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December 2016, Volume 66, Issue 12

Letter to the Editor

Rejuvenating lost communication through script training

Nadir Ali  ( Department of English Linguistics and Literature, University of Management and Technology, Lahore. )
Muhammad Shaban Rafi  ( Department of English Linguistics and Literature, University of Management and Technology, Lahore. )
Muhammad Sikander Ghayas Khan  ( Department of Speech and Language Pathology, Riphah College of Rehabilitation Sciences, Riphah International University, Lahore. )
Uzma Mahfooz  ( Senior Medical Officer, Multan Road, Health Centre, PTCL, Lahore. )

Madam, if language is considered a tool of communication; it would be significant to mention the effectiveness of script training as an intervention therapy for patients who have lost their language due to aphasia.
Aphasia is an acquired language disorder of communication resulting from the damage to the focal areas of brain that are responsible to control language, characterized by symptoms on all levels of language dysfunction.1 The most common cause of aphasia is Cardio Vascular Accident, i.e. stroke, acquiring aphasia as a result which constitutes 85% of all etiologies. 2 JafarT, conducted a study in Karachi which reports a stroke prevalence of 4.8%, the highest ever reported prevalence of stroke in the world. 3 The incidence of aphasia after an attack of stroke is about 30% in the acute phase of disease.4
Patients with aphasia developing severe dysfunction of language are unable to communicate normally5 and are presented with impaired comprehension, grammaticality, fluency, repetition skills and laborious word retrieval.6 This reduced ability to communicate negatively affects their functional, psychological and other everyday activities, and ultimately create a major individual and community health burden.5
There are many treatment programs available, however script training therapy shows positive outcomes in the production of practiced script. In script training, patients with aphasia are trained on short scripts or simple sentences for some weeks, using in-session therapy and its recordings. Treatment session may last 30-45 minutes with therapists along with daily homework practice. The content of script is selected by mutual consent of both patient and therapists with personal and real-world significance. Script training emphasizes on improving the fluency of speech, attempts to restore the effortless, natural, and automatic language production for patients specifically with Broca\\\'s aphasia.6
Aphasia requires a long-term follow up treatment to ensure their contribution in full range of professional and social activities.7 So it is necessary to make script training a cost-effective medium using the facility of video calling/recordings to ensure to receive extensive script training sessions. This continuous help highlights the improvement of conversational skills and facilitates their involvement in everyday life activities.3
Regular speech therapy is an expensive treatment, and relatively neglectful for the patient\\\'s immediate needs, thus creating an alarming situation. Providing treatment facilities the latest treatment strategies like script training will obtain positive outcomes sooner. With the limited availability of speech disorder rehabilitation services in Pakistan, it will help these patients to restore their lost communicative ability with confidence and can assist in making them active member of their speech community, not a social burden.

1.Ahlsén E. Introduction to neurolinguistics. John Benjamins Publishing; 2006.
2.Davidson B, Howe T, Worrall L, Hickson L, Togher L. Social participation for older people with aphasia: the impact of communication disability on friendships. Topics stroke rehabilitation. 2008;15:325-40.
3.Jafar T. Blood pressure, diabetes, and increased dietary salt associated with stroke-results from a community-based study in Pakistan. J Human hypertens. 2006;20:83-5.
4.Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Physical Med Rehab. 2010; 91:196-202.
5.Blom Johansson M. Aphasia and communication in everyday life: Experiences of persons with aphasia, significant others, and speech-language pathologists, 2012. Doctoral Thesis. Uppsala: Acta Universitatis Uppsaliensis; 2012. 101p.
6.Youmans G, Holland A, Muñoz M, Bourgeois M. Script training and automaticity in two individuals with aphasia. Aphasiology. 2005;19(3-5):435-50.
7.Goldberg S, Haley KL, Jacks A. Script training and generalization for people with aphasia. Am J Speech-Language Pathol. 2012; 21: 222-38.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: