The Therapeutic Effect of Schuell’s Stimulation Approach for Severe Chronic Aphasia

Abstract

ABSTRACT Background Hildred Schuell’s approach to aphasia therapy was developed in the 1960’s based on her vast clinical experience. Though few refer to the treatment as “Schuell’s”, her stimulation techniques remain widely used and the variables she describes as important (e.g., intensity and salience) are those that now have empirical evidence in promoting adaptive neuroplasticity. Schuell’s Stimulation Approach (SSA) was designed to be applicable to all severity types. This is compelling given the paucity of treatment options for people with particularly severe aphasia. Aims The aim of the current study is to investigate the viability and efficacy of SSA for individuals with chronic severe aphasia, reported as having “plateaued” following other treatments. Methods One participant with severe Wernicke’s and one with severe mixed transcortical aphasia participated in 30 hours of treatment over ten days. A single subject multiple baseline design across behaviours was employed. The treatment design was based on the SSA guidelines outlined by Coelho et al. (2012), and participant performance was compared pre- and post-treatment on language probes, discourse probes, standardised assessment and caregiver ratings. Results Both participants demonstrated improvement on standardised assessment and trained items; generalisation to untrained items and discourse was limited. Both participants also made subjective improvements according to caregivers and others, and one participant showed a decrease in anosognosia. Conclusions Intensively administered SAA may be a feasible treatment option for motivated individuals with chronic severe aphasia who have ceased to benefit from other therapies.