At Evergreen, our aphasia programs are built by a Speech-Language Pathologist and a Behaviour Analyst working together. I'm the SLP (Brittany), and Shawna is our Behaviour Analyst.
People are sometimes surprised by that pairing. In our experience, though, each field answers questions the other can't fully answer on its own, and our programs are stronger because of it.
As an SLP, I bring a detailed understanding of language: what is hard for a person, what kinds of errors they make, and what might be driving them. Shawna brings a detailed understanding of learning: how to teach a skill so it sticks, how to tell whether it's working, and how to help it show up in real life.
Here is what that looks like in practice.
Where the SLP starts: understanding the communication profile
As a Speech-Language Pathologist, I use standardized aphasia assessments to understand a person's communication profile. A typical assessment looks at:
how a person talks in conversation
how well they understand what they hear
whether they can repeat words and phrases
naming objects and finding words
reading and writing
everyday communication
From that, we get a picture of which parts of language are affected. Sometimes we also get a label, like Broca's aphasia or anomic aphasia. Those labels are useful shorthand between professionals, and they help with things like funding and referrals.
Here's something many families don't know: the type of aphasia is usually decided from how a person does on these tests, not from a brain scan. In community practice, we often don't see the scans at all.
Two people with the same label can also respond to therapy in very different ways. A label describes the pattern. It doesn't tell us which kind of help will work for this particular person, or where to start.
Where our work comes together: finding what helps
So we add a few extra steps to the assessment. They don't take long, but they change what we learn.
Finding words. When a word won't come, there are lots of ways to help. A clinician might ask the person to describe it, give a hint about what it's used for, start a sentence for them to finish, show a gesture, write the first letter, write the whole word, or say the first sound.
SLPs usually call these cues. Shawna calls them prompts. Either way, not every kind of help works for every person. One person finds the word as soon as they see it written. Another needs to hear the first sound. Another does best when the sentence is started for them.
So instead of guessing, we try each type of help on its own and note what happens. We look at naming things and naming actions separately, because they don't always respond the same way. If none of the supports work yet, we look at what a conversation partner can do instead, like offering written choices or asking yes or no questions.
Saying words clearly. Some people know the word they want but have trouble getting the sounds out. We try different ways of helping with that too, such as seeing the word written, watching and saying the word together, or practising the sound on its own. Again, we're looking for what works for this person.
The second half is just as important. Once we find what helps, we plan how to slowly use less of it. Help that never fades can become something a person relies on. The goal is for the person to say the word on their own, and to still be able to say it next week.
Same results, two ways of reading them
Shawna and I often look at the same assessment results and ask different questions. Not opposing questions, but ones that fit together.
Say someone does better finishing a sentence ("You brush your teeth with a...") than answering a direct question ("What do you brush your teeth with?"). I see context helping with word finding. Shawna sees that the words are there when the sentence is doing some of the work. So we start with sentence starters and gradually move toward open questions.
Or say reading is a relative strength. I'd note that as something we can use. Shawna would make the written word the main support, then fade it step by step.
Same test, same person. Put together, the scores become an actual plan for how this person learns.
What a behavioural lens adds: looking at what happens around communication
This is an area where Shawna's training really adds to mine. I'll often notice a pattern in how someone communicates. Shawna helps us understand why that pattern keeps happening, and together we decide what to change.
Communication doesn't only happen in therapy. It happens at the kitchen table, on the phone and in a busy coffee shop. So we also look at what happens around the person when they communicate, and how that affects what they do next.
Here are three patterns we see often. None of them are anyone's fault. They usually develop because people are trying to help.
"He doesn't start conversations." Often, families have become very good at knowing what their loved one needs before they ask. That comes from love. But it means there is less reason to ask, and talking takes a lot of effort with aphasia. We look for natural ways to create reasons to communicate, like leaving something just out of reach or pausing a moment before helping. Then we keep track of how often the person starts on their own.
"She tries once, then looks at me." Many people try to fix a message once and then turn to a spouse or family member to finish it. From the outside, that can look like giving up. It makes sense, though. Handing it off works: the message gets across and the hard part is over, so the habit sticks. We work on making the attempt worth it. Partners learn to wait a few seconds and then offer a strategy, like written choices, instead of saying the word for them. We track how often the person tries before getting help, and how often their message gets across.
"He mostly points." Pointing and gesturing are fast, and they work. We see that as a strength, not something to replace. We don't take gesture away. We add other options, like writing or a choice board, and keep building speech alongside them.
In each case, we decide what we're working on, measure it, and change what happens around it. That is often where the biggest real-life changes come from.
Why we work together
Aphasia can leave people feeling caught between who they were and who they are now. We wrote more about that in our blog, Still You, But Changed: Understanding Identity After Aphasia and Stroke. Part of moving forward is building new skills that actually work in daily life, at home, with family and out in the community.
Neither of us would build these programs the same way on our own. My work helps us understand what is happening with a person's language. Shawna's work helps us understand how that person learns, and how we'll know if the plan is working. Together, we can move from test scores to a plan that fits the person, and keep adjusting it as they change. Progress with aphasia can continue for years, and the plan should grow with the person.
This collaborative approach is at the heart of our Intensive Aphasia Program. If you or someone you love has aphasia and you're wondering what might help next, reach out to our team. We'd be happy to talk it through!
