Senate Passes Medicare Relief Legislation

By a vote of 69-30 the Senate passed Medicare relief legislation H.R. 6331, which will avert a 10.6% payment cut and extend the therapy cap exceptions process through January 2010. The bill also includes language that will recognize private practice speech-language pathologist's ability to bill Medicare.

"Treating Aphasia in Bilingual and Spanish Speakers"

Maria L. Munoz, PhD CCC-SLP reported during SPEAKING OUT! National Aphasia Association on aphasia in Spanish speakers. She indicated that "Spanish aphasia is different than English aphasia."

For example, in Spanish aphasia, changes in vowels are fewer in phonological paraphasias than in English aphasia. In Spanish aphasia, voicing changes are also less common. More common are changes in manner of articulation (tenedor -> tedendor) and changes in place of articulation (bosina -> gosina).

Spanish is a heavily inflected language which adds parts to words to change their meanings. In semantic paraphasias in Spanish aphasia, errors are often within the same semantic field, are antonyms, superordinates, or have proximity. Strongest predictors for accuracy of naming in Spanish aphasia include: age of acquisition, word frequency, and visual complexity. Weak predictors, on the other hand, are: imageability, word length, and animacy. In Spanish, syntax is more complex than in English. Within verb morphology, there are 3 stem classes, 4 tenses, 3 persons, 2 numbers, 3 moods, 2 aspects while in English there are no stem classes, 2 tenses, 1 person, 1 plural (number) , and auxilary verbs for mood and aspect. In noun morphology, Spanish has 2 gender, and 1 number while English has no gender, and 1 number. As compared to English aphasia, in Spanish aphasia syntactic errors include: difficulty processing flexible word order, less difficulty processing subject-verb agreement, more difficulty processing both active and passive sentences, more difficulty processing negation, omission of articles, errors in noun and verb inflection, and an over-reliance on simple syntactic structures.

Spanish orthography is transparent so that it is read as it is spelled. There are no irregular words. In agraphia, Spanish aphasia shows homophone errors (casa -> kasa; brazo -> braso; boca -> voca) rather than non-homophone errors. In alexia, literal paralexias are common in Spanish aphasia while semantic paralexias are not (are common in English aphasia).

Treatment Strategies: 1) "Consider the specific features of each language."
2) "Consider what cues are important in that language."
3) "Consider how responsiveness to cues may depend on language proficiency."

ACT (modified) Beeson and Hillis, 2001: pick out syllables from field as in "pe ta lo" chosen from "lo pe mi ta so."

Anagram copy task.

CART Copy and Recall Task.

Response Elaboration Training: Present picture, cue: "Tell me about this..." Then elaborate the client's response via questions and then restatement.

With bilingual speakers, some say to target the stronger language; others say to target the weaker language because generalization will occur better.

The End Is Near

The end of your practicum is fast approaching. In the last days, begin to take control of the patients on our list. Think ahead a bit more; plan who you need to see and what you want to accomplish with those persons.

Be especially attentive to chart reviews and good data keeping.

Control your antecedents and consequents during therapy! Have fun.

Verbal Feedback in Testing and in Treatment

When testing, the idea is not to give verbal feedback that indicates whether the individual was correct or incorrect. The VF you give should be more of an encouraging kind: "You're doing well." "Just do your best."

During treatment, however, your verbal feedback is therapy. Without your verbal feedback, the individual you are treating does not know whether his or her responses are correct or incorrect. If you do not indicate incorrectness, then the person does not have an opportunity to learn the best response. If you do not indicate correctness, the individual also does not receive reinforcement for that correct response. In other words, no treatment is occurring.

Keep this in mind as you approach evaluation and therapy.