PACE Therapy at Home: 9 Practical Exercises to Support Aphasia Recovery

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Living with aphasia can transform everyday conversations into complex challenges. Your thoughts remain clear, but the pathway to sharing them becomes blocked or altered.

This is where PACE therapy emerges as a beacon of hope—a revolutionary approach that recognizes communication extends far beyond spoken words—and you can practice PACE outside of speech therapy sessions with friends and family at home.

By embracing multiple channels of expression and focusing on successful message delivery rather than perfect speech, PACE therapy opens new doors to meaningful connection and interaction.

Understanding PACE Therapy: A Paradigm Shift in Aphasia Treatment

PACE (Promoting Aphasics' Communicative Effectiveness) represents a fundamental shift in how we approach aphasia rehabilitation.

Traditional speech therapy with a licensed SLP often emphasizes correcting specific linguistic deficits—working on word retrieval, grammar, or articulation in isolation. While these skills matter, PACE takes a broader, more functional perspective.

Anyone can act as a therapy partner, putting evidence-based practice like PACE into action at home and with minimal resources. At its core, PACE therapy operates on four essential principles:

1. Natural Information Exchange Communication occurs through genuine information sharing, not artificial drills. Participants have real reasons to communicate, creating authentic motivation and engagement.

2. Equal Participation Both the person with aphasia and their communication partner take turns being the sender and receiver of messages. This balanced dynamic mirrors real-world conversations and builds confidence on both sides.

3. Free Choice of Communication Channels Success is measured by effective message transmission, regardless of the method used. Speaking, writing, drawing, gesturing, pointing to pictures, or using technology—all are valid and valuable communication tools.

4. Feedback Based on Message Success Instead of correcting linguistic errors, feedback focuses on whether the intended message was successfully communicated. This positive reinforcement encourages risk-taking and creative problem-solving.

Who Can Benefit from PACE Therapy at Home?

PACE therapy has demonstrated remarkable effectiveness across various aphasia presentations and causes including stroke recovery, progressive conditions, and traumatic brain injuries:

Stroke Survivors

• Expressive (Broca's) Aphasia: Individuals who understand well but struggle with speech production find PACE particularly liberating, as it validates their intact comprehension while providing alternative expression methods.

• Mixed Aphasia: Those with both comprehension and expression challenges benefit from PACE's multimodal approach and reduced pressure for perfect linguistic performance.

• Global Aphasia: Even individuals with severe language impairments can participate meaningfully when communication channels are opened beyond speech.

Progressive Aphasia

• Primary Progressive Aphasia (PPA): As language abilities change over time, PACE helps individuals and families adapt their communication strategies, maintaining connection despite evolving challenges.

• Frontotemporal Dementia: The flexible, creative nature of PACE accommodates the changing communication needs throughout disease progression.

Traumatic Brain Injury and Tumor Recovery

• Cognitive-Communication Disorders: PACE addresses not just language deficits but also attention, memory, and executive function challenges that impact communication.

• Acquired Aphasia: Whether from accident or medical intervention, PACE provides hope and practical strategies for rebuilding communication skills.

The Science Behind PACE: Why It Works

Research consistently demonstrates PACE therapy's effectiveness through several mechanisms:

Neuroplasticity Activation

By engaging multiple brain regions simultaneously—visual, motor, cognitive, and linguistic areas—PACE promotes neural reorganization and the development of alternative communication pathways.

Functional Communication Training

Unlike isolated skill practice, PACE activities mirror real-world communication demands, promoting transfer of learned strategies to daily life situations.

Confidence Building

Success-focused feedback creates positive associations with communication attempts, reducing anxiety and encouraging continued practice and risk-taking.

Partner Training

PACE naturally educates communication partners about effective support strategies, improving overall communication success within relationships and communities.

Setting Up Your Home PACE Practice

Creating an effective PACE practice environment requires minimal materials for in-home speech therapy for people with aphasia, but it does need some thoughtful preparation:

Essential Materials

• Barrier Materials: Large books, folders, or cardboard screens to create visual barriers when needed

• Image Collections: Family photos, magazine pictures, printed images from online sources, or commercial card sets

• Drawing Supplies: Plain paper, pens, markers, or dry-erase boards

• Real Objects: Household items, tools, toys, or personal belongings

• Technology Tools: Tablets with drawing apps, communication apps, or picture libraries

Environmental Considerations

• Comfortable Seating: Arrange chairs to facilitate easy eye contact and gesture visibility

• Good Lighting: Ensure adequate illumination for reading, writing, and gesture recognition

• Minimal Distractions: Choose quiet spaces away from television, radio, or high-traffic areas

• Accessible Materials: Keep supplies within easy reach for spontaneous practice opportunities

Timing and Frequency

• Short, Regular Sessions: 15-30 minute sessions work better than longer, infrequent practices

• Energy-Appropriate Scheduling: Plan sessions when the person with aphasia feels most alert and energetic

• Flexible Timing: Allow sessions to end naturally rather than forcing continuation when fatigue sets in

Comprehensive PACE Activity Library

Beginner-Level Activities: Building Foundation Skills

1. Enhanced Picture Description

Materials: Detailed photographs or illustrations depicting scenes, people, or events

Setup: Create a barrier between participants. The speaker examines an image while the listener cannot see it.

Execution: The speaker communicates everything they observe using any available method—speech, gestures, drawing, writing, or combinations thereof. The listener works to understand and may ask clarifying questions.

Variations:

• Use family photos to add personal relevance

• Start with simple images and progress to complex scenes

• Include emotional content to practice expressing feelings

• Use images that tell stories or show sequences

Therapeutic Benefits: Enhances word-finding abilities, promotes creative expression strategies, builds confidence in multimodal communication, and strengthens descriptive language skills.

2. Object Identification Challenge

Materials: Collection of 20-30 common household objects or printed object cards

Setup: Objects are hidden from one participant while the other examines them.

Execution: The speaker must convey the identity of each object without directly naming it. They might describe its function, demonstrate its use, draw its shape, or provide contextual clues.

Variations:

• Group objects by category (kitchen items, tools, clothing)

• Use objects with multiple functions to encourage creative descriptions

• Include items with strong sensory associations

• Progress from concrete objects to abstract concepts

Therapeutic Benefits: Strengthens semantic networks, encourages flexible thinking, develops circumlocution strategies, and builds tolerance for word-finding difficulties.

3. Strategic Yes/No Investigation

Materials: Picture cards or written concepts on paper slips

Setup: One person selects a card without showing it to their partner.

Execution: The guesser asks yes/no questions to identify the target item. The responder answers using gestures, facial expressions, writing, or speech—whatever feels most natural.

Variations:

• Limit questions to specific categories (Is it living? Is it found indoors?)

• Use topics of personal interest (family members, favorite foods, hobbies)

• Include abstract concepts (emotions, experiences, memories)

• Allow drawing or gesturing as part of responses

Therapeutic Benefits: Develops strategic questioning skills, enhances comprehension abilities, builds inference and deduction skills, and promotes interactive communication patterns.

Intermediate-Level Activities: Expanding Complexity

4. Navigation and Direction Giving

Materials: Simple maps, floor plans, or hand-drawn layouts of familiar spaces

Setup: Both participants have copies of the same map, but only one knows the destination.

Execution: The direction-giver guides their partner from a starting point to a specific destination using any communication method. The follower traces the route and asks for clarification when needed.

Variations:

• Use maps of familiar places (home, neighborhood, grocery store)

• Create treasure hunt scenarios with multiple stops

• Include landmarks and reference points

• Progress from simple layouts to complex multi-level buildings

Therapeutic Benefits: Strengthens spatial language, develops sequencing abilities, promotes clear and organized communication, and builds confidence in giving instructions.

5. Sequential Story Construction

Materials: Series of 4-6 pictures showing a logical sequence or story progression

Setup: The speaker arranges pictures in correct order while the listener has the same pictures in random arrangement.

Execution: The speaker describes the sequence, helping the listener arrange their pictures in matching order. Communication can include storytelling, describing connections between images, or explaining cause-and-effect relationships.

Variations:

• Use personal photo sequences (vacation trips, family events)

• Create fictional stories with provided images

• Include problem-solving scenarios

• Allow collaborative story creation

Therapeutic Benefits: Enhances narrative skills, develops logical sequencing abilities, strengthens cause-and-effect reasoning, and promotes sustained communication exchanges.

6. Collaborative Art Creation

Materials: Drawing paper and art supplies for both participants

Setup: One person examines a target image while the other prepares to draw.

Execution: The describer guides the artist in recreating the image through verbal instructions, gestures, and demonstrations. The artist asks questions and seeks clarification throughout the process.

Variations:

• Use geometric shapes and patterns for precision practice

• Include emotional or expressive elements in drawings

• Create collaborative abstract art based on themes or feelings

• Progress from simple line drawings to detailed illustrations

Therapeutic Benefits: Promotes detailed descriptive language, enhances spatial and directional vocabulary, builds collaborative communication skills, and develops patience with communication breakdowns.

Advanced-Level Activities: Real-World Application

7. Daily Experience Narrative

Materials: Prompt cards with time periods or activities (morning routine, grocery shopping, weekend plans)

Setup: Participants take turns sharing experiences with specific communication constraints.

Execution: The speaker describes their experience using limited verbal expression combined with gestures, drawings, or demonstrations. The listener actively engages through questions and clarification requests.

Variations:

• Focus on emotional aspects of experiences

• Include problem-solving elements (What did you do when...?)

• Practice future planning and hypothetical situations

• Incorporate social interactions and conversations

Therapeutic Benefits: Builds real-world communication confidence, develops personal narrative skills, strengthens emotional expression abilities, and promotes independence in social situations.

8. Persuasion and Argumentation

Materials: Prompt cards with debate topics, decision scenarios, or preference discussions

Setup: Present scenarios requiring persuasive communication or decision-making.

Execution: The speaker advocates for their position using all available communication tools while the listener asks challenging questions and seeks clarification of reasoning.

Variations:

• Use personally relevant decisions (vacation destinations, meal choices)

• Include moral or ethical dilemmas for deeper discussion

• Practice consumer advocacy (returning items, making complaints)

• Engage in hypothetical problem-solving scenarios

Therapeutic Benefits: Develops argumentative discourse skills, builds confidence in expressing opinions, strengthens reasoning and logic presentation, and prepares for real-world advocacy situations.

9. Interactive Problem Solving

Materials: Scenario cards describing everyday problems or challenges

Setup: Present complex situations requiring collaborative problem-solving.

Execution: Participants work together to understand the problem, generate solutions, and evaluate options using flexible communication strategies.

Variations:

• Use real-life challenges faced by the person with aphasia

• Include multi-step solutions requiring planning and organization

• Practice emergency or urgent situation communication

• Engage in creative problem-solving with multiple possible solutions

Therapeutic Benefits: Enhances collaborative communication, develops critical thinking expression, builds confidence in complex conversations, and strengthens real-world problem-solving abilities.

Maximizing PACE Therapy Success

For Communication Partners

Patience and Positivity: Allow time for message development and celebrate successful communication regardless of the method used. Avoid rushing or finishing sentences unless specifically requested.

Active Participation: Engage fully in both speaking and listening roles. Your genuine interest and participation directly impact the person with aphasia's motivation and success.

Flexible Support: Offer different types of assistance based on individual needs and preferences. Some people prefer minimal help, while others benefit from more active support.

Natural Feedback: Respond to the message content rather than the communication method. Focus on understanding and responding appropriately rather than correcting linguistic errors.

For Individuals with Aphasia

Embrace All Communication: Remember that successful message transmission matters more than perfect speech. Drawing, gestures, and technology are legitimate and valuable communication tools.

Practice Self-Advocacy: Communicate your preferences for support and feedback. Help your partners understand what assistance works best for you.

Celebrate Progress: Acknowledge improvements in communication effectiveness, confidence, and strategy use—not just speech clarity or word retrieval speed.

Stay Engaged: Continue practicing and challenging yourself with new activities and more complex communication situations.

Adapting PACE for Different Aphasia Types

Expressive Aphasia Adaptations

• Emphasize alternative communication modalities

• Provide extra time for message formulation

• Focus on core message transmission over grammatical accuracy

• Encourage use of key words and gestures together

Receptive Aphasia Modifications

• Use visual supports and written backup

• Simplify complex instructions initially

• Check comprehension frequently through demonstration

• Provide multiple examples and repetition when needed

Global Aphasia Accommodations

• Start with very concrete, familiar topics

• Use real objects whenever possible

• Keep sessions shorter but more frequent

• Celebrate any successful communication attempt

Technology Integration in PACE Therapy

Hand-held devices have become pervasive, and chances are you’ve got one in your pocket right now. Here’s how you can use your phone or tablet to augment or enhance PACE therapy.

Communication Apps

• Symbol-based applications: Allow selection and combination of pictures or symbols

• Text-to-speech programs: Support written communication when speaking is challenging

• Drawing applications: Provide sophisticated tools for visual communication

• Video calling platforms: Enable remote PACE practice with family and friends

Adaptive Equipment

• Communication boards: Low-tech options for gesture and pointing support

• Voice amplifiers: Help with volume challenges during speech attempts

• Specialized keyboards: Support written communication when hand function is affected

• Eye-gaze systems: Provide communication access for individuals with severe motor impairments

Measuring Progress in PACE Therapy

Functional Communication Measures

• Message Success Rate: Percentage of intended messages successfully communicated

• Strategy Use Flexibility: Variety and appropriateness of communication methods employed

• Communication Confidence: Self-reported comfort and willingness to engage in communication

• Partner Satisfaction: Feedback from family and friends regarding communication effectiveness

Tracking Tools

• Communication logs: Daily records of successful and challenging interactions

• Video recordings: Periodic documentation of PACE sessions for progress review

• Strategy checklists: Monitoring of communication method usage and effectiveness

• Goal achievement records: Documentation of functional communication milestone attainment

Long-term Benefits and Outcomes

Research consistently demonstrates that PACE therapy produces lasting improvements in:

• Functional communication effectiveness across various settings and partners

• Confidence and willingness to engage in communication attempts

• Quality of life and social participation through improved interaction abilities

• Family and caregiver satisfaction with communication success

• Independence in daily communication tasks and social situations

Building Your PACE Therapy Journey

Recovery from aphasia is rarely linear, and progress often comes in waves rather than steady upward climbs. PACE therapy acknowledges this reality by focusing on functional success rather than perfect performance. \

Every successful message—whether spoken, drawn, gestured, or written—strengthens neural pathways and builds confidence for future communication attempts.

The beauty of PACE lies in its recognition that communication is fundamentally about human connection.

When we remove the pressure for perfect speech and instead celebrate successful message sharing, we open doors to meaningful interaction that might otherwise remain closed.

Whether you're just beginning your aphasia recovery journey or seeking to enhance existing communication strategies, PACE therapy offers hope, practical tools, and a pathway to reconnection.

Through consistent practice, patient support, and celebration of all communication successes, individuals with aphasia can rebuild their voice and reclaim their place in conversations that matter.

Remember: your message matters more than the method you use to share it.

PACE therapy helps you discover and develop the communication strategies that work best for you, building bridges to the connections and conversations that enrich life and restore confidence in your communicative abilities.

Ready to Begin Your PACE Therapy Journey?

Don't let aphasia define your communication story. If you or a loved one is ready to explore the transformative power of PACE therapy and other evidence-based speech treatment approaches, professional guidance can make all the difference in your recovery journey.

Contact Nina today to discover how personalized, research-backed speech therapy can help you rebuild confidence and reclaim your voice. Specializing in aphasia recovery and functional communication strategies, Nina provides compassionate, expert care tailored to your unique needs and goals.

Serving communities in Lantana, Lake Worth, Boynton Beach, and coastal Palm Beach County, Nina brings evidence-based practice directly to you, whether online or through convenient home visits.

Your communication breakthrough is waiting. Take the first step toward reconnecting with the conversations and relationships that matter most.

Get in Touch!

Frequently Asked Questions: PACE Therapy for Aphasia and Stroke

1) What is PACE therapy?
PACE stands for Promoting Aphasics’ Communicative Effectiveness. It is a conversational approach that helps people communicate using any effective channel, including speech, gesture, writing, drawing, or AAC. The goal is successful message exchange in real-life situations.

2) Who can benefit from PACE therapy?
Adults with aphasia after stroke or brain injury are the most common candidates. PACE can also support people with apraxia of speech or dysarthria when communication breakdowns make everyday conversations difficult.

3) How does a typical PACE session work?
Therapist and client take turns sending and receiving messages with a shared purpose, like describing a picture or solving a task. The focus is on getting the idea across, not perfection, and cues are added as needed to help the message succeed.

4) Can PACE therapy be done at home?
Yes. With guidance from a speech-language pathologist, families can practice short, structured activities at home and embed PACE principles into daily routines like meals, phone calls, and planning the day.

5) What materials do I need to practice PACE?
Simple tools work well. Picture cards, everyday objects, a notepad and pen, a whiteboard, or a communication app are often enough to practice sending and receiving messages in different ways.

6) How can family and caregivers help?
Caregivers can model slow, supportive conversations, ask clear questions, accept any successful communication method, and give time for responses. They can also help set up short daily practice sessions and track what works best.

7) How is PACE different from drill-based speech therapy?
Drill approaches often target specific sounds or words in isolation. PACE centers on natural conversation with shared information needs and encourages any strategy that makes the message succeed, which can generalize better to real life.

8) Does PACE work for severe aphasia or apraxia?
Yes, with adaptations. For severe aphasia or apraxia, sessions may rely more on gestures, drawing, yes or no responses, written keywords, or AAC tools, with frequent cues and smaller targets that build success step by step.

9) How do we measure progress with PACE?
Progress can be tracked by time to get messages across, the number of successful exchanges, reduced need for cues, and improvements in participation and confidence during everyday conversations reported by the client and family.

10) What role do AAC and technology play in PACE?
AAC fits naturally into PACE because any effective mode counts. Low-tech boards, texting, speech-generating apps, and photo libraries can all support message success and help conversations move forward.

11) How often should I practice PACE?
Daily practice in short, focused sessions works well. Many people aim for 10 to 20 minutes once or twice a day, plus quick opportunities during routine activities.

12) Why is it called PACE and is the name outdated?
The method was named when the term “aphasics” was common in clinical writing. Today many prefer person-first language such as person with aphasia. The approach itself remains useful, and you can refer to it as the PACE approach for people with aphasia.