working memory deficits. these deficits can occur in both the verbal domain as well as the visuospatial domain. furthermore, these deficits are often associated with performance on language specific tasks such as naming, lexical processing, and sentence comprehension, and discourse production. other studies have found that most, but not all people with aphasia demonstrate performance deficits on tasks of attention, and their performance on these tasks correlate with language performance and cognitive ability in other domains. even patients with mild aphasia, who score near the ceiling on tests of language often demonstrate slower response times and interference effects in non-verbal attention abilities. in addition to deficits in short-term memory, working memory, and attention, people with aphasia can also demonstrate deficits in executive function. for instance, people with aphasia may demonstrate deficits in initiation, planning, self-monitoring, and cognitive flexibility. other studies have found that people with aphasia demonstrate reduced speed and efficiency during completion executive function assessments. regardless of their role in the underlying nature of aphasia, cognitive deficits have a clear role in the study and rehabilitation of aphasia. for instance, the severity of cognitive deficits in people with aphasia has been associated with lower quality of life, even more so than the severity of language deficits. furthermore, cognitive deficits may influence the learning process of rehabilitation and language treatment outcomes in aphasia. non-linguistic cognitive deficits have also been the target of interventions directed at improving language ability, though outcomes are not definitive. while some studies have demonstrated language improvement secondary to cognitively-focused treatment, others have found little evidence that the treatment of cognitive deficits in people with aphasia has an influence on language outcomes. one important caveat in the measurement and treatment of cognitive deficits in people with aphasia is the degree to which assessments of cognition rely on language abilities for successful performance. most studies have attempted to circumvent this challenge by utilizing non-verbal cognitive assessments to evaluate cognitive ability in people with aphasia. however, the degree to which these tasks are truly 'non-verbal' and not mediated by language in unclear. for instance, wall et al. found that language and non-linguistic performance was related, except when non-linguistic performance was measured by 'real life' cognitive tasks. prevention of aphasia aphasia is largely caused by unavoidable instances. however, some precautions can be taken to decrease risk for experiencing one of the two major causes of aphasia: stroke and traumatic brain injury (tbi). to decrease the probability of having an ischemic or hemorrhagic stroke, one should take the following precautions: exercising regularly eating a healthy diet, avoiding cholesterol in particular keeping alcohol consumption low and avoiding tobacco use controlling blood pressure going to the emergency room immediately if you begin to experience unilateral extremity (especially leg) swelling, warmth, redness, and/or tenderness as these are symptoms of a deep vein thrombosis which can lead to a stroke to prevent aphasia due to traumatic injury, one should take precautionary measures when engaging in dangerous activities such as: wearing a helmet when operating a bicycle, motor cycle, atv, or any other moving vehicle that could potentially be involved in an accident wearing a seatbelt when driving or riding in a car wearing proper protective gear when playing contact sports, especially american football, rugby, and hockey, or refraining from such activities minimizing anticoagulant use (including aspirin) if at all possible as they increase the risk of hemorrhage after a head injury additionally, one should always seek medical attention after sustaining head trauma due to a fall or accident. the sooner that one receives medical attention for a traumatic brain injury, the less likely one is to experience long-term or severe effects. management when addressing wernicke's aphasia, according to bakheit et al. (2007), the lack of awareness of the language impairments, a common characteristic of wernicke's aphasia, may affect the rate and extent of therapy outcomes. robey (1998) determined that at least 2 hours of treatment per week is recommended for making significant language gains. spontaneous recovery may cause some language gains, but without speech-language therapy, the outcomes can be half as strong as those with therapy. when addressing broca's aphasia, better outcomes occur when the person participates in therapy, and treatment is more effective than no treatment for people in the acute period. two or more hours of therapy per week in acute and post-acute stages produced the greatest results. high-intensity therapy was most effective, and low-intensity therapy was almost equivalent to no therapy. people with global aphasia are sometimes referred to as having irreversible aphasic syndrome, often making limited gains in auditory comprehension, and recovering no functional language modality with therapy. with this said, people with global aphasia may retain gestural communication skills that may enable success when communicating with conversational partners within familiar conditions. process-oriented treatment options are limited, and people may not become competent language users as readers, listeners, writers, or speakers no matter how extensive therapy is. however, people's daily routines and quality of life can be enhanced with reasonable and modest goals. after the first month, there is limited to no healing to language abilities of most people. there is a grim prognosis leaving 83% who were globally aphasic after the first month they will remain globally aphasic at the first year. some people are so severely impaired that their existing process-oriented treatment approaches offer no signs of progress, and therefore cannot justify the cost of therapy. perhaps due to the relative rareness of conduction aphasia, few studies have specifically studied the effectiveness of therapy for people with this type of aphasia. from the studies performed, results showed that therapy can help to improve specific language outcomes. one intervention that has had positive results is auditory repetition training. kohn et al. (1990) reported that drilled auditory repetition training related to improvements in spontaneous speech, francis et al. (2003) reported improvements in sentence comprehension, and kalinyak-fliszar et al. (2011) reported improvements in auditory-visual short-term memory. most acute cases of aphasia recover some or most skills by working with a speech-language pathologist. recovery and improvement can continue for years after the stroke. after the onset of aphasia, there is approximately a six-month period of spontaneous recovery; during this time, the brain is attempting to recover and repair the damaged neurons. improvement varies widely, depending on the aphasia's cause, type, and severity. recovery also depends on the person's age, health, motivation, handedness, and educational level. there is no one treatment proven to be effective for all types of aphasias. the reason that there is no universal treatment for aphasia is because of the nature of the disorder and the various ways it is presented, as explained in the above sections. aphasia is rarely exhibited identically, implying that treatment needs to be catered specifically to the individual. studies have shown that, although there is no consistency on treatment methodology in literature, there is a strong indication that treatment, in general, has positive outcomes. therapy for aphasia ranges from increasing functional communication to improving speech accuracy, depending on the person's severity, needs and support of family and friends. group therapy allows individuals to work on their pragmatic and communication skills with other individuals with aphasia, which are skills that may not often be addressed in individual one-on-one therapy sessions. it can also help increase confidence and social skills in a comfortable setting.: 97 evidence does not support the use of transcranial direct current stimulation (tdcs) for improving aphasia after stroke. moderate quality evidence does indicate naming performance improvements for nouns but not verbs using tdcs specific treatment techniques include the following: copy and recall therapy (cart) – repetition and recall of targeted words within therapy may strengthen orthographic representations and improve single word reading, writing, and naming visual communication therapy (vic) – the use of index cards with symbols to represent various components of speech visual action therapy (vat) – typically treats individuals with global aphasia to train the use of hand gestures for specific items functional communication treatment (fct) – focuses on improving activities specific to functional tasks, social interaction, and self-expression promoting aphasic's communicative effectiveness (pace) – a means of encouraging normal interaction between people with aphasia and clinicians. in this kind of therapy, the focus is on pragmatic communication rather than treatment itself. people are asked to communicate a given message to their therapists by means of drawing, making hand gestures or even pointing to an object melodic intonation therapy (mit) – aims to use the intact melodic/prosodic processing skills of the right hemisphere to help cue retrieval of words and expressive language: 93 centeredness theory interview (cti) - uses client centered goal formation into the nature of current patient interactions as well as future / desired interactions to improve subjective well-being, cognition and communication. other – i.e. drawing as a way of communicating, trained conversation partners semantic feature analysis (sfa) – a type of aphasia treatment that targets word-finding deficits. it is based on the theory that neural connections can be strengthened by using related words and phrases that are similar to the target word, to eventually activate the target word in the brain. sfa can be implemented in multiple forms such as verbally, written, using picture cards, etc. the slp provides prompting questions to the individual with aphasia in order for the person to name the picture provided. studies show that sfa is an effective intervention for improving confrontational naming. melodic intonation therapy is used to treat non-fluent aphasia and has proved to be effective in some cases. however, there is still no evidence from randomized controlled trials confirming the efficacy of mit in chronic aphasia. mit is used to help people with aphasia vocalize themselves through speech song, which is then transferred as a spoken word. good candidates for this therapy include people who have had left hemisphere strokes, non-fluent aphasias such as broca's, good auditory comprehension, poor repetition and articulation, and good emotional stability and memory. an alternative explanation is that the efficacy of mit depends on neural circuits involved in the processing of rhythmicity and formulaic expressions (examples taken from the mit manual: "i am fine," "how are you?" or "thank you"); while rhythmic features associated with melodic intonation may engage primarily left-hemisphere subcortical areas of the brain, the use of formulaic expressions is known to be supported by right-hemisphere cortical and bilateral subcortical neural networks. systematic reviews support the effectiveness and importance of partner training. according to the national institute on deafness and other communication disorders (nidcd), involving family with the treatment of an aphasic loved one is ideal for all involved, because while it will no doubt assist in their recovery, it will also make it easier for members of the family to learn how best to communicate with them. when a person's speech is insufficient, different kinds of augmentative and alternative communication could be considered such as alphabet boards, pictorial communication books, specialized software for computers or apps for tablets or smartphones. intensity of treatment the intensity of aphasia therapy is determined by the length of each session, total hours of therapy per week, and total weeks of therapy provided. there is no consensus about what "intense" aphasia therapy entails, or how intense therapy should be to yield the best outcomes. a 2016 cochrane review of speech and language therapy for people with aphasia found that treatments that are higher intensity, higher dose or over a long duration of time led to significantly better functional communication but people were more likely to drop out of high intensity treatment (up to 15 hours per week). intensity of therapy is also dependent on the recency of stroke. people with aphasia react differently to intense treatment in the acute phase (0–3 months post stroke), sub-acute phase (3–6 months post stroke), or chronic phase (6+ months post stroke). intensive therapy has been found to be effective for people with nonfluent and fluent chronic aphasia, but less effective for people with acute aphasia. people with sub-acute aphasia also respond well to intensive therapy of 100 hours over 62 weeks. this suggests people in the sub-acute phase can improve greatly in language and functional communication measures with intensive therapy compared to regular therapy. individualized service delivery intensity of treatment should be individualized based on the recency of stroke, therapy goals, and other specific characteristics such as age, size