Our chat host tonight, Monday, January 21, 2002, is Leonard L LaPointe, Ph.D.
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.  He is currently
Editor-in-Chief of the Journal of Medical Speech-Language Pathology. 
Dr. LaPointe has published and presented a tremendous number of books,
book chapters, papers and lectures. He will be chatting tonight about neurological
cognitive and communicative disorders, especially aphasia.

<Robin>Welcome! Tonight we are chatting with Dr. Leonard LaPointe about
   aphasia and neurological communication disorders.
<Robin> Hello Dr. LaPointe!  Thank you for joining us tonight
<Leonard LaPointe> Hi Robin. It's a pleasure to be here again.
<Denise> Ahoy captain. I am an SLP who works in a university clinic
   setting. I work with quite a few people with chronic aphasia who have
   significant reading problems. Of course there are many different
   profiles, characteristics and severity levels but many have
   phoneme/grapheme difficulties. Can you suggest any approaches I
   might use and a few good references?
<Leonard LaPointe> Denise: Two of the sources on acquired dyslexia
   that I am most close to are the chapter by Wanda Webb in Aphasia
   and Related Neuro Lang disorders (Thieme, 1997), and Aphasia a
   Clinican Approach by Rosenbek, Wertz, and LaPointe (Pro-Ed).
<Robin> Dr. LaPointe, could you give us a general definition of aphasia?
<Leonard LaPointe> Definition of aphasia...difficulty in comprehending and producing
   language across modalities caused by brain damage. Simplified definition.
<Linda> I have a question; tell me when I may ask.
<Robin> Go ahead, Linda
<Linda> My aunt had a stroke last April. She is global and says only "cee, cee, cee"
   in response to anything asked. Is there any stim that could help?
<Leonard LaPointe> I appreciate the frustration of your aunt's limited output, Linda. A good
   evaluation to expose any strengths across the modalities is very important for starters.
<Linda> Being realistic, given the time frame, is there reason to believe her skills will increase?
<Leonard LaPointe> Way too little info to tell. I'd be optimistic but not set unreasonable goals.
<keri and brooke> Dr. LaPointe, when do you believe in stopping treatment in people with
<Leonard LaPointe> When no measureable or significant change is taking place (plateau across
   modalities); when the person no longer is motivated to continue. These are a couple of
   criteria. There are more.
<AngieFSU> I understand the criteria for discontinuing therapy, but it does get complicated when
   the client feels that therapy is the only place he/she can communicate--with people that are
   understanding.  When do we ethically stop treatment then? I guess I am referring to a client with
   primary progressive aphasia (in the later stages).
<Leonard LaPointe> It isn't unusual for a client to feel frustrated when the end of treatment is
   suggested...Usually some type of maintenance group along with community support groups for
   both caregivers and spouses are useful.
<Adrienne FSU> I think incorporating the caregiver helps with the ethical dilemma of ending therapy
   when the client doesn't want to.
<Adrienne FSU> Dr. LaPointe- what type of things can you advise the caregiver to
   do when therapy is discontinued?
<Leonard LaPointe> My answer is to consult some of the sites that reflect caregiver suggestions
   such as NAA and some of the work by Aura Kagan, Byng & Co from UK; Linda Worrall from
   Australia; Roberta Elman from CA.
<Adrienne FSU> Thank you!
<Leonard LaPointe> Home treatment and caregiver incorporation are both good suggestions.
<Leonard LaPointe> I think the new social models of aphasia rely increasingly on spouse,
   caregiver, volunteer partners as viable means of treatment.
<Denise> I have a question about software to treat aphasia. Do you have any
<Linda> Re software: Become a beta tester for Bungalow Software; it's software for aphasia.
<Leonard LaPointe> Check out some of the aphasia software sites on the web; bungalow
   software; sources at the NAA (National Aphasia Association) site.
<Robin> We had some great chats addressing this topic...take a look in our archives.
<stacy> I actually have a question.. Dr. LaPointe I am working with a client with Broca's aphasia
   on writing skills and using the CART Procedure but stuck on activities to provide him with at
<Leonard LaPointe> Ask the person with Broca's aphasia what he wants to be able to write,
   Stacy. I like to have them try to construct a list of most important functional tasks.
<becky> What is the CART Procedure?
<stacy> it is a step-by step procedure which works on beginning the client with a copying task
   then move on to anagrams (choosing appropriate letters for the word) and then having them
   recall the word on their own.
<dpeer> Dr. LaPointe, this is a hypothetical question, but can a patient who is being treated for
   Broca's aphasia be later diagnosed as having Anomic aphasia?
<Leonard LaPointe> Many aphasia types evolve as time/treatment progresses. People do not
   necessarily always remain a Broca's or what ever. Andrew Kertesz has a book and several
   articles on the change of aphasia type...so yes, it could be Broca's early; Anomic later.
<dpeer> Dr. LaPointe, thank you for answering my question.dpeer
<Leonard LaPointe> You're welcome.
<Linda> But if it's global one year later, it's probably going to remain global, isn't it?
<Leonard LaPointe> Yes. Global after one year is not a global sentence; but in all likelihood it
   suggests a lot of hemispheric damage.
<stacy> Dr. LaPointe, I have one other question for you. I am recently beginning to see a client
   with anomic aphasia and he would like to work on reading. The difficulty is that he has a vision
   problem where he can not see the lower right quadrant of a page. I have come up with a few
   techniques when reading a book but the problem is he drives and problems must arise when
   reading a sign. How can I help him with this difficulty?
<Adrienne FSU> oh man!
<AngieFSU> WoW
<Marilyn> Should he be driving?
<Linda> Can he compensate by tilting his head back?
<stacy> that was my issue too...
<Adrienne FSU> Is there anything we can do as professionals to have him pass a driving test?
<Leonard LaPointe> Driving and perceptual/cognitive/language problems of a person recovering
   from stroke is a very important issue. It requires team coordination on decisions among the
   neurologist, and all the rehab specialists. Sometimes the very difficult issue of driving
   competency must be addressed and tested with a client.
<stacy> How would I go about addressing this... shouldn't I refer him to an eye specialist to see if
   driving is an option for him?
<Leonard LaPointe> I think a neuroophthalmologist would be the best choice of all...they have
   experience with driving competency issues (as do occupational therapists).
<Robin> Stacy, have you spoken with the OT about this?
<stacy> No, my first visit with him is this Wed. but from his chart I do not think that there is
   an OT that he sees regularly.
<Leonard LaPointe> Many rehab units now have a simulated driving exercise; we used it for a
   professor I worked with in Arizona. After the test (which he failed miserably) he said, "All those
   people I ran over!" He realized.
<Marilyn> Stacy, if he is your client, it would be your right to review all his records, speak to all his
   doctors, especially the neurologist and have the rehab team require a written and visual driving
   competency exam including a road test...I am concerned there will be a baby carriage in that
   lower right quadrant and the speech-language pathologist may be the best one to focus on
<Leonard LaPointe> Good advice from Marilyn
<stacy> thanks everyone for your help
<dpeer> Dr. LaPointe, a patient who has not suffered a stroke, but acquired aphasia, could it be
   due to another cause, say if she is diabetic?
<Leonard LaPointe> Aphasia is always the result of brain damage (by definition); metabolic
   diseases and disorders are associated with stroke but some form of brain damage is
   necessary to cause aphasia.
<AngieFSU> I want to be sure I understand you. Can diabetes, which is a risk factor for a stroke,
   lead to a brain injury of some type thereby causing Aphasia?
<Leonard LaPointe> Yes. It is a risk factor for stroke but not the primary cause of aphasia.
<dpeer> Dr. LaPointe, thank you for the insight about diabetes and aphasia.
<Linda> So is it still aphasia if the expressive and receptive language is impaired but no evidence
   exists for neuro insult--and the patient is a child?
<Adrienne FSU> oooh, Linda you hit a hot topic I think!
<Adrienne FSU> would that be what is referred to as "developmental aphasia"?
<Linda> Yes, I've worked with these kids for many years.....
<Leonard LaPointe> OH! another bit of data. The patient is a child. That complicates it greatly.
   Can't call it aphasia unless we have documented brain damage in my opinion.
<Linda> So what do we call it?
<Leonard LaPointe> Developmental aphasia is a can of worms...and has been for 30 years.
   Not my area of expertise.
<Linda> Do we just define the receptive and expressive language impairment?
<Leonard LaPointe> Sure. Define and describe behaviorally and continue to try to find the
   underlying cause.
<Linda> Yes, here in CA we used to call these classes "aphasia class"
<Linda> We rarely ever are able to find the underlying cause.
<Linda> Not having worked with adults, would the interventions be essentially the same?
<Leonard LaPointe> I'd be reluctant to diagnose a developmental language delay or difference as
   aphasia without neurological history or signs.
<Linda> Well, one often sees gross and fine motor signs--apraxia, for example...
<Linda> Sometimes parents are willing to admit to having used recreational drugs during the
<Linda> So if those examples were all you had, would you still be reluctant to call it
   developmental aphasia?
<Leonard LaPointe> Yup
<Adrienne FSU> isn't there some point where you give up on exact classification and work on
   helping the kid communicate?
<Leonard LaPointe> An important point, Adrienne. We have no treatment to aphasia type formulae
   anyway and usually plan intervention relative to specific cognitive/communicative treatment
<Linda> You and my old prof, Mary Oeschlagger agree! She and I wrestled with this one!!!
<Marilyn> Linda, recreational drugs would be my first thought...would be interesting research
   paper to assign to interns/students...type of drug, etc. possibly we could find a drug to repair
   the brain damage done to the children...
<AngieFSU> I find primary progressive aphasia to be very interesting... what can we do for
   someone in the mid-later stages (when even the simplest AAC device is boggling)?
<Leonard LaPointe> If even the most rudimentary AAC devices are not effective and useful, then
   painful and frustrating issues must be faced about what we have to contribute aside from
   psychosocial benefits.
<Robin> Dr. LaPointe, can you tell us about the latest research in aphasia?
<Leonard LaPointe> Latest research: Well, I'm impressed with all of the new stuff coming out on
   physiological changes in the brain that result from practice and therapy. Also, the new social
   models of aphasia and the psychosocial approaches to looking at identity change, depression,
   etc.; Also, the models that view aphasia as a cognitive (attention and memory) issue.
<jill> While I realize that most aphasias are a result of brain damage, how do you feel about these
   attention and memory issues pre-aphasia v. post-aphasia?
<Leonard LaPointe> Pre-Post attention issues. May be two different problems. But certainly
   attention issues prior to stroke may compound the impairment.
<Linda> --and I guess without a school history, for example, we may never know if the patient had
   learning or cognitive disabilities pre-stroke..
<Leonard LaPointe> right, Linda, premorbid status is important.
<Leonard LaPointe> Our NeuroCog-NeuroCom lab at FSU is very busy trying to establish a
   research agenda on cognitive aspects of neurogenic disorders. We are testing several clinical
   populations (dementia; Parkinson's; aphasia; TBI) to attempt to unravel the specific types of
   attention and memory problems that accompany or are a part of the communication disorder.
<dpeer> Can imbalance or excess of medications lead to brain damage that would lead
   to aphasia, especially if the patient hasn't suffered a stroke?
<Leonard LaPointe> Yes. dpeer. There are many etiologies of aphasia other than stroke, though
   thromboembolic stroke is by far the most frequent cause.
<AngieFSU> Dr. LaPointe, do you have any advice for those of us that are just starting a career in
   this field?
<Leonard LaPointe> Yes, Angie: First of all celebrate your choice. You have chosen something
   that is meaningful and useful. You will need patience and lots of study and hard work to get
   experienced enough to feel a little comfortable. You may have several identity crises yourself
   about how you fit into it all. Perfectly normal. Finally, the untold wealth that accumulates is
   mind-boggling (kidding of course). It is a noble profession. There are some equal, but none
<AngieFSU> Thanks for the advice!
<Robin> Well, the time has flown by! It is time to wind up our chat! Thank you, Dr. LaPointe, for joining
   us tonight and sharing your wisdom!