Aphasia Intervention Strategy: Sentence Production Program for Aphasia (SPPA)

 

➤ Introduction to Sentence Production Program for Aphasia (SPPA)

Aphasia is an impairment associated with language which which affect language expression , language comprehension and the ability to read and write. It causes always due to a injury to the brain - most commonly from a stroke particularly in older people.

Sentence Production Program for Aphasia (SPPA) is a therapy technique which is use by Speech and Language Pathologist to help people with Aphasia to improve expressive language in sentence level. Many treatments for Aphasia focuses on word finding and naming, Forming sentences is another area that is difficult for many people with aphasia. Using SPPA the goal is to support individuals with Aphasia to form more complex sentences.

➤   Candidacy for SPPA

This approach is suitable for the patients with  Non-fluent Aphasia , such as Broca's Aphasia who are with Agrammatism, or a difficulty with sentence structure and syntax. 

Also in order to be capable the patient with Aphasia need to have basic comprehension skills as well as attention and memory. This requires the person's ability to understand a story that read by the clinician and remember some information.

  ➤   Contraindications

This approach is not ideal to those who have Global and Fluent Aphasia and also who have Wernicke's Aphasia, with mild to severe comprehension difficulties due to difficulties in comprehending spoken messages given by the clinician. 

Also this is not applicable for those who with language expression single word level and with limited attention and memory.

  ➤   Key principles and Procedure

SPPA contains 8 sentence types and each type has 2 levels of difficulty in order to improve language expression - sentence level. In here the clinician will elicit a set of target sentences using a picture or story telling. In each of the sentence type, the individual will first try to repeat the sentence (level 01), if the client is able to repeat the sentence then the clinician will ask a question to get the answer on their own (level 02). The goal is to improve to form more complex sentences for functional communication.

➤  Materials

When doing the technique the SPPA administration manual is used in the combination with stimulus book. The clinician need to have the access for manual and the stimulus book in order to use. If the clinician does not have access , adult friendly related pictures can use as an option (e.g. Cookie theft ) and questions based on a story telling.

Score sheets and Progression sheets will use to score the level and the progression of  the client.

        SPPA manual and stimulus book

     Cookie theft picture                                                                                                                                                  

                                                                                                        SPPA score sheet            

                                                                 SPPA progress sheet

                                                                   

                                             

➤  The eight sentence types in order of difficulty :

                  

                  01. Imperative Intransitive - e.g. Get down

                  02. Imperative Transitive - e.g. Watch your steps

                  03. WH - Interrogative , (What & Who) -

                        e.g.  What are you reaching for ?

                                Who is going ?

                  04. WH - Interrogative , (Where & When) - 

                        e.g. Where is the glasses ?

                               When is dinner ?

                  05. Declarative Transitive - e.g. I like tea 

                  06. Declarative Intransitive - e.g. He fells

                  07. Comparative - e.g. The plate is clean

                  08. Yes - No Questions - e.g. Is the floor wet ?

      

 How to do SPPA Approach

➤   Sentences are presented together with a picture or a story and introduce

 within a context read out by the clinician. 

➤  The picture or the story contains sentences that are targeted on therapy. 

And each target sentence has two levels of difficulty : Level 01 and Level 02

The patient must complete all level 01 sentences before advancing to level B

➤  The person with Aphasia first try to repeat the sentence (level 01).

      E.g. John is climbing on the stool in the kitchen to get the cookies from the cookie jar. Emma shows John and tells him that get down

           Clinician ask the patient : What does Emma says ?

             Correct answer : '' Get down''

             

➤  If the client able to repeat the sentence , the clinician will ask a questionto get them  to say it on their own (level 02).

      

       E.g. Clinician ask the patient: When Emma shows John , what does she says ?

                Correct answer : '' Get Down ''

➤  Use the same strategies with 8 sentence types.

 ➤  Video Demonstration

              🔍SPPA Approach  - (Please go through this link to watch the video demonstration)

                  

                                                                        

➤   Sample outcome recording sheet

➤  Scoring  → 

 1 point  - Fully Correct Response (Self corrected , Adding additional meaningful words, Substituting substantive words while maintaining syntax of the target phrases.)

  0.5 point - Partially Correct Response (One word omitted or produced in error)

  0 point - Incorrect Response ( Two + words omitted or produced in error)

                        

 ➤ Home based activities

Home based activities in SPPA will help the individuals with Aphasia to use practiced sentences during day today tasks and have more exposure to use them functionally. Communication partner can give them the chance to use those sentences during day today life. It will stimulate the clients brain consequently.

       

          🔘 Practice at home  →

Provide the caregiver with the sentences that the client has produce correctly during the session and have them practice at home within daily activities. 

           

         🔘  Use during social settings  →

Communication partner / Caregiver need to give opportunities to identify and make comments for suitable social setting like grocery shopping, friends' gatherings, travelling using the sentences that the client correctly produce. If there is any difficulty to produce the sentence advice the caregiver to follow the steps of SPPA in order to produce the sentence.

           🔘  Interactive Story telling  →

Engage with the story telling tasks during leisure time regarding social contexts like going to the doctor , making a phone call. Include the sentences that the clients be able to produce during the task and make him identify and give the responses within the task in order to have a more practice to produce sentences. Use the strategy to expand the complexity of the sentence.

In conclusion, the Sentence Production Program for Aphasia (SPPA) is a therapy tool which is easy and very straight-forward to administer. SPPA aims to expand the grammatical structures and improve sentence production skills in individuals with Aphasia in sentence level of language expression. It offers a supportive framework for individuals to regain and strengthen language abilities, improving their quality of life and social interactions.