How do we perform arithmetic calculations? 🧠 ⚙️ 🔢
Successful calculation requires retrieving arithmetic facts from long term memory and using conceptual knowledge to correctly execute mathematical procedures.
Acalculia Treatment: Number Transcoding
𝗡𝘂𝗺𝗯𝗲𝗿 𝗧𝗿𝗮𝗻𝘀𝗰𝗼𝗱𝗶𝗻𝗴 is the process in which numbers are "translated" from one format to another (i.e., converting the written word four into the Arabic numeral 4 or the spoken word "four"). 🔢 🗣️ ✍🏼
This skill is deceptively simple, as how we say a number depends on the context it is in (e.g., the number 230 may be said as "two hundred and thirty," while 2:30 PM is said as "two-thirty").
Acalculia Assessment
Acalculia Classifications
Cognitive Models of Numerical Processing
How can number processing be conceptualized? 🔢 🧠
Models of numerical processing are helpful tools for better understanding the types of arithmetic errors made by people with acalculia. While these errors can be seemingly random upon first glance, theoretical models help provide a framework for recognizing why certain errors are made and how treatment can be individualized to best fit the unique needs of our clients.
Agraphia Treatment: Sentence-Level Treatment
Agraphia Assessment: Sentence-Level Assessment
The Neuroscience of Writing
What areas of the brain have been associated with agraphia when lesioned? 🧠 💥
Writing is a complex process, with 𝗠𝗔𝗡𝗬 areas of the brain playing a role. This results in large neural networks responsible for the writing process ✍🏼
That being said, the traditional agraphia classifications do have lesion sites that are associated with them.
Combined Lexical and Sublexical Treatment
In order to correctly write a word, there are a LOT of steps involved 🧩
Therefore, for many people with agraphia there is no one single cause for their writing problems. Rather, there are a variety of language processing components that are compromised and result in difficulty writing single words. ✍🏼
𝗖𝗼𝗺𝗯𝗶𝗻𝗲𝗱 𝗟𝗲𝘅𝗶𝗰𝗮𝗹 𝗮𝗻𝗱 𝗦𝘂𝗯𝗹𝗲𝘅𝗶𝗰𝗮𝗹 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 (Johnson, Ross & Kiran, 2017) is designed to target ALL aspects of written word processing. 👊🏼
Agraphia Treatment: Single Word-Level Treatments
What are your go-to treatment approaches for writing at the single word-level? 📝
Though the specific treatment technique used will depend on your client’s individual needs, it’s helpful to be familiar with a variety of approaches so that you’ll always be ready to go at a moment’s notice! 🙌🏼👊🏼
Here are 3 different approaches that you’ll want to have in your clinical toolbox:
Agraphia Classifications
Agraphia Assessment: Single-Word Assessment
When assessing for agraphia at the single word-level, what are you looking for? 🕵️♂️
Written language is complicated, and there are lots of factors that go into understanding the difference between why a client may write COW for “horse” or spell SIGHKIK for “psychic” 🐄 🔮
Here are some linguistic variables you’ll want to pay close attention to when assessing agraphia at the single word-level:
What Books Do Your Clients Want to Read?
📚 What books do your clients want to read? 📚
I’ve been working with a client who belongs to an online book club, and the most recent discussion focused on passages from Kate Andersen Brower’s “𝗙𝗶𝗿𝘀𝘁 𝗪𝗼𝗺𝗲𝗻: 𝗧𝗵𝗲 𝗚𝗿𝗮𝗰𝗲 𝗮𝗻𝗱 𝗣𝗼𝘄𝗲𝗿 𝗼𝗳 𝗔𝗺𝗲𝗿𝗶𝗰𝗮’𝘀 𝗙𝗶𝗿𝘀𝘁 𝗟𝗮𝗱𝗶𝗲𝘀” 🇺🇸
We’ve been using 𝗔𝘁𝘁𝗲𝗻𝘁𝗶𝘃𝗲 𝗥𝗲𝗮𝗱𝗶𝗻𝗴 𝗮𝗻𝗱 𝗖𝗼𝗻𝘀𝘁𝗿𝗮𝗶𝗻𝗲𝗱 𝗦𝘂𝗺𝗺𝗮𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 (𝗔𝗥𝗖𝗦) and the 𝗣𝗤𝗥𝗦𝗧 𝗺𝗲𝘁𝗵𝗼𝗱 to dive into the passages for the book club, allowing my client to better understand what she is reading and come up with discussion points for the group 🗣
Alexia Treatment: Life Participation Approach
In order for therapy to make the biggest impact, therapy tasks need to be centered around meaningful activities 🗣
The 𝗟𝗶𝗳𝗲 𝗣𝗮𝗿𝘁𝗶𝗰𝗶𝗽𝗮𝘁𝗶𝗼𝗻 𝗔𝗽𝗽𝗿𝗼𝗮𝗰𝗵 𝘁𝗼 𝗔𝗽𝗵𝗮𝘀𝗶𝗮 utilizes a model known as the 𝗔-𝗙𝗥𝗢𝗠 (Living with Aphasia: Framework for Outcome Measurement). The A-FROM has 4 distinct domains that all contribute to living with aphasia.
Alexia Classifications
When diagnosing an alexia, there are 2 major types of classifications: 𝗣𝗲𝗿𝗶𝗽𝗵𝗲𝗿𝗮𝗹 𝗔𝗹𝗲𝘅𝗶𝗮𝘀 and 𝗖𝗲𝗻𝘁𝗿𝗮𝗹 𝗔𝗹𝗲𝘅𝗶𝗮𝘀
𝘗𝘦𝘳𝘪𝘱𝘩𝘦𝘳𝘢𝘭 𝘈𝘭𝘦𝘹𝘪𝘢𝘴 affect the early stages of the reading process and involve difficulty perceiving the written word. In a Peripheral Alexia, individual letters may be misidentified and lead to errors such as reading “book” for BOOT.
𝘊𝘦𝘯𝘵𝘳𝘢𝘭 𝘈𝘭𝘦𝘹𝘪𝘢𝘴 affect the later stages of the reading process and involve impairments of lexical processing and sublexical processing. In a Central Alexia, the semantic system may be impaired which results in the word COW being misread as “horse” (thereby making a semantic substitution).
Alexia Treatment: Discourse/Paragraph-Level Treatments
Alexia Assessment: Paragraph/Discourse-Level Assessments
When assessing reading skills at the paragraph/discourse-level, emphasis is typically placed on comprehension of stated and implied main ideas
By utilizing a paragraph/discourse-level assessment, you’ll get better insight into your client’s inferencing skills, the effect of text length on comprehension, and better insight into how reading difficulties may impact functional reading tasks in everyday life (such as reading a menu or reading an online news article)
Oral Reading for Language in Aphasia
Looking for a general sentence/discourse-level treatment for alexia? Consider checking out 𝗢𝗿𝗮𝗹 𝗥𝗲𝗮𝗱𝗶𝗻𝗴 𝗳𝗼𝗿 𝗟𝗮𝗻𝗴𝘂𝗮𝗴𝗲 𝗶𝗻 𝗔𝗽𝗵𝗮𝘀𝗶𝗮 (ORLA)!
ORLA is based on a stimulation approach, where repetitive practice through multiple modalities leads to over-learning of skills (and therefore better maintenance of therapy gains)
Alexia Treatment: Sentence-Level Treatments
Begin Aphasia Therapy with the End in Mind
By beginning aphasia therapy with the end in mind, we are creating our goals and treatment plans with the understanding that we may only be seeing our patients for a limited amount of time. It is imperative then that we work with our patients to determine what it is that they are looking to achieve in treatment and what would be most helpful for them in this amount of time.