Sentence Production

Program for Aphasia

(SPPA)
Maria Moritz
Natalie Brickner

Overview of Treatment
Designed

to enhance functional
communication.

Sentence

Production Program for Aphasia

(SPAA) is the revised version of Helm
Elicited Language Program for Syntax
Stimulation (HELPSS).

Philosophy of Treatment

Aphasics do not have a lack of grammatical knowledge, but

simply have difficulty accessing it (Gleason et al.,1975).

Grammatical knowledge can be accessed with proper cues

(Weigel & Bierwisch, 1970).

The hierarchy was created to facilitate successful responses

and the difficulty level increases gradually (Gleason et al.,
1975).

Multiple exemplars are included for each sentence type to

increase generalizability .

Population

Studied on individuals with Brocas aphasia

Designed to treat agrammatism

Must have well preserved auditory comprehension, attention,

and memory.
Agrammatism is characterized by one-three word utterances
consisting of primarily nouns and verbs with limited functor words and
morphemes.

Not appropriate for:

Global and fluent aphasia

Minimal speech output

Severely impaired auditory comprehension

Significant attention, memory, or other cognitive deficits

Subject Information

GS

47 year old male

Left Cerebrovascular Accident (LCVA) in 1995

Moderate Brocas Aphasia

Verbal Expression:

Auditory Comprehension:

Agrammatic: 1-3 word utterances, limited functors and verbs

Relatively intact (functional for communication ADLs)

Apraxia of Speech:

Mild

Intelligible speech

Rationale of Treatment
GS

presents with moderate Brocas aphasia. Verbal

expression is characterized by agrammatism (1-3
word utterances, limited verbs, functors, and
morphemes). Auditory comprehension is relatively
preserved and functional for activities of daily living.

Fulfill

functional communication needs

e.g.,

call 911 & call the doctor

Uses

the 8 most commonly used sentence constructions

Cookie Theft Picture Output

Example of a good candidate:
Mothersahwashin dishes but.fauza(faucet) and
overflowing.boyah.stool.(long pause).fall.and
cookies and sister.and.
GS:
Boy isumumboy is umumcookies jar yeafall stool
and girl yeaand mom isover flow sinkyeawater, drying
umguyor womanyea and yeaover flow sinkyea

Components of the SPAA

Administration
Stimulus

Manual

Book
Score Sheets
Progress Sheets

SPPA Session Score Sheet

SPPA Overall Progress Score Sheet

Methods
Feedback
Use

clinical judgement

Though

it is a highly structured program, it is important

to individualize the task in order to increase success.

Practice
No

practice stimuli is provided.

Eight Sentence Types

Sentence Type

Example

Imperative Intransitive

Come here.

Imperative Transitive

Answer the phone.

Wh- Interrogative (What and Who)

What are you making?

Who is going?

Wh- Interrogative (Where and

When)

Where is the paper?

When are you leaving?

Declarative Transitive

I make coffee.

Declarative Intransitive

She works.

Comparative

Hes funnier.

Yes-No Questions

Is it raining?
Do you need money?

Sentence Levels:
Level A
1.

Story is presented WITH the target sentence

2.

A probe question is presented

3.

Client is required to produce target sentence

Example:
Clinician: Nicks school bus arrives in 15 minutes and Nick is sill
asleep, so his mother tells him, Wake up! What does his
mother say?
Client: Wake up!

Sentence Levels:
Level B
1.
2.
3.

Story is presented WITHOUT the target sentence

A probe question is presented
Client is required to produce target sentence
Example:
Clinician: Nicks school bus arrives in 15 minutes and he is still
asleep, So what does his mother tell him to do?
Client: Wake up!

Presentation of Sentences
Part 1:

Level A is presented first

If the client is successful, Level B is presented immediately after

If the client is NOT successful, Level B is marked N/A

The client MUST obtain a score of 13/15 (85%) in order to

move on to part 2.

Part 2:

Level B is presented in isolation

The client MUST obtain a score of 13/15 (85%) in order to

move on to sentence type 2.

Demonstration
Level A:
Clinician: Nicks school bus arrives in 15
minutes and Nick is sill asleep, so his
mother tells him, Wake up! What does
his mother say?
Client: Wake up!
Level B:
Clinician: Nicks school bus arrives in 15
minutes and he is still asleep, So what
does his mother tell him to do?
Client: Wake up!

Scoring
1

= Fully Correct Response

Self-corrected

responses

Adding

additional meaningful words while maintaining

syntax and including the appropriate target phrase
Target

phrase: Come here

Client

Response: Come here, doggy

Substituting

substantive words while maintaining syntax

of the target phrase
Target

phrase: When are you leaving?

Client

Response: When are you going?

Scoring
.5

= Partially Correct Responses

One

word omitted or produced in error

Target

Phrase: Who is laughing?

Client

Response: Who laughing?

0 = Incorrect Responses
Two

+ words omitted or produced in error

Target

Phrase: Are you cold?

Client

Response: Cold?

Measurable Outcomes
Goal:

GS will demonstrate verbal expression as

necessary for communication activities of daily
living.
Objective:

GS will independently demonstrate proper

syntactic structure within utterances of increasing length
and complexity during structured activities 85% of the
time.

Video Demonstrations

Results
GS

independently demonstrated proper syntactic structure

within utterances of increasing length and complexity during
structured activities 86% (13/15) of the time.
Task:

Sentence Production Program for Aphasia: Sentence type 1

- Level A & B.

Results:

Objective met.

GS

independently demonstrated proper syntactic structure

within utterances of increasing length and complexity during
structured activities 73% (11/15) of the time.
Task:

Sentence Production Program for Aphasia: Sentence type 1

- Level B.

Results:

Objective not met.