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Taal: therapie samenvatting deel verworven
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Notities les, ppt's en cursus De afbeeldingen komen uit de slides van mevrouw Vandenborre. Ik haalde hiermee een 18/20
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SAMENVATTING TAAL: THERAPIE- VERWORVEN STOORNISSEN1 Algemeen kader .............................................................................................................................................. 4
1.1 Conceptuele referentiekaders ............................................................................................................... 4
1.1.1 Evidence based practice: algemeen .................................................................................................. 4
1.1.2 Biopsychosociaal model: ICF ............................................................................................................. 5
1.1.3 Multimodaal model met focus op communicatie ............................................................................. 6
1.1.4 Taakspecifiek model met focus op taal ............................................................................................. 7
1.2 Behandeldoelen opstellen en formuleren ............................................................................................. 7
1.2.1 Smartie doelen .................................................................................................................................. 7
1.2.2 Impact van niet- talige cognitieve functies ....................................................................................... 8
1.3 Taaltherapie als vorm van neurorevalidatie ........................................................................................ 10
1.3.1 Neurorevalidatie ............................................................................................................................. 10
1.3.2 Neurale plasticiteit in relatie tot gedragsplasticiteit ....................................................................... 10
1.3.2.1 Neurale reactivatie ................................................................................................................. 10
1.3.2.2 Neurale aanpassing: neurale reorganisatie en neurale compensatie .................................... 11
1.3.3 Consolideren ................................................................................................................................... 11
1.3.4 Conclusie ......................................................................................................................................... 11
1.4 Behandelmateriaal .............................................................................................................................. 12
1.4.1 Materiaalkeuze: parameters bij het bepalen welke woorden je gebruikt ...................................... 12
1.4.2 Materiaalkeuze: hoe en wanneer aanbieden? ................................................................................ 13
1.5 Prognose .............................................................................................................................................. 13
1.6 Afasietherapie: kwalitatieve neurologopedie ..................................................................................... 14
1.7 Afasietherapie: veel onbeantwoorde vragen ...................................................................................... 14
2 Behandelvormen bij volwassenen met neurogene communicatiestoornissen ............................................ 15
2.1 Voorlichting en begeleiding ................................................................................................................. 15
2.2 Stoornisgericht, CLT ............................................................................................................................. 16
2.2.1 Concreet stoornisgericht therapiemateriaal ................................................................................... 16
2.2.1.1 CL benadering: semantiek ...................................................................................................... 17
2.2.1.2 CL benadering: fonologie ........................................................................................................ 17
2.2.1.3 CL benadering: woordvinding ................................................................................................. 18
2.2.1.4 CL benadering: syntaxis .......................................................................................................... 18
2.3 Functioneel, communicatiegericht handelen ...................................................................................... 18
2.3.1 aanmoedigen totale communicatie: NAH fotogroep ...................................................................... 18
2.3.2 Aanleren compensatiestrategieën: SMTA ....................................................................................... 19
2.3.3 Implementeren in het dagelijks leven ............................................................................................. 19
2.4 Constrained- Induced aphasie Therapy (CIAT) .................................................................................... 19
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, 2.5 Neurostimulatie ................................................................................................................................... 20
2.5.1 rTMS ................................................................................................................................................ 20
2.5.2 tDCS ................................................................................................................................................. 20
2.6 Werken met ondersteunende communicatie ..................................................................................... 21
2.6.1 Klassieke GRID display ..................................................................................................................... 22
2.6.2 nieuwe visual scenes en remnants .................................................................................................. 22
2.7 Communicatiepartnertraining ............................................................................................................. 22
2.8 Behandelfocus ..................................................................................................................................... 24
2.8.1 Jij, als therapeut .............................................................................................................................. 25
2.8.2 Materiaalkeuze ................................................................................................................................ 25
2.8.3 Responsemanagement .................................................................................................................... 25
2.8.4 Intensiteit, duur, aanvang en inhoud van je behandeling ............................................................... 26
2.8.4.1 Inschakelen van niet-professionele, getrainde vrijwilligers ................................................... 27
2.8.4.2 Inschakelen van e-Health ....................................................................................................... 27
2.8.5 Individueel of in groep? ................................................................................................................... 27
2.8.6 Thx= continu keuzeproces ............................................................................................................... 28
3 Taaltherapie bij volwassenen met afasie ...................................................................................................... 29
3.1 Historische context .............................................................................................................................. 29
3.1.1 Behavioristische school ................................................................................................................... 29
3.1.2 Stimulatieschool .............................................................................................................................. 29
3.1.3 pragmatische school ....................................................................................................................... 30
3.1.4 Neurolinguïstische school ............................................................................................................... 30
3.1.5 Cognitief neuropsychologische school ............................................................................................ 30
3.1.6 Sociale school .................................................................................................................................. 31
3.2 Beïnvloedende factoren: patiëntgerelateerd ...................................................................................... 31
3.3 Beïnvloedende factoren: patiËntgerelateerd ...................................................................................... 33
3.4 Doel afasietherapie.............................................................................................................................. 34
3.5 Evidence based practice ...................................................................................................................... 34
3.5.1 Effectiviteitsstudies ......................................................................................................................... 34
3.5.2 Richtlijnen........................................................................................................................................ 35
3.5.3 EBP .................................................................................................................................................. 36
3.6 Behandelfasen bij een stabiel ziektebeeld .......................................................................................... 36
3.6.1 Acute fase ........................................................................................................................................ 36
3.6.2 Revalidatiefase ................................................................................................................................ 37
3.6.3 Chronische fase / consolidatiefase .................................................................................................. 37
3.7 Psycho-educatie: voorlichting en begeleiding ..................................................................................... 37
3.8 Concreet behandelmateriaal ............................................................................................................... 38
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, 3.9 conclusie bij afasietherapie ................................................................................................................. 38
4 Taalthx bij volwassenen met een cognitief communicatieve stoornis ......................................................... 40
4.1 Historische context .............................................................................................................................. 40
4.2 Evidence based practice ...................................................................................................................... 41
4.3 Behandelfocus ..................................................................................................................................... 42
4.3.1 Stoornisgericht materiaal ................................................................................................................ 43
4.3.2 Functioneel materiaal ..................................................................................................................... 45
4.4 Psycho-educatie................................................................................................................................... 46
5 Taaltherapie bij volwassenen met een degeneratieve communicatiestoornis (dementie) .......................... 46
5.1 Historische context .............................................................................................................................. 46
5.2 Evidence based practice ...................................................................................................................... 47
5.3 Behandelfocus ..................................................................................................................................... 48
5.3.1 Behandelfasen bij een degeneratief ziektebeeld ............................................................................ 48
5.3.1.1 Preklinische fase ..................................................................................................................... 48
5.3.1.2 Fasen van ‘eigenlijke’ dementie ............................................................................................. 48
5.3.2 Behandeldoelen .............................................................................................................................. 49
5.4 Psycho-educatie................................................................................................................................... 52
5.5 Concrete behandeltechnieken ............................................................................................................ 53
5.5.1 Directe stoornisgerichte therapie ................................................................................................... 54
5.5.2 Directe functionele therapie ........................................................................................................... 55
5.5.2.1 Realiteitsoriëntatietraining..................................................................................................... 55
5.5.2.2 Reminiscentiethx .................................................................................................................... 56
5.5.3 Directe emotionele therapie ........................................................................................................... 56
5.5.3.1 Validatiethx............................................................................................................................. 56
5.5.3.2 Snoezelen ............................................................................................................................... 56
5.5.4 Directe alternatieve therapie .......................................................................................................... 57
5.5.5 Directe participatieve therapie ....................................................................................................... 57
5.5.6 Spaced-retrieval training ................................................................................................................. 57
5.5.7 Errorless learning ............................................................................................................................ 58
5.5.8 Actieve betrokkenheid .................................................................................................................... 58
5.5.9 Geheugenboek ................................................................................................................................ 58
5.5.10 Montessori thx ............................................................................................................................ 58
5.6 Concrete communicatietips bij dementie ........................................................................................... 58
5.7 Nog communicatietips voor dementie (en afasie) .............................................................................. 59
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, 1 ALGEMEEN KADER
Communicatie → onvoorwaardelijke intentie om de ander te willen begrijpen
Taal:
Modaliteiten → lezen,spreken, schrijven en begrijpen
Linguïstische niveaus → morfologie, pragmatiek, morfosyntaxix, semantiek..
Motorische spreekact: tong en lippen in juiste positie zetten
1.1 CONCEPTUELE REFERENTIEKADERS
• Startpunt taalthx: primum non nocere (Hippocrates)
• Hoofddoel: verbeteren functionele communicatie
• Dit doel kan je vanuit verschillende invalshoeken bekijken
o EBP
o ICF (biopsychosocial model)
o Multimodaal model
o Je kan ook onderscheid maken tussen stoornisgerichte thx en functionele thx
(complementair!)
1.1.1 EVIDENCE BASED PRACTICE: A LGEMEEN
• Evidence based medicine= wekwijze waarbij keuzes in de zorg worden onderbouwd met het beste
bewijsmateriaal uit wetenschappelijk onderzoek.
• Evidence based practice= bij paramedische zorg= het beste bewijsmateriaal uit de klinische praktijk via
wetenschappelijk onderbouwde onderzoeken
o Combineer je met klinische expertise als logo + voorkeur patiënt
• Beslissing is van evidence base dals ze voldoet aan 4 criteria:
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