Summer 2011
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 them.

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 therapy.

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.

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