Intervention in Aphasia (NADIIA)
The Protocol
Information and video demonstration for speech pathologists
NADIIA is a multilevel intervention that integrates robust therapies for words and sentences into naturalistic discourse contexts (e.g. giving opinions, story-telling, explaining). While targeting language abilities that are used in the everyday communication of daily life, NADIIA simultaneously draws on the cognitive underpinnings of language, e.g. planning, sequencing, prioritising, taking both a metalinguistic and a metacognitive approach. Discourse frameworks provide a scaffold for the different types of speaking (genre) needed to communicate every day. These are coupled with highly salient, individualised topics that are intended to create a bridge to improve communication in daily life.
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The principles of NADIIA
​NADIIA is based on a set of principles. These are the critical ingredients that the clinician carries out as part of therapy:
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Integration of multiple language levels (words, sentences, macrostructure) into the planning and production of each discourse topic discussed in the therapy session.
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An interactive approach with errorless learning techniques encouraged. While trial and error occurs at all levels, error-free production is supported through writing responses, and error reduction supported through modelling.
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Lexical items and topics driven by topic and interest; not predetermined by clinician.
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Explicit instruction of individualized lexical strategies where appropriate/needed.
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Retrieval of nouns, verbs, and adjectives to increase access to syntactic structures and semantic associations.
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Explicit instruction of sentence frameworks for lexical selection.
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Explicit instruction of discourse frameworks (organizational maps) for each of the four discourse genres. These are (1) narrative (2) recounts (3) procedures and (4) opinions. Each genre has a unique structure, based around ‘story grammar’, but with similarities that can be loosely divided into ‘beginning’, ‘middle’ and ‘end’.
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Explicit instruction of the cognitive processes of planning, organising, and monitoring of discourse.
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Use of visual mind maps of discourse frameworks (organisational maps) which can be faded out – but always provide a reference point.
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Consistent evaluation using visual rating scales to promote self-monitoring.
Protocol
The most recent version of the NADIIA protocol (Whitworth & Cartwright, 2020) is available here. This protocol includes options for both individual and group delivery.
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