Less Naming, More Action! How the VNeST approach can improve aphasia
After an individual suffers a stroke, the person may be left (literally) at a loss for words. This classic hallmark of stroke or brain injury is called aphasia and results in word-finding difficulties and/or comprehension challenges. At times the person's aphasia may be so severe that it negatively impacts their ability to even communicate simple thoughts. In more milder cases, although the formation of thoughts may be easier, generating specific words, especially words not commonly used, becomes more challenging. Most individuals who experience aphasia struggle with retrieving the names of objects, people, or places, which is called anomia. This reduction in ability to generate novel thoughts and ideas can lead to the individual to feel lonely, isolated, and frustrated, which may lead to them withdrawing from situations once found pleasant, elevating their risk for depression, and may even exacerbate the word finding deficits that already exist.
Traditional speech-language therapy approaches to aphasia tend to focus on word-finding and naming using every day items or pictures. In these cases, the items being named are often nouns, where limited generalization (carryover) into other types of language and information is noted (Edmonds & Babb, 2011, p. 131). One therapy approach, called Verb Network Strengthening Treatment, or VNeST, has been found to bridge the gap of word finding and generazation in aphasia treatment. Developed primarily by Dr. Lisa Edmonds, PhD, CCC-SLP, VNest therapy focuses on verbs versus nouns, encouraging the connections of the people who perform the action and object it is performed on. Think of it as a scaffolded subject-verb-object set up.
The VNeST approach, unlike other aphasia treatments, does not use images or picture cards, but the printed word itself. The design of this treatment is intended to activate mental images and encourage flexible thought. By doing this, the individual is able to access verb networks and probe recall of related words, thus enhancing semantic associations and connections that are more similar to simple sentence structure. Dr. Edmond's research has found that VNeST may "promote generalization of sentence production beyond treated concepts and tasks" (Edmonds et al., 2014, p. S324), which means that gains may show up on words that were never practiced.
How is VNeST completed? Very simply! All you need is a list of verbs - choose verbs that are transitive, meaning they take an object. For example, "catch" or "drive" would work because they can take an object (e.g. the dog catches the ball, or the man drives a car).The verbs should be not too generic or specific, and avoidance of verbs like is, do, or have is recommended because they can be hard to specifically associate. Once you have your verb, think of 3 people (or nouns) who could perform the action, and then 3 objects the action could be done to. Focus on being as specific as possible with noun selection, and even consider using the names of family, friends, and pets! Also try to use as many different meanings of the verb as possible, too. For instance, "run" could be physically running, or relate to running a business. Once you are set up, randomly select a triad (subject -verb-object) combination. Have the patient generate a sentence then expand on the thought by asking wh- questions: what, where, why, when, who, how. Verb conjugation is not required, but can be done to make the sentences work, and there are no wrong answers! There are additional steps to the VNeST approach, but this is the main core (learn more by clicking the link below).
Here is a funny example that was used in a recent therapy session with a client who has a mild to moderate aphasia from a prior stroke and happens to be an ELL (English as a learned language). The client chose the verb "run," the subject "dog," and object "business." Using the VNeST approach, the patient was able to formulate a hysterical story about a dog (further specified to be a pit-bull) running a pet store (in her local community) in which he was funded by accepting donations, and unfortunately did not survive the economic stress of the pandemic and had to close. This individual was using language and words she does not always use, was laughing and having fun, and was producing longer, more specific sentences as the activity progressed.
VNeST has been found to be effective for use with individuals with aphasia deficits ranging from mild to moderate-severe. Formal training or certification is not needed to use this approach which makes it highly accessible to any provider. Some limitations in use is the individual should be able to understand instructions and have some ability to either speak or write their answers, which can both be impacted by a stroke. A speech-language pathologist should perform an thorough comprehensive assessment prior to recommending VNeST for a client. Another advantage to this approach is it can be modified to fit the needs of the client and does not have to be performed the same way every time. It is more important to utilize the theory behind the approach and to remember the goal of activation of language networks, not to focus on memorization or accuracy. As a final consideration, is this approach is just fun. The set-up of his approach can lead to very funny sentences and stories, and lots of laughter. Clients are more likely to be engaged with language therapy tasks that promote fun and creativity, thereby reducing related stress of being accurate, which enhances engagement, participation, and overall generalization. In short, less naming, more action!
Interested in VNeST? Download your "How To" guide with or without apps here: https://tactustherapy.com/vnest-verb-network-strengthening-app/
American Speech-Language-Hearing Association. (n.d.). Practice portal glossary. Practice Portal. Retrieved December 8, 2021, from https://www.asha.org/practice-portal/glossary/.
Edmonds, L. A., & Babb, M. (2011). Effect of verb network strengthening treatment in moderate-to-severe aphasia. American Journal of Speech-Language Pathology, 20(2), 131–145. https://doi.org/10.1044/1058-0360(2011/10-0036)
Edmonds, L. A., Mammino, K., & Ojeda, J. (2014). Effect of verb network strengthening treatment (VNeST) in persons with aphasia: Extension and replication of previous findings. American Journal of Speech-Language Pathology, 23(2). https://doi.org/10.1044/2014_ajslp-13-0098
How to: Vnest - verb network strengthening treatment for aphasia. Tactus Therapy. (2021, March 24). Retrieved December 8, 2021, from https://tactustherapy.com/vnest-verb-network-strengthening-app/.
National Aphasia Association. (2021, September 15). Retrieved December 8, 2021, from https://www.aphasia.org/.