Our guest chat host tonight, February 12, 2001, is Leonard L LaPointe, PhD.
Dr. LaPointe is the Francis Eppes Distinguished Professor of Communication Disorders
at Florida State University, as well as the annual visiting professor
at the University of Queensland, Australia. Currently, he is also
Editor-in-Chief of the Journal of Medical Speech-Language Pathology.
Dr. LaPointe has published and presented numerous books, book
chapters, papers and lectures. He will be chatting about neurological cognitive and
communicative disorders, especially aphasia, neuromotor speech
disorders, and the effects of right or left hemisphere lesions on
attention, memory, and language.
Dr Leonard LaPointe> Locked -in syndrome essentially is complete
quadraplegia, sometimes with no facial movement as well; yet the language
and cognitive system is intact. It is strictly a profound motor speech problem.
<Ana> I see
<Ana> so it is very different from autism
<Suzanne> Wow... this may be facile, but is it caused by injury or...??
<Ana> was that a bad question?
<Anonymous367> it can be caused by brain stem CVA, ALS...
<Suzanne> 367: I see. Thank you. I've never heard of this before.
<Keely> me either Suz
<Adrienne> Parkinson's can have it too right?
<Adrienne> or is that different?
<Anonymous367> yes, parkinson's too
<Suzanne> 367: you are in the know!
<Adrienne> 367: what experiences have you had with it?
<Adrienne> I don't know if you guys have seen the message board...
<Adrienne> there are a lot of references Dr. L gave me
<Adrienne> there are also websites from Dr. Bourgeois last week
<jill> I'd be interested in the types of brain injuries Dr LaPointe is
seeing/working with now
<Adrienne> I do know this about Dr. L:
<Adrienne> he is setting up a new lab at Florida State Univ.
<Adrienne> there are a lot of references Dr. L gave me
<Keely> AAC lab?
<Adrienne> lots of cognitive testing on the computers
<jill> Am I to assume he is involved with CHAD?
<Adrienne> another prof (Dr. Lasker) has the AAC lab
<Adrienne> Dr. LaPointe, I started explaining the new lab you're getting
<Anonymous8667> What can you tell me about working memory and/or
attentional deficits in aphasics?
<Dr. Leonard LaPointe> Back on task. Some of us feel that cognitive resource
allocation is part and parcel of the problem in aphasia.
<Anonymous8667> Any treatment for it?
<Dr. Leonard LaPointe> Several. But many of them have not been well
researched. It makes sense that if one could intervene on working memory
deficit or attention problems, one might have better luck with auditory
<Dr. Leonard LaPointe> We're currently researching working memory and
aphasia. See the Caspari, et al reference in the list Adrienne posted
for more details.
<jill> Dr LaPointe: Who is treating the Aphasic patient now? We are told
our hospital externships will consist largely of swallowing tx
<Suzanne> jill: that I've heard, too.
<Dr. Leonard LaPointe> Who is treating? Many go untreated. Many of us are
worried that people with neurogenic language disorders are neglected.
<jill> yes I've heard the insurance problem here in California has left
many out of tx.
<Suzanne> Why neglected? Non-payment by insurers, or??? Just harder to
justify treament if no progress can be guaranteed?
<Anonymous8667> Could resource allocation be involved in anomia?
<Dr. Leonard LaPointe> Anomia. I think anomia is mostly a linguistic word
retrieval deficit, but cogntive search strategies may well be involved
<Dr. Leonard LaPointe> Why neglected? Because working with dysphagia is
more likely to be reimbursed; and in many cases may be quicker.
<Suzanne> Will the extension on the Medicare cap help, do you think?
<Suzanne> (I mean not having the cap)
<Dr. Leonard LaPointe> Yes. This is not 1998-99 anymore. But we still have
a lot of work to do to get chronic conditions reimbursed properly.
<Anonymous8667> What about the efficacy of group tx for aphasics vs.
<Dr. Leonard LaPointe> Big movement to group treatment. I don't think there
is as much efficacy for groups, but the new social models of aphasia
convince us that this is a useful approach. Individual will never fade away
<Adrienne> is it feesible to start with indiv, then go to group? Group
seems like a good setting to practice generalization
<Dr. Leonard LaPointe> My approach to aphasia treatment is eclectic. The social
model and group intervention is very good. So are linguistic, cogntive,
modality, and other approaches.
<Suzanne> What is the linguistic approach? What does it entail?
<Dr. Leonard LaPointe> Strictly working on the elements of language. Syntax,
semantic processing, phonological elements.
<Anonymous8667> How do you determine the cogntive status of a global
<Adrienne> if anyone is unfamiliar with terms, shout out
Suzanne> Could that be done in a group setting?
<Dr. Leonard LaPointe> Cognitive status of global? Well, many things are
masked in global aphasia. We can only infer, since very little is able
to be communicated. Goals with a person with global aphasia would be much
Anonymous8667> What about the concept of life-long aphasia therapy?
<Dr. Leonard LaPointe> Depends on what is meant by "therapy" I guess.
<Suzanne> What about childhood apraxia-- do you think there ARE lesions
causing it, or is "apraxia" really a misnomer as it differs from apraxia
in adults (except for the "scheduling" of speech movements)
<Anonymous8667> I think it is alot more in the psychosocial realm
<Dr. Leonard LaPointe> Lots of controversy about the nature and etiology of
developmental apraxia of speech.
<Suzanne> We just keep hearing in class that it's apraxia... but no one
<Robin> I have been reading a lot about child hood apraxia....I am on a
listserv from an apraxia support group
<Keely> I am treating a child with apraxia, it doesn't seem psychosocial
<Adrienne> what are you doing with your client Keely?
<Suzanne> It is fascinating to me that there are all these oral-motor probs..
but no PATHOLOGY... it is hard to wrap my brain around.
<Dr. Leonard LaPointe> I don't have a lot of experience with kids, but I believe
that some of the developmental motoric problems that create phonological
selection and sequencing disturbance is very like the apraxia of speech
seen in some adult cases.
<Keely> lots of drill..vowels and phonemes NOT in isolation, but in syllable
and short words
<Keely> also oral-motor exercises
<Suzanne> How does the Tx of dev. apraxia differ from traditional articulation
therapy... or does it?
<Suzanne> (Besides oral-motor exercises)
<Dr. Leonard LaPointe> There may well be a pathology...or lack of complete
development of some important motor programming areas. Just undetected
by current means.
Keely> practicing words in isolation doesn't work for apraxia, I've read
that they need to practice connected speech
<Dr. Leonard LaPointe> Good sources are Michael Crary's book published by
Singular and any of Edythe Strand's work.
<Suzanne> Oohhhh. Wow. It's just so mysterious. I've seen how much
therapy can positively affect a child... going from vowel sounds to
actual sentences. It's amazing!
<Adrienne> sounds like you've done your research Keely
<Suzanne> I will take a look at those books for more info.
<Keely> well, had to read up to know what to do in therapy!!
<Suzanne> keely: TOTALLY.
<jill> Dr LaPointe: what types of tests do you find the most useful for
Aphasic evaluations, tests that help the clinician set reasonable goals...
<Adrienne> what types of tests do you find the most useful for Aphasics?
<Dr. Leonard LaPointe> Tests to allow reasonable goals. Audrey Holland's
CADL; Western Aphasia Battery; Boston Diagnostic Aphasia Battery; and
a few special tests of reading, comprehension, etc.
<Suzanne> Are any of those available in other languages, for a multicultural
<Suzanne> Normed to the population, not just translated.
<Dr. Leonard LaPointe> Not many, but a few are. There's one called the
Bilingual Aphasia Test (or battery).
<Dr. Leonard LaPointe> Not much available for bilingual speakers; but more
in Spanish and in French in North America than some of the other languages.
Dr. Leonard LaPointe> Mostly translated.
<Suzanne> That's a big problem in the Silicon Valley-- so many speakers
of Spanish, Tagalog, Vietnamese, Chinese (Mandarin AND Catonese).... phew.
it makes assessment THAT MUCH more difficult.
<jill> Thank you Dr. LaPointe...when you are presented with an aphasic patient
with a variety of speech and language needs...what needs to you
consider to be at the "top of the list" re: tx?
<Dr. Leonard LaPointe> I try to find out what is most important to improving
the communicative quality of life of each person. For some it may be
reading. For some conversational discourse. For some auditory comprehension.
<Keely> makes sense
<Shinfan> Yes, I have a client who is Apraxic and has Broca's aphasia. I
would like to learn more about this topic. Dr. Lapointe, Do you know
how much practice in speech is appropriate for someone who is apraxic?
<Dr. Leonard LaPointe> incorporating the person's input into the equation is
<jill> yes they have been emphasizing the importance of a a complete history
and background...from what you say it sounds like a major consideration......
<jill> they= our professors at Northridge
<Shinfan> My client is interested in using speech to communicate, but my
supervisor feels that he will not make much progress due to the nature
of his problem.
<Keely> definitely critical Dr. LaPointe! They need to be involved in the
<Dr. Leonard LaPointe> A great chapter on Broca's aphasia is one written by
Kevin Kearns in a book entitled Aphasia and Related Neurogenic Language
Disorders, published by Thieme.
<Adrienne> well guys, it is getting late here in EST, any final questions
for Dr. LaPointe?
<Shinfan> Thank you. Dr. LaPointe.
<Keely> Thanks, I will definitely announce these chats to my NSSLHA chapter!!
<Dr. Leonard LaPointe> It was my pleasure. I enjoyed the great questions and
interaction. Best wishes to all of you.
<jill> Best wishes to you Dr LaPointe. and Thank you..
<Ana> I am writing an article for students in the Oklahoma Speech-Hearing
Assoc newsletter about these chats.
<Robin> Thank you again Dr. LaPointe!
<Ana> thanks Dr. LaPointe
BEDSIDE READING: REFERENCES FROM DR. LAPOINTE:
Bauer, C. (1992). From the patient's point of view. Cognitive Rehabilitation, 10 (2), 8-11.
Bienemann, K. L. (1989). Psychological implications of right hemisphere injury. In P.A. Pimental & N. A. Kingsbury (Eds.), Neuropsychological aspects of right brain injury (pp. 65 - 72). Austin, TX: Pro-Ed.
Bigler, E. D. (1990). Traumatic brain injury: Mechanisms of damage, assessment, intervention, and outcome. Austin, TX: Pro-Ed.
Blosser, J. L. & DePompei, R. (1994). Pediatric traumatic brain injury: Proactive intervention. San Diego: Singular Publishing Group.
Brookshire, R. H. (1998). An introduction to neurogenic communication disorders (5th ed.) St. Louis: Mosby Year Book.
Caspari, I. C., LaPointe, L. L., Katz, R. C., & Parkinson, S. (1994). Working memory and aphasia. Paper presented at annual meeting of the Clinical Aphasiology Conference, Traverse City, MI.
Chamberlain, M., Tennant, A., & Neumann, V. (1995). Traumatic brain injury: Services, treatments, outcomes. San Diego: Singular Publishing Group.
Green, B., Steven, K., & Wolfe, T. (1997). Mild traumatic brain injury: A therapy and resource manual. San Diego: Singular Publishing Group, Inc. [1-800-521-8545]
Hartley, L. L. (1995). Cognitive-communicative abilities following brain injury: A functional approach. San Diego: Singular Publishing Group, Inc.
Holland, A. (1982). When is aphasia aphasia? The problem of closed head injury. In R. H. Brookshire (Ed.) Clinical aphasiology: Conference Proceedings 1982. Minneapolis: BRK Publishers, 345-349.
Journal of Medical Speech-Language Pathology (1993-present). San Diego: Singular Publishing Group, Inc. (Phone 1-800-521-8545).
LaPointe, L. and Culton, G. (1969).Treatment of visual-spatial deficits in right hemisphere damage. J Speech and Hearing Disorders.
LaPointe, L. L. (1990). Aphasia and related neurogenic language disorders. New York: Thieme Medical Publishers.
LaPointe, L. L. & Katz, R.C. (1998). Neurogenic disorders of speech. In G. Shames, E. Wiig, & W. Secord (Eds.) Human Communication Disorders: An Introduction. New York: Macmillan Publishing.
LaPointe, L. L. (1994). Neurogenic disorders of communication. In F. Minifie, (Ed.) Introduction to communication sciences and disorders. San Diego: Singular Publishing Group, Inc. 351-397.
Lezak, M.D. & O'Brien, K.P. (1990). Chronic emotional, social, and physical changes after traumatic brain injury. In E.D. Bigler (Ed.) Traumatic brain injury. Austin, TX: Pro-Ed, 365-380.
Myers, P. S. (1983). Treatment of right hemisphere communication disorders. In W. H. Perkins (Ed.), Current therapy in communication disorders (Vol. 3, pp. 57-67). New York: Thieme-Stratton.
Myers, P. S. & Mackisack, L. (1990). Right hemisphere syndrome. In L. LaPointe, (Ed.) Aphasia and related neurogenic language disorders. New York: Thieme Medical Publishers, Inc.
Murdoch, B. E. (1990). Acquired speech and language disorders: A neuroanatomical and functional neurological approach. London: Chapman and Hall.
Perecman, E. (Ed.). (1983). Cognitive processing in the right hemisphere. New York: Academic Press.
Richards, W. (1991). From the patient's point of view. Cognitive Rehabilitation, 9 (5), 8.
Rosenbek, J. C., LaPointe, L. L., & Wertz, R. T. (1989). Aphasia: A clinical approach. Austin, TX: Pro-Ed.
Sohlberg M. & Mateer, C. (1989). Introduction to cognitive rehabilitation. New York: Guilford Press.
Teasdale, G. & Jennett, W. B. (1974). Assessment of coma and impaired consciousness. Lancet ii: 81.
Tompkins, C. A. (1995). Right hemisphere communication disorders: Theory and management. San Diego: Singular Publishing Group.
Wertz, R. T., LaPointe, L. L., & Rosenbek, J. C. (1991). Apraxia of speech in adults: The disorder and its management. San Diego: Singular Publishing Group.