Schuell's Stimulation Approach

Overview

Originally developed by Hildred Schuell in the 1960's, Schuell's stimulation approach to aphasia treatment is an evidence-based practice that was designed for all types and severities of aphasia (Coelho et al., 2008); Marsalisi et al., 2022). Schuell's stimulation approach focuses on using an auditory modality with high intensity and salience to target comprehension of receptive language, as well as other aspects of aphasia (Marsalisi, 2020; Marsalisi et al., 2022). Using this approach, clients are asked to complete tasks based on auditory stimulation that is presented by the clinician (Aphasia Therapy Planner, n.d., Marsalisi, 2020). The level of stimulation and tasks presented will vary depending on the severity level of aphasia (Aphasia Therapy Planner, n.d., Marsalisi, 2020). Levels can range from asking the client to repeat one word or sets of words, matching spoken words to pictures, and following directions (Aphasia Therapy Planner, n.d.). Activities used with this approach shoudl vary according to patient severity level and meaningfulness to the client.

How to Utilize Schuell's Stimulation Approach During Treatment

Since Schuell's stimulation approach is an "approach", it does not have a specific protocol for clinicians to follow (Therapy Insights, 2022). That being said, there are many different ways to implement this approach during therapy. Since there is no specific protocol, implementation can be flexible across various materials and should focus on utilizing the client's strengths. Below is a list of helpful tips for implementation in therapy:

• Use primarily auditory stimulation

• Choose a stimulus and task suited to the client's level of severity

• Begin with an easy warm up task

• Use repetitive auditory stimulation

• Elicit the maximum possible amount of responses

• Clinicians should provide feedback about the accuracy of responses

• Clinicians should motivate and encourage the client

• The clincian should use a systematic and intensive approach

• Reduce background noise to avoid competing stimuli

• Clinicians should choose realistic, operative, and unambiguous objects or pictures

• Choose words that are semantically, phonetically, and visually different to avoid confusion

• Provide biofeedback (such as a video) 

• Encourage breaks to minimize fatigue

(Coelho et al., 2008;Therapy Insights, 2022)

Materials

The materials utilzied for Schuell's stimulation approach should be adapted to the client's ability levels. Materials should focus on familiar, everyday objects to promote functionality and focus on familiar language (Coelho et al., 2008; Aphasia Therapy Planner, n.d.; Therapy Insights, 2022). Activities can include identifying and naming a picture of a letter named by the clinician, repeating words spoken by the clinician, reading sentences or passages aloud and repeating them, matching pictures of objects to the object named by the clinician, matching an object to the verbal description given by the clinician (Aphasia Therapy Planner, n.d.). A great option for clinicians to utilize is the Language Activity Resource Kit - Second Edition (LARK-2). The LARK is a kit that includes a workbook, photo cards, and collection of real objects, such as hammers, cups, socks, and spoons. This kit allows flexibility for different severity levels of aphasia and focuses on using functional objects in therapy. The clinician can use this in combination with Schuell's stimulation approach for receptive therapy, or can even use the same materials for receptive therapy. 

Example Goal

In six months, Client will correctly identify an object or photo of an object when given a verbal description of the object with 80% accuracy across three consecutive sessions, as measured by clinician data.

References

Aphasia Therapy Planner. (n.d.). Schuell’s Stimulation Approach to Rehabilitation. Aphasia Therapy Planner. http://aphasiatherapyplanner.weebly.com/schuells-stimulation-approach-to-rehabilitation-reading.html. 

Coelho, C., Sinotte, M., Duffy, J.R.. (2008). Schuell's Stimulation Approach to Rehabilitation. In R. Chapey (Ed.). Language Intervention Strategies in Adult Aphasia (5th ed.) (pp. 403-449). Lippincott Williams & Wilkins.

Marsalisi, C., (2020). The Efficacy of Intensive Application of Schuell’s Stimulation Approach for Chronic Wernicke’s Aphasia: An Analysis and Comparison. Master's Theses. 1476.

https://opencommons.uconn.edu/gs_theses/1476.

Marsalisi, C., Hughes, S., & Mozeiko, J. (2022) The Therapeutic Effect of Schuell’s Stimulation Approach for Severe Chronic Aphasia. Aphasiology. DOI: 10.1080/02687038.2022.2096206.

Therapy Insights. (2022). Oral Reading for Language in Aphasia (ORLA) – Printable Handouts for Speech, Occupational, and Physical Therapists. Therapy Insights.