A Closer Look

Posted by on Jun 13, 2012 in | 0 comments

iTAWC is an example of what has come to be known as an “ICAP” (an Intensive Comprehensive Aphasia Program). This means that it is one of a handful of programs world-wide that offer a variety of treatment methods and approaches to people with aphasia, including those focused on recovery, social participation and technology, within an intensive treatment format. iTAWC is on the cutting edge of evidence-based aphasia treatment.

Program Overview

iTAWC runs for four weeks. The first and last days are filled with activities such as orientation, assessment, client and family interview, client/family/therapist meetings, debriefing and guest speakers. For the remaining eighteen days, clients receive 3 to 4 hours per day (Monday to Friday) of highly personalized speech and language therapy.

As you can see above from the above photo (taken at our wrap-up party at the end of the program in 2011) iTAWC provides a big support network for a small group of iTAWC participants! Family, friends and care workers are included along with the therapists and clients (and interns during the summer sessions).

Treatment Details

The program is truly intensive, as can be seen from the overview below of a sample daily treatment schedule. This is why it is very important for participants to have adequate stamina and endurance to enroll in our program.

Daily Schedule
8:45	Gather with other participants for coffee, cookies and small talk.
9:00	First of Two Individual Therapy Sessions with S-LP
10:00	Second of Two Individual Therapy Sessions with S-LP
11:00	Lab Session
	Focus on Technology – iPad, telephone use, computer, Skype, email, Facebook, etc. as appropriate
12:00 -1:00	Lab Session / small group discussion
	Focus on Function – conversation skills, structured conversation (i.e., telling a story, asking questions), reading, further work on technology as appropriate

* This sample is for a summer session in which student interns deliver some of the services. At other times of year, the treatment sessions are delivered by registered SLPs and is one hour shorter.

Approaches / Methods Used

The approaches and methods used reflect the developers’ commitment to the key concepts of intensity, the primacy of verbal language, small numbers of participants, a high degree of personalization of both materials and goals, a high ratio of staff to clients and use of current research in the field, including research regarding neuroplasticity and social/life participation approach to aphasia. Up to date technology is used, including computer programs for speech practice, iPad applications as needed and email practice. Here are some highlights of iTAWC:

Individual program goals are developed in concert with each client and their family members and target improvement of speech and language skills as well as life participation and community integration
Massed practice and intensity are cornerstones of our approach
Throughout the program, we carefully plan a follow-up program for each client, written in an aphasia-friendly format, which can be used by each client to continue making use of skills learned after the program ends
We use vocabulary and highly customized materials specific to each client’s daily activities
Individual speech and language therapy sessions each day,
“Labs” with a focus on practical communication skills are available daily.
Verbal expression ( “talking”) is the major focus of the program for most clients
Constraint Induced Language Therapy, Treatment of Underlying Forms, Verb Network Strengthening Treatment, Multiple Oral Re-reading, Aphasia Scripts, Rosenbeck’s Eight Step Continuum, Oral Reading for Language in Aphasia and more evidence-based treatment approaches are used with clients, as and if appropriate for their needs. (See Links and References for details).
Computer-based and tablet activities specific to individual needs for both recovery-based treatment and for helping clients stay socially connected to friends and family after the program ends,
Small group activities/discussions with prescribed themes
A private consultation with an experienced technology consultant for each client is included
Family meetings, support and education are an important component of iTAWC

Student Intern Training

A client and his primary student intern work together on a presentation the client gave to the group.

At iTAWC, we are committed to furthering the state of aphasia treatment by providing clinical internship opportunities to future speech-language pathologists during our summer sessions. University of British Columbia graduate students spend a month with us, beginning with training before clients arrive at iTAWC. Each graduate student SLP (speech-language pathologist) intern is paired with one client for the first and fourth quarters of the treatment program; hence each student has a primary client and each client has a primary student. While the students also rotate through a second and third client, gaining exposure to different types and degrees of aphasia and different individuals, there is no doubt that their strongest bond is with their “primary” client and we have seen some long-term relationships develop as a result of this bond. Because some of the therapy is delivered by student interns in the summer sessions, these programs are expanded by one hour daily to ensure clients receive full value for their fee.

Students also serve as “guides” to the clients – they stay with their client all day, escorting them from one therapy session to the next and helping to provide consistency for the client throughout the day. Note that clients work with students only under the direct supervision of an experienced and fully qualified SLP. Student clinicians are included in our program to increase the intensity of treatment in a cost-effective manner and to reflect our commitment to enriching the state of knowledge about evidence-based aphasia treatment for future SLPs; student interns are not present to substitute for SLP contact.

A client with her primary student intern during a treatment session.

Family Involvement

At iTAWC, we know that family and friends are an integral part of the life and recovery of people with aphasia. Hence, a family intake and exit interview are part of our treatment and assessment process. While family members are not required to be available throughout the entire five weeks, we do encourage interested friends and family members to participate if they and their family members wish. (There may also be some times when we ask that family members stay home, in order to provide our clients the opportunity for more independence in communication.) Assuming that the client with aphasia agrees, family members are included in the goal-setting and follow up training for their loved one.

family and speech-language pathologist during aphasia treatment Left: Family meetings include the whole team: SLPs, students, clients and family members.

Right: In the foreground, a client, her care worker, her sister, an SLP student intern and one of her SLPs explore relevant technology, while in the background, a client, his wife, a student intern, the senior SLP and the staff SLP assigned to him have a family “exit” meeting.