Script Training for Aphasia
Brett McCardel, MS, CCC-SLP
May 2025
What is Script Training?
• Script training is a functional, individualized
language treatment for people with aphasia.
• Focuses on repeated practice of personally
relevant monologues or dialogues.
• Aims to improve fluent, automatic speech
production in everyday situations.
• Combines motor learning principles and
behavioral rehearsal.
Why Use Script Training?
Enhances communication Reduces language-related
confidence and anxiety by providing
participation. structured phrases.
Potential generalization
Effective across aphasia
to untrained discourse
severities and types.
contexts.
Key Components of Script Training
Personalization: Scripts reflect client's daily needs and goals.
Repetition: Intensive, repeated practice enhances fluency.
Cueing hierarchy: Clinician support is reduced over time.
Multimodal practice: Includes reading, listening, speaking,
and sometimes writing (depending on exact protocol).
Developing Scripts
• Collaborative planning between client and clinician.
– Consider tools such as the Life Interest and Values Cards for
help with determining meaningful scenarios
• Scripts are typically 3–6 sentences (monologues) or 6–
12 turns (dialogues).
• Examples include greetings, ordering food, phone
calls, and storytelling.
• Script templates can help structure scripts consistently
and reduce the time it takes to create a script.
– See Kaye & Cherney (2016) for examples of script templates
Sample Script Template
Ordering at a Restaurant
• Turn 1 (Waiter): Do you know what you’d
like to order?
– Client: Yes, I would like a ENTRÉE.
• Turn 2 (Waiter): And to drink?
– Client: A DRINK, please.
• Turn 3 (Waiter): Is there anything else
you’d like?
– Client: Could I also get a SIDE?
Modifying Scripts for Difficulty Level
Kaye & Cherney (2016)
suggest that an appropriate Scripts with more complex
script difficulty is one where language have a better
the client can produce 30% chance of generalizing to
of the script correctly upon untrained scenarios
first presentation
Modifying Scripts for Difficulty Level
• Potential ways to modify script difficulty:
– Increasing Readability Difficulty
• Using longer words and sentences
– Flesch-Kincaid Grade Level Formula in Microsoft Word
– Increasing Grammatical Difficulty
• Using more verbs and morphemes
– Increasing Semantic Difficulty
• Using less-frequent words
Examples of Script Levels
Response to “How did you like our pizza?”
• Level 1: The best in CITY!
• Level 2: You have the best pizza in CITY!
• Level 3: You have the best pizza in CITY. Next time I’ll order dessert.
• Level 4: You have the best pizzeria in CITY. Next time I’ll order dessert, too!
• Level 5: I believe you have the best pizzeria in CITY. The next time we come,
we’ll definitely order dessert!
Kaye & Cherney, 2016
Demo of Script Development Process
Deciding Deciding on Script Scenarios
Highlighting Highlighting Key Points to Include in Scripts
Developing Developing Script Drafts
Modifying Modifying Script Difficulty
Deciding on Script Scenarios
• Life Interests and Values Cards
– 121 black-and-white 5x8 inch cards designed to
support people with aphasia in expressing
preferences and guiding therapy
– Focus on participation in four categories:
• Home and Community Activities
• Relaxing and Creative Activities
• Physical Activities
• Social Activities
Deciding on Script Scenarios
• Using the Life Interests and Values Cards,
the client reported wanting to talk to friends
about a recent vacation
– A trip to the Oregon Coast/Haystack Rock
– Monologue for sharing pictures from trip
Deciding Key Points to Include in Scripts
Brainstormed with client and spouse regarding
highlights from trip
Key points/highlights included:
• Going to Oregon Coast
• Driving down in RV
• Seeing Haystack Rock
• Getting coffee from Sleepy Monk café
• Enjoying hikes in the area
Developing Script Drafts
• 5 key points/highlights to focus on from trip
– Create a 5-sentence script
• Work with client and spouse to co-create
sentences
– Spouse volunteered to take the lead on
creating sentences
• Verified with client that each sentence was
accurate and what she wanted to talk about
1st Script Draft
We decided to go to the Oregon Coast for New Years.
We drove down in our RV on I-5; we were excited to get away!
Much of our time was spent walking around the beach near Haystack
Rock, and our dog had lots of fun chasing the birds.
We were able to go get coffee every morning from our favorite coffee
shop down there: Sleepy Monk.
There were some beautiful hikes we did and everything was so green.
Modifying Script Difficulty
• When asked to repeat each sentence from
the 1st draft with written support, the client
produced each one with <30% accuracy
– Need to modify each sentence to try
and achieve ~30% baseline
– Modify number of words in sentence,
syntax, and morphology to create
simpler script
Modifying Script Difficulty
• Original: We were able to go get coffee
every morning from our favorite coffee
shop down there: Sleepy Monk.
– Reduce word count
– Simplify sentence structure
• Revised: Every morning, we got coffee from
Sleepy Monk.
Revised Script
We went to the Oregon Coast for New Years.
Driving the RV was exciting!
We walked to Haystack Rock and the dog chased birds.
Every morning, we got coffee from Sleepy Monk.
The hiking trail was green and beautiful.
Script Training Protocols
• A variety of script training protocols
exist in the research literature
• Most focus on 3 primary components:
– Listening/Modeling by Clinician
– Choral Reading/Repetition
– Independent Production
A Script Training Protocol:
-Choose One Phrase to Train at a Time
-Provide Card with Phrase Written Down
• Clinician modeling of the target phrase
• Clinician and client produce phrase in unison
• Clinician and client produce phrase in unison with clinician
fading participation
A Script Training
Protocol • Independent production by the client with written cue card
– Aim for 10-15 productions of 95% accuracy by client
(Youmans et al. 2011)
• Independent production by client without written cue card
– Aim for 20 productions of 95% accuracy by client
• Continue training of next phrase in script and repeat
• Include articulatory placement and phonemic cues as needed
• Typically 3 sessions/week for 3–6 weeks. Home practice is
highly encouraged.
Script Training Protocol Demo
Ways to Measure Script Success
• Percent Script-Related Words Correct
• Rate of Speech
• Disfluencies per Script
• Client Confidence Rating Scale for Script
Clinical Considerations
Appropriate for aphasia, apraxia of speech, and
primary progressive aphasia.
Visual supports, pacing strategies, and video
modeling enhance outcomes.
Can use high-tech (apps, recordings) or low-tech
(notebooks, cue cards) tools.
Evidence of Effectiveness
Improved fluency Increased
and grammatical confidence in real-
accuracy in world
practiced scripts. communication.
Effective for both
acute and chronic
aphasia.
References and Other Resources
• Hollo, A., Ensar, B., & Meigh, K. M. (2024). Effects of script training to improve
discourse in a patient with chronic aphasia. Perspectives of the ASHA Special
Interest Groups, 9(1), 35–48. [Link]
• Hubbard, H. I., Nelson, L. A., & Richardson, J. D. (2020). Can script training
improve narrative and conversation in aphasia across etiology? Seminars in
Speech and Language, 41(1), 99–124. [Link]
• Kaye, R. C., & Cherney, L. R. (2016). Script templates: A practical approach to
script training in aphasia. Topics in Language Disorders, 36(2), 136–153.
[Link]
• Youmans, G., Youmans, S. R., & Hancock, A. B. (2011). Script training treatment
for adults with apraxia of speech. American Journal of Speech-Language
Pathology, 20(1), 23–37. [Link]