Table 3.

Language dementia care pathway vignette

How the Aphasia is Affecting Margaret's Daily Life	Margaret's Identified Strengths	Corresponding Recommendations for Margaret
Margaret is less active socially and finds it hard to stay busy when her partner is at work. She often watches TV and wishes she had more to do.	She is independent in most of her personal activities of daily living.	New modified community activities were suggested, including volunteer work that does not rely heavily on communication with others, such as walking dogs for a local shelter.
Margaret has word finding pauses and hesitations and increased difficulty with auditory comprehension at the conversation level. Spontaneous speech is especially difficult when speaking over the telephone.	Margaret has preserved memory for recent events; no behavioral changes have been reported.	Create a communication friendly environment by reducing distractions, using one-on-one conversations and speaking in simple sentences to facilitate auditory comprehension. Communication enhancement strategies (eg, family asking more “yes-no” questions and Margaret using gestures to help explain what she is trying to say). Speech therapy focused on creating home program targeting the rehearsal of personally relevant words, including names, important locations, and other important words she uses during daily conversations. Telephone scripts were designed and rehearsed to promote word retrieval and fluency during telephone conversations.
Her partner and children are less likely to converse with her for fear of creating frustrating situations when she cannot find a word.	She has preserved insight into her condition and resulting changes.	Speech-language pathologist trained Margaret and her family to create a system for when to help fill in the words for her during conversation. Also trained family on appropriate verbal cues to increase Margaret's use of semantic circumlocution, so she can self-cue or communicate her message more easily to others. A communication wallet was also created, which contains lists of words by category that Margaret frequently uses during conversations with family and friends. Margaret was trained to use the wallet when unable to retrieve the word. Education on the disease and support was provided for her young sons and her partner. Directed family to the Association for Frontotemporal Dementia Web site for kids and teens http://www.aftdkidsandteens.org.
Errors with spelling	She is interested in writing e-mails to friends and family.	Used augmentative technology, such as the Google application or Dragon software on Margaret's smartphone to assist her with spelling. With this application, she could speak the word and the device used speech recognition software to spell out the word for her.