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.
Sentence Production Program for Aphasia (SPPA)
Summary: The Sentence Production Program for Aphasia (SPPA) (Helm-Estabrooks & Nicholas, 2000) is a published therapy resource for clients with agrammatic aphasia that trains a range of sentence structures. It is intended for clients who have good comprehension of sentences and mild to moderate expressive difficulties (Hielscher-Fastabend, 2008). The SPPA trains clients to first repeat target sentence structures (level A) and then, once competent in this, use these sentence structures to complete narratives (level B). The programme includes pictures to help elicit each structure and is arranged hierarchically, progressing from relatively simple to more challenging sentence structures. The SPPA targets the following 8 present-tense sentence structures:
The SPPA is a revised version of an earlier resource, the Helm Elicited Language Program for Syntax Stimulation.
- Imperative intransitives (e.g. “Sit down”)
- Imperative transitives (e.g. “Drive the car”)
- Wh-interrogative (what and who) (e.g. “What are you eating?” / “Who is coming?”)
- Wh-interrogative (where and when) (e.g. “Where is the cat?” / “When is he arriving?”)
- Declarative transitive (e.g. “I eat fruit”)
- Declarative intransitive (e.g. “She speaks”)
- Comparative (e.g. “She’s braver”)
- Yes/no questions (e.g. “Are we lost?”)
The SPPA is a revised version of an earlier resource, the Helm Elicited Language Program for Syntax Stimulation.
Example: The SPPA is available to buy as a therapy pack from www.proedinc.com (includes administration manual and stimulus book). Therapists may also choose to create their own repetition and story-completion tasks for clients based on the principles of the SPPA (see example questions below).
Beginning with sentence type 1, the therapist should deliver the 15 level A questions (the SPPA includes 15 level A & B questions and accompanying pictures for each sentence type). Once the client achieves 90% accuracy with level A questions (i.e. repetition tasks), they progress to level B questions (i.e. narrative completion tasks). Once 90% accuracy is achieved with the 15 level B questions the therapist can move on to sentence type 2.
Example of questions targeting Wh-interrogative sentence structure:
Example of questions targeting comparative sentence structure:
Beginning with sentence type 1, the therapist should deliver the 15 level A questions (the SPPA includes 15 level A & B questions and accompanying pictures for each sentence type). Once the client achieves 90% accuracy with level A questions (i.e. repetition tasks), they progress to level B questions (i.e. narrative completion tasks). Once 90% accuracy is achieved with the 15 level B questions the therapist can move on to sentence type 2.
Example of questions targeting Wh-interrogative sentence structure:
- The client is shown picture of a woman looking lost
- The therapist reads the following story: “Sally is going to meet her friend at the cinema. She is lost. She stops a stranger and asks “Where is the cinema?”. What does she ask the stranger?”
- The client responds: “Where is the cinema?”
- The therapist asks: “When sally is looking for the cinema, what does she ask?”
- The client responds: “Where is the cinema?”
Example of questions targeting comparative sentence structure:
- The client is shown picture of a woman looking unwell
- The therapist reads the following story: “When Rachel feels sick, she takes medicine. What does Rachel do when she is feeling sick?”
- The client responds: “She takes medicine”
- The therapist asks: “When Rachel feels sick, what does she do?”
- The client responds: “She takes medicine”
Evidence Base: There are limited studies into the effectiveness of SPPA. Silagi et al. (2014) examined the effects of SPPA treatment on a participant with Broca’s aphasia. 32 weekly sessions (30 minutes in length) were delivered. The participant saw improvements in trained sentences as well as greater use of function words and reduction in deletions in a semi-spontaneous picture description task. However, these gains were not maintained at one year post therapy.
Helm-Estabrooks & Albert (2004) report some details of delivery of SPPA to a participant with agrammatic aphasia approximately 4 years post onset. Following 7 sessions (2 one hour sessions per week), the participant improved to within the normal range in terms of target words produced, word-to-content ratio, and grammaticality in a picture description task, although elements of agrammatism persisted. No follow-up testing is reported.
Helm-Estabrooks & Albert (2004) report some details of delivery of SPPA to a participant with agrammatic aphasia approximately 4 years post onset. Following 7 sessions (2 one hour sessions per week), the participant improved to within the normal range in terms of target words produced, word-to-content ratio, and grammaticality in a picture description task, although elements of agrammatism persisted. No follow-up testing is reported.
References
Helm-Estabrooks, N. & Albert, M.L., 2004. Manual of aphasia therapy. Austin, TX: PRO-ED
Helm-Estabrooks, N. & Nicholas, M., 2000. Sentence Production Program for Aphasia. Austin, TX: PRO-ED
Hielscher-Fastabend, M., 2008. Language disorders. In: Rickheit, R. & Strohner, H. eds. Handbook of communication competence. New York: Mouton de Gruyter, 441-498
Silagi, M.L., Hirata, F.N., & de Medonça, Z., 2014. Sentence production in rehabilitation of agrammatism: a case study. Dementia & Neuropsychologia, 8(3), 297-301
Helm-Estabrooks, N. & Albert, M.L., 2004. Manual of aphasia therapy. Austin, TX: PRO-ED
Helm-Estabrooks, N. & Nicholas, M., 2000. Sentence Production Program for Aphasia. Austin, TX: PRO-ED
Hielscher-Fastabend, M., 2008. Language disorders. In: Rickheit, R. & Strohner, H. eds. Handbook of communication competence. New York: Mouton de Gruyter, 441-498
Silagi, M.L., Hirata, F.N., & de Medonça, Z., 2014. Sentence production in rehabilitation of agrammatism: a case study. Dementia & Neuropsychologia, 8(3), 297-301
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