Profile of a Center of Excellence: University of Michigan's Residential Aphasia Program

Patient information and support groups for aphasia abound, and community-based treatment programs are growing in number, but one program stands out: the University of Michigan's Residential Aphasia Program (RAP) in Battle Creek. It is the only intensive residential rehabilitation program for persons with aphasia in the United States, and it must be doing something right. An outcomes analysis conducted by the program showed near-universal improvement on one or more verbal tasks. Seventy-three (97%) of 75 patients who had been living with aphasia for up to 5 years before entering the program showed gains on at least one verbal measure following therapy.

The RAP is a 6-week residential program offered 8 times a year to groups of 12 to 15 patients. Overall, however, the program annually provides services to about 1000 persons with aphasia. Local hotels that partner with the University of Michigan provide housing that includes extended-stay discounts and shuttle bus services.

The staff includes 9 full-time and 2 part-time advanced-degree speech-language pathologists certified by the American Speech-Language-Hearing Association. Patients receive 15 hours of individual therapy, 5 hours of group therapy, and 3 hours of computer-assisted training each week. The program also offers 1- and 2-week courses designed to provide intensive therapy in a specific area of language deficit disorder. Encouraged by program results, "Some return for as many as 6 or 7 follow-up sessions," said Joanne Marttila Pierson, PhD, CCC-SLP, associate director of the program.

SOCIAL INTERACTION AND ARTISTIC STIMULATION

"We know that language use changes based on the context," explained Pierson. The therapy is rigorous and diverse because "people need to work and apply what they've learned with others in different settings."

Rehabilitation includes participation in a weekly dinner that allows patients to practice communication in social situations. Other events include attendance at baseball games, museums, zoos, and farmer's markets. The RAP also uses music and art therapy to help participants develop tools for expression.

The stimulation provided by daily, intensive therapy is believed to help the brain re-map. "We suspect that we're activating some new areas for them" through the multi-mode therapy, said Pierson. "They have to use their non-dominant side. The brain has to do a lot of work to make that happen."

According to Argye Hillis, MD, MA, associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore, neuroplasticity allows recovery of communication skills. The impact of learning on the brain is observable, she said. "Functional imaging studies have shown significant changes in areas of activity during training." She believes that intensive daily training is more effective than the hour-a-day, 3-times-a-week regimen.

COMPREHENSIVE SUPPORT

The RAP also offers a comprehensive education and support system for caregivers and spouses, said Pierson. For example, caregivers are taught new ways to manage communication with aphasic persons. Strategies might include speaking slower, being more patient when waiting for a response, asking "yes" or "no" questions rather than open-ended ones, and writing questions on paper.

Some caregivers, such as Craig Rahl of Chesapeake, VA, whose wife, Lindsay, became aphasic after a stroke in 2002, attend therapy sessions as well as separate sessions offered to caregivers. Craig stressed the importance of emotional support for both the patient and the caregiver and expressed the challenge he and Lindsay are facing because of her disability: "Friends and family drift away. They don't know how to handle it. And it's hard for caregivers when they are so emotionally attached," he said.

Indeed, Lindsay, aged 50 years, returned to the program this fall to participate in her third session. After achieving minimal improvement with a local community-based rehabilitation clinic and a series of local therapists, she attended the RAP for the first time in January 2004. Encouraged by its ability to help her regain communication skills, she returned for a second session in September 2004. "She made gains in both speech and comprehension" during both sessions, said Craig, who never gave up on finding an effective rehabilitation program for his wife. Now she can read the newspaper, read traffic signs and give directions, and order dinner from a menu.

--Kathy Stone

Kathy Stone is a freelance writer in St Paul.