to no therapy. This is the time to increase your sessions.
- People with a high-level aphasia tend to be caught in the middle—too "normal" to be included with the more severely affected, but not "normal" enough to do more complex speaking, reading, and writing tasks. It's a tough place to be— they end up filling time and feeling unproductive, frustrated with the situation. With more focused treatment, the client can potentially return to some type of work and feel productive again.
- High-level intensive aphasia treatment focuses on college-level skills. This typically includes speed of auditory and written comprehension, organization of writing and speaking, detailed discussions of topics, role-playing, complex auditory information, etc. While standardized aphasia testing may show a score of around 90%, this test isn't looking for high-level skills. The typical aphasia tests only measure how well you repeat word/sentences, follow directions, read a paragraph, describe a picture, write your name and address, etc. Their purpose is to tell us the type and severity of aphasia.
- It may help the client make better life decisions. When they enter our program, many clients realize that they don't want to do that specific job anymore and may choose something in that realm that's less demanding. As one spouse reports, "If I'd have told him that, he wouldn't have listened. Now he's discovered that on his own", which makes everyone happier by changing their expectations.
The moral of this story is: don't stop therapy just because your loved one's language is superficially good. If they're unhappy with their progress and want to do more—have arguments or detailed discussions, read books, write reports, dispute your credit card bill—then there's more work to be done, but the pay-off can be huge. An investment of time now could go a very long way.
