Reduced Syntax Therapy

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The Reduced syntax therapy (REST) is a speech therapy method for the treatment of severe Agrammatismus whose aim is the syntactic structure of spontaneous speech to improve a person and so to expand their language of communication.

requirements

In order for Reduced Syntax Therapy to be used as a therapeutic measure, a person must have been diagnosed with a grammatical spontaneous speech. It is a way of speaking that is characterized by the following features:

Patients who are treated with the REST method are therefore those whose spontaneous speech at the beginning of the therapy consists practically only of one to two word utterances and who use (almost) no finite verbs and only a few functional words. People who can easily produce finite verb forms and utterances with multiple syntactic constituents are not intended for this therapy method.

Further conditions for using the REST are:

  • It should be possible for the patient to name images with frequent morphologically simple nouns and verbs without too much retrieval problems.
  • A good understanding of language by the patient is beneficial. If the receptive skills are insufficient, however, speech comprehension exercises must be done parallel to the individual therapy phases.
  • It is beneficial for the success of the therapy if the written language is also included in the REST as a support.

Basics and aim of therapy

The therapeutic approaches to the treatment of agrammatism can be summarized in different groups of methods. REST is a so-called strategy-oriented approach. It is assumed that similar symptoms on the linguistic surface (such as agrammatic spontaneous speech) can be caused by different disorders. The aim of therapy in this regard is the reorganization of specific linguistic and cognitive processing routes, i.e. H. the optimization of routes received, the modification of disturbed processes and the development of compensatory strategies. In each individual case, therefore, specially suitable therapeutic measures are taken.

The therapeutic goal of the approach used in reduced syntax therapy is not based on the linguistic norm. It must be made clear to the patient that the only goal is to be able to convey more content in everyday conversations without having to pay attention to the correct sentence form.

Therapeutic approach

The patients are stimulated to retrieve syntactic structural fragments holistically and to express them without further morphological-syntactic processing. It is helpful if there is as close a semantic relationship as possible between the content words of the individual syntactic constituents at the beginning of therapy , because this makes it easier to call up the lexemes from the mental lexicon . The development of the linguistic structures in the patient takes place in several, precisely defined therapy phases that systematically build on one another.

Phase 1

The therapeutic goal is that the patient can make utterances with two syntactic constituents, each constituent consisting of only one word. The sentence fragments given by the therapist consist of an infinite verb and a direct object or an adverb , whereby the syntactic structure corresponds to that of a verb phrase with an infinite verb at the end. The patients are presented with images of activities such as “drinking coffee”, “washing hands” or “watering flowers”. Both words must be uttered in a unit of intonation by the patient when reproducing .

First, the receptive understanding of the object-verb connection is checked by giving the above utterances aurally and the patient should point to the corresponding figure. If this succeeds safely, a semantically narrower selection set is given, in which the noun and the verb changes once, e.g. B. "Cut bread / eat bread / cut sausage / eat sausage".

To train the structures, exercises are useful in which the patient should give elliptical utterances, e.g. B .: “Monika wants to bake cakes today. What does Monika want to do today? ”-“ Bake cakes ”.

Try to activate two-word utterances in spontaneous speech as early as possible . Questions about the daily routine are particularly suitable. The perfect forms are also used, which often do not cause problems for the patient, e.g. B. "Drank tea".

However, a common problem for patients is that many frequent verbs, mainly verbs with a prefix , are morphologically complex. In many cases, therefore, exercises with complex verbs such as “an-” versus “make out” or “open” versus “close” are necessary. It is suitable u. a. following exercise: The therapist and the patient each claim the opposite in a feigned argument. So says the therapist z. For example: "Open the door" and the patient says: "Close the door".

Phase 2

In this phase, prepositional phrases are introduced which - like the objects and adverbs - are closely tied to the verb and are therefore part of the verb phrase.

At this stage, it is also important to work on differentiating the meaning of prepositions . This can be practiced well by contrasting pairs such as “went to Cologne” versus “came from Cologne”.

Phase 3

Usually, the transition from phase 2 to phase 3 is a critical step in therapy that some, but not all, patients can manage. Phase 3 only begins when the structures from the previous phases can be called up fluently in the exercise situation and can often be observed in spontaneous speech.

In phase 3, the structures from phases 1 and 2 are expanded by three additional structures:

These structures with subject are more difficult because they are syntactically more complex and probably not fully accessible as sentence fragments in the syntactic network. They also do not correspond to the elliptical structures of normal colloquial language.

For structures without an object, only intransitive verbs should be used so that patients get used to verbalizing the object in transitive verbs. In order to work out these structures, the patient is told that every utterance must contain information on the agent , patient and verb, according to the scheme: "Who did what?"

It is also important to convey to the patient that he will only include the subject in the utterance if this is pragmatic , i.e. H. if it is not identical to the speaker or if it is not already mentioned in the context.

Phase 4

In this phase, the structures of phases 1 - 3 are expanded by free additions, e.g. B. the form "I bought a dress from H&M." - "I bought a dress from H&M."

It is usually easier for patients if a fixed position in the sentence is initially given for a new constituent. Free additions of the time should be used as the first constituent in the sentence and free additions of the place should be placed at the end of the sentence, e.g. For example: "Take a trip tomorrow" or "Book bought in Füssen". The fixed sequence for the therapy could therefore be: “When / who / what did / where”.

Prepositional phrases that are part of the verb phrase should be placed immediately in front of the verb, as in: "Frau went to the cinema".

Phase 5

In the last phase, the structures are expanded by selecting bit-transitive verbs and stimulating them with direct and indirect objects - verbs like “give”, “dedicate”, “forbid”, “accuse”.

Overview of the therapy phases
Therapeutic
phase 		syntactic constituents
(syntactic function) 		Examples
1 NP - V
(direct object - infinite verb) 		Writing letters
having drunk coffee
AP - V
(adverb - infinite verb) 		slept badly
waited a long time
2 PP - V
(adverbial - infinite verb) 		went to Cologne
to climb a tree
3 NP - V
(subject - infinite verb) 		Woman slept
Peter cried
NP - NP - V
(subject - object - infinite verb) 		Willi Haus bought
Kati's broken leg
NP - AP - V
(subject - adverb - infinite verb) 		Otto laughed out loud.
Erika drove quickly
NP - PP - V
(subject - adverbial - infinite verb) 		Luise drove to Füssen
Klaus fly to London
4th AP / PP -… -… - V (- AP / PP)
(time -… -… - infinite verb (- place)) 		yesterday (Willi) bought
Kati leg broken house in Munich
5 ... - NP - NP - V - ...
(indirect object - direct object - infinite verb) 		(Otto) Egon stole 5 euros.
(Fritz) Lisa wrote a letter

AP = adverbial phrase
NP = noun phrase
PP = prepositional phrase
V = infinite (transitive or intransitive) verb

Therapy study

Anja Hegemann also discusses a study by Schlenck et al. There, 11 severely agrammatic patients with the onset of the disorder more than 12 months ago and pretreatment with intensive syntax therapy were treated with REST either daily for 6 weeks or three times a week for 12 weeks. On average, a significant increase in two-component utterances and, to a lesser extent, three-component utterances was achieved. A control examination was carried out 10-18 months later in 4 of the persons examined, in which 3 patients showed a stable treatment result and one person showed a slight relapse to the increased use of single-constituent expressions.

literature

  • C. Schlenck, KJ Schlenk, L. Springer: The treatment of severe agrammatism, reduced syntax therapy (REST). Georg Thieme Verlag, Stuttgart 1995.
  • Anja Hegemann: Agrammatic language production. Considerations on symptoms, diagnosis and therapy. Inaugural dissertation to obtain the doctoral degree of the curative education faculty of the University of Cologne in 2004. [kups.ub.uni-koeln.de/1235/ Cologne publication server]

Individual evidence

  1. ^ A. Hegemann: Agrammatic language production. Cologne 2004, DNB 972405054 , p. 202. Above in the text phrase adoption. The work is made available by the University of Cologne.
  2. ↑ C. Schlenck, K.-J. Schlenck, L. Springer: The treatment of severe agrammatism. Reduced Syntax Therapy (REST). Stuttgart 1995, ISBN 3-13-100181-X , p. 46ff.