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Breaking the Rules and Adapting...Making Supplemental Aphasia Therapy Accessible, Fun, and Useful

Intensive Aphasia therapy has been proven to be beneficial for Persons with Aphasia (PWA). However, intensive therapy can also be costly and difficult to fit into your schedule. One thing we always encourage our clients to do is participate in home practice programs and supplement their therapy in other ways with socialization, groups, book clubs, etc. Supplemental therapy is a cost-effective way to boost your regularly scheduled therapy.

One couple went above and beyond to think outside the box and create a fun and motivating supplemental therapy program. Frank and his wife, Terri*, started their journey in February of 2020 when Frank had a stroke which resulted in Aphasia. Frank was initially diagnosed with having a moderate-severe stroke. However, his physical impairments resolved relatively quickly--leaving him to focus solely on his Aphasia therapy. As Frank recalled his initial deficits following his stroke he said, “I couldn’t talk. I don’t remember being as bad as I was… Ask me a farm animal and I would say cow and ask for more and I’d say cow—on my best day I could name 3 farm animals.” He recounted that early in his recovery, he was unable to call his children and grandchildren by name which impacted his life greatly. In addition to this, he described difficulty with numbers and repetition. Terri added that when Frank first got speech therapy in the hospital, he couldn’t hear the difference between b and p. The speech pathologist worked on this every session, but he was not able to hear the difference between the two sounds. She said that this was very frustrating for him. They both knew that Frank had a long road of recovery ahead.

Frank and Terri have always had a love for games and a competitive spirit. So, after his stroke, it only seemed natural to use games to supplement his therapy goals. However, they did not simply pull games off the shelf. Together, they created new games and adapted board games to align with Frank’s progress. Over the next few months, they created an arsenal of games which they used as supplemental therapy. It is important to note that Frank started off at a level that worked for him. He started with games that focused on his comprehension and ability to name objects. Soon enough, they were adapting the games to make them more challenging as Frank improved. Below are some of the things Frank and Terri did that resulted in such a successful supplemental therapy program.

Make games accessible/without materials.

One thing Frank and Terri would go above and beyond to do, was to work games into their daily life at all points in their day. Rather than sitting to play a board game, they played words games while they took their daily walk around their neighborhood. This small adjustment added hours of supplemental therapy to Frank’s day. Earlier in his recovery process they would practice labeling anything that he saw around him on his walk--- a mailbox, clouds, trees, a road, grass, a house, etc. Soon they adjusted to using the alphabet, generating a word that starts with each letter of the alphabet (later referred to as the Alphabet (A-Z) game). They played the game 20 questions, and they generated lists of places they traveled to and their top 5 favorite things about those locations. As Frank improved, their games would often turn into conversations.

Include everyone

Expanding your circle of support can also be a great way to keep supplemental therapy motivating and engaging. Frank allowed his wife, children and grandchildren all to take part in his recovery. He said, “The more you can involve your family in your recovery... each family member brings something different.” His granddaughter created a carnival where he was required to count money, his grandson created flashcards for reading and his daughter started to give him piano lessons. Frank recalled that what impacted him the most-- wasn’t a game at all. It was that his children and grandchildren continue to call him to ask for advice about life and home projects. He said, “It was important to me that although I couldn’t speak well, they were relying on me for my guidance and intelligence and the role that I always played as their father.” At the time, Frank didn’t realize that these phone calls also doubled as a supplemental therapy task because he was required to verbalize procedures and tasks in order to help his children. In the end, each person in his life was able to bring their own unique interests to engage Frank and move him along in the recovery process.

Break the rules and adapt

Frank and Terri figured out ways to adapt games to fit Frank’s abilities. Frank stressed how important it was for him that he and his wife did not start off as competitors. They started by leaving the timer in the box, discussing answers as a team during Trivia, and focusing on him achieving as much success as possible. Adapting games allows you to play without competing against your “old-self”. By adjusting the task difficulty, they were able to keep the game challenging and engaging without being overwhelming. For example, when they played the Alphabet (A-Z) game where they were required to come up with a word for each letter:

  1. First, they started with just him generating any word that started with each letter.

  2. Then, they would take turns for each letter which encouraged him to be faster.

  3. Next, they restricted the words by a category—only animals.

  4. As he improved, and his therapy started to target higher level vocabulary, they added an adjective to every noun they came up with (Artificial Aardvark).

Align games with your therapy goals

Frank and Terri were able to adapt their games to focus on therapy goals. For example, when Frank’s therapy goals focused on using more specific verbs, they used the Alphabet (A-Z) game to generate a verb- object pairs (i.e. Bounce a ball). When his goals shifted to varying his vocabulary, they used the Alphabet (A-Z) game to generate Adjective-noun pairs.

So why did games work so well as supplemental therapy? For Frank, who has always loved games, I think the answer is motivation. Games provided an experience which supported Frank’s autonomy and competence. According to the Self-Determination Theory (SDT) both factors are important pieces to promote high quality intrinsic motivation and engagement. Another potential answer lies in the principles of neuroplasticity. Games allowed Frank to increase the amount of time he was practicing, therefore increasing the intensity of his therapy, the amount of repetitions he completed for a task and allowed him to use the skills and strategies he learned in therapy in his daily life.

Developing your own home therapy program can be challenging but extremely valuable. It is important to work with your therapist and family members to find activities that are fun and engaging and encourage you to practice outside of your therapy sessions. What motivates you to keep practicing?

Follow us on social media as we share our client’s ideas for their own home practice in our new series called “Activities Designed As Personal Therapy by Persons With Aphasia”(ADAPT by PWA).

Please note: *Frank and Terri gave author permission to use their names in this article

Thank you to both Frank and Terri for allowing me to share their story.


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