Thematic Language Stimulation Therapy

1
Thematic Language Stimulation Therapy

• Chapter 16

2
Defining TLS...

• Type of organized aphasia therapy that improves
  language processing and functional communication
  skills by using thematically related vocabulary
  in multimodality stimulation.
• Based on words, contexts, tasks, and target
  improvements
• Clinician based determines patients skill level

3
TLS Organization

• Organization, 2 ways
• 1. Thematic vocabulary
• personally relevant
• fairly universal
• units consist of 8-10 words
• primarily nouns/verbs
• 2. Creation of predictable linguistic stimuli
  for each task

4
TLS Delivery

• Stimulus Adequacy
• intended result
• functionality
• redundancy
• Maximal Patient Response
• all modalities
• Extension of Material and Language
• variety of tasks
• thematic units broken down over time
• Systematic and Intense Presentation
• from introductory to identification of theme, to
  manipulation of language in sequence

5
TLS and Functional Communication

• Transition to a functional context
• Natural environments
• analysis and problem solving
• provides combinations of cues and strategies to
  facilitate improved language function
• links from clinical to functional language
  stimulation by manipulation of the theme.

6
TLS Assessment

• Thorough assessment should derive
• which cerebral processes are impaired
• the level at which performance breaks down
• Formal tests may provide some info, but
  observation is best!

7
Establishing Baseline

• A baseline of functional communication should be
  obtained by consdiering
• 1. How well does the patient initiate and
  sustain conversation?
• 2. How well does the patient express himself or
  herself verbally/nonverbally?
• 3. How well does the patient follow conversation
  and directions? How complex can auditory demands
  be before performance breaks down?

8
Formal Testing

• Focal Points of Formal Testing
• Repetition
• Sentence Construction
• Automatic Language
• Picture Description
• Following Instructions
• Yes/No Reliability
• Reading Comprehension
• Oral Reading
• Graphic Expression

9
Cognitive and Behavioral Considerations

• Certain behaviors should be observed, described
  and noted
• Patient Involvement
• Specific Symptom Awareness
• Task Orientation and Retention
• Perseveration
• Visual Perception

10
Treatment Delivery

• These ?s should be asked before therapy can
  begin
• 1. Is this person a good candidate for TLS?
• 2. How should tasks be chosen and sequenced?
• 3. What cues are most beneficial to achieve
  maximal success in treatment?
• 4. How do I select theme and vocabulary?

11
Insight of TLS Outcome A study

• Design Choice
• single-subject studies
• Looked _at_ whether or not TLS was more effective
  than a traditional approach.
• TLS and NON TLS models alternated for 3 weeks
• Subject Selection
• individuals able to complete course
• no regard to age, type of aphasia, etiology,
  duration of symptoms
• Procedures
• Audiotaped/videotaped
• .5 hour sessions 5 days week for 3 weeks
• Results
• little can be confirmed b/c small pts. In study

12
Conclusion

• TLS therapy, because of its strong dependence
  upon structure, may be a more organized
  observational environment for shared therapy
  insights!