As a speech therapist, we can sometimes get used to this performing the same tasks in a similar way, without thinking different angles or approaches to our therapeutic techniques. I hope this blog will help us with that “industry” our traditional way of thinking and encourages us to consider inclusion the two most important “V words” when it comes to aphasia rehabilitation.

The first “V word” – the HEART and the core of our sentences

“Dinner… uh… yes, dinner. The beach… the water… Oh yes, the sun. Although it depends on the severity level, it is not uncommon for a person with aphasia to have a single word. Nouns are usually some of the more common words expressed by people suffering from aphasia, which is why their verbal communication can sometimes be described as “telegraphic”. For example, a person with aphasia may say when describing a pictorial scene “Man…car…dog…boat…kite…” and so on. Any sentence structure or syntax may be missing, and often verbs are either omitted entirely or quite sparse. So here lies our first V word – VERBS!

Verbs are real the core of our sentences, and without them our sentences do not exist, leaving a lot of room for interpretation. It may also happen that when we say a noun, we START at the END of our sentence. For example, “kite,” instead “Girl Flying a Kite” Or “Dinner” instead “We ordered dinner.” Although the creation of this single noun may allow the communication partner (listener) to get on the field, many unknowns remain, which may lead to potential communication disruptions. “Dinner…uh…yes, dinner.” How about dinner? Have you had dinner? DID YOU ORDER DINNER? DO YOU COOK dinner? Does anyone deliver dinner? There are many options and without our verbsTThe verbal message is incomplete and leaves room for misinterpretation.

How do we work with verbs?

A key start is to make sure we are not only on naming pictures and objects during home exercises or speech therapy sessions. It must exist big emphasis on VERBS and related concepts. One of the more well-known, evidence-based therapies developed for people with aphasia is the so-called VNeST (verb network strengthening treatment), created by Lisa Edmonds and her colleagues. The idea behind this treatment is that by generating people (agents) and objects (patients) associated with specific verbs, semantic web related to this verb will be strengthened, and this way it verb

will become more easily available. Let’s take a verb for example “TO FIX.” Who repairs? These are your people associated with the verb – Plumber, electrician, carpenter, mechanic, etc. We then discuss and generate objects associated with these people (e.g. What is the plumber fixing? Toilet; What is the mechanic fixing? – Brakes), and so on. However, the person with aphasia wants access to more verbs than just the small target subset – so how does it work?

The idea behind this verb enhancement therapy is that by focusing on a verb like “fix” and finding words related to it, related verbs such as “repair” and “rebuild” will also become easier because they are RELATED concepts.

Remaining challenge (at least one of them):

What about those verbs that are less graphic and specific? These words that were once part of the vocabulary, but are now difficult to access and seem difficult to target in therapy. For example, verbs like design, advise, produce, formulate etc. These verbs may be less common or familiar and are often less recognizable, making them more difficult to include in conversation, so they need to be addressed and included in treatment. Consider the VNeST approachand simply start by generating people associated with these verbs. Who designs? The artist designs. Who else designs? The architect designs. Then build on that concept and make sure you come up with a variety

possibilities like this improves cognitive flexibility and word retrieval ability.

The “other” V-word – the HEART and CORE of our WORDS

Just as verbs form the core of our sentences, VOWELS are the core of our words. When a person introduces himself with Apraxiamotor speech disorder, which often accompanies aphasia, may affect vowels much more valuable and important than targeting consonants. Take for example the phrase “How are you?” Almost all of the sounds in this question are vowels (i.e. ahOO –ah – EEOO). If someone is able to pronounce ONLY the vowels, the phrase becomes quite understandable when speaking, even without filling in consonants. Additionally, it may happen that by targeting vowels, the consonants will start to complement each other.

How do we work on vowels?

I like to start with 3 vowels EE (as in BEET), OO (as in BOOT), ah (as in HOT) because of a few reasons. They are the most DIFFERENT from each otherand therefore it can serve as yours anchoring vowels before you turn to others. They may also be easier to learn because there are more mouth positions for them clearly specificand it may be model easier than some others.

Vowels may be something that is simply drilled, perhaps starting with them separately and then branching out into vowel + consonant and consonant + vowel combinations. Additionally, pronouns they consist mainly of vowels, AND they are a great way to start a sentence, so I like to move towards targeting subjective pronouns as quickly as possible. I use pronouns: I, you, he, she, we and them – and again I start by simply focusing on the vowels.

I (a-EE)

You yes)

He (EE)

She (EE)

We (EE)

They)

Since most pronouns have three anchor vowels, this is a great way to start. Once you have established the vowels when creating pronouns, see if you can add consonants. If not, stick to vowels. Try conjugating pronouns with a verb to start building a subject + verb sentence, and consider choosing a verb that also contains one of the 3 anchor vowels (i.e. eat – EE, EE). You can continue this activity by creating sentences with subjects (pronouns), verbs and objects. Focus on making vowels accurately, without spending too much time on consonants.

Remaining challenge (at least one of them):

These consonants that we hoped would “fall into place” failed to be pronounced and continue to be a challenge for my apraxic patient. Once you have established at least 3 anchor vowels and are ready to integrate the consonants, consider targeting ONLY the FIRST consonant in one word (except the vowel). Initial audio accuracy really helps improve overall speech intelligibility (intelligibility). Start with the consonants that

are easiest for the patient to imitate and focus on words or short phrases (preferably one-syllable) that place a strong emphasis on the use of these sounds in the initial position. You can even ask them to complete some of the remaining consonants in the word without having to aim them.

To sum up:

In conclusion, I hope some of these thoughts and ideas encourage you to do just that reassess and perhaps reconsider your current approachfocusing more on the means of our words and sentences…ours VOWELS AND VERBS. They really are like that valuable makeupour speech and language, and we should not overlook or underestimate them when this is the case treatment of people suffering from aphasia and apraxia. They serve as anchors for clearer speech, more linguistic content and overall better communication skills.