Supported Communication for Aphasia

(SCA™)
Strategies for ___

Shirley Morganstein, MA/CCC-SLP

copyright 2009 Shirley

Morganstein
How does aphasia interfere with
communication?
 Difficulty with transaction: the exchange
of information
 Difficulty with interaction: social
connection, and personal core

copyright 2009 Shirley

Morganstein
Ed’s Conversational Assets
 Excellent “connection” with his partner
 Good eye contact
 Good attention to speaker, genuine interest in exchanges
 Good use of gesture, facial expression, voice tone,
pantomime, and sometimes, drawing or writing.
 Strong motivation to succeed, and “hang in there.”

copyright 2009 Shirley

Morganstein
E’s Conversational Challenges
 Little speech output
 Occasional words or phrases
 Perseverative words (“Boom,” “Yay”) which are sometimes not
appropriate
 Frequent error words when speech is available, or
correct words, but difficulty with pronouncing them
clearly.
 Trouble using “yes” and “no”.
 Difficulty using writing.
 Occasional “frustration blocks”

copyright 2009 Shirley

Morganstein
As Partners, What do we need
to know?
 Aphasia is a problem
with language but not
cognition.
 People with aphasia
know more than they
may be able to
indicate to you.
 Communication is a
partnership.
copyright 2009 Shirley
Morganstein
Aura Kagan: Supported
Conversation™
 Train partners: ways to
support communication
wherever aphasia
interferes.
 Train partners: recognize
the competence of
people with aphasia.
 Expands opportunity,
and builds confidence.

copyright 2009 Shirley

Morganstein
Supported Conversation
General Tenets:
 “I know you know.”
 Use of external aides to support
communication.
 Emphasis on social exchange in as normal a
manner as possible, given the supports.
 Is not about “improving” the person with
aphasia, but enhancing the communicative
experience.

copyright 2009 Shirley

Morganstein
Comprehension Strategies
for E:
 Simplifying Structure in Getting Your
Message Across

 Think of ways to say or ask things in a

simple, but not childish way, using graphic
supports.
 Pare down language, keep it natural.

copyright 2009 Shirley

Morganstein
Example
 When you saw Shirley the other day, did
you tell her about your doctor’s
appointment next Friday?
vs
 (pointing to a calendar entry) Did you tell
Shirley about Friday?

copyright 2009 Shirley

Morganstein
Comprehension Strategies
 Move from the general to the specific as
you speak
 Example:
• We’ll talk to Shirley.
• We’ll talk about communication.
• The talk about communication may help.
 Slow down: but not too slow…

copyright 2009 Shirley

Morganstein
More Comprehension
Strategies
 Rephrase when you are not understood.
Example:
 Since today is really cold, I think you should
wait in the living room until I pull the car around
vs
 Today is really cold. Wait here (point) for me.

copyright 2009 Shirley

Morganstein
Conversation Strategies
 Clarifying: When E communicates, it’s
easy to wind up on the wrong track. In
fact, I sometimes wind up on the wrong
train. I often need to clarify something
before going further.

copyright 2009 Shirley

Morganstein
Conversation Strategies
 The trouble with “yes” and “no”:
 He says them like he means them.
 He says the wrong one a lot of the time.

Clarifying “yes” and “no”

• Use the written words and have him point
• Use thumbs up/down to verify

copyright 2009 Shirley

Morganstein
Conversation Strategies for Ed:
Binary Choices
 It is sometimes easier to get into the ball
park if you know the field:
 Put two words at the top of the page, and get
him to indicate which of the two is the
subject. Then, keep going with two-choice
formats, and verify with yes/no
Today? Another Day?

Soccer game? Dinner out?

copyright 2009 Shirley

7:00? Early?
Morganstein
Conversation Strategies for Ed:
Keeping it honest
 Be truthful about “getting it”, and about
being frustrated yourself.
 Don’t confuse therapy with conversation.
If you are practicing an exercise, it is
different from having a conversation.
 Allow real discussions, even when they
are painful, or difficult.

copyright 2009 Shirley

Morganstein
More Conversation Strategies
 Reflect what you believe he is feeling: (Boy!
You seem really frustrated!”)
 Eliminate “therapizing” or “teaching”: avoid
trying to elicit an answer you already know.

copyright 2009 Shirley

Morganstein
Summing Up

• Slow down.
· Keep sentences simple, but adult.
· Convey one idea at a time.
· Move from a general comment to
the more specific details.

copyright 2009 Shirley

Morganstein
Summing Up

• Stay appropriately animated, using

humor when suited to the situation.
· Use props like magazines, pictures,
albums. maps

copyright 2009 Shirley

Morganstein
Summing Up
• Have pencil and paper available
always, and use them.
· Eliminate Ò therapizi ngÓor
ÒteachingÓ: avoid comments like,
ÒYou said that wellÓ.
· Reflect what you bel ieve he is
feeling: ( Ò You seem really angry!Ó)
· Never say y ou under stand, when
you donÕt.

copyright 2009 Shirley

Morganstein
What goes on in therapy
 Supported Conversation ™
 We talk about family, friends, activities, fears,
hopes, accomplishments, feelings, current
events, interests. He feels good about
succeeding in providing me with information I
didn’t know ahead of time, and, in bringing
stuff to the table. I also share things about
my personal life; this is a partnership, and he
likes that.
copyright 2009 Shirley
Morganstein
What goes on in therapy
 Writing/Speaking practice
 E copies, repeats, and talks about words I
select based upon their phonemic
composition, as I try to widen his repertoire of
sounds, and improve his ability to “get
something out” other than his stereotypes
when he tries to converse.
 The Califone: a great way for him to practice
individual sounds embedded in phrases.
copyright 2009 Shirley
Morganstein
What do I think may happen?
 Improved initiation of speech attempts
with increased repertoire may lead to
improved success in verbal mode.
 Improved use of drawing/writing to aid
verbal attempts
 Increased satisfaction in daily life.
 Expansion of activities as possible.

copyright 2009 Shirley

Morganstein
How do you all feel?

copyright 2009 Shirley

Morganstein
What are you doing for you?
 Time alone, or in activities you enjoy.
 Permitting your own feelings.
 Acknowledging the limits of situation, and
of your ability to impact.
 Laughing/crying/being.
 Finding the supports in others, or
counseling/therapy as needed.

copyright 2009 Shirley

Morganstein