Editing Receptive aphasia (section)

==Treatment==

There is currently no standardized treatment for Wernicke's Aphasia, meaning treatment varies from patient to patient depending on the severity of the lesion and the resulting deficits. In some patients, the first step of action is to attempt to treat the possible causes for the aphasia, such as removing a brain tumor, or treating a nervous system infection. This may not lessen the symptoms for the patient as damage to the brain is often already done, but it typically stops the aphasia from worsening. For the majority of patients with any kind of aphasia, speech and language therapy is the primary treatment. This focuses on improving language skills and learning how to communicate in various ways to allow their needs to be met. Since Wernicke's patients face comprehension deficits, they are often unaware of their condition and may pose unique challenges for their treatment because of this lack of awareness or concern for their deficit. Treatment plans are usually devised by a team of healthcare workers including a speech therapist, neuropsychologist, and a neurologist.<ref name=":1" /><ref name=":2">{{Cite journal |last=Hartwigsen |first=Gesa |date=2015 |title=The neurophysiology of language: Insights from non-invasive brain stimulation in the healthy human brain |url=http://dx.doi.org/10.1016/j.bandl.2014.10.007 |journal=Brain and Language |volume=148 |pages=81–94 |doi=10.1016/j.bandl.2014.10.007 |issn=0093-934X|doi-access=free |hdl=11858/00-001M-0000-0028-AADC-A |hdl-access=free }}</ref><ref name=":3">{{Cite journal |last=Bonilha |first=Leonardo |last2=Fridriksson |first2=Julius |date=2017 |title=Home-based therapy for chronic Wernicke's aphasia |url=http://dx.doi.org/10.1136/jnnp-2017-315842 |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=88 |issue=7 |pages=539–539 |doi=10.1136/jnnp-2017-315842 |issn=0022-3050}}</ref>

According to Bates et al. (2005), "the primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function". The topics of intensity and timing of intervention are widely debated across various fields.<ref name="Bates">{{cite journal|last1=Bates|first1=B.|last2=Choi|first2=J.|last3=Duncan|first3=P.W.|last4=Glasberg|first4=J.J.|last5=Graham|first5=G.D.|last6=Katz|first6=R.C....|last7=Zorowitz|first7=R.|title=Veterans affairs/department of defense clinical practice guideline for the management of adult stroke rehabilitation care|journal=Stroke|date=2005|volume=36|issue=9|pages=2049–2056|doi=10.1161/01.STR.0000180432.73724.AD|pmid=16120847|doi-access=free}}</ref> Results are contradictory: some studies indicate better outcomes with early intervention,<ref>{{cite journal|last1=Bhogal|first1=S.K.|last2=Teasell|first2=R.|last3=Speechley|first3=M.|title=Intensity of aphasia therapy, impact on recovery|journal=Stroke|date=2003|volume=34|issue=4|pages=987–993|doi=10.1161/01.STR.0000062343.64383.D0|pmid=12649521|doi-access=free}}</ref> while other studies indicate starting therapy too early may be detrimental to the patient's recovery.<ref name="Nouwens">{{cite journal|last1=Nouwens|first1=F.|last2=Visch-Brink|first2=E.G.|last3=Van de Sandt-Koenderman|first3=M.M.E.|last4=Dippeo|first4=D.W.J|last5=Kaudstaal|first5=P.J.|last6=de Law|first6=L.M.L.|title=Optimal timing for speech and language therapy after stroke: More evidence needed|journal= Expert Review of Neurotherapeutics|date=2015|volume=15|issue=8|pages=885–893|doi=10.1586/14737175.2015.1058161|pmid=26088694|s2cid=6863123 }}</ref> Recent research suggests, that therapy be functional and focus on communication goals that are appropriate for the patient's individual lifestyle.<ref name="LPAA">{{cite web|title=Life Participation Approach to Aphasia: A Statement of Values for the Future|url=https://www.asha.org/public/speech/disorders/LPAA/|website=American Speech-Language-Hearing Association}}</ref>

Specific treatment considerations for working with individuals with Wernicke's aphasia (or those who exhibit deficits in auditory comprehension) include using familiar materials, using shorter and slower utterances when speaking, giving direct instructions, and using repetition as needed.<ref name="Brookshire" />

=== Role of neuroplasticity in recovery ===

[[Neuroplasticity]] is defined as the brain's ability to reorganize itself, lay new pathways, and rearrange existing ones, as a result of experience.<ref name="Bayles">{{cite journal|last1=Bayles|first1=K.A.|last2=Tomodea|first2=C.K.|title=Neuroplasticity: Implications for treating cognitive communication disorders|journal=ASHA National Convention|date=2010}}</ref> Neuronal changes after damage to the brain such as collateral sprouting, increased activation of the homologous areas, and map extension demonstrate the brain's neuroplastic abilities. According to Thomson, "Portions of the right hemisphere, extended left brain sites, or both have been shown to be recruited to perform language functions after brain damage.<ref name="Thomson">{{cite journal|last1=Thomson|first1=C.K.|title=Neuroplasticity: Evidence from aphasia|journal=Journal of Communication Disorders|date=2000|volume=33|issue=4|pages=357–366|doi=10.1016/S0021-9924(00)00031-9|pmid=11001162|pmc=3086401}}</ref> All of the neuronal changes recruit areas not originally or directly responsible for large portions of linguistic processing.<ref name="Raymer">{{cite journal|last1=Raymer|first1=A.M.|last2=Beeson|first2=P.|last3=Holland|first3=A.|last4=Kendall|first4=D.|last5=Maher|first5=L.M.|last6=Martin|first6=M.|last7=Gonzolez Rothi|first7=L.J.|title=Transitional research in aphasia: From neuroscience to neurorehabilitation|journal=Journal of Speech, Language, and Hearing Research|date=2008|volume=51|issue=1 |pages=259–275|doi=10.1044/1092-4388(2008/020) |pmid=18230850 |url=https://www.researchgate.net/publication/5620839}}</ref> Principles of neuroplasticity have been proven effective in neurorehabilitation after damage to the brain. These principles include: incorporating multiple modalities into treatment to create stronger neural connections, using stimuli that evoke positive emotion, linking concepts with simultaneous and related presentations, and finding the appropriate intensity and duration of treatment for each individual patient.<ref name="Bayles" />

=== Auditory comprehension treatment ===
Auditory comprehension is a primary focus in treatment for Wernicke's aphasia, as it is the main deficit related to this diagnosis. Therapy activities may include:
* Single-word comprehension: A common treatment method used to support single-word comprehension skills is known as a pointing drill. Through this method, clinicians lay out a variety of images in front of a patient. The patient is asked to point to the image that corresponds to the word provided by the clinician.<ref name="Brookshire" />
* Understanding spoken sentences: "Treatment to improve comprehension of spoken sentences typically consists of drills in which patients answer questions, follow directions or verify the meaning of sentences".<ref name="Brookshire" />
* Understanding conversation: An effective treatment method to support comprehension of discourse includes providing a patient with a conversational sample and asking him or her questions about that sample. Individuals with less severe deficits in auditory comprehension may also be able to retell aspects of the conversation.<ref name="Brookshire" />

=== Word retrieval ===
Anomia is consistently seen in aphasia, so many treatment techniques aim to help patients with word finding problems. One example of a semantic approach is referred to as semantic feature analyses. The process includes naming the target object shown in the picture and producing words that are semantically related to the target. Through production of semantically similar features, participants develop more skills in naming stimuli due to the increase in lexical activation.<ref name="Boyle">{{cite journal|last1=Boyle|first1=M.|last2=Coelho|first2=C.A.|title=Semantic feature analysis treatment for anomia in two fluent aphasia syndromes|journal=American Journal of Speech-Language Pathology|date=2004|volume=13|issue=3|pages=236–249|doi=10.1044/1058-0360(2004/025)|pmid=15339233}}</ref>

=== Restorative therapy approach ===
Neuroplasticity is a central component to restorative therapy to compensate for brain damage. This approach is especially useful in Wernicke's aphasia patients that have had a stroke to the left brain hemisphere.<ref name="auto">Manasco, H. (2021). ''Introduction to neurogenic communication disorders''. Burlington, Massachusetts: Jones & Bartlett Learning.</ref>

''Schuell's stimulation approach'' is a main method in traditional aphasia therapy that follows principles to retrieve function in the auditory modality of language and influence surrounding regions through stimulation. The guidelines to have the most effective stimulation are as follows:
Auditory stimulation of language should be intensive and always present when other language modalities are stimulated.<ref name="auto"/>
* The stimulus should be presented at a difficulty level equal to or just below the patient's ability.
* Sensory stimulation must be present and repeated throughout the treatment.
* Each stimulus applied should produce a response; if there is no response more stimulation cues should be provided.
* Response to stimuli should be maximized to create more opportunities for success and feedback for the speech-language pathologist.
* The feedback of the speech-language pathologist should promote further success and patient and encouragement.
* Therapy should follow an intensive and systemic method to create success by progressing in difficulty.
* Therapies should be varied and build off of mastered therapy tasks.<ref name="auto"/>

Schuell's stimulation utilizes stimulation through therapy tasks beginning at a simplified task and progressing to become more difficult including:
* Point to tasks. During these tasks the patient is directed to point to an object or multiple objects. As the skill is learned the level of complexity increases by increasing the number of objects the patient must point to.<ref name="auto"/>
** Simple: "Point to the book."
** Complex: "Point to the book and then to the ceiling after touching your ear."
* Following directions with objects. During these tasks the patient is instructed to follow the instruction of manually following directions that increase in complexity as the skill is learned.<ref name="auto"/>
** Simple: "Pick up the book."
** Complex: "Pick up the book and put it down on the bench after I move the cup."
* Yes or no questions – This task requires the patient to respond to various yes or no questions that can range from simple to complex.<ref name="auto"/>
** Paraphrasing and retelling – This task requires the patient to read a paragraph and, afterwards, paraphrase it aloud. This is the most complex of Schuell's stimulation tasks because it requires comprehension, recall, and communication.<ref name="auto"/>

=== Social approach to treatment ===
The social approach involves a collaborative effort on behalf of patients and clinicians to determine goals and outcomes for therapy that could improve the patient's quality of life. A conversational approach is thought to provide opportunities for development and the use of strategies to overcome barriers to communication. The main goals of this treatment method are to improve the patient's conversational confidence and skills in natural contexts using conversational coaching, supported conversations, and partner training.<ref name="LaPointe">{{cite book|last1=LaPointe|first1=L.|title=Aphasia and Related Neurogenic Language Disorders|date=2005|publisher=Thieme Medical Publishers Inc.|location=New York, NY|edition=3rd}}</ref>
* Conversational coaching involves patients with aphasia and their speech language pathologists, who serve as a "coach" discussing strategies to approach various communicative scenarios. The "coach" will help the patient develop a script for a scenario (such as ordering food at a restaurant), and help the patient practice and perform the scenario in and out of the clinic while evaluating the outcome.<ref name="Davis">{{cite web|last1=Davis|first1=G.A.|title=Aphasia Therapy Guide|url=https://www.aphasia.org/aphasia-resources/aphasia-therapy-guide/|website=National Aphasia Association}}</ref>
* Supported conversation also involves using a communicative partner who supports the patient's learning by providing contextual cues, slowing their own rate of speech, and increasing their message's redundancy to promote the patient's comprehension.<ref name="Davis" />
Additionally, it is important to include the families of patients with aphasia in treatment programs. Clinicians can teach family members how to support one another, and how to adjust their speaking patterns to facilitate their loved one's treatment and rehabilitation.<ref name="LaPointe" />

Speech devices, while not a treatment that can improve a patient's language skills, help the patient communicate with caregivers through the use of pictures or speech.<ref name=":5" />

=== Clinical trials ===
More recently, researchers are developing medical treatments for aphasia using clinical trials for pharmacological and non-pharmacological approaches. Some medications include drugs affecting the catecholaminergic system, nootropic drugs, and medications used to treat Alzheimer's disease. The non-pharmacological approaches include transcranial magnetic stimulation and transcranial direct stimulation.<ref name=":2" /><ref name=":3" />