Aphasia treatment is individualized to address the specific areas of need identified during

assessment as well as the specific goals identified by the person with aphasia and his or
her family. Additionally, treatment occurs in the language(s) used by the person with
aphasia either by a bilingual SLP or with the use of trained interpreters, when necessary. In
general, the aim of aphasia treatment includes

restoring language abilities by addressing all impaired communication modalities and

focusing on training in those areas in which a person makes errors

strengthening intact modalities and behaviors to support and augment

communication

compensating for language impairments by teaching strategies and by incorporating

augmentative and alternative methods of communication if they help to improve
communication

training family and caregivers to effectively communicate with persons with aphasia
using communication supports and strategies, in order to maximize communication
competence

facilitating generalization of skills and strategies in all communicative contexts

educating persons with aphasia, their families, caregivers, and other significant
persons about the nature of spoken and/or written language disorders, the course of
treatment, and prognosis for recovery.

Because of the complexity and nature of aphasia, and based on the individual's language
profile and values, interventions vary. There are many ways to organize treatment options,
including by aphasia type or by primary signs and symptoms. However, since most
individuals with aphasia present with a variety of communication deficits and bring different
backgrounds and unique needs to the treatment situation, treatments here are organized
using the framework proposed in the WHO's ICF framework (2001).
This framework considers two overarching components: health conditions and contextual
factors. The health conditions component is most relevant to the treatment descriptions
below, while the contextual factors must be considered for all patients throughout the
treatment process. Health conditions include body functions and structures and activity and
participation.

Copyright 2008 by Aphasia Institute. Adapted with permission.

In the section below, some of the aphasia treatments described directly address body
function impairments (e.g., difficulty formulating syntactically correct sentences, finding
words, comprehending words or sentences), while others focus on communication activity
and participation (e.g., working directly on functional tasks or situations in everyday
activities such as answering the phone, completing paperwork, or ordering food).
Regardless of the approach used, the ultimate goal of aphasia treatment is to maximize the
individual's quality of life and communication success, using whichever approach or
combination of approaches meets the needs and values of that individual.
The following are brief descriptions of both general and specific treatments for persons with
aphasia. It is important to note that while the interventions below are categorized by a
specific ICF domain (e.g., impairment-based treatment), the outcomes of treatment may
extend across domains (Simmons-Mackie & Kagan, 2007). Where available, links to
evidence and expert opinion regarding the intervention are provided. This list is not

exhaustive nor does inclusion of any specific treatment approach imply endorsement from
ASHA.

Language Impairment-Based Treatment

A treatment approach that addresses all communication modalities (spoken, written, and
gestures) and focuses on training those areas in which a person makes errors.

Computer-Based Treatment
Treatment involving the use of software programs targeting various language modalities.

Constraint Induced Language Therapy (CILT)

Intensive treatment approach focused on increasing verbal output. In contrast to many other
approaches, CILT discourages the use of compensatory communication strategies, such as
gestures or writing.

Melodic Intonation Therapy (MIT)

Treatment using intonation patterns (melody, rhythm, and stress) to increase the length of
phrases and sentences. Reliance on intonation is gradually decreased over time. MIT
targets improvement in spoken language expression.

Reading Treatment
Treatment designed to improve decoding and comprehension of written language.

Syntax Treatment
Treatments designed to improve the grammatical structure of utterances, including

Treatment of Underlying Forms

An approach, grounded in linguistic theory, designed to improve sentence production for
people with agrammatism that starts with training more complex sentence structures.

Verb Network Strengthening Treatment

A verb treatment approach designed to improve word retrieval in simple active sentences.
Verbs are trained with pairs of related nouns to improve sentence production.
Chaining (Forward and Reverse)an approach that breaks tasks/words/sentences into
small parts and teaches the beginning (or end) part first.
Sentence Production Program for Aphasiaa prescribed treatment program designed to
aid the production of specific sentence types.

Word Finding Treatment

Treatments designed to improve word finding in spontaneous utterances, including

Word Retrieval Cueing Strategies (semantic and cueing verbs)an approach that
provides additional information, such as the beginning sound of a word or contextual cues,
to prompt word recall.
Gestural Facilitation of Namingan approach that uses gestural interventions to facilitate
verbalization.
Response Elaboration Traininga treatment approach designed to improve word finding
and increase the number of content words used by a person with aphasia. The clinician
elaborates on the person with aphasia's utterances to improve conversational abilities.
Semantic Feature Analysis Treatmenta word retrieval treatment where the person with
aphasia identies important semantic features of a target word (e.g., building, books, quiet
for "library"); this is thought to activate the semantic network and possibly aid in retrieval of
nontargeted but related words.

Writing Treatment
An intervention designed to improve expression via written language.

Activities/Participation-Based Treatment
Multimodal Treatment
Treatment approaches focusing on the use of effective and efficient communication
strategies via nonverbal and alternative means, including
Augmentative and Alternative Communication (AAC)treatment involving the use of
augmentative aids, such as picture and symbol communication boards and electronic
devices, to help individuals with aphasia express themselves.
Visual Action Therapytreatment used with individuals with global aphasia. This nonvocal
approach trains persons with aphasia to use hand gestures to indicate specific items.
Promoting Aphasics' Communication Effectiveness (PACE)treatment designed to
improve conversational skills using any modality to communicate messages. Both the
person with aphasia and the clinician take turns as message sender or receiver, promoting
active participation from the person with aphasia.
Oral Reading for Language in Aphasia (ORLA)treatment using auditory, visual, and
written cues to assist the person with aphasia in reading sentences aloud.

Partner Approaches

Treatment approaches engaging communication partners to facilitate improved

communication in persons with aphasia, including
Conversational Coachingtreatment designed to improve communication between the
person with aphasia and primary communication partners. The SLP serves as the "coach"
for both partners.
Supported Communication Intervention (SCI)an approach to aphasia rehabilitation
that emphasizes the need for multimodal communication, partner training, and opportunities
for social interaction. The three essential elements of SCI are incorporating augmentative
and alternative communication, training communication partners, and promoting social
communication, including participation in an aphasia group.
Social and Life Participation Effectivenessan approach that focuses on the real-life
goals of the person with aphasia, considering what the person can do with and without
support. Intervention may also focus on others affected by aphasia, such as family
members. Learn more.

Pragmatic Treatment
Treatment designed to address social communication deficits, such as appropriate word
choice, nonverbal communication, and understanding the rules of conversation.

Reciprocal Scaffolding
Treatment approach in which communication skills are addressed in natural, relevant
situations where the person with aphasia takes on the role of instructor to "novices" during
conversations about topics of interest to the person with aphasia. The relationship allows
both parties to demonstrate and reinforce communication strategies.

Script Training
Treatment approach in which the clinician and person with aphasia construct a monologue
or dialogue that is practiced intensely so that the person with aphasia can communicate
about a topic of interest to them.

Service Delivery
See the service delivery section of the aphasia evidence map for pertinent scientific
evidence, expert opinion and client/caregiver perspective.
In addition to determining the type of speech and language treatment that is optimal for the
person with aphasia, consider other service delivery variables that may have an impact on
treatment outcomes such as format, provider, dosage, and timing.

Format

Format refers to the structure of the treatment session (e.g., group vs. individual) provided
to the person with aphasia.

Provider
Provider refers to the person providing the treatment (e.g., SLP, trained volunteer,
caregiver).

Dosage
Dosage refers to the frequency, intensity, and duration of service.

Timing
Timing refers to the timing of rehabilitation relative to the onset of aphasia.

Setting
Setting refers to the location of treatment (e.g., home, community-based).

Bilingual Considerations
In addition to the service delivery variables mentioned above, it is important to consider a
person's language needs when selecting the language of intervention. Damage to the
language center of the brain in bilingual individuals may produce aphasia across languages.
Recovery of language may vary depending on the type of aphasia, how languages were
acquired-simultaneously or sequentially-and the degree of proficiency and demands for the
use of each language.
The goal of intervention might not be a full recovery of all language(s) used. For example,
consider the patient/client with severe global aphasia who spoke English at work and
Spanish at home and in the community. Return to work may not be feasible. English might
be incorporated into treatment at a minimum; however, Spanish might be the primary focus
to return the person to daily activities. It is essential to consider the linguistic demands on
the patient/client.
Questions to consider when treating bilingual individuals with aphasia include the following:

How many languages does the person speak?

At what point did he or she learn English or a secondary language?

When and with whom does he or she use each language? For example, what
language(s) are spoken at work, at home, and with family or friends?

What is the prognosis? How will that impact language(s) that are needed to
communicate?

In addition to considering these questions, clinicians may need to consult with another
professional, such as a bilingual SLP, a cultural/language broker (a person trained to help
the clinician understand the person's cultural and linguistic background to optimize
treatment), and/or an interpreter. An SLP will need to determine the language of treatment
and its impact on cross-language generalization (i.e., improvement in the nontreated
language). The language of intervention must involve the language that the person uses in
the home. Demands for services in additional languages will depend on the person's ability
to return to premorbid levels of functioning.

Legal Requirements
In the United States, Title VI of the Civil Rights Act of 1964 (Title VI of the Civil Rights Act,
42 U.S.C 2000 et seq.) ensures equal access to services regardless of language
spoken. Therefore, health care organizations are required to seek the assistance of an
interpreter for provision of service when there is not a client-clinician language match.
Executive Order 13166, issued by President Clinton on August 11, 2000, clarifies that all
federal agencies shall develop and implement a system by which persons with limited
English proficiency (LEP) can access services and shall ensure that persons with LEP have
the opportunity to provide input to federally funded agencies (Moxley, 2002). Federal
agencies that fail to meet these guidelines are at risk of facing a number of potential
consequences, including losing federal funding if they are found to be discriminatory in
practice (Limited English Proficiency, 2013).

Cultural Considerations
Views of the natural aging process and acceptance of disability vary by culture. Cultural
views and preferences may not be consistent with medical approaches typically used in the
U.S. health care system. It is essential that the clinician demonstrate sensitivity to family
wishes when sharing potential treatment recommendations and outcomes. Clinical
interactions should be approached with cultural humility.
Note: This section is under construction and will be developed in full detail based on the
work of ASHA's Cultural Competence Practice Portal team.