Visual Action Therapy (VAT)

Visual Action Therapy (VAT) is a non-verbal or gestural compensatory approach to aphasia intervention in which patients use symbolic gestures rather than speech. This strategy is designed for severally impaired or globally aphasic individuals. It is a hierarchically structured program with three levels that uses objects, realistic line drawings of objects, an action pictures representing a figure properly using the objects. In time, the client moves from matching pictures and objects to using gestures in order to communicate simple functional messages. There are 3 types of VAT which include proximal limb, distal limb and bucco-facial. All three variations follow the same basic training sequence as summarized below (Roth, 2021).

Following these steps, the use of real life objects is eventually discontinued. The only stimuli used are pantomime gestures and action pictures.

Basic sequence steps for VAT

Placing objects on pictures
Placing pictures on objects
Pointing to the object
Pointing to the picture
Object use training
Action picture demonstration
Following action picture commands
Pantomimed gesture demonstration
Pantomimed gesture recognition
Pantomimed gesture production
Representation of hidden objects
Production of gesture for hidden objects

Recommended objects for bucco-facial VAT

A whistle, flower, lollipop, drinking straw and lip balm

Evidence Based

VAT is based on the principle that people with severe language impairments often retain symbolic abilities that underlie language use. Patients with global aphasia retain a rich conceptual system in at least some of the cognitive operations necessary for natural language.

Previous research studies reveal that VAT results include significant increases in auditory comprehension and pantomime in 8 globally aphasic patients who failed to respond to traditional language approaches (Helm-Estabrooks et al., 1982) as well as improvements in pantomime verbal repetition and auditory comprehension in 6 people with aphasia and bucco-facial apraxia (Porch, 1967).

Appropriate candidates for this compensatory approach include individuals with the following characteristics:

(Roth, 2021, p. 309)

Example Goal of Person with Aphasia that would benefit from VAT

Sam will identify the correct picture in a field of 4 when presented with a real life object of the picture at 90% accuracy given 0-2 visual cues.

Data collection sheet example

References

Helm-Estabrooks, Nancy, et al. “Visual Action Therapy for Global Aphasia.” Journal of Speech and Hearing Disorders, vol. 47, no. 4, 1982, pp. 385–389., https://doi.org/10.1044/jshd.4704.385.

Porch, Bruce E. Porch Index of Communicative Ability. Consulting Psychologists Press, 1967.

Roth, Froma P., and Colleen K. Worthington. Treatment Resource Manual for Speech-Language Pathology. Plural Publishing Inc., 2021.

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