When we work on saying a word in the clinic, we often expect that the same word will be more easily produced in conversation. This is called generalization. What we do in therapy generalizes to real life.

But unfortunately, generalization is not guaranteed. Our “train and hope” technique isn’t usually all that effective. A lot of research has been done on exactly what it takes to generalize speech therapy for aphasia, and the results are, well, messy.

I’ve had the pleasure of reading through the 43-page chapter on generalization in the book Aphasia Rehabilitation: Clinical Challenges, and I’d like to share my take-aways with you.

While we often talk about generalization like it’s a single thing, there are actually 2 main types of generalization:

1. Response generalization, or being able to do the same thing you did in therapy, but with untrained stimuli. For example, if therapy works on saying the words “apple”, “orange”, and “pineapple”, you might think the person will then be able to say “banana” without practice.
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2. Stimulus generalization, or being able to use the same word, structure, or skill in another setting or context. For example, if therapy works on saying “I’m done” when an activity is complete in the clinic, you might think the person will then be able to say “I’m done” when they’ve finished a meal or they’ve completed a task at home.

Since each type of generalization has different approaches to enhance it (and factors that limit it), it’s important to decide which kind of generalization you want to achieve or what you are measuring.

Important Factors in Generalization

While we can’t always control this, it’s interesting to note that most generalization happens when the person has strong cognitive skills. People who are more aware of what’s working and what’s not, and who are good at remembering to use internalized strategies, tend to generalize to new words and contexts more easily.

For example, the treatment called Semantic Feature Analysis is good at helping people recall the words they practice, but it doesn’t tend to generalize to untrained words. However, people who are prompted to come up with their own cues and walk themselves through the describing process are better able to apply the process to new words or to word-finding gaps during a conversation. This makes it important to encourage independence as soon as possible.

We should also know that generalization is only going to happen if the treatment is successful, and it’s most likely to happen for items or situations that most closely resemble the training. For example, if you’re drilling a specific sentence structure, you’re more likely to hear other sentences with the same structure used – if your drill work is effective.

7 Things You Can Do To Increase Generalization:

1. Work on sentences instead of individual nouns or verbs. A treatment like Verb Network Strengthening Treatment (VNeST) is excellent for this and has been shown to generalize to untrained verbs.
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   Read how to do VNeST and then use our Advanced Naming Therapy app to get lots of practice using the Create activity.
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2. Use “loose training”, or activities that aren’t so rigid. Response Elaboration Training (RET) and Script Training with variable prompts are two examples of this type of flexible therapy that can build confidence, helping the skills generalize to less structured situations.
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   Read how to do RET on our website and download a free data tracking sheet.
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3. Pick harder targets in therapy. The Complexity Account of Treatment Efficacy (CATE) suggests that working on more complex sentence structures or less typical words will generalize to simpler or more typical items without training.
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   You can use harder levels in Advanced Comprehension Therapy or Number Therapy with support if they’re not too frustrating. Use the harder activities called Add One and Exclude in Category Therapy and you may see the Find and Classify activities come easier.
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4. Teach strategies rather than specific words. Learning to self-cue, describe, or rely on a word-finding strategy will be useful in more contexts than memorizing a list of words.
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   Download a list of word-finding strategies here! Print the list and leave it in front of your client while using Naming Therapy, Advanced Naming Therapy, or Conversation Therapy. When a breakdown in word-finding happens, ask them to consciously choose which strategy to try.
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5. Target specific language processes rather than a specific skill or language modality. Sometimes a task that’s done in writing will generalize to speech, provided the therapy is addressing the underlying language breakdown common to both forms of expression, such as semantic retrieval, provided that the orthographic and phonological output lexicons are both in-tact.
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   The Build activity in Advanced Comprehension Therapy doesn’t require speaking or writing, but it may help with both by activating syntactic awareness.
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6. Use functional targets that are likely to be used multiple times a day for a greater chance of generalizing to other situations or conversation partners. Even if there is no generalization to other items, at least the ones you’ve worked on are useful.
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   This is why we encourage you to select only the words your client wants to practice and even add your own words to our Language Therapy 4-in-1 app! Add a dog’s name or favorite foods, then remove the items you don’t need from the app through the Settings. Or use the Phrases in Apraxia Therapy that are most useful in everyday life.
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7. Encourage home practice. Home practice is often essential for getting enough intensity of practice and exposure to enough stimuli.
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   I think you know what I’m going to say here. The Tactus Therapy apps are perfect for home practice! Use them in the clinic while doing skilled therapy, then encourage your clients to practice at home with the same tools, sending reports back to you for monitoring. Download a free app prescription pad here.

I hope this is helpful! We still have a lot to learn about generalization, but this information should get you past “train and hope” and more confidently selecting treatments that will benefit your clients with aphasia.

All the best,

Megan

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P.S. If you’d like to read the full chapter, you can buy a copy of the book through our Amazon affiliate link. Here’s the citation: