Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Schuell's Stimulation Approach to Rehabilitation (Writing)
Summary: More of a school of thought in aphasia rehabilitation than a specific therapy, Schuell’s Stimulation Approach highlights the central importance of auditory processing for all aspects of language ability and targets this in order to promote reorganisation of the brain (Coelho et al., 2008). It encompasses a wide variety of tasks that provide intensive auditory stimulation e.g. following directions, spoken word to picture matching and word repetition, as well as many tasks that also require additional processes (e.g. word retrieval, sentence formulation, reading and writing). Tasks are manipulated so as to vary the processing load, e.g. progressively longer commands, increased number of pictures in spoken word to picture matching tasks. A range of other therapy approaches discussed in this app could also be considered stimulation approaches, e.g. Melodic Intonation Therapy and Visual Action Therapy (Helm-Estabrooks & Albert, 2004).
Example: The following are examples of tasks that can be used to target writing skills, many of which also provide auditory/reading stimulation or require the client to use expressive language. Therapy tasks that more specifically stimulate spoken language comprehension, expressive language or reading are also available (see links at bottom of this page).
As noted in Coelho et al. (2008), the therapist should start with tasks in which the client is able to engage but experiences some difficulty (i.e. 60-80% accurate responses prior to treatment). As clients become more accurate at a given task (i.e. when the client is 90% accurate), the therapist should gradually increase the processing load on the client by varying factors such as (e.g. increasing the length of word the client is prompted to write). Schuell et al. (1964) advise eliciting as many responses as possible during a session and state that incorrect responses should be responded to with increased auditory stimulation (e.g. additional cues from the therapist) rather than corrections. Many of these tasks can be made more/less demanding by, for example, varying the speed of delivery or use of cues (e.g. picture of target word). Tasks should involve repetitive presentation of stimuli and each stimulus should prompt a response (Coelho et al., 2008).
Adapted from Coelho et al. (2008)
As noted in Coelho et al. (2008), the therapist should start with tasks in which the client is able to engage but experiences some difficulty (i.e. 60-80% accurate responses prior to treatment). As clients become more accurate at a given task (i.e. when the client is 90% accurate), the therapist should gradually increase the processing load on the client by varying factors such as (e.g. increasing the length of word the client is prompted to write). Schuell et al. (1964) advise eliciting as many responses as possible during a session and state that incorrect responses should be responded to with increased auditory stimulation (e.g. additional cues from the therapist) rather than corrections. Many of these tasks can be made more/less demanding by, for example, varying the speed of delivery or use of cues (e.g. picture of target word). Tasks should involve repetitive presentation of stimuli and each stimulus should prompt a response (Coelho et al., 2008).
- Copying:
- Writing familiar phrases or sequences:
- Writing to dictation:
- Sentence completion:
- Reading comprehension with written responses:
- Note taking:
- Retelling narratives in writing:
Adapted from Coelho et al. (2008)
Evidence Base: Given the widespread and varied use of Schuell’s Stimulation Approach, it is challenging to give an accurate summary of studies into its effectiveness. Detailed below are some examples of studies that have used this approach.
Basso et al. (1979) investigated the effect of a stimulation approach for 281 participants with aphasia (162 treated, 119 control) over at least six months of therapy (at least 3 sessions per week), finding that it had a positive effect on language rehabilitation outcomes across all modalities. Factors such as the length of time since onset and severity of aphasia negatively influenced participants’ outcomes.
Wertz et al. (1989) delivered wide-ranging, personalised stimulation therapy to 121 participants with a range of aphasia types for 12 weeks. This study found that participants who received therapist-led stimulation therapy made significantly more progress on language measures than untreated participants.
Basso et al. (1979) investigated the effect of a stimulation approach for 281 participants with aphasia (162 treated, 119 control) over at least six months of therapy (at least 3 sessions per week), finding that it had a positive effect on language rehabilitation outcomes across all modalities. Factors such as the length of time since onset and severity of aphasia negatively influenced participants’ outcomes.
Wertz et al. (1989) delivered wide-ranging, personalised stimulation therapy to 121 participants with a range of aphasia types for 12 weeks. This study found that participants who received therapist-led stimulation therapy made significantly more progress on language measures than untreated participants.
References
Basso, A., Capitani, E., & Vignolo, L.A., 1979. Influence of rehabilitation on language skills in aphasic patients: A controlled study. Archives of Neurology, 36(4), 190-196
Coelho, C.A., Sinotte, M.P., & Duffy, J.R., 2008. Schuell's stimulation approach to rehabilitation. In: Chapey, R. ed. Language intervention strategies in aphasia and related neurogenic communication disorders. 5th ed. Baltimore, MD: Lippincott Williams & Wilkins, 403-449
Helm-Estabrooks, N. & Albert, M.L., 2004. Manual of aphasia therapy. Austin, TX: PRO-ED
Schuell, H., Jenkins, J.J., & Jimenez-Pabon, E., 1964. Aphasia in adults: diagnosis, prognosis, and treatment. London: Hoeber
Wertz, R.T., Weiss, D.G., Aten, J.L., Brookshire, R.H., Garcia-Bunuel, L., Holland, A.L., Kurtzke, J.F., LaPointe, L.L., Milianti, F.J., Brannegan, R., Greenbaum, H., Marshall, R.C., Vogel, D., Carter, J., Barnes, N.S., & Goodman, R., 1986. Comparison of clinic, home, and deferred treatment for aphasia: a Veterans Administration cooperative study. Archives of Neurology, 43, 653-658
Basso, A., Capitani, E., & Vignolo, L.A., 1979. Influence of rehabilitation on language skills in aphasic patients: A controlled study. Archives of Neurology, 36(4), 190-196
Coelho, C.A., Sinotte, M.P., & Duffy, J.R., 2008. Schuell's stimulation approach to rehabilitation. In: Chapey, R. ed. Language intervention strategies in aphasia and related neurogenic communication disorders. 5th ed. Baltimore, MD: Lippincott Williams & Wilkins, 403-449
Helm-Estabrooks, N. & Albert, M.L., 2004. Manual of aphasia therapy. Austin, TX: PRO-ED
Schuell, H., Jenkins, J.J., & Jimenez-Pabon, E., 1964. Aphasia in adults: diagnosis, prognosis, and treatment. London: Hoeber
Wertz, R.T., Weiss, D.G., Aten, J.L., Brookshire, R.H., Garcia-Bunuel, L., Holland, A.L., Kurtzke, J.F., LaPointe, L.L., Milianti, F.J., Brannegan, R., Greenbaum, H., Marshall, R.C., Vogel, D., Carter, J., Barnes, N.S., & Goodman, R., 1986. Comparison of clinic, home, and deferred treatment for aphasia: a Veterans Administration cooperative study. Archives of Neurology, 43, 653-658
Schuell's Stimulation Approach to Rehabilitation (Expressive Language)
Schuell's Stimulation Approach to Rehabilitation (Spoken Language Comprehension)
Schuell's Stimulation Approach to Rehabilitation (Reading)
Schuell's Stimulation Approach to Rehabilitation (Spoken Language Comprehension)
Schuell's Stimulation Approach to Rehabilitation (Reading)
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