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WORD Therapy Guide

 

WORD Therapy Guide for Clinicians (Best, Hughes & Shobbrook, 2015)

This document was developed as a result of a research study investigating the use of phonological and semantic cues in therapy for children with word finding difficulties. The study involved delivering therapy to 20 children aged from six to eight years identified as having word finding difficulties using the Test of Word Finding 2 (German, 2000). Semantic or phonological cues were separated in different therapy conditions and children received one type of therapy (semantic or phonological) for six weeks, followed by the other after a six week break. The results of the project are on the basis of phonological and semantic cues being delivered separately, as described below. The following is a description of the therapy delivered for the research study: if you adapt this programme for clinical use, we would be interested in hearing from you. This document is intended as a ‘step-by-step’ guide and you may find it easier to study the relevant section in detail as you conduct the sessions.

For further information about the research, please see https://sites.google.com/site/wordfinding/

WORD Project Logo
Principles
  • The primary aim is for children to value and enjoy the WORD therapy, in the context of their previous experience of word-learning and word-finding, which they are likely to have found frustrating.
  • For many children, their word-finding difficulties occur in the context of wider communication needs which may affect receptive language, expressive language and attention. The therapist takes account of each child’s language level and wider needs during the intervention.
  • A further key aim is for children to develop strategies that they can use independently by the end of the intervention whenever they are unable to retrieve words. This aim is designed to be achieved gradually as the therapy progresses. In early sessions the child is becoming aware of the features of words and in later sessions exploring how they can best help themselves when they become stuck.
  • When using word webs, the goal is for the child to be working towards producing the correct name by generating features and ‘thinking around the word’. With this in mind, the therapist does not provide the word form for the child until the final naming attempt.
  • As therapy progresses, the intention is for activities to become more meta-cognitive (see Phase 2, below) and communicative (see Phases 3 and 4). The principles of encouraging reflection on word-finding strategies and on using words to communicate run through the programme and will help therapists determine how to respond to each individual child.
  • It is important for therapists to have close guidance when delivering the WORD interventions to ensure that therapy is delivered consistently, according to the protocol. During the WORD Research Project, this included peer shadowing and observing videos of both early and later-stage sessions.
Background Details
  • Sessions occur once a week. Approximately 25 mins are spent on pure therapy activities, e.g. word webs and barrier games. Up to 15 minutes extra is allocated to naming probes, generating ideas for additional items to work on and short breaks between tasks.
  • Up to 30 items are treated each half term. These should be chosen with the children and/or their carers/teachers to ensure maximum functional benefit. It is advisable for words to be selected according to the child’s interests and/or the school curriculum. From our experience on the WORD Project, it is best to avoid introducing words that are closely related, either in meaning or phonology, during the same therapy block.
  • Name all target words at the beginning of each session (include all each time, regardless of success with previous attempts, as the nature of word-finding difficulties means children’s ability to access words may vary from session to session). Do not give specific feedback on individual items at this stage, but provide general encouragement. It is advisable to alternate between 4 different randomised orders of naming probes (forwards, backwards, forwards from half-way through and backwards from half-way through), as people tend to recall the first and last items in a series best, and the middle items worst.
  • A comedy buzzer may be used as a fun/motivating device for children to press when they cannot name, or wish to pass on an item. This is to reduce frustration at being asked to repeatedly name items without feedback.
  • If any of the therapy items is named correctly of the start of the session, then that item will not be treated on that day.
  • Therapy items will be treated in a continuous, cyclical order, aiming to cover at least as many items as in the previous session. Start with words previously not worked on and continue through as many as possible, returning to those covered previously if time allows.
  • Length of therapy activities will be fairly constant throughout (usually under 30 minutes), regardless of how many items are covered.
  • Ideally, all sessions should be video-recorded to ensure the child’s progress is correctly recorded and to allow the therapist to seek feedback on the delivery of sessions through supervision and/or peer support.
  • If the child offers information spontaneously, e.g. gestures or writing the word, do not specifically inhibit or encourage responses in different modalities. Just accept the correct information without commenting further. The therapist may offer alternatives if the child appears stuck and follow the child as to their preferences for providing features orally or where appropriate by gesture, drawing or writing.
Materials
  • Hard copy pictures of all therapy items for naming probes at start of sessions.
  • Naming probe record sheets
  • ‘Comedy buzzer’ for child to press when unable to name an item.
  • Fun game, e.g. jacks, tiddlywinks, pick-up sticks for child to play as quick ‘brain break’ while therapist prepares and organises therapy items.
  • Hard copy of semantic / phonological ‘word webs’ for all therapy items.
  • Record sheets, including tick charts for monitoring participants’ production attempts and overall response to therapy.
  • Alphabet chart needed for phonological therapy condition.
  • Handheld video camera.
  • Hardback book to act as ‘barrier’ for later sessions.
  • Counters and post-box, or similar, to act as reward system during barrier game phase.
  • Dice for final session (if appropriate level achieved).
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