Thinking Outside the Stroke: Treating Primary Progressive Aphasia (PPA)

Abstract

In this article, we explore the symptoms, cause, treatment potential, and supportive services for individuals diagnosed with Primary Progressive Aphasia (PPA). Although it is possible to regain certain cognitive abilities with stroke or brain injury, in PPA, language abilities worsen and other symptoms emerge with time, shortening the lifespan. The goal of speech therapy for PPA is not to regain lost language, but rather to maximize communication for as long as possible. In this article, we offer information and tools for speech-language pathologists to help people living with PPA achieve these goals and improve overall quality of life.

Behavioural interventions for enhancing life participation in behavioural variant frontotemporal dementia and primary progressive aphasia

“…For individuals with PPA, the impairments with communication are rooted in the breakdown of the language system, which can result in significant word-finding problems as well as difficulties understanding single words, simple commands, and basic conversations (for a review see Khayum, Wieneke, Rogalski, Robinson, & O'Hara, 2012). For individuals with bvFTD, the communication impairments are initially more related to the blunted expression and comprehension of emotional information [e.g., prosody, empathy] resulting in problems with the pragmatics of communication.…”

“…Assisting the individual and family and/or caregiver with skills for successful interactions will promote positive social relationships and assist with daily life task completion. In anticipation of further decline in communication skills, SLP services may shift to teaching the use of communication tools, such as augmentative communication devices or communication boards (for a review see Fried-Oken, Beukelman, & Hux, 2012; Khayum, et al, 2012). Overall, SLP interventions are focused on developing effective communication skills and strategies proactively, which allows the individual with FTD and his/her caregiver to become proficient in the use of strategies and augmentative devices prior to when they need to be relied upon.…”

“…Anecdotal reports indicate that SLP services are useful for individuals with FTD, especially if therapy is maintained throughout the course of disease and realistic goals are set that are patient-centered and include the family and/or caregiver (seeKhayum, et al, 2012 for a review for PPA). However, recent evidence suggest that persons with FTD are not being referred for and thus not receiving SLP services as readily as persons with other neurological diseases (e.g.…”

“…Recent research suggests that the caregiver burden is greater in FTD than in other progressive dementia because of the communication and behavioral control impairments that are inherent in FTD, but not necessarily part of the symptom picture for other progressive dementias (Mioshi, Bristow, Cook, & Hodges, 2009; Riedijk et al, 2006). Integration of the family and caregiver(s) into the rehabilitation process provides them opportunities for learning about FTD and its impact on life functioning, to put into context the changes that are occurring cognitively, behaviorally, and physically to the individual with FTD, and to learn ways to cue, prompt, assist and structure the home environment to maximize life functioning for the entire family (Khayum, et al, 2012; Letts et al, 2011). Additionally, caregivers can play a critical role in the rehabilitation process by tracking and reporting symptoms over time so that the interventions can be tailored to needs of the individual with FTD (Jicha, 2011).…”

The CARE Pathway Model for Dementia

“…Interventions should focus on personally relevant stimuli to generalize to functional contexts as much as possible (see Table 1 for example strategies). 28–30 A speech-language pathologist is the most relevant referral for this pathway.…”