What is the recommended approach for pragmatic language therapy?

Recommended Approach for Pragmatic Language Therapy

Pragmatic language therapy should focus on functional communication with intensive, individualized intervention that includes conversation skills training, alternative communication methods, and involvement of communication partners. 1

Core Components of Pragmatic Language Therapy

Assessment and Planning

• Complete comprehensive assessment of communication abilities across multiple domains: comprehension, speaking, reading, writing, gesturing, use of technology, pragmatics, and conversation 1
• Identify specific pragmatic deficits using validated tools 1
• Develop individualized goals and intervention plan in collaboration with the patient and family/caregivers 1
• Regularly reassess goals and plans at appropriate intervals 1

Intervention Approaches

1. Conversation-Based Therapy

• Focus on improving participation in conversations with family and friends 1
• Train specific conversational skills:
  • Turn-taking
  • Topic maintenance
  • Responsiveness
  • Appreciation of listener knowledge
  • Adaptation of discourse style 2
• Use supported conversation techniques for potential communication partners 1

2. Functional Communication Training

• Target ability to convey messages by any means 1
• Implement alternative communication methods when needed:
  • Gesture training
  • Drawing techniques
  • Writing strategies
  • Augmentative and alternative communication (AAC) devices 1, 3
• Practice communication in real-world contexts 3

3. Language Processing Support

• Address underlying language deficits that impact pragmatic skills 3
• Provide therapy for:
  • Word retrieval (getting words out) 1
  • Fluency of speech 1
  • Comprehension of others' speech 1
  • Reading and writing as needed 1

4. Social Skills Training

• Use role-play to practice pragmatic skills in simulated real-life settings 4
• Target stylistic variation (adjusting communication style based on context) 4
• Practice requesting clarification when communication breakdowns occur 4
• Incorporate dual-tasking while speaking as a form of distraction 1

Delivery Methods

Intensity and Format

• Provide intensive therapy (at least 45 minutes daily, five days a week in early phases) 3
• For chronic communication disorders (>6 months), implement at least 10 hours/week of therapist-led therapy plus 5+ hours/week of self-managed training 3
• Incorporate both individual and group therapy sessions 1
• Use computerized treatment programs to supplement therapist-provided intervention 1, 3

Partner/Family Involvement

• Train family members and communication partners in supported conversation techniques 1, 3
• Implement Parent-Child Interaction Therapy (PCIT) for children with language impairments 5
• Engage families in the entire intervention process 1
• Provide education about communication strategies and how to support the individual 1

Evidence-Based Approaches for Specific Populations

For Stroke-Related Aphasia

• Begin therapy as early as tolerated after onset 1, 3
• Focus on functional communication, reading comprehension, and expressive language 1
• Use constraint-induced language therapy for appropriate candidates 1
• Implement conversation partner training for family members 1

For Children with Developmental Disorders

• Use structured educational approaches with explicit teaching 1
• Implement the Social Communication Intervention Programme (SCIP) combining language processing, pragmatic, and social understanding therapies 2
• Apply the Pragmatic Intervention Programme (PICP) for preschool children with ASD or DLD 6
• Consider Parent-Child Interaction Therapy to alter parent interaction styles to match the child's communicative needs 5

Monitoring Progress

• Use functional communication measures rather than solely relying on standardized language tests 7
• Assess changes in conversation using structured observation protocols 7
• Gather feedback from communication partners about real-world communication changes 7
• Document progress in language function, communication abilities, and social participation 3

Common Pitfalls to Avoid

• Focusing only on language structure while neglecting pragmatic aspects of communication 1, 2
• Discontinuing therapy too early (benefits can still be achieved in chronic stages) 3
• Failing to involve communication partners in the intervention process 1
• Using outcome measures that don't capture functional communication changes 7
• Not providing sufficient intensity of intervention 3

By implementing this comprehensive approach to pragmatic language therapy with appropriate intensity and focus on functional communication, patients can achieve meaningful improvements in their ability to communicate effectively in everyday situations.