Treatment of Paraphasia after Left Hemisphere Stroke

Background and Aim : Paraphasia is a speech error which might be observed in aphasic patients. It refers to a substitution of a wrong word or sound for a target word or phoneme. Three types of paraphasia are phonemic paraphasia, verbal (semantic) paraphasia, and neologism. Regarding the negative effect of this issue on communication, this article aimed to present a case treatment in a Persian-speaker aphasic adult.Methods : The patient was a 58-year- old man with left hemisphere from stroke for the first-time (post-injury time=8 months and 15 days) referred to speech-language therapy. He had no other acquired disorders and visual and auditory deficits. CT scan of this patient indicated he had a lesion in the left frontal lobe. He was assessed regarding speech and language abilities. Therefore, he had non-fluent aphasia, verbal apraxia, and ideational apraxia. One of his speech impairments was verbal (semantic) paraphasia that refers to a word substitution, often is related to the target word. An Eight-Step Task Continuum generated by Rosenbek et al. (1973) was used for treating paraphasia including integral stimulation and simultaneous production, integral stimulation and delayed production with visual cue, integral stimulation and delayed production with no visual cue, integral stimulation and successive productions without intervening stimulation and without auditory or visual cues, written stimuli and simultaneous production, written stimuli and delayed production, appropriate utterance elicited by question, appropriate response in a role-playing situation. This approach was based on integrated visual and hearing stimulation. Additionally, innovative cases were added to the aforementioned steps.Results : After learning each word by the patient, the speech-language therapist would provide the situation in which the patient was forced to use the target word. At first, the therapist produced the words several times lipreading method and then, the patient was asked to repeat them. After that, the patient produced the target words in the appropriate situations; this step could be considered as a complementary step of the whole procedure. Since the patient right hemisphere was intact, the situation was created with gestures so that the patient could remember the words easier, and the words were taught via melodic intonation training (MIT), and was repeated by the patient with a firm and melodious tone in the practical situations. Since the patient could often produce the words initiated with b or m ; the training was begun with words initiated with these phonemes. The 10 session treatment lasted a maximum of 1 hour twice a week. After treatment, the patient was able to produce sentences containing three words and even some words in the appropriate situations such as be in (sit down), bâdâm (almond), bârân (rain), bâyad (must), be mâr (count), and names of his family members. Furthermore, he was able to repeat some words without paraphasia, but not in the appropriate situations. After the treatment sessions, only about 10% of the patient’s paraphasia was remained.Conclusion : Rosenbek et al.᾽s treatment approach is a useful and efficient technique for treating paraphasia. It seems that the innovative cases might accelerate the treatment procedure.

Keywords:

stroke , aphasia , paraphasia , treatment , Persian