Ken was a quiet older gentleman who never initiated conversation. He had a great sense of humor, and would respond with short quips, but rarely said anything to extend a conversation. I was about to discharge him when I learned about Attentive Reading and Constrained Summarization (ARCS). Read on to learn how ARCS improved his conversation skills.
Free DIRECT download: Rules for retelling or summarizing (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- Learn about Ken.
- A quick refresher on ARCS.
- How I modified ARCS-W for Ken.
- The home exercise program.
- Extending the exercise to television.
- How Ken improved.
- If you’ve used ARCS, how did it go?
- Related Eat, Speak, & Think posts.
- Recommended reading.
Learn about Ken
Ken was in his late 60s, retired, and living with his wife. He had experienced a couple of strokes, leaving him with physical and cognitive-linguistic impairments. I’d been seeing him for a few months, working on word retrieval, safety, reasoning, and problem solving.
While he made progress in multiple areas, and always completed the assigned exercises, he didn’t make any noticeable progress at the conversation level. In all the weeks I’d been going, he never initiated conversation. He’d typically respond to efforts to get him to talk, but often with long hesitations. And his responses were usually very short and humorous. He rarely said anything to keep the conversation ball rolling. His wife said that he was no different with anyone else, including her.
I was ready to discharge him from speech therapy when I learned about ARCS from an ASHA continuing education course. Ken and his wife both wanted to try it, so we continued with therapy. My ultimate goal was to teach Ken and his wife how to do it on their own so that they could continue after I discharged.
A quick refresher on ARCS
I recently wrote a tutorial on ARCS, but here’s the basic format.
- Find an interesting article written around a grade 5 level.
- Ask your patient to read or listen to the entire thing to get familiar with the content.
- Have your patient read the first 2-3 sentences.
- Ask your patient to summarize in their own words, without looking at the text.
- RULES: Use only specific words and don’t add any extraneous information.
Continue in this way until you reach the end.
ARCS was also modified to include writing. Basically, ARCS-W expands on the above steps:
- After reading 2-3 sentences, ask your patient to write down the key words and phrases.
- You also write them down. Ask your patient to compare their list with yours, discuss the differences, and keep the agreed-upon key words and phrases.
- Your patient would then use the final list to summarize what they just read.
How I modified ARCS-W for Ken
I tried the basic ARCS format with Ken, but he had too much difficulty remembering details. So I added the writing component, which I’ve often found to help with recall.
However, this revealed a new issue. When asked to write down a list of key words or phrases, Ken tended to write down entire clauses or even copy sentences.
I tried to instruct and model how to identify just the key idea in each sentence, but that didn’t seem to help. So I changed this step to provide additional support, as well as to keep the exercise moving.
When it was time to identify the key words and phrases, I asked him tell me what the key words were. We’d discuss it, then when we agreed, I asked him to highlight just those words.
Once we agreed on all the key words and phrases in that section, I asked him to copy the highlighted words and phrases down in a list.
Then he would use that list to summarize the section he’d just read.
We worked through the entire article in this manner, paragraph by paragraph.
Once he had listed the key words and phrases for the entire article, I asked him to retell the entire article using just the list. Occasionally he would require a cue to stay on topic during the retell, but in general, he did quite well.
The home exercise program
At each session, I provided a new article for Ken to use as an exercise with his wife’s assistance. Ken read the article. Then for each sentence, he would identify the key word or phrase. He and his wife would discuss, and when they reached agreement, Ken highlighted it.
After he highlighted words or phrases, he added them to his list.
Then once he reached the end of a paragraph, he summarized it in his own words while referring to his list.
When I returned for the next session, he’d use his list to retell the entire article.
Sometimes, his list of key words and phrases was sufficient for him to recall the article. Other times, the list was too brief to prompt his memory, and I had him reread the article before using the list to retell it.
Extending the exercise to television
Ken preferred watching television to reading, and he spent much of each day in front of the TV. I wanted to make his preferred activity more cognitively stimulating and interactive, so I asked Ken to try summarizing what he’d just watched to his wife.
For instance, he could pause or mute the TV after a news story or when a commercial came on to relate what he’d most recently seen. He could even try summarizing a commercial. Summarizing a news story or a commercial can be easier than summarizing the last several minutes of a program.
This worked quite well, as you can read in the next section.
How Ken improved
The last week I saw Ken, he initiated conversation with me, and he took two or three conversational turns without prompting. His wife said he’d started doing the same with her as well. She also reported that he was giving her an update on what she’d missed on TV when she returned to the living room.
This represents a significant improvement from his baseline, which was basically to respond only when spoken to. And even that was slow and limited.
Not only did Ken improve in his initiation and conversational turn taking, he also improved the length of his utterances and the cohesion of his conversation. His picture description narrative upon discharge was well-organized with a topic sentence characterizing the entire scene followed by concise sentences describing all the pertinent action.
If you’ve used ARCS, how did it go?
Have you used ARCS? If so, how did it go? Did you modify the exercise? If you haven’t used ARCS or ARCS-W yet, I’d encourage you to try.
Related Eat, Speak, & Think posts
- Attentive Reading and Constrained Summarization tutorial.
- Free multimedia resources for the SLP.
- Collaborative goal setting to identify meaning cognitive goals.
- Improve aphasia outcomes by creating intensive home exercise programs.
Recommended reading
- Obermeyer, J. A., & Edmonds, L. A. (2018). Attentive Reading with Constrained Summarization adapted to address written discourse in people with mild aphasia. American Journal of Speech-Language Pathology (27), 392-405. https://doi.org/10.1044/2017_AJSLP-16-0200
- Obermeyer, J. A., Rogalski, Y., & Edmonds, L. A. (2019). Attentive Reading with Constrained Summarization – Written, a multi-modality discourse-level treatment for mild aphasia. Aphasiology. https://doi.org/10.1080/02687038.2019.1686743
- Rogalski, Y., & Edmonds, L. A. (2008). Attentive Reading and Constrained Summarisation (ARCS) treatment in primary progressive aphasia: A case study. Aphasiology, 22(7), 763-775. https://doi.org/10.1080/02687030701803796
- Rogalski, Y., Edmonds, L. A., Daly, V. R., & Gardner, M. J. (2013). Attentive Reading and Constrained Summarisation (ARCS) discourse treatment for chronic Wernicke’s aphasia. Aphasiology. https://www.tandfonline.com/doi/abs/10.1080/02687038.2013.810327
Free DIRECT download: Rules for retelling or summarizing (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Image by Pexels-2286921 from pixabay.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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