According to Bates et al. (2005), "the primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function". The topics of intensity and timing of intervention are widely debated across various fields. Results are contradictory: some studies indicate better outcomes with early intervention, while other studies indicate starting therapy too early may be detrimental to the patient's recovery. Recent research suggests, that therapy be functional and focus on communication goals that are appropriate for the patient's individual lifestyle. Specific treatment considerations for working with individuals with Wernicke's aphasia (or those who exhibit deficits in auditory comprehension) include using familiar materials, using shorter and slower utterances when speaking, giving direct instructions, and using repetition as needed. Role of neuroplasticity in recovery Neuroplasticity is defined as the brain's ability to reorganize itself, lay new pathways, and rearrange existing ones, as a result of experience. Neuronal changes after damage to the brain such as collateral sprouting, increased activation of the homologous areas, and map extension demonstrate the brain's neuroplastic abilities. According to Thomson, "Portions of the right hemisphere, extended left brain sites, or both have been shown to be recruited to perform language functions after brain damage. All of the neuronal changes recruit areas not originally or directly responsible for large portions of linguistic processing. Principles of neuroplasticity have been proven effective in neurorehabilitation after damage to the brain. These principles include: incorporating multiple modalities into treatment to create stronger neural connections, using stimuli that evoke positive emotion, linking concepts with simultaneous and related presentations, and finding the appropriate intensity and duration of treatment for each individual patient. Auditory comprehension treatment Auditory comprehension is a primary focus in treatment for Wernicke's aphasia, as it is the main deficit related to this diagnosis. Therapy activities may include: * Single-word comprehension: A common treatment method used to support single-word comprehension skills is known as a pointing drill. Through this method, clinicians lay out a variety of images in front of a patient. The patient is asked to point to the image that corresponds to the word provided by the clinician. * Understanding spoken sentences: "Treatment to improve comprehension of spoken sentences typically consists of drills in which patients answer questions, follow directions or verify the meaning of sentences". * Understanding conversation: An effective treatment method to support comprehension of discourse includes providing a patient with a conversational sample and asking him or her questions about that sample. Individuals with less severe deficits in auditory comprehension may also be able to retell aspects of the conversation. Word retrieval Anomia is consistently seen in aphasia, so many treatment techniques aim to help patients with word finding problems. One example of a semantic approach is referred to as semantic feature analyses. The process includes naming the target object shown in the picture and producing words that are semantically related to the target. Through production of semantically similar features, participants develop more skilled in naming stimuli due to the increase in lexical activation. Restorative therapy approach Neuroplasticity is a central component to restorative therapy to compensate for brain damage. This approach is especially useful in Wernicke's aphasia patients that have suffered from a stroke to the left brain hemisphere. Schuell's stimulation approach is a main method in traditional aphasia therapy that follows principles to retrieve function in the auditory modality of language and influence surrounding regions through stimulation. The guidelines to have the most effective stimulation are as follows: Auditory stimulation of language should be intensive and always present when other language modalities are stimulated. * The stimulus should be presented at a difficulty level equal to or just below the patient's ability. * Sensory stimulation must be present and repeated throughout the treatment. * Each stimulus applied should produce a response; if there is no response more stimulation cues should be provided. * Response to stimuli should be maximized to create more opportunities for success and feedback for the speech-language pathologist. * The feedback of the speech-language pathologist should promote further success and patient and encouragement. * Therapy should follow an intensive and systemic method to create success by progressing in difficulty. * Therapies should be varied and build off of mastered therapy tasks. Schuell's stimulation utilizes stimulation through therapy tasks beginning at a simplified task and progressing to become more difficult including: * Point to tasks. During these tasks the patient is directed to point to an object or multiple objects. As the skill is learned the level of complexity increases by increasing the number of objects the patient must point to. * Simple: "Point to the book." * Complex: "Point to the book and then to the ceiling after touching your ear." * Following directions with objects. During these tasks the patient is instructed to follow the instruction of manually following directions that increase in complexity as the skill is learned. * Simple: "Pick up the book." * Complex: "Pick up the book and put it down on the bench after I move the cup." * Yes or no questions – This task requires the patient to respond to various yes or no questions that can range from simple to complex. * Paraphrasing and retelling – This task requires the patient to read a paragraph and, afterwards, paraphrase it aloud. This is the most complex of Schuell's stimulation tasks because it requires comprehension, recall, and communication. Social approach to treatment The social approach involves a collaborative effort on behalf of patients and clinicians to determine goals and outcomes for therapy that could improve the patient's quality of life. A conversational approach is thought to provide opportunities for development and the use of strategies to overcome barriers to communication. The main goals of this treatment method are to improve the patient's conversational confidence and skills in natural contexts using conversational coaching, supported conversations, and partner training. * Conversational coaching involves patients with aphasia and their speech language pathologists, who serve as a "coach" discussing strategies to approach various communicative scenarios. The "coach" will help the patient develop a script for a scenario (such as ordering food at a restaurant), and help the patient practice and perform the scenario in and out of the clinic while evaluating the outcome. * Supported conversation also involves using a communicative partner who supports the patient's learning by providing contextual cues, slowing their own rate of speech, and increasing their message's redundancy to promote the patient's comprehension. Additionally, it is important to include the families of patients with aphasia in treatment programs. Clinicians can teach family members how to support one another, and how to adjust their speaking patterns to facilitate their loved one's treatment and rehabilitation.
Receptive aphasia
Global aphasia
Anomic aphasia
Expressive aphasia
Jargon aphasia
Hemispatial neglect
Compulsive hoarding
Visuospatial dysgnosia