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Primary Progressive Aphasia: A Life Participation Treatment Approach

presented by Becky Khayum and Emily Rogalski

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Disclosure Statement:

Financial: Becky Khayum is owner of MemoryCare Corporation and a consultant on Communication Bridge research study at the Cognitive Neurology and Alzheimer’s Disease Center at the Northwestern Feinberg School of Medicine.

Emily Rogalski is a salaried Associate Professor with Northwestern University Feinberg School of Medicine and receives grants from NIH, foundations, and other philanthropic sources.

Becky Khayum and Emily Rogalski receive compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-financial: Becky Khayum and Emily Rogalski have no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact support@medbridgeed.com. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

Accreditation Check:
Primary Progressive Aphasia (PPA) is a clinical dementia syndrome with no cure and unique management needs. Speech-language pathologists (SLPs) may be unsure of how to approach treatment for those with PPA versus those with stroke-induced aphasia. The heterogeneity of symptoms and the progressive nature of the disease require a holistic, person-centered approach, using a combination of impairment-directed and compensatory interventions to increase participation in meaningful life activities. The recommended strategies need to be adjusted over time to meet a patient’s changing communication needs as the disease progresses. This course will provide a roadmap for person-centered assessment and treatment for those with PPA.

Meet Your Instructors

Becky Khayum, MS, CCC-SLP

Becky Khayum is a speech-language pathologist and co-founder of MemoryCare Corporation, a company that provides therapy, support, and counseling for individuals with neurodegenerative disease in the Chicago and Indianapolis areas. She specializes in the non-pharmacological treatment of dementia syndromes, with a focus on person-centered care. Khayum also participates in research targeting treatment approaches for Primary…

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Emily Rogalski, PhD

Dr. Emily Rogalski is a neuroscientist and Associate Professor of Psychiatry and Behavioral Sciences at Northwestern University’s Feinberg School of Medicine. She currently serves as Associate Director of the Mesulam Cognitive Neurology and Alzheimer's Disease Center and as Imaging Core Leader of our NIA-funded Alzheimer’s Disease Center. Dr. Rogalski research falls under the broad umbrella…

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Chapters & Learning Objectives

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1. Primary Progressive Aphasia: The Clinical Syndrome, Progression, and its Association with Neurodegenerative Diseases

PPA is a clinical dementia syndrome characterized by deficits in language with relative sparing of other cognitive domains. This chapter will describe the clinical dementia syndrome of PPA and its defining features, in order to better provide disease education and counseling to individuals with PPA and their family members. It will cover initial symptoms, progression of deficits, and its association with different underlying neuropathology including Alzheimer’s disease and frontotemporal lobar degeneration.

2. Treatment, Building the Care Team, Advocacy, and Future Directions in PPA Research

SLPs are in a unique position to provide disease education and counseling for patients and families coping with a diagnosis of PPA. This chapter will share resources about available advocacy organizations dedicated to improving disease education about PPA for those in the general population and among health care providers. It will conclude with a discussion regarding future directions of research initiatives.

3. Assessment and Treatment Planning in PPA

The heterogeneity of symptoms and the progressive nature of the PPA requires a holistic approach, with the following variables taken into account when an SLP is designing a plan of treatment: (1) individual’s strengths and weaknesses in communication and their severity, (2) individual’s hobbies and interests, (3) individual’s (and care partner's) assessment of communication challenges and therapy goals (4) motivation, and (5) care partner involvement/support. Discussion will cover how to integrate the use of functionally focused standardized tests into a person-centered, dynamic assessment that will identify ways to increase life participation in meaningful activities. The A-FROM / life participation approach for aphasia (LPAA) and Michelle Bourgeois’ “Flip the Rehab Model” will be introduced as important models to guide person-centered assessment and treatment planning. Goal writing and how to document progress for a neurodegenerative condition will also be discussed, to ensure reimbursement.

4. Person-Centered Life Participation Approach: A Combination of Impairment-Based and Compensatory-Based Interventions

This chapter will describe the differences between impairment vs. compensatory approaches and how to use of a unique combination of these approaches for each individual with PPA, with integration of personally relevant stimuli to support a functional, person-centered plan of care. Because PPA is progressive, strategies will need to be adjusted to meet each individual’s changing communication needs over time.

5. Person-Centered, Life Participation Approach: Impairment-Based Interventions

The chapter will highlight impairment-based interventions, with a focus upon integrating personally relevant stimuli during treatment. Rehearsal of personally relevant words with the use of cueing hierarchies to increase lexical retrieval and motor speech production in daily conversations will be discussed, along with formation of personalized scripts for script training home exercise programs. This chapter will provide examples of how to apply the impairment-based interventions to support life participation goals.

6. Person-Centered, Life Participation Approach: Activity/Participation-Based and Compensatory Interventions

This chapter will describe evidence-based compensatory approaches for expressive language, auditory comprehension, reading, and writing for people with PPA and how to apply the strategies to support person-centered, functional goals. The chapter will discuss how to best determine what types of compensatory tools, including communication aids, will be most appropriate for each individual: high-tech vs. low-tech, word-based vs. picture-based, and portable vs. larger visual aids. Practical strategies for utilizing technology to create personalized aids within sessions and increasing family member involvement will also be discussed.

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