Operant conditioning and programmed instruction in aphasia rehabilitation.

Abstract

Behavior theory has fallen from favor as a fOlll ldation for aphasia rehabilitation. Once a robust basis for experimental and clinical examination of commmrication disorders in adults, behavior modification has been larg ely absent in the literature of the past 25 years. This paper advocates a return to the application of a behavioral framework for the treatment of aphasia, with particular attention to the principles of reinforcement, and punishment, including overcorrection. It also advocates a return to such programs of instruction as melodic intonation therapy and to the application of contemporary alternate augmentative communication systems (AAC). The language of sets provides an overall framework for approaching aphasia therapy.

Behavior analysis and aphasia: A current appraisal and suggestions for the future

“…While current practice in SLP may be conceptualized along neuro linguistic lines, the on‐the‐ground approach is essentially behavioral and holds no fundamental incompatibility with a behavior analytic approach (Koenig & Gerenser, 2006). SLPs even employ many of the same practices as behavior analysts, including the frequent use of single‐subject analysis (Thompson, 2006), antecedent manipulation (i.e., prompting, modeling; Keenan, 1966; Lowell et al., 1995, Thompson et al., 2006), fading (Salvatore, 1976; Melodic Intonation Therapy [MIT]; Sparks & Holland, 1976), shaping (Holland & Harris, 1968; Silkes et al., 2019), and consequence delivery (Goldfarb, 2006; Holland & Harris, 1968; Kushner et al., 1973). This SLP work provides additional empirical support for the efficacy of operant techniques in aphasia treatment that is also demonstrated in purely behavioral work (e.g., chaining, delayed feedback, socially and self‐mediated consequences, and differential reinforcement; Doyle et al., 1989; Goodkin, 1969; Porsteinsson & Sigurðardóttir, 2007; Sigurðardóttir & Sighvatsson, 2006, 2011; Sundberg et al., 1990).…”

Modifying Melodic Intonation Therapy

“…During and after my own MIT research [6], I discussed Sprechgesang with Robert Sparks on several occasions. We spoke at the meeting of the Academy of Aphasia in Cape Cod in 1980, and exchanged letters (in the years before Email) about our forthcoming chapters in the same book [7,8]. My preference would have been to call the intermediate level between singing and speaking Sprechstimme, or speech-voice, for the reasons noted below.…”