SWITCH!: Therapy Board Game Targeting Expressive Modality

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SWITCH! Therapy Board Game Targeting Expressive
Modality Switching in Aphasia Krystal Peralta,
MS and Marjorie Nicholas, PhD
How to Play
Board Game Development
Abstract

• SWITCH! provides a structured interaction
  between two communication partners by having them
  take turns in expressing a particular message.
  Four color-coded modality cards may be
  implemented to visually enforce the act of
  switching. These include visual prompts to
  gesture, draw or write, speak, or use an
  alternative communication device (if
  appropriate).

Generalization of trained communication
modalities (e.g speaking, writing, drawing, using
a communication book) is one of the ultimate
objectives in aphasia therapy. Several
researchers have purported that in order to
achieve this goal, isolated training of each
modality is not sufficient for successful
carryover. In fact, a range of executive
functions are necessary for functional use of
multi-modal communication in the community
setting and therefore must be considered when
implementing functionally based speech-language
therapy. The SWITCH! aphasia therapy board game
specifically targets cognitive flexibility by
having the individual with aphasia engage in an
interactive game that requires multimodality
expression.

• When developing the game board, pieces, and
  target stimuli, the following were considered
• Target stimuli all target items should be able
  to be easily communicated across multiple
  modalities and also be functional for many
  individuals.
• Fine motor abilities developing game pieces
  and target cards that can be manipulated by
  clients with decreased fine motor abilities.
• Aesthetics color scheme and lines should not
  be visually distracting.

Modality Queue
Sample stimulus cards

• Each player selects a set of modality cards
  based on their expressive capabilities and places
  them in a modality queue (see above). A Modality
  card is turned over when the player has attempted
  to convey a particular message.

• 36 single unit target stimulus items are
  displayed on playing cards that include pictures
  of objects (e.g. comb, car, book), people and
  animals (e.g. boy, girl, dog), and descriptors
  (e.g. angry, married, small). For each turn, a
  player communicates a target item while the other
  guesses.

Introduction and Background

• SWITCH! was developed under the hypothesis that
  many individuals with aphasia may have decreased
  abilities in executive functioning which
  negatively impact successful carryover of learned
  communication skills. Executive functioning
  skills may include initiating, planning, as well
  as monitoring communicative attempts and feedback
  in order to determine whether the message was
  understood In addition. Like impaired linguistic
  processes, impaired executive functioning
  functions can also be treated in the clinical
  setting.. This has spurred several researchers
  into exploring executive functioning treatment in
  aphasia.
• SWITCH! primarily targets cognitive
  flexibility, an important executive function
  necessary for individuals to switch to another
  communication modality in order to repair a
  failed communication attempt.
• The board game allows the client to take a
  journey through the brain and practice
  multi-modal communication in an interactive game
  format. Candidates are clients that use at least
  more than one modality for communication.

Sample response card

• If the players communicative attempt fails,
  the expectation is that he/she will switch to
  another modality in order to repair the failure.
  If the player fails to switch after their
  communication partner provides verbal (I dont
  understand) or nonverbal feedback (head shake), a
  bell will then be used to explicitly signal that
  the attempt has failed.
• The act of switching to another modality,
  despite the possibility of leading to another
  failed communicative attempt, is still rewarded
  by having the player move an extra space for each
  switch on the game board.
• Two playing levels
• Beginner Level the player is expected to
  express the target item using all modalities on
  the queue, before their partner guesses.
• Pro Level the player may use any modality to
  express the target item, and is expected to
  switch when their attempt has failed. The object
  of the game is to reach the last space and be
  titled Switch Master.

Clinical Observation Trials

• Clinical trial use of SWITCH is ongoing in two
  Boston area clinics with people who have aphasia
• Modifications to the game rules and stimuli
  will be made after these trials are complete

ASHA Convention, Boston MA November 2007