REHABILITATION & RECOVERY
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Re-Stacking the Deck
L!V Cards Give a Voice to People with Aphasia
By Elizabeth Witherspoon, PhD
Scientists at the University of
North Carolina at Chapel Hill (UNC) have developed a new tool to help people
with aphasia express themselves and set their own rehabilitation and recovery
goals. They are called Life Interests and Values (L!V) Cards.
Patients recovering from stroke who have aphasia
need to be able to set meaningful goals for themselves with the help of
physical, occupational and speech therapists. Frustration and loss of a voice
in the process can lead them to withdraw and become passive about rehab.
Therapists used to help people with aphasia by
using cue cards with color photos showing life activities. During rehab, people
with aphasia pointed to the photos to show which activities they wanted to be
able to do, such as drive a car or grocery shop. Then they pointed to another
card with a number scale to show how important it was to them.
Katarina Haley, PhD, co-director of the Center for
Aphasia and Related Disorders at UNC, and Jenny Womack, an occupational
therapist on faculty, found problems with these cards though. The photos were
too busy and caused confusion. Instead, they thought that clear and expressive
line drawings showing very specific activities might work better.
Using grants from the school and the National
Institute of Health’s Clinical and Translational Science Awards at UNC, they
developed more than 100 L!V Cards. They spent five years testing and refining
The final set includes 95 cards showing activities
in four categories: home and community, creative and relaxing, physical and
social. Another 11 cards show emotions so patients can say how they feel about
an activity. The rest of the cards help with conversations, such as a green
check mark meaning “yes” and a red X
meaning “no,” to mark piles during sorting.
Once the cards were created, developers
interviewed caregivers separately from people with aphasia using the L!V Cards.
Then they compared what each said they thought the survivors’ goals were for
therapy. The creators found that survivors and caregivers agreed less than 70
percent of the time. They then brought the groups together to discuss what they
had agreed and disagreed upon and to set goals for therapy. The change in
communication method really helped survivors more accurately chart goals.
“There was always this very emotional and very
informative interaction between the person with aphasia and the
caregiver,” says Haley. From there, she
said, they worked together to address goals for physical, occupational and speech
Carl McIntyre is using the cards in another way.
He was a successful working actor based in Charlotte, N.C., before a massive
stroke at age 44. Now he and UNC speech-language pathology graduate student
Samantha Goldberg are collaborating. Working with the cards, they write scripts
in advance for conversations he expects to have. For example, making a doctor’s
appointment by phone can be a huge task for someone with aphasia. Yet with a
script that McIntyre can read from, based on goals communicated with L!V Cards,
he now speaks with amazing clarity. He even includes the smallest of words that
he usually leaves out.
Elizabeth Witherspoon, PhD, is a
freelance science writer based in Durham, N.C. She writes about work of the
NIH’s Clinical and Translational Science Awards at UNC, whose mission is to
help move scientific discoveries into practical use more quickly.
For more information about the L!V Cards, go to
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