Back in January, when we could still gather together, a group of members of our Aphasia Center met weekly for Musical Mondays. Musical Mondays was designed to be a 10-week trial program to explore the question: “What can music do for you?”. We completed 9 weeks of our program before COVID-19 changed the way in which we interact with each other, for now. Those 9-weeks were filled with laughter, music, sharing, and support. We learned a lot from each other and experienced the power of music. Although the program is over, for now, there are many ways to incorporate music into your life!
Aphasia therapy has long used singing as a tool for regaining speech. Let’s start with singing and then look at other ways music can help with communication skills and shared experiences.
Sing, Sing, Sing
Melody, rhythm, and familiarity with favorite and/or emotionally charged songs may allow a person with aphasia to sing words he/she may not be able to speak. Start by singing a favorite song or a song that connects you to a happy memory in your life.
If the song has repeated words in the chorus, is slow paced, and uses short words, all the better. But, start with a song you love. Sing along with someone. There are lots of ways to do this. Sing with a family member or find a song on you-tube, Pandora, or other sources of music you may want to explore. We found YouTube to be particularly helpful because we could often find the song we wanted to sing with the words in view on the computer screen.
If you are singing at home, sing along with the song each day, for 10 to 15 minutes. Over time, gradually make the sound softer on your computer and sing a bit louder. When you feel ready, try singing the song on your own.
Here are a couple of favorite “sing-along” songs from our group.
Queen, We are the Champions
The Beatles, Let It Be
Clap your hands
Rhythm and rate (tempo in music) are important parts of music and speech. Copying a rhythm pattern and/or creating a rhythm pattern by clapping your hands, beating on a drum or tabletop, or tapping your foot is good for you. Start with short rhythmic patterns and gradually try to copy longer patterns. Listen carefully to the pattern you are repeating. Do they sound the same? This activity exercises listening skills, auditory memory, and fine motor coordination. Use this listening skillwhen you are speaking to help yourself take your timewhen talking.
Notice the different rhythms in these two pieces of music:
ABBA, Dancing Queen
Jean Luc Ponty, Cosmic Messenger
Music and Mood
A 2013 study in the Journal of British Psychology found that people who listen to upbeat music could improve their mood and boost happiness in just two weeks. Music can also be energizing or relaxing and a source of comfort. See how different types of music affect your mood
Some aphasia practice apps let you add your own, personal items. These include Sentence Shaper and Tactus Therapy. Here are two videos showing how to “Add Personal Items” to the Naming and Writing activities in Tactus Therapy Language Therapy.
The MossRehab Aphasia Center was founded on the principles
of the Life Participation Approach to Aphasia (LPAA, Chapey et al., 2000). These principles include:
goal is enhancement of life participation
are available to all affected by aphasia
and intervention targets personal and environmental factors
is measured by documented life changes
The importance of adherence to these principles is brought
into sharp relief by recent evidence:
of persons with aphasia report having no friends at 6-months post-stroke (Aphasia
Access White Paper, Simmons-Mackie, 2018)
Practice Recommendations (Shrubsole et al., 2017; Simmons-Mackie et al.,
for all persons with aphasia
impact on quality of life
Goals people with aphasia have for themselves (e.g.,Worrall et al., 2011)
control and independence
The question is, how can we make measurement of life changes
feasible and practical when confronted with the reality of clinical practice? Is it possible to measure objectively what is
in many ways a subjective experience?
We propose that the answer is, yes! In the weeks to come, we will be posting a series on suggestions for strategic outcome measurement based on the principles of the LPAA. Each of these will be based on the following, fictitious, case example.
Donna is a 67 y/o
woman, 14-months s/p ischemic L MCA affecting fronto- parietal and superior
temporal cortex, sparing Wernicke’s area.
She is right-handed and is a native English speaker. She worked as an outpatient coordinator for a
local children’s specialized hospital for 25 years, having retired 6 months
prior to her stroke. She has 5 adult
children and 15 grandchildren ranging in age from 15 years to 3 months. A month prior to her stroke, she and her
husband rescued a 7 year-old American Staffordshire Terrier from a local
Per WAB-R, Donna presents with conduction
aphasia, but her language production may be better characterized as borderline
fluent with mild apraxia of speech. Word
retrieval difficulty is characterized by use of non-specific words
(thing/stuff, pronouns without antecedents), empty circumlocution, frequent
pauses lasting longer than 2 seconds, and comments indicating difficulty. Agraphia without alexia is also present. She and her husband both report that she
spends most of her days watching TV, which was not her habit prior to her
In today’s post, we’ll demonstrate one tool, Key Life Inventories (Simmons-Mackie
& Damico, 2001), which can be used to proceed from initial assessment to an
outcome that reflects this client and her co-survivor’s goals for themselves.
Key Life Inventories can serve as practical method to organize your conversation and support clients in reflecting on their lives, what has changed since their stroke, and what is going to important to them moving forward. People with aphasia may need multimodality assistance to comprehend what information is being asked of them and to express that information. Visual aids, such as the LIV cards (Haley et al., 2010) and the Assessment for Living with Aphasia (Kagan et al., 2010) are two examples of clinical tools that can provide that support.
The first step will be to help your client think about what activities were important to them before the stroke, whether those activities are still important to them, and any new things that have become important to them since the stroke. Below is an example Key Life Inventory for Donna.
The next step will be to help the client think about the, “What now?“. How will this exercise be used
to move toward goals they have for themselves? In doing so, it can be important to help
clients communicate about what strengths they have and how those strengths can
be harnessed in the pursuit of priorities, whether they are the same those
before the stroke or are new.
Help clients think about not only activities in which they want to engage, but also how engaging in those activities will move them toward fulfillment of the responsibilities they feel in the relationships and roles they have in their lives. Below are some examples from Donna’s case.
Just as clients don’t tend to come
to us with goals like, “I want to increase my auditory comprehension to 80%
accuracy”, we cannot work toward a goal to “host a pot luck family dinner with
80% accuracy”. We must apply clinical expertise to translate
Donna’s desired outcomes into cognitive-linguistic skills and tasks and communicative
competencies, and to determine any internal or external barriers that need to
In Donna’s elaborated KeyLife Inventory below, we now position the newly established goals as the starting point that informs the choice of clinical tools to:
Determine the skills required and how to train/support/facilitate progress
Identify any internal (e.g., lack of confidence) and external barriers to progress
Confirm plan with the client, implement plan, assess/measure progress
In the next post in our series,
we’ll examine how we might engage Donna and her co-survivor in ongoing
conversation about progress toward her cognitive-linguistic goals, as well as positive
change in Donna’s communication confidence, and how we might assess the degree
to which the treatment strategies we’ve chosen are facilitating progress toward
of this post were originally presented at the 2018 ASHA Convention in a talk
entitled, Strategic outcome measurement using the life participation approach
to aphasia, presented by the Aphasia Access Research Working Group (Antonucci,
Cherney, Kagan, Haley, Holland, Schwartz, Simmons-Mackie, & Kiran).
Evidence-Based Practice in Aphasia- Evidence Tables
E., Heinemann, A., Semik, P., & Cherney, L. R. (2011). Psychometric properties of the communication
confidence rating scale for aphasia (CCRSA): Phase 2. Aphasiology, 25(6-7), 727-735.
et al., 2000. Life Participation Approach to Aphasia: A Statement of Values for
the Future. ASHA Leader 5(3):4-6
L. R., Babbitt, E. M., Semik, P., & Heinemann, A. W. (2011). Psychometric
properties of the communication confidence rating scale for aphasia (CCRSA):
Phase 1. Topics in Stroke
Rehabilitation, 18(4). 352-360.
R. (Ed.). (2006). Group Treatment of Neurogenic Communication Disorders: An
Expert Clinician’s Approach, (2nd ed.), San Diego, CA: Plural
K. & Pimentel (2007). Measuring outcomes of group therapy. In R. Elman (Ed.).
Group treatment for neurogenic communication disorders: The expert clinician’s
approach. (2nd ed. ) San Diego, CA: Plural Publishing.
Charles (1995). Co-Constructing Meaning in Conversations with an Aphasic Man. Research
on Language and Social Interaction , 28 (3), 233-260.
KL, Womack JL, Helm-Estabrooks N, Caignon D, & McCulloch KL, (2010). The
Life Interest and Values Cards. Chapel Hill, NC: University of North
Carolina Department of Allied Health Sciences.
KL, Womack JL, *Harmon TG, McCulloch M, & Faldowski R. (2018). Life
activity choices by people with aphasia: Repeated interviews and proxy
agreement. Aphasiology. doi:10.1080/02687038.2018.1506087
K., Byng, S., Lamping, D. L., & Smith, S. C. (2003). Stroke and Aphasia
Quality of Life Scale39 (SAQOL39): Evaluation of Acceptability, Reliability,
and Validity. Stroke, 34(8), 1944-1950.
T., Holland, A., & Rowega, M. (2002). Conversational coaching: Treatment
outcomes and future directions. Aphasiology, 16(7), 745-761.
W., Doyle, P., Stone, C.A., Austermann-Hula, S. N., Kellough, S., Wambaugh,
J., Ross, K. B., Schumacher, J. G., & St. Jacque, A. (2015). The Aphasia
Communication Outcome Measure (ACOM): Dimensionality, Item Bank Calibration,
and Initial Validation. Journal of Speech, Language, and Hearing Research,
A. et al., (2008). Counting what counts: A framework for capturing reallife
outcomes of aphasia intervention, Aphasiology 22(3), 258-280.
A. et al., (2008). Counting what counts: A framework for capturing reallife
outcomes of aphasia intervention, Aphasiology 22(3), 258-280.
A., Simmons-Mackie, N., Victor, J. C., CarlingRowland, A., Hoch, J.,
Huijbregts, M., Streiner, D., & Mok, A. (2010). Assessment for Living
with Aphasia (ALA). Toronto: Aphasia Institute.
A., Winckel, J., Black, S., Duchan, J. F., Simmons-Mackie, N., & Square, P.
(2004). A set of observational measures for rating support and participation in
conversation between adults with aphasia and their conversation partners. Topics
in Stroke Rehabilitation, 11(1), 67-83.
A. (2006). The Western Aphasia Battery–Revised. San Antonio, TX: The
S. et al., (2018). Survey of aphasia assessment measures implemented in clinical
and research settings. Poster presented at the 2018 Clinical Aphasiology
Conference, Austin: TX.
J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib, C.
(1989). The Communicative Effectiveness Index: development and psychometric
evaluation of a functional communication measure for adult aphasia. Journal
of Speech and Hearing Disorders, 54(1), 113-124.
B., Fromm, D., Forbes, M. & Holland, A. (2011). AphasiaBank: Methods for
studying discourse. Aphasiology, 25, 1286-1307.
J.F., & Murray, L.L. (2003). Functional measures of naming in aphasia: Word
retrieval in confrontation naming versus connected speech. Aphasiology, 17,
L.E. & Brookshire, R. H. (1993). A system for quantifying the informativeness
and efficiency of the connected speech of adults with aphasia. Journal of
Speech and Hearing Research, 36(2), 338-350.
R. W. (2004). Goal attainment scaling as a clinical measurement technique in
communication disorders: A critical review.
Journal of Communication Disorders, 37(3), 217-239.
K., Worrall, L., Power, E. & O’Connor, D. E. (2017). Recommendations for
post-stroke aphasia rehabilitation: an updated systematic review and
evaluation of clinical practice guidelines. Aphasiology, 31(1), 1-24.
N. et al., (2017). The top ten: Best practice recommendations for aphasia. Aphasiology,
N. N. & Damico, J. S. (2001). Intervention outcomes: A clinical application
of qualitative methods. Topics in Language Disorders, 22(1), 21-36.
N.N. (2018). Aphasia in North America. Aphasia Access
K., Porter G., & Howard, D. (2004). Comprehensive Aphasia Test.
S. J. et al. (2016). Which outcomes are most important to people with aphasia
and their families? An international nominal group technique study framed
within the ICF. Disability and Rehabilitation, 1-16.
G. G., Harrison-Felix, C. L. et al., (2004).
Quantifying environmental factors: a measure of physical, attitudinal,
service, productivity, and policy barriers.
Archives of Physical Medicine & Rehabilitation, 85(8),
A. (2003). The Application of Conversation Analysis (CA) to the Management of
Aphasia. Publié dans Revue Tranel (Travaux neuchâtelois de linguistique),
R. (2006). Applying conversation analysis to aphasic talk: From investigation
to intervention. Revue Française de Linguistique Appliquée, 11(2), 99-110.
L., Sherratt, S., Rogers, P., Howe, T., Hersh, D., Ferguson, A., &
Davidson, B. (2011). What people with aphasia want: Their goals according to
the ICF. Aphasiology, 25(3), 309–322.
MRRI Institute Scientist Edward Wlotko, PhD, will serve as principal investigator of a subcontract award totaling more than $1M from the National Institutes of Health. The research is part of a grant, entitled “Cognitive control and sentence processing in aphasia,” received by Malathi Thothathiri, Ph.D., of the Department of Speech, Language & Hearing Sciences at George Washington University. Dr. Thothathiri is a former postdoctoral fellow at MRRI. Continue Reading
Aphasia can be quite frustrating for people who struggle to communicate. In addition to naming difficulties, some people with aphasia experience comprehension impairment, where hearing or reading the name of an object conveys the wrong image or meaning.
Erica Middleton, PhD, has been studying naming problems for eight years. Her last six years have been spent researching how people with aphasia can relearn and comprehend names, first as a Post-Doc at Moss Rehabilitation Research Institute (MRRI), and now as the Institute Scientist leading MRRI’s Language and Learning Laboratory.
In this video, Dr. Middleton talks about a five year, $2.4 million grant she received from the National Institutes of Health that will lead to a theory of learning needed to advance aphasia rehabilitation.
Public radio station WHYY recently took an in-depth look into aphasia that featured interviews with experts from MossRehab’s Aphasia Center and members of its “Conversation Cafes.”
“While there are no guarantees about where you will end up in your recovery, opportunities for rehabilitation and opportunities for improving and increasing communication skills are lifelong,” Aphasia Center Director Sharon Antonucci, PhD, told the radio show The Pulse. Antonucci emphasized that recovery from aphasia can continue years after a stroke. Continue Reading
Two donors, Stewart and Sally Eisenberg, have decided to endow the Reta’s Games Group at the MossRehab Aphasia Center, in honor of their family matriarch, Reta Eisenberg.
Reta has been a tireless advocate for families living with aphasia for almost 30 years. She was instrumental in the founding of the Aphasia Center in 1996 after witnessing the impact aphasia had on her husband, Marty, prior to his death. Like others struggling with aphasia, Marty was unable to speak in full sentences, read a book, write his name, express basic needs such as hunger, and would use the wrong words or forget words when communicating – including the names of their children. Continue Reading