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.
Treatment of Aphasic Perseveration (TAP)
Summary: Treatment of Aphasic Perseveration (TAP) is an approach developed by Helm-Estabrooks, Emery, & Albert (1987) that is intended to reduce instances of verbal perseveration by making individuals more aware of instances of perseveration in their output. Once the barrier of perseverative responses is removed it is theorised that individuals are better able to produce target words (Helm-Estabrooks & Albert, 2004).
Criteria for Treatment: Individuals who exhibit the following may benefit from TAP:
*as tested using Boston Diagnostic Aphasia Examination (BDAE) confrontation naming subtest: count number of perseveration errors on subtest, divide this by 38 (total number of targets in subtest) then multiply by 100 for a percentage. Moderate perseveration = 20-49% and severe perseveration = 49% and above.
(As described in Helm-Estabrooks et al., 1987)
- Auditory comprehension and memory skills that are intact or moderately preserved
- An ability to name some objects
- Moderate to severe recurrent perseveration*
*as tested using Boston Diagnostic Aphasia Examination (BDAE) confrontation naming subtest: count number of perseveration errors on subtest, divide this by 38 (total number of targets in subtest) then multiply by 100 for a percentage. Moderate perseveration = 20-49% and severe perseveration = 49% and above.
(As described in Helm-Estabrooks et al., 1987)
Example: TAP is carried out through a picture/object naming task, incorporating several general strategies and eleven specific cues. TAP is designed to be alternated with a traditional aphasia language therapy, each being delivered for blocks of 5 weeks.
Following assessment with the BDAE confrontation naming subtest to determine the severity of the client’s perseveration, the therapist establishes a hierarchy of difficulty for the semantic categories covered in this subtest (e.g. perseveration is least notable for action naming and most notable when naming letters of the alphabet). TAP begins with categories where perseveration is less apparent and works towards more impaired categories. Additionally, the therapist selects cues used within sessions so as to provide progressively less support and promote independence.
Administration procedure:
Following assessment with the BDAE confrontation naming subtest to determine the severity of the client’s perseveration, the therapist establishes a hierarchy of difficulty for the semantic categories covered in this subtest (e.g. perseveration is least notable for action naming and most notable when naming letters of the alphabet). TAP begins with categories where perseveration is less apparent and works towards more impaired categories. Additionally, the therapist selects cues used within sessions so as to provide progressively less support and promote independence.
Administration procedure:
- Therapist presents target picture/object and asks client to name it.
- If client is correct the therapist informs them of this and moves onto the next target.
- If the client is incorrect the therapist draws on the general strategies and eleven specific cues to support the client. The therapist selects at most three specific types of cue to support the client within each session (although these can be changed between sessions to optimise performance). Clients can receive up to 3 cues for each target.
- Explaining that a perseverative error has occurred and what perseveration is.
- It may also be helpful to write the perseverative error on a piece of paper, tear this up and leave it in the client’s view as a visual reminder not to say the word. The therapist can point to the paper as an additional prompt should the perseverative error reoccur.
- Monitoring pace of presentation suits client’s needs and ensuring minimum 5 second gap between targets.
- Sets of targets in a semantic category should be clearly separated from the subsequent set. Clients may benefit from a short break with informal conversation or a nonverbal task to reduce the chance of perseverative errors from the previous set.
- Time interval before response (e.g. therapist asks client to wait 5/10 seconds before naming target)
- Gesture cue for target
- Drawing cue (i.e. therapist or client draws target)
- Description of target’s form/function
- Sentence completion (client completes sentence in order to name target)
- Part-word written cue (therapist writes first part of target word and client finishes written form and then reads this aloud
- Phonemic cue
- Written word cue (therapists presents client with written form of target for them to read aloud)
- Word repetition (therapist models target for repetition)
- Speech/singing of target in unison with therapist.
Evidence Base: Just one study has been undertaken into the effects of TAP. Helm-Estabrooks et al. (1987) delivered TAP and traditional aphasia therapy to three participants with aphasia in an alternating treatment, single-case study design. A significant reduction in perseveration was reported for all participants in the TAP treatment stage as measured on the Boston Diagnostic Aphasia Examination confrontation-naming subtest. However, the use of an alternating treatment design makes it difficult to determine whether and to what extent there were carry over effects between two treatments used (Thompson, 2006). The authors do not report whether participants generalised this reduction in perseveration to untrained targets.
References
Helm-Estabrooks, N. & Albert, M.L., 2004. Manual of aphasia therapy. Austin, TX: PRO-ED
Helm-Estabrooks, N., Emery, P., & Albert, M.L., 1987. Treatment of aphasic perseveration (TAP) program: A new approach to aphasia therapy. Archives of Neurology, 44(12), 1253-1255
Thompson, C.K., 2006. Single subject controlled experiments in aphasia: The science and the state of the science. Journal of Communication Disorders, 39(4), 266-291
Helm-Estabrooks, N. & Albert, M.L., 2004. Manual of aphasia therapy. Austin, TX: PRO-ED
Helm-Estabrooks, N., Emery, P., & Albert, M.L., 1987. Treatment of aphasic perseveration (TAP) program: A new approach to aphasia therapy. Archives of Neurology, 44(12), 1253-1255
Thompson, C.K., 2006. Single subject controlled experiments in aphasia: The science and the state of the science. Journal of Communication Disorders, 39(4), 266-291
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