Aphasia Intervention Strategy: PACE a Practical Approach for Improving Communication skills

Aphasia is a language impairment that affects verbal communication, comprehension, reading, writing, and gestural expression. Aphasia often caused by a stroke. It can impact different levels of language processing, making it difficult for individuals to express and understand language.

Promoting Aphasics Communication Effectiveness (PACE) is an intervention approach designed for non-verbal individuals with aphasia. It encourages communication using the most accessible and effective modalities for the individual, such as gestures, drawing, and/or other alternative communication methods. The goal of PACE is to create a natural conversational setting where both the person with aphasia and their communication partner takes equal turns sharing and interpreting messages. 

                    

Patient population                

This approach can be implemented for individuals with severe expressive aphasia which may have very limited verbal ability or be completely non-verbal. 

Also, this technique is designed for patients with mild and moderate aphasia which may have occasional word-finding difficulties, difficulty in forming sentences and understanding complex language.

Contraindications               

The PACE may not be ideal for those with moderate to severe receptive aphasia (Wernicke's aphasia) due to difficulties in understanding spoken or written messages, leading to communication breakdown. 

Key principals and procedure                

This approach creates a natural two- way communication while involving both presenter (sender) and receiver. The individual is encouraged to use any method to convey the message in a meaningful and practical way similar to real world conversation. 

    How to do PACE

📌Step -01 

• A set of pictures, objects or prompts can be used for message exchange process. 

📌Step -02 

•  The sender picks a message (Eg- a picture or word) and communicates using any method. The receiver needs to interpret the message and provide feedback. 

Methods can be used during the communication

📂Gestures (Hand movements, Pointing)   

📂Facial expressions (emotions)

📂Drawing (sketching idea or the object)

📂Writing (write key words or sentence)

📂Speech (If possible)      

Drawing/ Writing 

Gestures 

                   

 

📌Step -03

• Repetition, Alternative methods or clarification can be used if needed during the activity. The therapist needs to support and encourage successful communication (while taking turns) rather than focusing on correctness. 

 📌Step -04

• Therapist needs to reinforce successful communication and adapt the communication methods based on the patient's abilities. 

Video demonstration                   

Sample outcome recording sheet                     

Home based activities                    

Home-based activities in PACE technique helps individuals with aphasia to practice communication using different modalities in natural settings. Family member/ Friend or Caregiver or can participate as communication partners during the following activities. 

📝Daily objects identification task 

• Pick any household items like key, cup, brush, scissor, pen (at least 10 for one trial). Follow the same procedure in PACE and communicate the name and/ or function using any communication method. 

📝Making a shopping list 

• This task encourages a real-world communication practice. sender and receiver need to make a grocery list together. Person with aphasia need to use the trained communication methods to add his/ her preferred items to the list. 

 

📝Practice daily actions 

• Sender and receiver can act out or express daily actions or small phrases (Eg- opening a door, turn on the tv, brushing teeth) using trained communication methods. 

In conclusion, Promoting Aphasics Communication Effectiveness (PACE) is a therapy approach designed to improve functional communication in individuals with aphasia. It allows to communicate through any communication modality such as gestures, drawing, writing, and speech, focusing on functional and successful message exchange. This approach helps to reduce frustrations, increase independence, improve confidence in individuals with aphasia by promoting flexible communication in real life interactions.