Script Training in Nonfluent/Agrammatic-Primary Progressive Aphasia
An evidence-based approach to managing communication deficits is critical to therapeutic success. In the current case, we describe an approach to therapy for an individual with nonfluent/agrammatic-primary progressive aphasia (nf-PPA) based on patient history, as well as his social, community, and vocational environment, and best clinical evidence.
BH, a 64-year-old, right-handed man, was actively employed as a pharmacist. He presented with a 4-year history of decline in communicative function. Early in this decline, he was incorrectly diagnosed with Alzheimer’s disease. He then received a thorough neurological assessment. On examination, BH was alert and oriented to person, place, and time. He named all of the pictures on the NIH Stroke Scale and followed a three-step command. His speech was hesitant and groping, and he made inconsistent errors when producing multisyllabic words. He repeated “no ifs, ands, or buts” and was able to spell WORLD forward and backward. When presented with words to remember, he was able to register 3/3 words and recalled all three words after a 10-minute delay. He was able to copy the intersecting pentagon figure and drew a clock with properly placed numbers and hands. BH’s pupils were equal and reactive to light, his visual fields were full, and his extraocular movements were full without nystagmus. His facial movements and palatal elevation were symmetric, and his tongue protruded at midline. BH did not demonstrate arm drift, focal weakness, or dysmetria. He was able to walk on a narrow base and perform a tandem walk without difficulty. Magnetic resonance imaging indicated minimal ischemic white matter changes in the left periventricular regions. Based on this assessment, with the primary findings being issues with motor speech production, the neurologist diagnosed BH with a primary progressive apraxia of speech (AOS). He was referred for a speech and language evaluation and treatment.