Source For Aphasia
Source For Aphasia
Lisa A. Arnold
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Receptive Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Imitating Common Gestures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Imitating Gestures with Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Understanding Gestures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Single-Stage Commands (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Two-Stage Commands (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Body Part Identification (3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Object Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Picture Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Picture ID Using an AAC Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Word ID Using an AAC Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Identifying Common Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Simple Yes/No Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Moderate Yes/No Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Complex Yes/No Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Simple Paragraphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Moderate Paragraphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Complex Paragraphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Reading Comprehension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Letter Matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Letter Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Word Matching with Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Word Matching without Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Word ID with Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Word ID without Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Phrase Matching with Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Phrase ID with Reduced Cueing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Sentence ID with Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Sentence ID without Pictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Question Comprehension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Paragraph Comprehension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Aphasia is often extremely frustrating for the client and his family/caregivers.
The client suffers because he has a decreased functional system of communica-
tion. And because of this language breakdown, many family members feel their
loved ones are now becoming mentally ill or senile. This could not be further
from the truth. From my years of experience dealing with clients suffering from
psychosis and dementia, I’ve learned that aphasia often does not mimic these
other neurological impairments. Aphasia resulting from stroke in the absence of
any previous neurological difficulties such as dementia, is usually free of any
memory or cognitive impairment. Simply stated, aphasia is a language disorder.
I’ve written this book as a therapy guide with the most important remediation
activities for easing receptive and expressive aphasia. As clinicians, we must
often prioritize our treatment programs for aphasic clients. In other words, we
need to identify and remediate the most important and functional areas first,
then move to higher level treatments such as writing. I believe that a client who
undergoes the kind of aphasia therapy offered in this book is not “relearning”
language. Rather he is reminding the brain of language that is still there in the
neurological center. The language just needs nudging and cueing to resurface.
The Source for Aphasia Therapy is packed with functional tasks and simple com-
pensatory techniques. The activities are easy and inexpensive enough to teach
them to the client’s family members, caregivers, and even friends. These strate-
gies are vital for successful aphasia therapy and are meant to be used until inde-
pendence is reached, or until the client/caregivers are effectively using func-
tional strategies and cueing mechanisms.
Throughout the the book, the pronouns he and him are used to refer to the client
merely for the sake of the book’s consistency. Of course the book is for female as
well as male clients.
It’s often difficult to define receptive language to clients and their caregivers.
I’ve found that using words like “understanding” or “comprehension” to
describe receptive language functions, seems to convey a clearer meaning of
your therapy focus to others. Because receptive language is not visible like
expressive communication, family members or caregivers may become confused
regarding the SLP’s remediation tactics. It’s your obligation to educate these
individuals and assure them that expressive communication will also be re-
mediated, but that receptive language skills simply cannot be ignored.
The activities in this section provide a wide range of stimulus items designed to
increase receptive language in the aphasic client. It is vital to begin these ther-
apy approaches at a level appropriate for the client and to continue with that
level from activity to activity. Eventually, the client should reach a plateau where
skill levels stabilize and further improvement is unlikely. Work closely with
other disciplines (PT, OT, RN, Activities, etc.) to discover what receptive lan-
guage difficulties are most frustrating for the client and staff members.
I’ve tried to devise user-friendly activities that require little or no preparation for
the clinician. You will also note that the number of stimulus items for most activ-
ities is large. Most of your clients will need to practice a skill over and over
before proficiency is gained. We all become bored using the same items over and
over. Enjoy the variety.
As a therapist, I’ve been in your shoes. I’ve used other receptive language work-
books that seemed to just miss the mark. I hope that using these receptive
language activities will provide clients with steady success and clinicians with
the opportunity to watch that incredible transformation.
Instructions: Perform each gesture. Then ask the client to imitate you and also have him
say a word associated with the gesture, such as wave, hi, or goodbye. Present
happy facial expressions and comfortable body language as your primary
mode of communication. Don’t give a lot of commands because excessive
verbalizations to a client who understands very little spoken language might
frighten or frustrate him. Tell the client, “Just do what I do.”
• Use index cards with single words or short phrases associated with the ges-
tures to provide additional visual cues.
• Pair movement with music if the client enjoys this type of therapeutic inter-
vention. Occasionally a client’s comprehension of written language is much
better than his comprehension of spoken language.
Activity: Perform these common gestures and ask the client to model or imitate them.
Verbalize the command as you perform it.
1. Smile.
2. Wave hello.
3. Cross your arms.
4. Cover your eyes with your hands.
5. Open your mouth widely as if surprised.
6. Close your eyes.
7. Hold your nose as if something smells bad.
8. Hold your forehead as if you have a bad headache.
9. Place your hands on your hips as if you are angry.
10. Clap your hands.
11. Stick out your tongue.
12. Kiss your hand.
13. Nod your head as if agreeing.
14. Shake your head from side to side.
15. Place your finger over your mouth as if to say, “shhh.”
Instructions: Fill a grocery bag with the following functional items or common items avail-
able to you: cup, spoon, bowl, pencil, paper, hairbrush, comb, washcloth,
toothbrush, lipstick/lip balm (client’s), lotion, napkin, toothpicks, dental floss,
hand mirror, watch, magazine, and hat or ball cap. You can usually find these
items in the client’s hospital room. Place each object one at a time on the
client’s hospital table. Model the appropriate gesture with the object and ask
the client to imitate your gesture. Verbalize the command as you model the
gesture, and say it again as the client imitates the gesture. Increasing verbaliza-
tions helps the client make associations between spoken commands and
gestures.
Compensatory • Use hand-over-hand assistance to mold the client’s bodily movements into
Strategies: appropriate actions if necessary.
• Use index cards as written, visual cues. Fold the cards and place them on
the client’s portable dining table in his hospital room.
Activity: Perform these common gestures and ask the client to model or imitate them.
Verbalize the command as you perform it.
1. Drink from a cup.
2. Eat with a spoon and bowl.
3. Write with a pencil and paper.
4. Brush or comb your hair.
5. Wipe your face with a washcloth.
6. Brush your teeth.
7. Put on lipstick or lip balm.
8. Put on lotion.
9. Wipe your mouth with a napkin.
10. Pick your teeth with a toothpick.
11. Floss your teeth with dental floss.
12. Hold up a hand mirror to see your face.
13. Look at a watch for the time.
14. Open a magazine and thumb through the pages.
15. Put on a hat or ball cap.
Goal: The client will increase auditory comprehension and receptive language to
within functional limits for following gestural commands during various
activities throughout the day.
Instructions: In this activity, you will perform common gestures, and the client will model
your gestures. It’s best to do this activity when the client either grooms him-
self or performs therapeutic activities. Keep verbalizations to a minimum.
The listed activities are suggestions. Feel free to substitute common gestures
that are more appropriate to you or your client.
• Keep objects appropriate to the activity nearby. For example, have the
toothbrush and toothpaste right in front of the client for the first activity.
Sometimes just seeing the object serves as an automatic cue.
Activity: Perform these gestures and ask the client to model them.
1. Brush your teeth.
2. Brush your hair.
3. Eat.
4. Drink.
5. Wash your face or hands.
6. Sit up in bed.
7. Raise an arm.
8. Raise a leg.
9. Sit down.
10. Lean forward.
11. Dry your hands.
12. Rest.
13. Stand up.
14. Look up at the ceiling.
15. Turn around.
Goal: The client will increase the ability to follow single-stage commands to 80-90%
accuracy.
Instructions: Give the client each command and ask him to do exactly what you say. Tell
him you’re trying to work on his ability to understand simple directions.
Explain that this type of task will help him follow directions in other settings
such as physical therapy and/or special events and activities.
• For clients who can read some words, you can use index cards with written
commands to augment the verbal commands.
Activity: Give the commands to the client and ask him to follow them.
1. Look up at the ceiling.
2. Look out the window.
3. Point to the door.
4. Place your hand on your stomach.
5. Open your mouth.
6. Stick out your tongue.
7. Clap your hands.
8. Put your hands over your ears.
9. Point to the light.
10. Raise your arm up high.
11. Cross your arms.
12. Close your eyes.
13. Point to the floor.
14. Put your hand on top of your head.
15. Snap your fingers.
Goal: The client will increase the ability to follow single-stage commands to 80-90%
accuracy.
Instructions: Place the following objects in a large plastic bowl or tub: pencil, pen, car keys,
spoon, notepad, envelope, dollar bill, quarter, blank check, and greeting card.
Ask the client to retrieve an item, take it out of the tub, and place it on the
table. After all items have been taken out, ask the client to place the items back
in the tub, one at a time, following your command.
• Write the name of each object on an index card if the client responds better
to this therapy.
Goal: The client will increase the ability to follow two-stage commands to 80-90%
accuracy.
• Write the name of each object on an index card if the client responds better
to this therapy.
Goal: The client will increase the ability to follow two-stage commands to 80-90%
accuracy.
Instructions: In this activity, you are helping the client move from dealing with objects to
dealing with pictures. Polaroid® photographs are a great way to make the
transition between a real object and a black and white line drawing. Take
photos of at least 20 functional objects in the client’s environment, for example:
soap, washcloth, toothbrush, towel, TV, etc. (You can also get some ideas for
objects from the Core Vocabulary Pictures on pages 22 and 23.) Place the pho-
tos on a table in front of the client. Tell him you will ask him to point to two
pictures at a time in the order that you tell him. Tell him not to point until you
say, “Go.” After each trial, move the pictures to various locations for variety.
• Review each photograph with the client before the activity begins and ver-
bally identify each photo if necessary. If a client is having trouble, start the
activity with a visual field of 10 pictures and work your way up to 20.
Activity: Take 20 photographs and lay them out randomly in front of the client. Ask
him to identify pictures two at a time. Use photos of objects that are appro-
priate and convenient for your situation.
Goal: The client will increase awareness of body parts and their positions in space
and identify specific body parts to 80-90% accuracy.
Instructions: Stand the client in front of a body-length mirror so he can see his entire body.
Repeat the commands and have the client identify the body parts on his own
body. Tell him that right and left is reversed in a mirror. Explain that the activ-
ity will get harder as it progresses.
• If the client is having trouble with the right/left aspect of the last few items,
don’t frustrate him by continuing with this difficult task until you’ve come
up with some specific compensatory strategies. If the mirror confuses him,
don’t use it.
Activity: Have the client identify the following body parts on his own body while stand-
ing in front of a mirror.
1. Point to your head. 21. Point to your forehead.
2. Point to a foot. 22. Show me a cheek.
3. Point to your stomach. 23. Show me an ear.
4. Point to a shoulder. 24. Show me your chest.
5. Point to a leg. 25. Point to a thumb.
6. Point to your nose. 26. Show me your left ear.
7. Point to a knee. 27. Show me your right hand.
8. Show me an ankle. 28. Point to your right leg.
9. Show me a wrist. 29. Point to your left cheek.
10. Point to your neck. 30. Point to your right eye.
11. Point to your waist. 31. Show me your left leg.
12. Point to an eyebrow. 32. Show me your right knee.
13. Show me a thigh. 33. Point to your right elbow.
14. Show me an eye. 34. Point to your right ear.
15. Point to your hair. 35. Show me your left foot.
16. Point to a hand. 36. Show me your right thumb.
17. Point to some toes. 37. Show me your right cheek.
18. Show me a hip. 38. Point to your left hip.
19. Point to some fingers. 39. Point to your left knee.
20. Point to your left eye. 40. Show me your right foot.
Goal: The client will increase awareness of body parts and their positions in space
and identify specific body parts to 80-90% accuracy.
Instructions: Show the client the pictures of the face on page 16 and of the body on page 17.
Tell him you will name specific body parts and that he will point to each one
you name. Explain that the activity will get harder as it progresses. Repeat
commands when necessary.
Compensatory • If necessary, point to the actual part on yourself or the client as you give the
Strategies: verbal command.
• Write the name of each body part on a cue card.
Activity: Name a body part and ask the client to point to the named part on one of the
pictures. Start each command with the phrase, “Point to the chin,” or “Show
me the leg.” Increase the difficulty of the activity by naming more specific
parts; for example, “Show me the right leg.”
Goal: The client will increase awareness of body parts and their positions in space
and identify specific body parts to 80-90% accuracy.
Instructions: Photocopy the face and body diagrams on pages 18 and 19. Cut out the body
parts along the perforated lines and place the parts randomly in front of the
client. Name a body part. Ask the client to pick up each part and put the parts
together to form a face or body.
Compensatory • If the client is having trouble constructing the face or body because the
Strategies: pieces are too small or are unrecognizable, point with a pencil to certain
parts or start with easily identifiable parts like the eyes and hair.
Activity: Cut up the following two diagrams and lay out the parts randomly in front of
the client. Name a body part. Have the client pick up the correct one and ask
him to put the parts together to make a complete person. Then ask him to put
each body part picture into an envelope as you name it.
Goal: The client will increase auditory comprehension to 90% accuracy for object
identification in gradually increasing visual fields.
Instructions: Gather some common, functional objects like a toothbrush, towel, comb, etc.,
or some that are based on the Core Vocabulary Pictures on pages 22 and 23
(not the pictures themselves). Start the activity by putting two objects in front
of the client. Name one of the objects and ask him to pick up the correct one.
Once the client reaches 90% accuracy in a visual field of two objects, progress
to four, six, eight objects, etc.
• For some lower-level clients, name both objects before naming the targeted
object.
Activity: Place two objects in front of the client. Name one and ask him to choose the
one you named. Progress to four, six, and eight objects if appropriate.
Goal: The client will increase auditory comprehension to 90% accuracy for picture
identification in gradually increasing visual fields.
Instructions: Photocopy the Core Vocabulary Pictures on pages 22 and 23. Choose appro-
priate pictures. Cut out the pictures you’ll use. As in the Object Identification
activity on page 20, start this activity by placing two pictures in front of the
client. Name one and ask him to point to the correct one. When the client
reaches 90% accuracy in a visual field of two, move to four, six, and eight pic-
tures, until you find his maximum visual field for the activity.
Compensatory • For some lower-level clients, name both objects before naming the targeted
Strategies: object.
• If the client doesn’t understand the target word or can’t correctly identify
the object, guide his hand to the correct object as you repeat the word slowly
as many times as needed.
• Here are some other ideas for the pictures. Enlarge them. Laminate them.
Place velcro on the backs. Put the pictures on an upright board.
Activity: Place two pictures from the Core Vocabulary Pictures in front of the client.
Name one and ask him to choose the correct one. Progress to four, six, and
eight pictures if appropriate.
Goal: The client will increase the ability to identify meaningful pictures at the appro-
priate visual field level on an AAC board 80% of the time.
Instructions: With the client’s help, select a group of words from the Core Vocabulary
Pictures on pages 22 and 23 that are meaningful to your client or based on his
needs. Then construct an AAC (augmentative and alternative communication)
board. Use inexpensive, lightweight plywood or stiff cardboard backing to
make it. Glue, tape, or paste the pictures to the board in a configuration you
want. Name a picture and ask the client to point to the correct one, or ask the
client to name a picture and then have him point to the correct one.
• Vary the arrangement of the pictures on the board to compensate for visual
field cuts or neglect. Cover the AAC board with clear contact paper or some
type of lamination to protect it against damage.
• Use a one-inch silver ring to attach the board to the client’s wheelchair,
walker, or handbag to encourage more consistent use of the board.
• Reduce the size of the pictures so they can be carried in a wallet insert.
• Use a mouthstick or ask the OT for some tips to increase the client’s physical
abilities.
Activity: With the client’s help, choose several pictures from the Core Vocabulary
Pictures on pages 22 and 23. Photocopy them, cut them out, and arrange them
on an AAC board. Name the pictures and ask the client to identify them.
(A note on AAC boards: High-tech AAC devices are sometimes quite expen-
sive, and reimbursement for them is often difficult to obtain. Don’t view a
handmade AAC board as a therapy “failure.” You are providing the client
with a simple, functional communication system. With severely aphasic
clients, this is sometimes the best you can do.)
Goal: The client will increase auditory comprehension to 90% accuracy for object
word identification in gradually increasing visual fields.
Instructions: This activity is similar to the previous activity, Picture ID Using an AAC Board.
The activity is for the client who can still read, but is so severely expressively
aphasic, that an AAC word board is necessary. Use an AAC alphabet board if
the client can still sequence letters to spell words. With the client’s help, select
a group of words meaningful to your client from the Vocabulary Word Lists on
pages 26 and 27. There are 80 words—40 based on the Core Vocabulary Pic-
tures and 40 additional words. Photocopy pages 26 and 27, cut apart into sep-
arate words, and place single words in front of the client. Ask him to identify
the words as you name them. Following the instructions in the previous activ-
ity, construct or obtain an AAC board and attach the appropriate words. Name
a word and ask the client to point to the correct one, or ask the client to name a
word and then point to it.
Compensatory • Use an AAC notebook rather than a board for higher-level clients.
Strategies:
• Enlarge the words.
• Vary the arrangement of words on the board to compensate for visual field
cuts or neglect.
• Use a one-inch silver ring to attach the board to the client’s wheelchair,
walker, or handbag to encourage more consistent use of the board.
• Reduce the size of the words so they can be carried in a wallet insert.
• Use a mouth stick or inexpensive head pointer if necessary. Ask the OT for
some tips to increase physical abilities for your client.
• Have the client use the board in various situations outside of therapy; for
example, asking for medicine at the nurse’s station, selecting a favorite food
at dinner time, or participating in a group recreational activity.
Activity: With the client’s help, choose several words from the Vocabulary Word Lists on
pages 26 and 27. Photocopy them, cut them apart, and arrange the words on
an AAC board. Name the words and ask the client to identify them.
Goal: The client will increase the ability to understand common community signs to
90% accuracy.
Instructions: Photocopy the common community signs on pages 28 and 29. Cut them into
sections and affix them to index cards if you wish. Laminate them or cover
them with clear contact paper to protect them. Place 2-4 signs in front of the
client. Name a sign and ask him to point to the correct one. Work your way
up to four, ten, and twenty signs, if the client can name that many.
Activity: Place pictures of the common signs in front of the client two at a time. Affix
them to index cards if this is helpful. Name one and have him point to the cor-
rect one. Increase the visual field as appropriate.
NO
TURN
ON
RED
Goal: The client will increase auditory comprehension to 90% accuracy for simple
yes/no questions.
Instructions: Ask the client the following simple yes/no questions. Explain that the ques-
tions will get more difficult as the activity progresses.
• If the client thinks the questions are too simple or sound ridiculous, just con-
vince him they’ll get more difficult or agree with him. Do not condescend to
the client.
7. Is it raining outside?
8. Is it cold outside?
12. Is it daytime?
Goal: The client will increase auditory comprehension to 90% accuracy for moderate
yes/no questions.
Instructions: Ask the client the following moderately complex yes/no questions. Explain
that the questions will get more difficult as the activity progresses.
• If the client thinks the questions are too simple or sound ridiculous, just con-
vince him they’ll get more difficult or agree with him. Do not condescend to
the client.
Activity: Ask the client the following moderately complex yes/no questions.
6. Is today Monday?
15. Did you listen to the news on the radio this morning?
28. Do you think you will be able to drive when you leave here?
30. Will you be able to manage your finances when you leave here?
35. Will you be able to do yard work when you leave here?
45. Do you have three doors that lead in and out of your home?
48. Did you exercise on a regular basis before you became ill?
49. Would you normally eat a tossed salad at the end of a meal?
51. Do you have any brothers or sisters who are older than you?
Goal: The client will increase auditory comprehension to 90% accuracy for complex
yes/no questions.
Instructions: Ask the client the following complex yes/no questions. Explain that the ques-
tions will get more difficult as the activity progresses.
• If the client thinks the questions are too simple or sound ridiculous, just con-
vince him they’ll get more difficult or agree with him. Do not condescend to
the client.
18. Do you dry off before you get out of the pool?
19. Will you pay more for a car if you finance it rather than paying cash?
20. Do most people pay the entire amount in cash when they buy a house?
21. If you are second in line, are you near the front of the line?
23. If you are happy, does that mean that you are not sad?
44. Should you call the gas company if you smell natural gas in your house?
47. Should you leave your wallet on the seat of a car parked at the mall?
49. Should you dry your hair with an electric hair dryer while you take a bath?
Goal: The client will increase auditory comprehension to 90% accuracy for simple
paragraphs.
Instructions: Read a paragraph to the client. Ask him to answer the questions that follow.
There are six questions—three context questions and three yes/no questions.
Some questions may be easier or more appropriate for the client’s comprehen-
sion level, so choose accordingly. Explain that the activity gets harder as it pro-
gresses. Try not to let the client read the paragraph himself since this is mainly
a receptive language activity.
• Choose questions that match the client’s level of verbal output. For exam-
ple, a client with limited verbal output can answer yes/no questions by
nodding or shaking his head.
Activity: Read each paragraph and have the client answer the questions that follow.
1. John came home from work with a splitting headache. His temperature was 102° by the time
he got home at 5:45 p.m. He was sure he had the flu.
a. Who had a headache?
b. What time did he get home?
c. How high was his fever?
2. Beatrice’s grandson is graduating from college soon. In fact, the commencement ceremony is
at 10:00 Saturday morning.
a. Who is graduating from college?
b. On what day of the week is the ceremony planned?
c. What time will the ceremony begin?
3. Misty has developed an interest in photography. Yesterday afternoon at the mall, she pur-
chased a new 35 mm camera made by Nikon®.
a. What is Misty’s new interest?
b. What type of camera did she purchase?
c. Where did she purchase the camera?
4. When Paco awoke, he could smell the breakfast his wife, Mary, was cooking downstairs. He
smelled coffee, bacon, and the irresistible aroma of homemade cinnamon rolls.
a. What drink did Paco smell when he woke up?
b. What is the name of Paco’s wife?
c. Name at least two foods Paco is having for breakfast.
5. Betty was about to enjoy a full week of vacation away from her stressful job. On her first day
of vacation, she walked into the kitchen to discover a large puddle of water seeping from
under her refrigerator.
a. How long would Betty be on vacation?
b. On what day of her vacation did she discover the water?
c. Where was the water leaking from?
d. Did Betty discover the water on the second day of her vacation?
e. Was water leaking from under her dishwasher?
f. Did the leak happen on the second day of her vacation?
6. Marta’s first grandchild was due any day now. She just got a call and discovered that her
new grandson had been born last evening at midnight, weighing 8 pounds and 7 ounces.
a. What was the grandmother’s name?
b. How much did the baby weigh?
c. What time was the baby born?
7. Juan had been experiencing problems with his car for the last two weeks. The mechanic
informed him that his vehicle’s computer would no longer work and the repair job would
cost $1,000.
a. How long had Juan been having trouble with his car?
b. What had stopped working on his car?
c. How much would the repairs cost?
d. Had Juan experienced problems with his car for two weeks?
e. Did Juan have problems with the manifold in his car?
f. Did the repair job cost more than $500?
8. Steve likes to comparison shop for the best gasoline prices. The gas station in Fulton always
has gas ten cents cheaper than any station in Brookfield.
a. What did Steve comparison shop for?
b. How much lower was the price of gasoline at the Fulton Street station?
c. What cities were mentioned in the paragraph?
9. For the first time in franchise history, Bob’s hometown professional baseball team has made it
to the World Series. The last game of the series is scheduled for Saturday night at 8:00 at
Yankee Stadium.
a. What sport is mentioned in the paragraph?
b. What time will the last game of the series begin?
c. Where will the game be played?
10. It had rained all night long. When Rita woke up at dawn and walked into her living room,
she found a large puddle of water that had been caused by a leak in the roof near her bay
window.
a. What was the weather like?
b. At what time of day did Rita enter her living room?
c. What did Rita find in her living room?
11. Ishmael’s dog was 12 years old and had been quite sick over the last year. At a veterinarian
visit on Wednesday, Ishmael and the doctor decided to give the dog a new medication to ease
his arthritis.
a. What type of pet does Ishmael have?
b. How old is the dog?
c. What type of illness does the dog have?
12. When Harold received his telephone bill for $150, he knew something was wrong. Someone
else had used his telephone number to make several expensive long distance calls to Mexico
City.
a. How much is the telephone bill?
b. What is the man’s name?
c. To what city had the long distance telephone calls been made?
13. Bertha’s home needed major repairs. The roof was 32 years old, the paint was peeling, and
there was termite damage near her front door.
a. How old was the roof on the house?
b. What was the woman’s name?
c. Where was the termite damage?
14. Raul wanted to surprise his wife on their 50th wedding anniversary. She would be so pleased
when she saw the new red sedan he had parked in the garage.
a. How long had Raul been married?
b. What did Raul buy to surprise his wife?
c. What color was the car?
15. Martha decided to bake a German chocolate cake from scratch. She had all the ingredients on
hand in her cabinet except for the sugar and chocolate.
a. What was the woman’s name?
b. What was she planning to make?
c. Name one ingredient that she did not have in her cabinet.
16. The food served in the cafeteria of Richard’s retirement community was terrible. Richard col-
lected signatures on a petition to hold a community meeting for discussion of the matter.
a. What was wrong with the cafeteria?
b. Where was the cafeteria located?
c. What did Richard do to help solve the problem?
17. July was an extremely dry month. There was only a brief shower late in the month, and rain-
fall was six inches below normal for the year.
a. What month was mentioned in the paragraph?
b. How many showers occurred in July?
c. How many inches below normal was the rainfall?
18. Mia was ready to buy a new home. She was certain that she needed three bedrooms, two
bathrooms, and a large kitchen.
a. What did Mia want to buy?
b. How many bedrooms did she want?
c. How many bathrooms did she want?
19. Eugene needed a part-time job because he felt retirement was just too boring. He applied for
a job at a local department store and was hired to work in the furniture department.
a. Why did Eugene need a part-time job?
b. Where did he apply for a job?
c. What department was he hired to work in?
20. Charles had a special evening planned for Valentine’s Day. He hired a limo to pick up his
wife from work to meet him for a special dinner and then a Broadway show.
a. What special occasion was mentioned in the paragraph?
b. What type of vehicle was mentioned?
c. Where were Charles and his wife going after dinner?
21. When Doris opened up the Homerville Public Library that morning, there was clearly some-
thing wrong. Someone had broken into the building, stolen several computers and some
petty cash, and vandalized most of the bookshelves.
a. What city is the library in?
b. What had been stolen?
c. What had been vandalized?
22. Ian and Mary had not been out to see a movie in four years. When they finally went to one,
they were shocked to discover that a ticket now costs $6.50, and that a soft drink costs $3.00.
a. How long had it been since the couple last saw movie?
b. How much did a movie ticket cost?
c. How much did a soft drink cost?
23. John rented a movie from the video store on Friday. He didn’t remember to return the video
until Wednesday and he had to pay a $6.00 late fee.
a. On what day did John rent the movie?
b. On what day did John return the movie?
c. How much was the late-return fee?
24. Julio decided to pursue an advanced college degree at the age of 55. He planned to get his
Master’s Degree and Ph.D. in Psychology so he could become a licensed psychologist.
a. How old was Julio when he went back to college?
b. Name one degree he hoped to obtain.
c. What field did he want to study?
25. Sarah is beginning her first day of volunteer work at the local hospital. She plans to work in
the hospital gift shop from 9-6 every Wednesday.
a. What is the woman’s name?
b. Where does she do her volunteer work?
c. On what day of the week does she work?
26. Elvira is an expert quilter. She now has a new assignment to construct a 100-square quilt to
celebrate the 100th anniversary of the Women’s Auxiliary Guild.
a. What is Elvira an expert in?
b. How many squares does Elvira need to make her quilt?
c. What will the quilt be used to celebrate?
27. Lightning struck two TV sets in David’s home last week. He was worried they couldn’t be
fixed, but the repairman had them ready within two days. The job cost $55.
a. What happened to David’s TV sets?
b. How quickly did the repairman finish the job?
c. How much did the TV repairman charge David?
28. Charlotte enjoys interior decorating. So her daughter asked Charlotte to help select fabrics,
furniture, and lamps for her new sun room.
a. What does Charlotte enjoy doing?
b. Name one thing Charlotte helped select.
c. Which room did Charlotte help decorate?
29. Luc fell and broke his hip last week. Following surgery, he was scheduled for six weeks of
physical therapy, three times a week.
a. What happened to Luc?
b. What type of treatment is he receiving?
c. How often will he attend physical therapy?
30. Julia has suffered from dust allergies for most of her life. Her physician encouraged her to
use special covers for her pillows and mattress and told her to replace the carpet in her home
with hardwood or vinyl.
a. What is the woman’s name in the paragraph?
b. What is Julia allergic to?
c. What did her physician suggest?
31. Lucia inherited a pair of diamond earrings from her grandmother. The jeweler who
appraised the earrings told her they are two carats in weight and are worth approximately
$4,000.
a. What did Lucia inherit?
b. Who gave Lucia the earrings?
c. How many carats are in the diamonds?
32. Rosa walked into her dining room to find her two-year-old granddaughter holding a
100-year-old crystal vase. Rosa shocked the child into dropping the vase. It broke into a
thousand pieces.
a. What was the woman’s name?
b. How old was her granddaughter?
c. How old was the crystal vase?
33. Larry and Johann decided to go fishing early Saturday morning. They left at 5:00 a.m. and
fished at Lake Sinclair until dark without catching a single fish.
a. Who went fishing?
b. On what day did they go fishing?
c. On what lake did they fish?
34. It was time for Robert’s 30,000-mile service tune-up on his truck. He took the truck to an
independent mechanic who completed the tune-up and charged $300. The truck runs even
better after the tune-up.
a. How many miles were on Robert’s truck?
b. Where did Robert take the truck?
c. How much did the mechanic charge?
35. Tara filed her federal income taxes this year and waited for her refund. With the electronic
filing system, Tara received her $2500 refund in only five days.
a. What kind of refund did Tara wait for?
b. How long did it take for Tara to receive her refund?
c. How much was Tara’s refund?
36. Ethel needed to use a cane to help her walk, but she didn’t like the idea of using one. So her
daughter painted the cane pink, green, and white and she attached some colorful ribbons to
the cane. Now Ethel’s happier.
a. What did Ethel need to help her walk?
b. What colors did Ethel’s daughter paint the cane?
c. What did Ethel’s daughter attach to the cane?
37. Molly found her grandmother’s pound cake recipe in the bottom of a drawer. She followed
the recipe, entered the cake in a local contest, and won $75.
a. Who created the recipe originally?
b. Where did Molly find the recipe?
c. How much money did Molly win?
Goal: The client will increase auditory comprehension to 90% accuracy for mod-
erately complex paragraphs.
Instructions: Read a paragraph to the client. Ask him to answer the questions that follow.
There are eight questions—four context questions and four yes/no questions.
Some questions may be easier or more appropriate for the client’s comprehen-
sion level, so choose accordingly. Explain that the activity gets harder as it pro-
gresses. Try not to let the client read the paragraph himself since this is mainly
a receptive language activity.
• Choose questions that match the client’s level of verbal output. For exam-
ple, a client with limited verbal output can answer yes/no questions by
nodding or shaking his head.
Activity: Read each paragraph and have the client answer the questions that follow.
1. Daniel uses a cellular telephone in his sales job. His monthly bill is never less than $45. He
decided to shop around and found a great deal with another company for $20 a month.
a. What kind of phone does Daniel use?
b. What kind of job does Daniel have?
c. What was his monthly bill?
d. What is the new rate?
2. Juanita had always been interested in painting. She enrolled in a watercolor painting class at
her local community college. The class met twice weekly for three months. By the end of the
class, she could make beautiful paintings to decorate her living room walls.
a. What was Juanita’s interest?
b. Where did Juanita take her art class?
c. What type of painting did Juanita learn about?
d. Where did Juanita hang her paintings?
3. Martha got the flu in February even though she received her flu shot the previous October.
She had a fever of 100° and had to miss three days of work. The doctor assured her that her
bout with the flu would have been even worse without the flu shot.
a. When did Martha get her flu shot?
b. When did she come down with the flu?
c. How high was her fever?
d. How many days of work did Martha miss?
4. Hassan loves working in his vegetable garden. His tomato plants produce juicy, red tomatoes
until the first frost each fall. He sells the tomatoes for 50¢ each at a roadside stand.
a. What is the man’s name?
b. What does he grow?
c. When do his tomato plants stop producing fruit?
d. How much does Hassan charge per tomato?
6. Bob and Terri’s original home loan was for 30 years at 10% interest. Five years into the loan,
they refinanced at 8 l/2% interest for 30 years. Two years later, they were able to refinance
the loan for 15 years at 6 l/2% interest.
a. What type of loan did Bob and Terri have?
b. How much interest did they originally pay on their house?
c. When they refinanced the first time, what was the interest rate?
d. What was the interest rate when they refinanced the last time?
7. Each morning, Paul drank a cup of coffee before, during, and after breakfast. Before long, he
began to feel nervous and jittery, and he started having trouble sleeping at night. When he
changed to decaffeinated coffee, his problems went away.
a. What does Paul drink every morning?
b. How many cups of coffee does he drink every day?
c. How did Paul begin to feel after he drank coffee?
d. What did he have trouble doing at night?
8. Valentine’s Day fell on a Sunday this year. Beth and Erik decided to celebrate on Saturday, so
they made dinner reservations at Gregory’s restaurant for 8:00 p.m.
a. What special occasion is mentioned in the paragraph?
b. What day of the week does Valentine’s Day fall on in the paragraph?
c. When did Beth and Erik celebrate Valentine’s Day?
d. What time were their dinner reservations?
9. Elizabeth and her family had portraits taken at Hammond’s Photography Studio over the
weekend. She picked up the proofs on Monday afternoon and ordered one 8x10, four 5x7s,
and 20 wallet-sized photographs.
a. When were the pictures taken?
b. When did she pick up the proofs?
c. How many 5x7s did Elizabeth order?
d. How many wallet-sized photographs did she order?
10. Virginia always shops at Terry’s Market because of the monthly specials. On the last
Wednesday of each month, Terry’s has a one-day sale. Virginia tries to stock up on all of her
monthly groceries then. This month, Terry’s Market is selling ground beef for 99¢ a pound
and selling two-for-one laundry detergent.
a. What is the name of the grocery store?
b. On what day do they run the monthly specials?
c. How long does the sale last?
d. How much is the ground beef this month?
11. Larry McLean needs surgery to replace his left knee. He injured the knee playing college
football 30 years ago. The onset of arthritis has made the knee almost nonfunctional. Larry
got three medical opinions and will get his knee replaced this summer.
a. What type of surgery does Larry need?
b. What sport did Larry play?
c. How many medical opinions did Larry get?
d. When will Larry have his surgery?
12. It’s time for spring cleaning at the Taylor house. Each spring, Marge Taylor gives each of her
three children different jobs. This year, she told Amy to clean all the windows and blinds.
Paul has to wax the hardwood floors. Jeff needs to reorganize and clean up the garage.
a. What is the family’s last name?
b. What type of cleaning will they do?
c. How many children are in the household?
d. What was Jeff’s job?
13. Shirley needs only 15 hours of college credit to complete her degree in Middle-Grades
Education. She is currently teaching with a provisional teaching certificate. She has decided
to complete the 15 hours over the summer during her break from teaching.
a. How many hours of college credit does Shirley need to get her degree?
b. When does she plan to complete the college courses?
c. What type of degree does Shirley want to complete?
d. What kind of certificate is Shirley teaching with now?
14. Louise and Geraldo decided to get a dog to celebrate their recent retirement. They researched
different breeds and chose an Irish setter because a bigger dog needs to be walked more.
They figured this would help keep them in shape during their retirement years.
a. What did Louise and Geraldo decide to get?
b. What big event are they celebrating?
c. What type of dog did they choose?
d. Why did they choose an Irish setter?
15. Every Friday night, the Martins have a date. They started doing this shortly after their first
child was born. They go to their favorite Italian restaurant, order a bottle of wine with the
meal, and always end up talking for hours. The restaurant gave them a 20th anniversary
party last Friday night when they arrived for their regular 8:00 p.m. reservation time.
a. On what day of the week do the Martins have their date?
b. What type of restaurant do they go to?
c. How many years have they been married?
d. What time do they usually have dinner when they go out?
16. Koto decided to join a book club. On the last Friday of each month, the group meets at a club
member’s home to discuss the latest book. For October, the club has decided to read a biog-
raphy of Martha Graham, who was a pioneer of contemporary dance in the United States.
a. What type of club does Koto belong to?
b. On what day of the month does the club always meet?
c. What month was discussed in the paragraph?
d. What type of book will they read in October?
17. Jack and Allison needed a new washer and dryer, so they went to Taylor’s and chose a nice
set. But Taylor’s couldn’t deliver the set for ten days, so Jack and Allison bought their washer
and dryer from Simmons Appliances, because Simmons could deliver the set the same day.
a. What is the name of the man in the story?
b. Where did they first want to buy the washer and dryer?
c. Where did they finally decide to buy the washer and dryer?
d. What is the name of the woman in the story?
18. Every September, Heloise begins to buy gifts for the winter holidays. This year she bought a
set of skis for her son and a new bike for her daughter. The total for the two gifts was $450.
a. When does Heloise begin to buy gifts for the winter holidays?
b. What did she buy for her daughter this year?
c. What did Heloise buy for her son?
d. What was the total for the two gifts?
19. Chan didn’t have the money for a new car, so he looked for a used one. Last week, he found
a six-year old sedan with only 50,000 miles on the odometer. He bought it for $2,000. He was
pleased with the good deal he found.
a. What did Chan buy?
b. How old was the used car?
c. How much did he pay for the car?
d. How many miles were on the odometer?
20. When Dana turned 50 years old recently, her hair was a salt-and-pepper color. She decided to
dye her hair back to its original black color. But when she dyed it, it looked like her head had
been dipped in black shoe polish. Dana had to pay $100 to have her hair lightened.
a. What color was Dana’s hair originally?
b. How old is she now?
c. What color was her hair just before she dyed it?
d. How much did Dana pay to have her hair lightened?
21. When her mother had a stroke five years ago, Margaret had to dress her mother during reha-
bilitation. But she found it difficult to dress her because of the cumbersome buttons and awk-
ward sleeves. So Margaret made her mother clothes that slipped on easily and had velcro fas-
teners. Soon she was taking orders for clothes from the patients at the center. Now she has
her own line of slip-on, geriatric clothing selling in major department stores.
a. What happened to Margaret’s mother?
b. How many years ago did the stroke occur?
c. Why was it diffcult for Margaret to dress her mother?
d. What type of fasteners did Margaret use on her mother’s clothes?
22. After having a baby, Adalais took a six-month maternity leave. After six months, she didn’t
want to go back to her work as an attorney full-time. So she hired a nanny so she could
return to work part-time.
a. How many children did Adalais have?
b. How long was her maternity leave?
c. What type of job does Adalais have?
d. What kind of worker did she hire to watch her baby?
23. On the morning of December 23, 1989, a big snowstorm hit and paralyzed much of the state
of Vermont. For ten straight days, the temperature didn’t rise above 20°. Major interstate
highways were closed. Some drivers had to drive for 24 hours to reach relatives for holiday
celebrations.
a. What year did the snowstorm hit?
b. What state was affected by the snowstorm?
c. How many days straight was the temperature under 20°?
d. How long did some drivers drive to reach relatives?
25. Donna was never very committed to wearing a seat belt. When her mother got in the passen-
ger seat of Donna’s new red Buick yesterday, she insisted Donna buckle her seat belt. Twenty
minutes later, they got into a serious car accident that left them both with cuts, bruises, and
some broken bones. The policeman told them that the injuries would have been fatal if they
hadn’t used seat belts.
a. What was Donna never very committed to doing?
b. Who rode with Donna in the car?
c. What color is Donna’s car?
d. What happened to Donna and her mother?
Goal: The client will increase auditory comprehension to 90% accuracy for complex
paragraphs.
Instructions: Read a paragraph to the client. Ask him to answer the questions that follow.
There are ten questions—five context questions and five yes/no questions.
Some questions may be easier or more appropriate for the client’s comprehen-
sion level, so choose accordingly. Explain that the activity gets harder as it pro-
gresses. Try not to let the client read the paragraph himself since this is mainly
a receptive language activity.
• Choose questions that match the client’s level of verbal output. For exam-
ple, a client with limited verbal output can answer yes/no questions by
nodding or shaking his head.
Activity: Read each paragraph and have the client answer the questions that follow.
1. This was the hottest summer Ada had ever experienced. The temperature had climbed to
over 90° for the last 20 days. Ada’s husband, Harold, noticed that it had become more dif-
ficult to cool the second floor of their home. Harold asked his neighbor and the neighbor
suggested Harold use a garden hose to clean out the coils of the air conditioner. Harold fol-
lowed the suggestion and felt a difference in 24 hours. Within three days, the cooling ability
of the air conditioner was back to normal.
a. What was Harold’s wife’s name?
b. What was Harold’s problem?
c. How high did the temperature get?
d. Whom did Harold speak to about the problem?
e. What did the neighbor suggest that Harold do?
2. Maria put a pie in the oven and set the timer for 45 minutes. The telephone rang, and Maria
answered it. It was her friend, Louise, informing her that she had come down with a bad
case of the flu. Louise told Maria that they would be forced to cancel their shopping plans for
tomorrow. The conversation continued for 20 minutes.
a. What was Maria baking?
b. Who called Maria?
c. What was wrong with Maria’s friend?
d. How long did the conversation last?
e. Who was coming to visit Maria tomorrow to go shopping?
3. Paul is graduating from college in December. His grandmother is unsure about what to give
him as a graduation present. She has consulted several different family members about it.
Paul’s grandfather suggested she buy a sweater. Paul’s mother thought a book would be
nice. Paul’s sister felt he would like some new cycling shorts. In the end, Paul’s grandmother
decided to give her grandson some money for a skiing trip to Colorado he had planned for
January.
a. When will Paul graduate from college?
b. Who suggested buying a sweater?
c. Name another item that was suggested.
d. What did Paul’s grandmother decide to give him?
e. Where will Paul go on his ski vacation?
4. It was 9:00 a.m., and for the third day in a row, Mr. Chin’s morning paper was not on his
doorstep. He waited another 30 minutes before he called the newspaper office. When the
receptionist answered, Mr. Chin informed her that he hadn’t received his newspaper for the
last three days. She assured Mr. Chin that his paper would be delivered within the next two
hours. She also gave him credit on his account for the missing papers.
a. At what time did Mr. Chin suspect that his paper might not arrive?
b. How long did he wait before he called the newspaper office?
c. Whom did Mr. Chin speak with at the newspaper office?
d. How many days did Mr. Chin not receive his newspaper?
e. What did the receptionist do for Mr. Chin?
5. When Darlene got home, she sensed that something was wrong. She walked to the backyard
to discover her dog, Buck, lying on the ground near the pasture fence. He had been badly
injured. Darlene suspected that one of the horses must have kicked him. She bundled up
Buck in a large quilt and put him in her truck. In 15 minutes, they arrived at the veterinar-
ian’s office. Buck had suffered lacerations that required stitches and three broken ribs. Four
weeks later, his health had improved and he was as feisty as ever.
a. What was the dog’s name?
b. Where did Darlene find Buck when they got home?
c. What animal probably injured the dog?
d. How long did it take to get Buck to the vet?
e. What did Darlene use to bundle up Buck?
6. Kara ran several errands on Saturday morning to get ready for her brother’s surprise birthday
party later that night. She dropped by the drug store to pick up film for her camera. Then
she picked up the cake at the bakery at 11:00 a.m. In the afternoon, Kara cooked various
appetizers and finished cleaning the house. She expected 15 guests at 7:00 p.m. Her brother
would arrive at 8:00 p.m. expecting to help Kara with her tax return. What a surprise!
a. What time is the party supposed to start?
b. What time did she pick up the cake?
c. How many guests are attending the party?
d. What did Kara cook in the afternoon?
e. What will Kara’s brother expect when he arrives?
7. Sofia has decided to rent a room at the local community center for her parents’ 50th wedding
anniversary. She’s invited nearly 200 people from their small town for an open-house recep-
tion. The event is planned for June 25th from 2:00 p.m. until 6:00 p.m. Her sister, Elena, will
handle all of the invitations. Her brother, Marco, will find the pianist. Sofia will take care of
the catering. Sofia’s daughter will order all of the flowers.
a. Where will the party be held?
b. What type of party is it?
c. How many people are coming?
d. What date is the party?
e. What will Marco do?
8. José is starting a new job this Monday. Today is Saturday, and he has quite a few things to do
before then. He needs to buy two new suits. He needs to go to an office supply store and
buy a new daily planner and several ballpoint pens. On Sunday, he’ll drive the twenty-mile
commute to decide how much time he needs to get to work each day.
a. When will José start his new job?
b. How many new suits will he buy?
c. What will José buy at the office supply store?
d. How many miles will he drive to work?
e. What will José do on Sunday?
9. After years of writing books in her field, Lisa decided to write a novel. The book will be his-
torical fiction. Lisa’s husband has a degree in history and has collaborated with her to com-
plete the necessary research. It took Lisa a little less than a year to complete the manuscript.
When she was finished, the novel contained 22 chapters and 374 pages. The process of find-
ing a literary agent to sell her work was very frustrating. Finally Lisa decided to submit her
manuscript to various publishers without using a literary agent. She and her husband agreed
they would try for one year to sell the manuscript before abandoning the idea.
a. What type of degree does Lisa’s husband have?
b. How long did it take Lisa to write the book?
c. How many chapters are in the book?
d. What was Lisa looking for?
e. Whom did Lisa submit her manuscript to?
10. At 2:00 a.m., Yuri heard a loud thud downstairs. He bolted up in his bed and turned on the
lamp. He called 911 and whispered to the operator to send police. Yuri then grabbed a rope
ladder he always kept in his upstairs bedroom. He used the ladder to escape from the house
before the intruder discovered his presence. When the police arrived, the burglar had already
escaped with a VCR and several expensive pieces of silverware.
a. What time was it when Yuri heard the intruder?
b. What did Yuri tell the operator?
c. What did Yuri keep in his bedroom that helped him escape?
d. Where was Yuri when he heard the intruder?
e. Name one item the thief stole.
11. Tomas had experienced trouble sleeping for the last four months. He asked for advice from
several friends. Each friend described a different home remedy. Janos told him to drink
warm milk. Sabina told him to take an antihistamine. Henri said reading just before bed
should help him fall asleep easily. None of the suggested remedies were successful. Tomas
then consulted his doctor who told him to stop drinking caffeine and to begin a daily exercise
program of walking. Now Tomas is sleeping well once again.
a. What was Tomas’s problem?
b. Whom did he talk to first?
c. What did Henri tell Tomas to do?
d. What did Sabina tell Tomas to do?
e. What did the doctor tell Tomas to do?
12. Lara agreed to keep her granddaughter, Mary, for the next two weeks while Mary’s parents
took a trip to Japan. During the first week, Lara took Mary to the pool, to the park, and to a
county fair. During the second week, Lara kept Mary busy with shopping trips, art projects,
and a short computer course for children. Mary didn’t have time to miss her parents!
a. What was the grandmother’s name?
b. Where did Mary’s parents go?
c. Name an activity Mary did.
d. How long were Mary’s parents away?
e. What didn’t Mary have time for?
13. Mr. Gomez suffered a stroke three months ago which affected his ability to speak clearly. He
was making good progress in his speech therapy, but his health insurance benefits only paid
two months of therapy. His wife asked the insurance company to extend additional benefits
to her husband. The company asked for letters from his doctor and speech pathologist
explaining the medical need for more therapy. The doctor refused to write the letter. He
doubted Mr. Gomez could make any more progress in therapy as this was the second stroke
he had suffered. Mr. and Mrs. Gomez disagreed and looked for a new physician.
a. What was Mr. Gomez’s medical problem?
b. How long did the insurance company pay for speech therapy?
c. What did the insurance company want from the doctor?
d. How many strokes has Mr. Gomez suffered?
e. What did the Gomez family decide to do?
14. One Saturday night, a fierce storm swept through Savannah, Georgia. It began with severe
thunderstorms bringing heavy rain. Then the rain turned into golf ball-sized hail. At 9:00
p.m., the weather service issued a tornado warning for the city. The weather forecaster pre-
dicted the tornado would enter the city around 10:00 p.m. Surprisingly, the tornado abruptly
changed course and missed the city. Savannah sustained only some minor property damage
due to trees felled by the storm. There were no serious injuries and no deaths.
a. What night did the storm occur?
b. When did the weather service issue the tornado warning?
c. What did the tornado do?
d. What caused minor property damage?
e. How many people were seriously injured?
15. The big fair was this weekend. The fund-raising fair began at 10:00 a.m. on Saturday morn-
ing and continued until midnight. There were arts and crafts, carnival rides, and lots of food.
The boys arrived at 11:00 a.m. and stayed until their parents picked them up just before sup-
per. They enjoyed the jazz music much more than the pop music group. The Senator’s
speech was boring to the young boys. They spent most of the afternoon riding the Ferris
wheel and the bumper cars.
a. Where did the boys go?
b. What time did the boys arrive?
c. What time did the fair begin?
d. What type of music did the boys prefer?
e. Name a ride that the boys enjoyed.
16. Daniel felt he needed a change in his life. He had grown up in Detroit and had never lived in
any other city. He researched other cities. He wrote to the Chambers of Commerce in three
cities: Seattle, Atlanta, and Denver. In three weeks, he got packets from all three cities. After
much debate, Daniel decided to move to Atlanta because of the warm climate.
a. What was the man’s name?
b. Where did he grow up?
c. Which cities did he write to?
d. Where did he decide to live?
e. Why did he choose Atlanta?
17. Mrs. Kirsch wanted every room in the house to receive a thorough cleaning this year. She
devised a plan to clean one room each week. This would take 10 weeks to complete, but she
felt it would be worth the time and effort. During the first few weeks, she and her husband
cleaned only the three bathrooms. Then they moved to the three bedrooms. Next on her list
was the kitchen. They totally reorganized the kitchen and had to spend two weeks on that
room alone. Finally, they completed the den, living room, and dining room. After the clean-
ing project was complete, she and her husband took a cruise to the Bahamas.
a. How many rooms did Mr. and Mrs. Kirsch clean each week?
b. Which room did they begin with?
c. Which room was totally reorganized?
d. How many bedrooms are in the house?
e. What was the total number of rooms the Kirsches cleaned?
18. Mr. Taylor needed to buy a fax machine for his new home office. He talked to friends and
researched several major brands. He had several specific requirements for his new fax
machine. He needed a machine that could fax and copy documents as well as interface with
his computer to become a printer. After searching for two weeks, he had narrowed the list to
three machines. His final selection was based on price and performance records. Mr. Taylor
was very pleased with the $350 machine that he purchased.
a. What type of machine was Mr. Taylor looking for?
b. Whom did Mr. Taylor talk to?
c. Name one feature that was a requirement for the machine.
d. How many weeks did Mr. Taylor search?
e. How much did the fax machine cost?
19. Kathy took Friday off from work to wait for the cable company to hook up her new television
service. The technician was scheduled to arrive around 11:00 a.m. She waited until 1:00 p.m.
and then called the cable office to check on the technician. The receptionist at the cable com-
pany told Kathy that the technician would arrive after 4:00 p.m. Kathy decided to go out for
lunch. She returned at 3:30 p.m. to find a note on her door that the technician had already
arrived to find no one home.
a. What day did Kathy take off from work?
b. What was the original appointment time?
c. How long did Kathy wait before she called the cable company?
d. Where did she go while she waited?
e. What happened while she was gone?
20. Tara Lang has been a school teacher for 30 years and now she’s retiring. During her first ten
years, she taught fourth grade. After that, she spent five years teaching fifth grade. The final
15 years were spent with first-graders. Tara enjoyed that particular age group immensely. It
was so rewarding to teach students how to read. In fact, the decision to retire has been a hard
one. But the arrival of twin grandsons made her decision a little easier. Tara will move to
Arizona as soon as the school year is over to be closer to her two new grandchildren.
a. What was the woman’s first name?
b. Which grade did Tara teach for the first ten years?
c. Which grade did Tara prefer teaching?
d. What was the best thing about first grade?
e. How many new grandchildren does Tara have?
21. When Mr. and Mrs. Yeung arrived at the condominium in Ormond Beach, Florida, they were
exhausted from the seven-hour drive. Their vacation condo had two large bedrooms and two
baths upstairs. There was a half bath, a lovely living room/dining room combination, and a
galley kitchen downstairs. The carpet was a beautiful sea green. The condo sat right on the
beach. The Yeungs enjoyed the peaceful, secluded beach and had fourteen nights of restful
slumber while listening to the ocean’s constant waves.
a. Where did the Yeungs go on vacation?
b. Where did the Yeungs stay?
c. How many bedrooms were in the condominium?
d. What color was the carpet?
e. How long was their vacation?
22. Construction will soon begin on the bypass highway around the city of McDonough. Ellen
and her husband, Ron, own 10 acres of land right where the highway will run through. The
city offered Ellen and Ron money for their house and property. Ellen had two more years
before she planned to retire from her teaching position. She didn’t want to sell. But Ron per-
suaded her to retire early and move to a house in Florida.
a. What city did Ellen and Ron live in?
b. How many more years did Ellen plan to teach?
c. How many acres did they own?
d. What was happening near their home?
e. Where did they move?
23. Sally decided she needed a first-aid kit in her home. She went to a large, local drug store to
find a preassembled kit. When she opened the kit, she felt many essential items were miss-
ing. Sally decided to compile the necessary items to make her own kit. She located a med-
ium-sized plastic box with a handle. She bought Band-Aids®, hydrogen peroxide, bandages,
ointment for burns and cuts, a small pair of scissors, a CPR mask, cotton balls, and salve for
insect bites. Sally felt much more prepared with her new kit. She planned to take it with her
on a camping trip next weekend.
a. What was the woman’s name in the paragraph?
b. Where did Sally buy the preassembled first-aid kit?
c. Name one item that was included in the kit Sally made herself.
d. Where is Sally going next weekend?
e. What was wrong with the preassembled first-aid kit?
24. Ben and Cherie wanted to rent a movie for Saturday evening. Ben was determined to rent an
action-adventure movie. Cherie preferred a comedy. The couple spent 45 minutes in the
video store trying to make their decision. Finally, they made a compromise. They discovered
if they rented a romantic drama for $5, they could receive two additional movie rentals for
free. Ben and Cherie watched the romantic drama on Saturday night. On Sunday afternoon,
Cherie watched her comedy while Ben worked in the garden. On Sunday evening, Ben
watched his action-adventure while Cherie went to visit a friend.
a. Who wanted to see the comedy?
b. How long did they stay in the video store?
c. How much did the video rental cost?
d. What did the couple receive free of charge?
e. What did Ben do while Cherie watched the comedy?
25. Oscar knew he had to quit smoking. After suffering a heart attack, his doctor vehemently
urged him to stop. Oscar tried to quit smoking by chewing nicotine gum. It didn’t work.
Then he used a nicotine patch and quit smoking for three months. He started again, though.
Six months after becoming a smoker again, Oscar went to a seminar and was hypnotized to
stop his smoking addiction. He also listened to audiotapes designed to curb his craving for
cigarettes. Eating peppermint candy also decreased his desire to smoke. He finally quit.
a. What health problem did Oscar experience?
b. What method did he try first to stop smoking?
c. What did he do at the seminar?
d. What did he eat that helped to decrease his desire to smoke?
e. Who urged Oscar to quit smoking?
As a clinician, you might value literacy and have a love of reading and literature.
Realize that many of your clients may not share this interest. Therefore, the read-
ing exercises in this section are function-based with stimuli from everyday life.
Make an extra effort not to inadvertently cause the client to feel stupid or foolish
when beginning instruction in reading. You may want to say, “I’m not really
teaching you to read. I’m helping to tweak your memory into remembering how
to read.” Also discuss how common it is for an aphasic client to experience a dis-
turbance in reading comprehension. Put his mind at ease and do not conde-
scend.
The following tasks are written in a very hierarchical manner. We begin by read-
ing single letters and end the section by reading paragraphs. Therefore, select
your client’s appropriate level of difficulty and work up until a plateau is
reached or until this section is successfully completed. If you need to go back to
relearn or sharpen certain weak spots, then do so until you’ve reached a level
your client is comfortable with. Homework for your client may be a good way
to increase rapid skill development.
Goal: The client will increase the ability to read and match upper- and lowercase let-
ters to 90% accuracy in order to improve reading skills.
Instructions: The client will read the cue letter on the left, then find its match on the right.
• Have the client trace each letter with his finger or a pen.
Activity: Ask the client to read the letter on the left and find its match on the right. The
first two and a half pages contain uppercase letters, and the last two pages
have lowercase letters.
B D B H S V O
Z D T Z R W M
C L I M X C F
Y J O E T Z Y
D S D R G X H
X B E X Q V W
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Letter Matching , continued comprehension
E C A F E J K
W W Z Y N M U
F X T L E F O
V P V R H I Q
G D B T G X Q
U U F D V M N
H O W V M R H
T R T Y I F E
I L Y O A I U
S B R T M S F
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J U A E J K T
R K R P B M N
K R S M F W K
Q Q O U V B J
L U T J N M L
P P B R K F C
M X Y N W M S
O U C G B P O
N F M T N K L
A I E A R K N
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Letter Matching , continued comprehension
n b n p m r s
q g b p q t u
a r s o a b u
l l t b k x y
o o c e i u a
m x y v r n m
p f g q p g h
k r k v t b x
r t b p m n r
j j g b q y z
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s t k z s r v
i l n j g t i
t t x n u a o
h m i k r h n
u m u a n o e
g b i t p h g
v m x v n y z
f l k j e f h
w r h w m v t
e e o i u a c
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Letter Identification comprehension
Goal: The client will increase the ability to listen and identify upper- and lowercase
letters to 90% accuracy in order to increase reading skills.
Instructions: Read the client the cue letter on the left and ask him to read and identify the
correct one on the right. Use a piece of paper to cover the cue letter.
Otherwise, the client will simply be matching letters as in the previous activity.
Compensatory • Photocopy, cut, and paste each letter on an index card so a group of cards
Strategies: can be easily manipulated. Photocopy and enlarge the letters if necessary.
Activity: Read the cue letter on the left without showing it to the client. Ask the client to
point to the correct letter in the row of six on the right. The first two and a half
pages contain uppercase letters and the last three pages contain lowercase let-
ters. Start each command with the words, “Show me the letter _________.”
L A T B L E F
A V A M G N O
Z S C E Y X Z
B V K R E B P
Y E K Y R O U
R R Y X P Q B
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C P G O C I U
D O Z C E B D
X Y X T K S H
E T I E B F L
W H K Q M W N
F F G H E L T
S U Q R H S G
V V W M N U A
G U B C O G Q
T E T F H M N
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Letter Identification , continued comprehension
H M N I H A T
O O T B P K R
I E M C I T H
M M N D R F E
J T J I L M Q
N N Z P R Y Z
U B U W M C D
Q F M S Z Q Y
K K R T B E F
P P B S F K G
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p b m l p q m
f f e h j l t
k r k j f g b
z p n m r t z
w m n w r k y
v v n w s r t
u e b a u t r
g l d g p j b
d o p z y m d
h n h t x v w
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Letter Identification , continued comprehension
j j q p g s i
o m w o a e u
i y j l k i z
t r m v j t i
r q r b e h n
e e o c i u a
x v x w z y k
d g f k t d b
y n m u y o a
m q v b n c m
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b b d g q p m
n t v s r m n
q p q g h t i
s c u o t s r
x v w x r t z
l t l h k b d
y j w y p g b
c i a g o c e
z z s t r y m
a p a d k g h
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reading
Word Matching with Pictures comprehension
Goal: The client will increase the ability to read and match single words with picture
cues to 90% accuracy in order to improve reading skills.
Instructions: Show the client the cue word on the left and have him read it aloud. Then ask
him to match the cue word to one of the four words on the right. Tell the client
to rely on the words first, then the pictures if it helps.
Compensatory • Enlarge and laminate the words and/or pictures for clearer and larger cues.
Strategies:
• Cut out the words and paste them on index cards. Let the client manipulate
the cards and allow him ample response time. If you cut and paste the
words/pictures, you can make many combinations.
• Tell the client not to become too dependent on the picture cues because they
won’t be used in the next activity.
Activity: Show the client the cue word on the left, let him read it aloud, and have him
match it with the correct word on the right. Use picture cues if necessary.
Goal: The client will increase the ability to match single words to 90% accuracy in
order to increase reading skills.
Instructions: Have the client read the cue word on the left aloud. Then ask him to match the
cue word to one of the four words on the right. This is the same activity as the
previous one, but without picture cues.
Compensatory • Write each word on an index card with a black marker so you can mani-
Strategies: pulate the cards easier.
• Point to each word if the client is having trouble. Continue to cue for
increased visual skills and scanning.
• Don’t read the words for the client unless he can’t complete an item. You
can sometimes give the client just the first sound of a word as a cue.
Activity: Have the client match the cue word on the left to the correct word on the right.
Goal: The client will increase the ability to identify/read and understand single
words to 90% accuracy with picture cues in a visual field of four.
Instructions: Hiding the cue word on the left, read the cue word and ask the client to iden-
tify its match on the right. Have him point to the correct word and ask him to
say it aloud. Tell him to rely first on the words, then on the pictures for help.
Cover the picture cues so the client will have to rely on the words. Uncover
them only if he needs help.
Compensatory • Take into account visual field neglect or visual field cuts.
Strategies:
• Mount the pictures on individual index cards so they can be easily manip-
ulated on the table. Move the index cards into any formation that the client
prefers for optimum visibility. To increase the difficulty of the activity,
increase the visual field of pictures from four, to six, eight, or higher.
Activity: Hide the cue word on the left and the picture cues. Read the cue word on the
left and ask the client to look at the four words on the right and find its match.
Ask him to point to it and say the word aloud. Uncover the picture cues only
if the client is having trouble identifying the cue word.
Goal: The client will increase the ability to identify/read and understand single
words to 90% accuracy in a visual field of four.
Instructions: Covering the cue word on the left, read the cue word aloud and ask the client
to identify its match on the right. Tell him that in this activity, he will not have
pictures to help him. Have him point to the correct answer and ask him to say
it aloud.
Compensatory • Take into account visual field neglect or visual field cuts.
Strategies:
• The client should be fairly independent in his cueing by now.
• Mount the words on individual index cards so they can be easily manip-
ulated on the table. Move the index cards into any formation that the client
prefers for optimum visibility.
Activity: Hide the cue word on the left, read it aloud, and ask the client to find its match
on the right. Tell him he won’t have pictures to help him.
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9. CD TV radio CD video
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Phrase Matching with Pictures comprehension
Goal: The client will increase the ability to identify/read and comprehend two- to
three-word phrases to 90% accuracy with picture cues.
Instructions: Ask the client to read aloud each cue phrase below. Then tell him to find its
match from the four phrases below it. Ask him to point to the correct phrase.
Compensatory • Take into account visual field neglect or visual field cuts.
Strategies:
• Accommodate for poor visual skills by enlarging pictures, mounting phrases
on index cards, etc.
• If you’re using index cards, use a visual field of two to four to begin the task
and gradually increase to eight if the client can handle it.
Activity: Have the client read each cue phrase and find its match from the four phrases
below it. Use the pictures to help him find the match. Ask him to point to the
correct answer.
1. heavy coat
2. school books
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3. bowl of soup
4. square shape
5. bowl of cereal
6. old wheelchair
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Phrase Matching with Pictures , continued comprehension
7. comic book
8. ripe plum
9. milk truck
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Phrase Matching with Pictures , continued comprehension
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Phrase ID with Reduced Cueing comprehension
Goal: The client will increase the ability to identify/read and understand two- to
three-word phrases to 90% accuracy with picture cues.
Instructions: Have the client read the cue phrase aloud. Then ask him to look at the pictures
below the cue phrase and point to the picture that matches the phrase he just
read. Tell him there aren’t words printed above the pictures as in the previous
activity.
Compensatory • Use hand-over-hand assistance to guide the client if he seems very confused.
Strategies:
• Accommodate any visual difficulty to include decreased acuity, visual field
neglect, visual field cuts, and/or decreased visual scanning.
• Allow the client to trace the cue words if this helps. Otherwise, reduce cue-
ing, as you are heading towards the client’s independence.
Activity: Show the cue phrase to the client and have him read it aloud. Then ask him to
choose the picture that matches the cue phrase.
1. shorter person
2. French dressing
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Phrase ID with Reduced Cueing , continued comprehension
3. math book
4. soft pillow
5. two glasses
6. bowls of rice
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Phrase ID with Reduced Cueing , continued comprehension
7. sliced cheese
8. cheese sandwich
9. soft blanket
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Phrase ID with Reduced Cueing , continued comprehension
g g G G
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Sentence ID with Pictures comprehension
Goal: The client will increase the ability to identify/read and understand simple sen-
tences to 90% accuracy with picture cues.
Instructions: Hiding the cue sentence from the client’s view, read the cue sentence to him.
Ask him to point to the correct sentence from the two or four below it. Have
him read it aloud. Hiding the cue sentence ensures that the client will not sim-
ply be matching the sentences, but reading and comprehending them. By this
point in this series of activities, the cue sentences and answers are not enlarged
and are not in bold type, but appear as they would in normal reading material.
Compensatory • Photocopy the pictures with their sentences and enlarge them to accom-
Strategies: modate visual impairments before you begin this activity. Place the pictures
in a configuration comfortable for the client.
Activity: Hide the cue sentence and read it aloud. Ask the client to point to the correct
match out of the two or four choices and read the sentence aloud. Use the pic-
ture cues if necessary.
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Sentence ID with Pictures , continued comprehension
The girl is sleeping in the top bunk. The girl is sleeping in the bottom bunk.
The swimmer is far from the pier. The swimmer is near the pier.
The dog will eat the food. The dog ate the food.
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Sentence ID with Pictures , continued comprehension
The wolf is chasing the deer. The shark is chasing the fish.
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Sentence ID with Pictures , continued comprehension
It’s a cloudy day. It’s a sunny day. It’s a rainy day. It’s a windy day.
Bread smells good. Rolls smell good. A rose smells good. Pizza smells good.
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Sentence ID without Pictures comprehension
Goal: The client will increase the ability to identify/read and understand simple sen-
tences to 90% accuracy without pictures cues.
Instructions: Tell the client you will show him four sentences. Tell him that you will read
one of the sentences and he will point to the sentence you read. (There are no
cue sentences in this activity, so choose whichever sentence of the four you
wish.) After each identification trial, you can ask the client to read the sen-
tences aloud as an extension activity. After you go through the activity, you
can do it again varying your cue sentence.
Compensatory • Use a piece of paper to block out text that may distract the client.
Strategies:
• Encourage the client to point to the words as he reads/says them or allow
him to trace letters with his finger. At this point, the client should be cueing
as independently as possible. Allow ample response time.
• Don’t give away the answer with your eyes as you read the cue sentence.
Activity: Choose a sentence among the four and read it aloud. Ask the client to identify
the one you read.
Get butter and eggs today. Orange juice is good for you.
2. Call the doctor after four o’clock. I will be home at seven o’clock.
The man sold his car at six o’clock. It’s ten o’clock now.
3. The roast will cook in two hours. Don’t wait too long to cook the meat.
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4. The robbery happened at the bank. The news from the hospital is good.
5. I wrecked my car on Maple Drive. The agent said the car was totalled.
The bank will be closed Monday. The bank makes money on ATMs.
The car wax is in the laundry room. The car seat is ripped.
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Sentence ID without Pictures , continued comprehension
11. Exercise will help keep you healthy. John never gets off the couch.
Louise exercises five times a week. Sammy just talks about exercise.
12. I’ve always wanted a van. A small car might not be safe.
An SUV is too big for the road. My husband really wants a truck.
13. I started a new diet yesterday. Drinking water is good for me.
I plan to stay in shape this year. I lost fifteen pounds last month.
I have taken some writing classes. I may write a book about my trip.
15. My sister went hiking in Canada. I plan to go snow skiing this winter.
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17. The party is planned for Saturday night. Mary has planned all the food.
Barry will take care of the drinks. Alma has bought a gift already.
18. I prefer to wait until it’s on video. John goes to the movies twice a week.
19. Football season is much too short. I heard about the strike in the NBA.
We can learn a lot from history. I wish all schools would teach phonics.
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Question Comprehension comprehension
Goal: The client will increase reading comprehension to 90% accuracy for functional
questions.
Instructions: In this activity, the client will read and answer sets of twenty questions that are
divided into What, Who(m), Where, When, and How questions. For each set,
there are ten multiple choice and ten non-multiple choice questions. If his
writing skills are good, he may write out the answers or circle the correct let-
ters. If writing skills are not intact, he may verbally give the answer.
Compensatory • The client should now be self-cueing for skills such as visual scanning or
Strategies: visual neglect.
Activity: Have the client read the following questions aloud and answer them verbally
or in written form.
What Questions
1. What name below is considered a boy’s name?
a. Paula
b. Paul
c. Patricia
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Who(m) Questions
1. Who helps to keep an office building or school clean?
a. principal
b. secretary
c. custodian
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18. Whom would you call if you smelled gas in your house?
__________________________________________________________________
19. Whom would you call if you thought an intruder was in your house?
__________________________________________________________________
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Where Questions
1. Where do you go to borrow a book?
a. book store
b. library
c. grocery store
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__________________________________________________________________
__________________________________________________________________
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Why Questions
1. Why would you call 911?
a. for a hangnail
b. in an emergency
c. as a joke
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Question Comprehension , continued comprehension
8. Why should you always wear a seat belt when riding in a car?
a. It can protect you in a crash.
b. It looks nice.
c. The car won’t start without it.
10. Why should you brush your teeth at least twice a day?
a. to keep your teeth and gums healthy
b. to keep you from eating too much
c. to keep you from getting a sore throat
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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Question Comprehension , continued comprehension
How Questions
1. How do you find a telephone number you don’t know?
a. Call the operator.
b. Look it up in a cookbook.
c. Call the phone company.
3. How would you get your house painted if you were ill?
a. Try to do it yourself, even though your health is not good.
b. Ask some young kid to do it.
c. Pay a painter to do a professional job.
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Question Comprehension , continued comprehension
8. How would you travel to London, England from the United States?
a. by train
b. by airplane
c. by car
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
14. How can you keep your flowers from dying during dry weather?
__________________________________________________________________
15. How could you raise money for a community project? __________________
__________________________________________________________________
__________________________________________________________________
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Paragraph Comprehension comprehension
Goal: The client will increase the ability to read and understand paragraph-level
material to 90% accuracy.
Instructions: Have the client read each paragraph and read the questions that follow. He
should circle or point to the correct answer, or verbally give it.
Compensatory • Have the client use self-cueing strategies like tracing or sounding out.
Strategies:
• Keep your cueing to a minimum.
• Let the client use a paper marker or other type of bookmark to keep his
place and to cover distracting stimuli on the page.
Activity: Ask the client to read each paragraph and the questions that follow. He may
circle or point to the correct answer or letter, or verbally give the answer.
1. Mae and Sam realized they were getting older when they started having trouble taking care
of their yard. They decided to move into Friendship City, a retirement community of cluster
homes. The organization does all yard work and all repairs on the houses through monthly
association fees, which are $150 per couple.
Who will take care of the yard work in Mae’s and Sam’s new place?
a. the organization
b. family members
c. Sam
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2. The baseball game was to begin at 5:00 p.m., but a thunderstorm started at 4:30. The game
was delayed for two hours. It was midnight before Charles and Sarah finally got home. But
they had stayed dry under the rain ponchos Sarah had insisted on bringing. Charles was
glad he had listened to his wife.
3. The Morrisses left for the beach at 9:00 a.m. and arrived on Tybee Island Beach an hour later.
They spent all day playing with their three children. The oldest child, Brian, didn’t put on
enough sunscreen. He suffered a bad sunburn and missed two days of school.
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Paragraph Comprehension , continued comprehension
4. Maria awoke Friday night at 2:00 a.m. with a terrible pain in her chest. She was sure she was
having a heart attack. Her husband called 911. After two days in the hospital, Maria received
an emergency gall bladder operation. Although she wasn’t feeling well after the surgery,
Maria was relieved that she had no heart problems.
5. David underwent cancer surgery 16 days ago. Last night, he began feeling short of breath.
He told his wife, Laura, and she looked up David’s medications on the Internet. She told
David that his medications might be causing the shortness of breath.
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Paragraph Comprehension , continued comprehension
6. When Amarita retired, she immediately bought a lake house on Lake Claire and put her old
house up for sale. To her surprise, the house sold in only a month. Amarita invited her wid-
owed sister to move into the lake house with her. It was nice to have a companion.
Did Amarita’s sister bring her husband to live with her at the lake? ______________________
7. Elizabeth was going through a mid-life crisis. She found it difficult turning 40. Her family
was shocked when she announced she was changing professions. After being a nurse for 18
years, she decided to become a romance writer. She bought a black sports car, dyed her hair
red, lost 30 pounds, and renewed her marriage vows after signing her first book contract.
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Paragraph Comprehension , continued comprehension
8. Sarah was shocked when her granddaughter was born weighing only 4 pounds, 11 ounces.
Her daughter had taken excellent care of herself during the pregnancy, but did experience
toxemia two weeks before delivery. But after two days of weight gain, mother and baby went
home together. Sarah’s granddaughter has turned out to be quite healthy. She is now eight
years old and has just completed second grade.
What illness did the mother have during the end of her pregnancy?
a. hives
b. toxemia
c. diabetes
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E xpressive L anguage
E xpressive aphasia is very frustrating for the client who has experienced a
neurological insult. It’s difficult for us to imagine the host of emotions expe-
rienced by a client unable to make even basic needs and wants known to others.
As speech-language pathologists, we witness this daily in rehabilitation units.
Other therapists also become frustrated due to the breakdown in communication
with the expressively aphasic client. It is our duty as therapists to provide a
functional means of expressive communication for all clients.
This section gives you a step-by-step, hierarchical approach. Stimulus items are
plentiful. Some of the more difficult tasks contain 100 stimulus items.
Hopefully, this will relieve boredom when a certain skill must be practiced
repeatedly.
Keep in mind as you use this book, that many clients will reach a plateau in ther-
apy. If their neurological incident is more serious, or if this is a second, third, or
even fourth neurological insult, some clients may never reach the conversation-
al activities at the end of this section. Generally, if a client spends two to three
weeks at a certain skill level and is unable to progress past this point in spite of
extensive cueing efforts, then he has probably reached that plateau. Also keep
in mind that it is the clinician’s responsibility to devise external cueing strategies
for caregivers and any self-cueing strategies that make expressive communica-
tion successful.
When a plateau in therapy has been reached, the clinician should then design a
functional means of expressive communication for the client. This can be an
AAC board or device, sign language, writing, or some other non-oral approach
to verbal expression combined with any independent language skills that have
been retained.
It is my hope that you will find the following activities to be engaging and func-
tional. Enjoy your challenges ahead!
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expressive
Automatic Sequences language
Goal: The client will increase expressive language skills to within functional limits
for producing automatic sequences.
Instructions: You’ll have the client say common phrases, sentences, and songs along with
you. Assure him that these automatic sequences are over-learned speech. In
other words, let him know he won’t be learning anything new, but retrieving
simple language from the language part of his brain. It may be slow going at
first, but once the activity gets going, most clients join in readily and are
amazed at how simple it is for them to say these phrases and sentences.
• Hold up your fingers as you count with the client. Write down letters as
you say the alphabet.
• Be positive. Tell the client he might feel a little silly at first, but that this
activity is a good starting point for decreasing expressive aphasia.
➤ the alphabet
➤ vowels a, e, i, o, u
➤ popular children’s songs (“Three Blind Mice,” “Jimmy Crack Corn,” etc.)
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Naming Objects within Sentences language
Goal: The client will increase expressive language to 90% accuracy for naming com-
mon, functional objects (with cueing as needed).
Instructions: Collect 10-20 objects based on the Core Vocabulary Pictures on pages 22 and 23.
Introduce an object to the client and ask him to identify it. Then read the client
a sentence and hold up the object. Ask the client to name it when you get to
the missing word.
Compensatory • Here are some additional cues. Say the first phoneme of each word. Write
Strategies: the first letter of the word (or the entire word) on a card and show it to the
client. Say the sentence prompt while holding up the object, and mouth the
target word silently as the client follows your lips.
Activity: Read each sentence to the client and hold up an object or picture of objects to
help him complete the sentence. Accept any reasonable answer not listed.
6. I will dry off after a bath with a big, fluffy ______________. (towel)
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Naming Objects within Sentences , continued language
20. I’m sick and it’s time for me to take my ______________. (medicine)
26. I’ll cut this steak with a fork and a ______________. (knife)
27. My lips are dry, so I’ll need some ______________. (lip balm)
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Naming Objects within Sentences , continued language
38. If I want to shave, I’ll need a new can of shaving ______________. (cream)
45. To eat the meat, I will need a knife and a ______________. (fork)
48. To walk on the cold floor, I’ll need my other ______________. (slipper)
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Naming Objects without Sentences language
Goal: The client will increase expressive language to 90% accuracy for naming com-
mon, functional objects with reduced external cueing.
Instructions: As in the previous activity, collect as many objects as possible based on the
Core Vocabulary Pictures on pages 22 and 23. Introduce an object and ask the
client to identify it. Tell the client you will not give him sentence cues this time
to help him.
Compensatory • Describe the object and verbally express its function. If this is not effective,
Strategies: attach a simple carrier sentence to lead the client, “This is a __________.”
• Give the client the first or second phonemes of the target word, “This is a
br__________.” (brush)
• If necessary, use the carrier sentence and the initial phoneme, then mouth
the rest of the word silently.
Activity: Use objects based on the Core Vocabulary Pictures or from the previous activity
and ask the client to identify each item as you pull it from a bag, or other
secluded place. Explain that he will not receive sentence cues.
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Picture Naming language
Goal: To increase expressive language to 90% accuracy for naming common, func-
tional pictures with cueing as needed.
Instructions: Photocopy the Core Vocabulary Pictures on pages 22 and 23 and cut them
apart (if you wish). Ask the client to name each picture as you show it to him.
Tell him you’ll provide appropriate cueing if he has difficulty.
Compensatory • Use plain pieces of white paper to cover up other pictures to eliminate
Strategies: distractions. Many clients become distracted when presented with a page
filled with pictures.
• Tape the pictures individually onto index cards and rearrange them.
• If the client is having extreme difficulty, use sentence prompts before each
named picture. Use the sentence prompts from page 138 (Naming Objects
without Sentences), or make up your own.
• Here are some additional cues. Describe the pictured object and state its
function. Gesture the object’s function. Provide the first phoneme of the
pictured object. Point to the word below the pictured object to serve as a
written cue. Silently mouth the pictured word.
Activity: Introduce a picture from the Core Vocabulary Pictures to the client and have
him name it.
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Expressing Object Functions language
Goal: The client will increase verbal expression to 90% accuracy for expressing object
functions with single word and phrase responses.
Instructions: Select either pictures from the Core Vocabulary Pictures on pages 22 and 23, or
objects based on the Core Vocabulary Pictures. Use at least 20 objects or pic-
tures per session to better determine that accuracy levels are valid and reflect a
large enough sample of responses. Ask the client to first name the object/pic-
ture, and then to tell you how each object is commonly used. For example,
hold up a spoon and the client will say, “spoon.” Then say, “Yes, this is a
spoon. What do you use a spoon for?” Continue until all 20 object functions
are stated.
Compensatory • Repeat this activity until the client reaches 80 to 90% accuracy.
Strategies:
• Give the client carrier phrases like, “This is a _____. It is used for _____.”
• Give a gestural cue to help the client find the object’s function; for example,
sip soup with an imaginary (or actual) spoon.
• Give the first sound of the object’s name. Mouth the words silently.
Activity: Present the client with pictures of objects from the Core Vocabulary Pictures or
based on the Core Vocabulary Pictures, and have him name each object and
then give the object’s function.
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Completing Common Sentences language
Goal: The client will increase verbal expression to 90% accuracy for single-word
responses during sentence completion tasks.
Instructions: Tell the client you will read a sentence and leave out the last word. He will
verbally provide the missing word. Explain that the sentences are ones he’s
probably heard many times in his life. There are three sets of questions:
simple, moderate, and complex. Answers are provided for the simple and
moderate questions, but not the complex ones. The simple questions are fairly
straightforward. The moderate questions may have more than one right
response, so be flexible with the client. The complex questions are more open-
ended and difficult. For the complex questions, try to reduce cueing.
Compensatory • Give the client the first phoneme of the answer. Use a carrier sentence
Strategies: and the initial phoneme, then mouth the rest of the word silently.
• If the client’s expressive aphasia is more severe, you can rhythmically beat
sounds of the sentence or write down the missing words on index cards.
• Allow the client to read the sentence along with you if he needs a visual cue.
Activity: Read each sentence and have the client fill in the missing word. Provide com-
pensatory cues as needed.
Simple Sentences
1. You can go up or ___________. (down)
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Completing Common Sentences , continued language
22. That one is on top and the other one is on the ___________. (bottom)
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Completing Common Sentences , continued language
33. It went from my head all the way down to my ___________. (feet, toes)
36. Did you tell me the truth or did you tell me a ___________? (lie)
39. The mattress was either too hard or too ___________. (soft)
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Completing Common Sentences , continued language
49. Early to bed, early to rise, makes a man healthy, wealthy, and _____. (wise)
56. I need this piece of pie like I need a hole in the ___________. (head)
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Completing Common Sentences , continued language
84. That woman has always been the talk of the ___________. (town)
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Completing Common Sentences , continued language
Moderate Sentences
1. It’s noon, so it’s time to eat my ___________. (lunch)
12. My hair is too long, and I need to get it ___________. (cut, done)
14. It’s so hot that you should turn on the ___________. (fan)
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Completing Common Sentences , continued language
21. Please get me some cream and sugar for my ___________. (coffee)
23. When I get out of the shower, I put on my ___________. (bathrobe, clothes)
32. I can’t see very well, so I need a new pair of ___________. (glasses)
33. Please get me some new batteries for my hearing ___________. (aid)
37. These sandals are worn out, so I need a new pair of ___________. (shoes)
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Completing Common Sentences , continued language
43. I’d like to curl up on the couch and read a good ___________. (book)
46. The dog is scratching at the door to go out for a ___________. (walk)
48. We have so much junk that I plan to have a garage ___________. (sale)
49. The doctor told me to open wide and stick out my ___________. (tongue)
50. I was so excited that I felt like jumping up and ___________. (down)
51. I want a hamburger, French fries, and a chocolate __________. (milk shake)
55. It’s a sunny Saturday, so you’d better mow the ___________. (lawn/grass)
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Completing Common Sentences , continued language
66. My eyes are drooping because I’m feeling very ___________. (sleepy, tired)
69. I cooked dinner, so you can wipe the ___________. (counter, table)
72. She sent me a gift, so I’ll write her a thank-you ___________. (note, card)
74. It’s been so long since I’ve ridden a bicycle built for ___________. (two)
78. They told me to sit out here in the waiting ___________. (room)
80. The bird is about to spread its wings and ___________. (fly)
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Completing Common Sentences , continued language
88. Could you please make me some macaroni and ___________? (cheese)
92. The elderly woman fell and broke her ___________. (hip, leg)
93. For many years now, I’ve had to use a walking ___________. (stick/cane)
98. We got up on the dance floor and did the fox ___________. (trot)
100. I hope you’re ready because it’s time for us to ___________. (leave, go)
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Completing Common Sentences , continued language
Complex Sentences
1. It’s time to go to the ___________.
20. It’s time to eat, so please come over here to set the ___________.
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Completing Common Sentences , continued language
34. To make a phone call, you now need a quarter and a ___________.
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Completing Common Sentences , continued language
60. During the baseball game, I saw a player steal second ___________.
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Completing Common Sentences , continued language
66. You should call the power company about last month’s ___________.
74. I’m going to can and freeze some of those fresh ___________.
80. I’m going to sit down here and eat this piece of ___________.
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Completing Common Sentences , continued language
82. I have been working too hard over the past ___________.
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Naming to Description language
Goal: The client will increase verbal expression and word retrieval to 90% accuracy
for single-word responses during naming drills.
Instructions: Tell the client you will describe certain objects. Then have him tell you what
the object is. Think of this as a good “warm-up” activity for many clients who
suffer word-retrieval difficulties. There are two sections: Nouns and Verbs.
Compensatory • Phonemic, syllabic, and gestural cueing is still permissible. But keep in
Strategies: mind that if you use these kinds of cues, then the client’s prognosis for
independent verbal expression worsens.
Activity: Read the following descriptions and have the client give you the answers.
Nouns
1. It has a back, a seat, and four legs. You sit down in it. (chair)
2. It has a collar and sleeves. It is made out of fabric. You wear it. (shirt)
3. It is usually white and it may have lines on it. Its shape is rectangular. You
write on it. (paper/notepad)
4. It has numbers and buttons. There is a cord and a receiver. It rings and
you can talk on it. (telephone)
5. It is a liquid. We all need it to live. It is clear and you should drink eight
glasses of it daily. (water)
6. This is made out of metal. It has a handle. One end is rounded. You use it
to eat soup. (spoon)
8. You wear this when you sleep. This clothing usually has two pieces.
(pajamas)
9. This has many pages and a hard or soft cover. You read it. (book)
10. This is something that has a frame. It is rectangular. It has a mattress and
box springs. (bed)
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Naming to Description , continued language
11. It has a sole, a tongue, eyes, and laces. You wear it on your foot. (shoe)
12. It has windows, doors, and a steering wheel. There are four tires and it
needs fuel to keep going. (car, vehicle)
13. It is a major appliance. It has various temperatures. It gets hot and cooks
food. (stove, oven)
14. It has a handle and bristles. It is used to keep your teeth clean. (tooth-
brush)
15. It comes in a bar or liquid. It makes suds. You use it to wash your hands
and clothes. (soap)
16. This is usually made out of leather. It has a buckle. It goes around your
waist. It holds your pants up. (belt)
17. This has a handle on one end and a point on the other end. You open it up
and use it on a rainy day. (umbrella)
18. This is made of soft paper. It comes on a roll. You find it in the bathroom.
(toilet tissue)
19. This is a string. It is usually white. The string is often coated with wax.
You use it to get food out from between your teeth. (dental floss)
20. It is a liquid. It usually comes in a mint flavor. You use it to rinse out your
mouth. (mouthwash)
21. This is a machine that has a screen and a keyboard. You use it to log onto
the Internet and communicate with others. (computer)
22. It has handles or straps. A woman carries this to hold her money and other
small, personal items. (purse)
23. This is an animal that many people have as a pet. It has fur. It wears a
collar and it barks. (dog)
24. This is a season. It is cold and it often snows in the north. (winter)
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Naming to Description , continued language
25. It is usually made of metal and/or plastic. It has two round handles and
two sharp blades. You use it to cut paper. (scissors)
26. It is made out of paper. You lick it to close it. Most people place letters
inside this and put an address and stamp on the outside of it. (envelope)
27. This is a vegetable that looks like a little tree. It is green. Many people
steam it to cook it. It is supposed to fight cancer. (broccoli)
28. This is a hot drink. It is black in color. Many people drink it when they
wake up in the morning. (coffee)
29. This is frozen water. You put it in a drink to keep it cold. (ice)
30. This is a vehicle that has a cab and a bed. Most people use this vehicle to
haul things. (truck)
31. This usually comes in packs of 20. It is bad for your health. You light it
and smoke it. (cigarette)
32. It is made of wax. It has a wick. You can light it and place it on the dinner
table. (candle)
33. It is made of paper or cloth. You use it during a meal to wipe your mouth
and hands. (napkin)
34. It is hard on the outside. It has a strap and buckle. It goes on your head
when you are riding a bike or motorcycle. (helmet)
35. This is a fruit that has a peel on the outside. It also has a stem. It can be
green, red, or yellow. Some people say if you eat one of these everyday, the
doctor will stay away. (apple)
36. This is something many women put in their hair. It is usually done in a
hair salon. It puts curl into straight hair. (permanent)
37. This comes in granules. It is white. Most people keep it in a shaker on the
kitchen table. You use it to season food. It is a condiment. (salt)
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Naming to Description , continued language
38. This is a season. Leaves fall from the trees. The air begins to get cooler and
people start wearing sweaters. (autumn)
39. This is outside by your front door. It has a button to push that causes it to
ring. You use it to let the homeowner know someone has come to visit.
(doorbell)
40. It goes on the bed. It is soft. Most people place this under their head while
they are sleeping. (pillow)
41. This goes up into the air. It takes people from place to place. It has an
engine. (airplane)
42. These help you see better. You wear them on your nose. Sometimes they
are bifocals or trifocals. (eyeglasses)
43. This is an electronic device that many people own. You watch movies, the
news, and other programs on this appliance. (TV)
44. This is a day of the week. It comes two days after Tuesday and two days
before Saturday. (Thursday)
45. This is a room in your house. It has a sink, a tub, and a toilet. (bathroom)
46. This is a place to live. It is usually in a building with many other units.
You have to pay rent to live there. (apartment)
47. This is a very common illness with no real cure. It causes sneezing, a
runny nose, and sometimes a cough. (cold)
49. It is in your home. It can go up and down. It has panes made of glass and
a screen on the outside. (window)
50. This is used in the summer in your house. It blows out cool air to reduce
the heat in your house. (air conditioner)
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Naming to Description , continued language
Verbs
1. This is something you should do three times a day. It is vital for your
health. It provides all the necessary nutrients for you body. (eat)
2. This is something you should do throughout the day. It keeps your body
from dehydrating. You need a cup or a glass to do this. (drink)
3. You do this for about 6-8 hours each night. It is accomplished when you lie
down, cover up, and put your head on a pillow. (sleep)
4. Many people do this when they sleep. It is often annoying and a hus-
band/wife may have trouble sleeping because of this noise. (snore)
5. You do this for exercise. It is very good for you. You can do it slowly. You
can do it outside or on an indoor track. Some people even do it at a shop-
ping mall when the weather outside is bad. You do it with your legs.
(walk)
6. You do this for exercise. You can do this in sprints or in marathons. You
may also do it to get away from someone. (run)
7. You do this when you’re walking or standing and you lose your balance
and are suddenly no longer on your feet. (fall)
9. You use your fingers to do this. You push keys on a board to make letters
on a computer screen or a piece of paper. (type)
10. Many speech therapists encourage patients to do this. When you do it, you
communicate and relate to others around you. You move your lips and
tongue and annunciate. (talk)
12. You do this when you show affection. You press your lips against another
person’s lips. (kiss)
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13. You use your ears to do this. You can enjoy beautiful music and other
sounds around you. (hear/listen)
14. You do this when you use your voice in a very loud manner. You may call
for a child to come into the house or you may be angry at someone. (yell)
16. You do this with your feet to move a bicycle forward. (pedal)
17. This is something we do each day to keep our bodies clean. (bathe, wash,
shower)
18. You might do this if you are sick or suddenly frightened. You begin to feel
woozy, dizzy, and then you slump to the floor. You are unconscious for a
short time. (faint)
19. You do this when you get a cold. You may also do this frequently in the
spring if you have hay fever. Air is forced through your nose. (sneeze)
20. This action often accompanies a cold. It can keep you up at night. You
should cover your mouth when you do this. If you do this enough, you’ll
get a sore throat. (cough)
21. When you do this you can look at the world and enjoy its beauty. You use
your eyes to do it. (see)
22. This is another word for preparing food. You use food, an oven, and
kitchen utensils, to do it. (cook)
23. You do this with a telephone. You pick up the receiver and dial the tele-
phone. (call)
24. Your nose lets you to do this. When you have a bad cold, it is hard to do
this. (smell)
25. You do this in your house. You can use a broom, mop, vacuum cleaner,
dust rags, and furniture polish. (clean)
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26. You must put food in your mouth to do this. The buds on your tongue
help you do it. (taste)
27. To do this, you must take a test and receive a license. You could have a
wreck while doing this. You use a car or other vehicle. (drive)
28. You do this every day when you put on clothes like pants, shoes, a sweater,
a dress, etc. (dress)
29. You do this when you eat. You need teeth to accomplish this. You move
your jaw up and down and grind food with your teeth. (chew)
30. You do this with your fingers. It is tactile. You place your fingers against
something. (touch)
31. This is something you do with a machine to the grass in your yard. You
don’t do it when it’s snowing, though. (mow)
32. You do this in a store. You go into the store, browse around, select an item,
and then pay the clerk. (shop)
33. Your doctor tells you to do this to stay healthy. It involves physical move-
ment to increase your heart rate. (exercise)
34. You do this with a pen and a piece of paper. You pick up the pen and
move it along the paper to form words and sentences. (write)
35. You need an appliance that gets very hot to do this. You plug in the appli-
ance, place an article of clothing on a board, and move the appliance over
the clothing to erase the wrinkles. (iron)
36. You do this using a broom. You take the broom and move it over the floor
to rake up small pieces of dirt and trash. (sweep)
37. You do this when you are sleepy. You open your mouth very wide. It tells
you that it is time to lie down and go to sleep. (yawn)
38. You need music to do this. You use your voice to draw out words that go
with the music. Your voice and words follow the melody. (sing)
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39. You do this when cleaning a floor. You use a device with a long, wooden
handle on one end and cotton strings or a sponge on the other end. (mop)
40. You do this by using a pencil or pen and art paper. You make images,
inspired by creativity and vision, on the paper with the pencil. (draw)
41. You do this in an airplane. You board the plane, it takes off, and you move
through the air. (fly)
42. You do this when you are sick or nauseated. The food you ate hours ago
comes up from your stomach and out of your mouth. (vomit)
43. This is similar to singing, but you keep your mouth closed and use your
voice to produce a tune. (hum)
44. This might happen when you walk. Your feet get tangled, you almost trip
and fall, but you regain your balance and stride in time. (stumble)
45. People who enjoy preparing sweets do this. They mix ingredients to make
items like pies, cakes, and cookies. (bake)
46. You do this by holding a book or magazine and moving your eyes across
the page. (read)
47. You do this in a boat on the water. You use a pole with a line attached.
There is a hook at the end of the line. (fish)
48. You do this to the clothes you take out of the dryer. You put the clothes
together in an orderly fashion so you can put them in drawers. (fold)
49. You do this with a needle and thread. If a button falls off your shirt, you
use the needle to put it back on. (sew)
50. You do this with wool yarn and two long needles. You use the long nee-
dles to weave the yarn together to make things like sweaters and blankets.
(knit)
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Two - or-More -Word Responses language
Goal: The client will increase verbal expression to 90% accuracy for producing two-
or-more-word responses during sentence completions/tasks.
Instructions: Read the client the sentence and ask him to complete the sentence with two or
more appropriate words. It’s not important what his answer is, as long as it’s
more than one word. Begin to fade cueing but assure the client that you will
continue to provide cueing if he needs it.
Activity: Read the client each sentence and have him fill in the completion with a phrase
of two words or more.
1. I want to ______________________.
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Situational Sentences language
Goal: The client will increase verbal expression to 80% accuracy while forming sen-
tences.
Instructions: Ask the client to listen as you read a short situation. Have him respond with
a short sentence. The goal is to begin reducing external cueing and to move
toward independent cueing and/or independent verbal expression. Don’t
worry if the client doesn’t match the given answer exactly. Accept any answer
that makes sense and is an actual sentence.
Compensatory • Show him the cue situation and the answer only if it helps him produce an
Strategies: appropriate verbal response.
Activity: Read each situation to the client and have him give an appropriate answer.
1. You are in a hospital room and it is time for your pain medication. You press the call button
and say,
I need my pain medicine.
2. You are sitting in a wheelchair out in the hallway of the rehabilitation center. You would like
to see your nurse, but you aren’t strong enough to wheel the chair all the way down to the
nurse’s station. A young man passes by and you say,
3. You are awakened in your hospital bed in the middle of the night. You are cold. You press
the call button to say,
4. You are sitting in a hospital room. Your mouth is dry and your stomach begins to rumble.
You press the call button to say,
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5. You have just completed physical therapy. You are exhausted and need to take a nap. You
look at your therapist and say,
6. You reach over to turn on your bedside lamp and the bulb is burned out. To your spouse,
you say,
7. You notice that a green plant in your room has wilted. When the nursing assistant walks in
your room, you say,
8. While you are dressing one morning, you notice that a button has fallen off your shirt. You
go to your daughter to say,
9. You wake up one morning to discover that your left leg is red and swollen. It is also quite
painful. You call the nurse to say,
10. You are ready for your morning grooming rituals. When you get to the sink, you discover
that your comb is missing. You press the call light to say,
11. You are tired of being in a hospital room. You’ve been told that your family can now take
you on short outings. When your daughter arrives, you say,
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12. You’d like to watch TV in your room. When you try to turn on the TV, nothing happens. You
gain the attention of a nurse’s aide to say,
13. You don’t have a telephone in your room. You go to the nurse’s station because you would
like to make a call. When you arrive at the nurse’s station, you say,
14. You want to write a note to yourself about when your daughter will be picking you up for a
doctor’s appointment. You approach the activities director and say,
15. When you get cereal with milk for breakfast, you realize the milk is spoiled. You see a nurse’s
aide and say,
16. You suffer from seasonal allergies. The pollen count is quite high and you have been sneez-
ing all day. You let out a sneeze in front of the physical therapist. Then you say,
I need a tissue.
17. You wake up one morning and you’re unsure what day and date it is. When the nursing
assistant walks in the room, you say,
18. You sit down to eat your lunch. Soup is being served, and you don’t have a spoon. When the
dining room attendant walks by, you say,
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19. At dinner one night, you notice that you don’t have a napkin. To the dining room attendant,
you say,
20. You get black coffee at breakfast one morning. You never drink your coffee black. After the
dining room attendant pours the coffee, you say,
21. Your food doesn’t have much taste. You would like to make it taste better, so you say to
someone at your table,
22. You go to an ice-cream parlor on a day trip and you’d like one scoop of ice cream on a cone.
It is your turn to give your order. You say,
23. You’d like a small amount of money each week to buy snacks and magazines at your retire-
ment community. Your son takes care of all your finances now. To your son, you say,
24. You would like to get out of your hospital bed to sit in a chair. But you need assistance trans-
ferring your body from the bed to the chair. You press the nurse’s call light to say,
25. You enjoy listening to music while lying in your hospital bed. You can’t reach the radio, but
your roommate can. So you say,
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26. Your roommate enjoys watching TV. This morning, he turned on the TV with the volume
extremely high. You notice that he has forgotten to place his hearing aid in his ear. So you
say,
Put in your hearing aid and turn down the TV, please.
27. It has been weeks since you had a haircut. When your son arrives to visit, you say,
I need a haircut.
28. You are at the check-out counter at a local convenient store. You need an extra nickel to pay
the clerk. You can’t find one, so you say to your daughter,
Can I borrow a nickel, please? (or) Give the clerk a nickel, if you have one.
29. You make a batch of chocolate chip cookies during your occupational therapy session. After
the cookies are out on a plate, you approach some of your new friends to say,
30. The telephone in your room is ringing. You can’t reach the receiver from your bed. To your
roommate, you say,
31. The sun is shining too brightly through the window of your room. It’s making you squint.
When the nursing assistant arrives, you say,
32. The housekeeping department in your retirement community has agreed to do your laundry
each week. They did not pick up your clothes yesterday and you are worried that they have
overlooked you. You approach the apartment manager to say,
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33. You have accompanied your spouse to pick up your daughter at the airport. You are not sure
about the plane’s exact arrival time. You ask the gate attendant,
34. You wake up in the middle of the night smelling smoke. Your spouse is soundly sleeping.
You immediately wake him up to say,
I smell smoke.
35. You recently heard that a close friend has just lost her spouse to cancer. You’d like to send a
sympathy card. To your daughter, you say,
36. A tire on your car went flat. You are only one mile from home. You pick up your mobile
phone and dial your home number. When your spouse answers, you say,
37. It’s dinner time and you want to wash your hands before you eat. You start to leave the
dining room to do this, when a nurse stops to ask where you are going. You say,
38. You are in a toy store trying to purchase a gift for your granddaughter’s first birthday. You
see a teddy bear that you know she would love. The bear is high on a shelf and out of your
reach. You locate a clerk to say,
Can you please get the bear on the high shelf for me?
39. You have received numerous floral arrangements and gifts since a recent illness. It is now
time to express your thanks. You have great difficulty writing. You call your daughter to say,
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40. You and your spouse recently purchased a new puppy. You know your spouse always for-
gets things. You are worried that the puppy has not yet been taken to the vet. When your
spouse comes home, you say,
Have you taken the puppy to the vet for shots yet?
41. You enjoy playing board games. Your best friend shares this interest. You call your friend to
say,
42. You are sitting in the kitchen while your daughter is using your recipe to make chicken pot
pie. You’re telling her step-by-step because the recipe is in your head and not written down.
You see that your daughter is about to place the pie into a 450° oven, which is much too hot.
So you say,
43. Your nephew wants to find out what you’d like for your birthday present. He has asked
about several different items. He brings up perfume, which you are allergic to. You then say,
44. You fell two days ago and suffered a bad break in your right arm. You now have a large cast
that you’ll have to wear for eight weeks. Your son asks you how long you will have to wear
the cast. You say,
45. You decide to begin a flower garden but you don’t have much experience. You go to a book-
store, but you can’t find the right type of book. You walk up to the clerk to say,
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46. Your spouse feels that you have both grown too old to take care of the yard duties. He wants
to hire someone younger to cut the grass and keep the trees lopped. You agree and say,
You’re right; let’s hire someone to keep the yard in good shape.
47. It is time to do the weekly grocery shopping. Since your illness, you’ve had to ask your
daughter to complete this chore. You need to tell her three more items to add to the grocery
list. You say,
Please add _____, _____, and _____ to the grocery list, please.
48. You think you may have the flu and it alarms you. You know that the flu can become quite
serious at your age. You make an appointment with your doctor. He asks you to describe
your symptoms. You then say,
49. You are embarrassed when you discover that you have allowed your car to run out of gas.
You pull over to the side of the highway and turn on your hazard lights. A policeman
arrives. With a red face, you say,
50. You and your spouse have planned a romantic dinner. You thought that everything was
ready. Then you realize you need matches for the candles. You have no idea where the
matches are in your house. To your spouse, you say,
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Building Sentences with Cueing language
Goal: The client will increase verbal expression to 90% accuracy for sentence form-
ulation exercises with cueing.
Instructions: In this activity, you will have the client arrange words to make sentences.
Photocopy the words on pages 178-180 and cut them apart into individual
squares. (You can also use the words from pages 26 and 27.) Tell the client
that you will select the first word, and he will need to find other words to
make a complete sentence. Have him pronounce each word that he adds.
After making a sentence, have him read the sentence aloud.
• If the client struggles selecting appropriate words, then select two words
and ask him to pick one that might help make the sentence. Use this dual-
choice mode for all words until an appropriate sentence is made.
• Mount the words on separate index cards and cover them with clear contact
paper.
• Feel free to add additional words or to customize more words to reflect your
client’s interests.
Activity: Photocopy the words on pages 178-180, cut them out, and place them ran-
domly in front of the client. Start the sentence for him by picking a word and
then have him add words until he makes a sentence.
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Building Sentences without Cueing language
Goal: The client will increase verbal expression to 90% accuracy for sentence formu-
lation without cueing.
Instructions: Tell the client you’ll verbally give him a word and that he must add words until
he makes a sentence. Explain that his sentence can be about anything, as long
as it makes sense. Use the word list from the previous activity for your target
words.
Compensatory • You can play a variation of this activity. You come up with one word, then
Strategies: the client comes up with one. Then you come up with another one, then he
does, etc.
• Experiment with three word sentences and build up to longer ones if the
client is able.
• Do not provide further cueing. The client should be striving for a maximum
level of independence at this point in therapy.
Activity: Verbally give the client a word from the previous activity’s list and have him
make up his own sentence.
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Having Conversations language
Goal: The client will increase sentence formulation skills to 90% accuracy at the level
of conversational speech.
Instructions: In this activity, you are slowly moving from making sentences to making
conversation. You will introduce the client to a number of conversational top-
ics—descriptions, interviews, and “what if” situations. Each section has its
own instructions. Feel free to add any personal items to the list to customize
your therapy.
Compensatory • Don’t put too much pressure on the client. Speech will usually flow easily
Strategies: from an aphasic client if he “forgets” he’s speaking. Also remind people
speaking with the client to be patient with his speaking ability.
Activity: Use the topics in this activity as a springboard to having conversations with
the client.
Descriptions
Ask the client to describe the following items in detail:
1. a car
2. a pet
3. a coat
4. a house/apartment/condo
5. his room
6. his hometown
7. his favorite restaurant
8. a particular outfit
9. a certain person
10. his mother
11. his father
12. his brother/sister
13. his backyard
14. his spouse
15. his watch
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Interviews
Expand on these topics by discussing appropriate questions prior to the inter-
view. You may want to have the client interview only you, or just other staff
members if he is open to this.
1. cost of living
2. military conflicts/war
3. taxes
4. weather
5. child care
6. using credit cards
7. the environment and its protection
8. jobs
9. educational trends
10. sports
11. current events
12. marriage and divorce
13. changes in health care
14. new technology (computers, E-mail, cell phones, etc.)
15. volunteerism
1-04-987654
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