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.
Script Training
Summary: Script Training, developed by Holland et al. (2002), involves practise of scripted monologues and dialogues. It is based on instance theory of automatisation (Logan, 1988) which holds that skill learning occurs most effectively when complete actions are practised in specific contexts. Applied to language-retrieval, this suggests that individuals with aphasia can best be supported to participate in spoken conversation by practising scripted full phrases that are modelled on functional and/or personally meaningful interactions.
Example:
Adapted from Holland (2011).
- The therapist works with the client to identify a situation or topic that is functional and/or personally meaningful and which the client is motivated to work on. Examples of these are making an an appointment with a doctor, ordering a meal, meeting someone for the first time, explaining about aphasia, talking about their hobbies or career, or even telling a joke.
- The therapist and client first work together to write a short draft script.
- The therapist may then adapt this script, potentially adjusting areas such as language, sentence structure and length to the ability of the client. However, the client must have the final say and may wish to override the therapist’s suggestions. Scripts should be kept short - as few as 3 or 4 sentences (as in Youmans et al., 2005) up to 15 sentences.
- The client is supported to regularly practise the script, e.g. during therapy sessions, with family/friends, and through independent practice. Written practice logs are a useful way to keep track.
Independent practice can be supported by making a video recording of the client or therapist performing the script. Pauses should be left in the video to allow the client to copy the target phrases when rewatching. AphasiaScripts™, a computer programme for Windows which incorporates an animated virtual therapist, can also be used for independent practice.
Adapted from Holland (2011).
Evidence Base: Youmans et al. (2005) delivered script training to 2 participants with chronic non-fluent aphasia. Following treatment, which involved practise with a therapist using a cueing hierarchy (30-45 minute sessions, 3 times weekly) and 15 minutes daily home practice, all scripts were mastered and speech productions were judged to be more automatic. Participants took between 5-11 sessions to master each script.
Bilda (2011) delivered video-based script training to 5 participants with chronic aphasia (various aphasia types and severities). Participants practised scripts for 3 hours per day over 10 days. Significant improvements were noted in production of target phrases during dialogue. Improvements were stable at follow-up (1 and 6 months post therapy). During interviews participants and their significant others reported improvements in day to day communication, social participation, and confidence.
Cherney and Halper (2008) carried out computer-based script training with 3 participants with chronic aphasia (anomic, Wernicke’s and Broca’s) over a 13 week programme. Participants first met with a therapist for 4 weeks (approximately 1 hour per week) to develop 3 conversational scripts before practising these scripts at home for 30 minutes per day for the remaining 9 weeks using AphasiaScripts™ computer software. Improvements in content, grammar, and speech rate were noted for all participants post therapy. Furthermore, 2 participants improved by more than 5 points on the Western Aphasia Battery - Aphasia Quotient (although similar improvements were not apparent on other language measures used). Exit interviews indicated that participants and their significant others felt that the therapy had led to increased spoken communication, improvements in reading and writing, and increased confidence.
Youmans, Youmans, & Hancock (2011) delivered a modified form of script training to 3 participants with apraxia of speech and mild anomic aphasia. Delayed feedback and randomised practice were incorporated in order to facilitate motor learning of the 3 target scripts. Script practice took place during 60 minute sessions with a therapist (2 to 3 times per week) and twice daily 15 minute home practice sessions. Participants took between 5-11 sessions to master each script. While mastered scripts were produced with generally fewer errors and less struggle, errors were still apparent (likely due to underlying apraxia of speech). Scripts were retained when follow-up testing was carried out 6 months post-treatment.
Bilda (2011) delivered video-based script training to 5 participants with chronic aphasia (various aphasia types and severities). Participants practised scripts for 3 hours per day over 10 days. Significant improvements were noted in production of target phrases during dialogue. Improvements were stable at follow-up (1 and 6 months post therapy). During interviews participants and their significant others reported improvements in day to day communication, social participation, and confidence.
Cherney and Halper (2008) carried out computer-based script training with 3 participants with chronic aphasia (anomic, Wernicke’s and Broca’s) over a 13 week programme. Participants first met with a therapist for 4 weeks (approximately 1 hour per week) to develop 3 conversational scripts before practising these scripts at home for 30 minutes per day for the remaining 9 weeks using AphasiaScripts™ computer software. Improvements in content, grammar, and speech rate were noted for all participants post therapy. Furthermore, 2 participants improved by more than 5 points on the Western Aphasia Battery - Aphasia Quotient (although similar improvements were not apparent on other language measures used). Exit interviews indicated that participants and their significant others felt that the therapy had led to increased spoken communication, improvements in reading and writing, and increased confidence.
Youmans, Youmans, & Hancock (2011) delivered a modified form of script training to 3 participants with apraxia of speech and mild anomic aphasia. Delayed feedback and randomised practice were incorporated in order to facilitate motor learning of the 3 target scripts. Script practice took place during 60 minute sessions with a therapist (2 to 3 times per week) and twice daily 15 minute home practice sessions. Participants took between 5-11 sessions to master each script. While mastered scripts were produced with generally fewer errors and less struggle, errors were still apparent (likely due to underlying apraxia of speech). Scripts were retained when follow-up testing was carried out 6 months post-treatment.
References
Bilda, K., 2011. Video-based conversational script training for aphasia: A therapy study. Aphasiology, 25(2), 191-201
Cherney, L.R, Halper, A.S, Holland, A.L., & Cole, R., 2008. Computerized script training for aphasia: Preliminary results. American Journal of Speech-Language Pathology, 17(1), 19-34
Holland, A., Milman, L., Muñoz, M., & Bays, G., 2002. Scripts in the management of aphasia. Paper presented at the World Federation of Neurology, Aphasia and Cognitive Disorders Section Meeting, Villefranche, France.
Holland, A., 2011. Developing and using scripts in the treatment of aphasia, AoS, and TBI. Live expert e-seminar, University of New Mexico. [online] Available at: <http://www.unm.edu/~atneel/shs531/aphasia-scripts2-handout.pdf> [Accessed 09/12/2016]
Logan, G.D., 1988. Toward an instance theory of automatization. Psychological Review, 95, 492-527
Youmans, G.L., Holland, A.L., Munoz, M.L., & Bourgeois, M., 2005. Script training and automaticity in two individuals with aphasia. Aphasiology, 19(3-5), 435-450
Youmans, G.L., Youmans, S.R., & Hancock, A.B., 2011. Script training treatment for adults with apraxia of speech. American Journal of Speech-Language Pathology, 20(1), 23-37
Bilda, K., 2011. Video-based conversational script training for aphasia: A therapy study. Aphasiology, 25(2), 191-201
Cherney, L.R, Halper, A.S, Holland, A.L., & Cole, R., 2008. Computerized script training for aphasia: Preliminary results. American Journal of Speech-Language Pathology, 17(1), 19-34
Holland, A., Milman, L., Muñoz, M., & Bays, G., 2002. Scripts in the management of aphasia. Paper presented at the World Federation of Neurology, Aphasia and Cognitive Disorders Section Meeting, Villefranche, France.
Holland, A., 2011. Developing and using scripts in the treatment of aphasia, AoS, and TBI. Live expert e-seminar, University of New Mexico. [online] Available at: <http://www.unm.edu/~atneel/shs531/aphasia-scripts2-handout.pdf> [Accessed 09/12/2016]
Logan, G.D., 1988. Toward an instance theory of automatization. Psychological Review, 95, 492-527
Youmans, G.L., Holland, A.L., Munoz, M.L., & Bourgeois, M., 2005. Script training and automaticity in two individuals with aphasia. Aphasiology, 19(3-5), 435-450
Youmans, G.L., Youmans, S.R., & Hancock, A.B., 2011. Script training treatment for adults with apraxia of speech. American Journal of Speech-Language Pathology, 20(1), 23-37
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