Treatment of Verbal Perseveration in Persons With Aphasia

Abstract

Providing language therapy to a person with aphasia (PWA) who exhibits a moderate to severe tendency to perseverate is one of the most difficult challenges with which a language therapist can be confronted. In the case of severe verbal perseveration, systematic language therapy may not even be possible. Thus, in such cases, to reduce or eliminate perseveration, the clinician needs to understand the mechanisms underlying verbal perseveration in the overall context of the individual's language impairment.

Under the premise that verbal perseveration reflects the primary language impairment, for example, and affects the retrieval of phonemes or word retrieval, the clinician will need to choose different therapy strategies for each PWA. Following a summary of general suggestions put forward in the aphasia literature for reducing perseveration, I will discuss available protocols for treating perseveration (e.g., Treatment of Aphasic Perseveration or TAP; Helm-Estabrooks, Emery, & Albert, 1987) and survey the publications on treatment of verbal perseveration.

Client MV's sister: … “I think I have to take my sister to the heart specialist. In the past weeks she has behaved a little differently and I am worried that she is having problems breathing. When I am having a conversation with her and she has problems speaking [i.e., the client gets stuck on a word she has previously produced or perseverates], all of a sudden she just stops talking and she takes a deep breath! Then slowly she starts talking again.”

Therapist: “No, Dr … ., you don't have to go to the heart specialist with your sister. She doesn't have any problems breathing. Your sister is just following my advice. I told her, that when she notices that she is having a problem finding the name of something or she says a word she has just produced, that she should stop talking and take a long deep breath. She should take a break and then slowly start all over again. Apparently she is really following my suggestion! I am really glad to hear that.”

Client MV's sister: “Oh, I am so relieved to hear that. I was worried about her! Come to think of it, after she takes a deep breath, she usually says the right word or something close to it!”

(Excerpts from a telephone conversation between a person with aphasia's [PWA's] therapist and the client's sister, translated from German.)