Response Elaboration Training Made Easy

This is a step-by-step guide to response elaboration training for speech therapy.

Response elaboration training, or RET, is an aphasia treatment technique that helps people recover from expressive aphasia. It doesn’t take much prep, and this guide will make it easy to use right away.

In this guide you’ll learn:

• How to do RET using pictures
• How to do RET using auditory prompts
• How to choose pictures and auditory prompts
• How to write RET goals

Let’s dive in!

What Is Response Elaboration Training?

The purpose of response elaboration training is to help people with expressive aphasia say more content words in everyday conversation. 

Content words include nouns, verbs, adverbs, pronouns, adjectives, and prepositions.

RET is unique because it allows the clinician to follow the patient’s lead when speaking. 

While there are loose guidelines, there are no specific rules to follow. Instead, you encourage your patient to speak longer utterances by 1) confirming their responses and then 2) chaining onto (elaborating) their responses.

Below, you’ll find the response elaboration training steps using visual or auditory prompts. 

How To Do Response Elaboration Training With Pictures

Classic response elaboration training (vs ‘modified’—more on that below) uses pictures as stimuli.

Here are the steps:

1. Show the patient a picture. Say, “Tell me as much as you can about this picture”
   • For example, there’s a picture of a person on the phone. The patient says, “Man…talking”
2. Positively confirm the patient’s response, then expand their utterance
   • “That’s correct. The man is talking to someone”
3. Ask wh-questions to elicit more information
   • “What is he using to talk to someone?”
4. Positively reinforce what they say, then provide a more complete sentence for them to imitate
   • “Yes! He’s talking to someone on the phone. Can you repeat that whole sentence?”
5. Keep elaborating with more wh-questions, as appropriate 

Repeat! Use at least 10 pictures for this activity.

Again, the goal is for the patient to produce more content words during spontaneous speech.

How To Choose Pictures

When using visual prompts, it’s best to choose a picture that is simple, has minimal details, and has an action (verb for your patient to name).

For this activity, use Picture Cards.  Below are 3 examples:

How To Do Response Elaboration Training With Auditory Prompts

An auditory prompt is another way to encourage more content words. It’s also known as ‘modified’ response elaboration training, or M-RET (Wambaug, 2013).

For this prompt, you’ll choose a multi-step functional task that’s familiar to your patient, then ask them to describe how to do it.

Examples are how to do a daily task, a hobby, a chore, etc.

How to do it:

1. Ask the patient the steps to doing a task
   • For example, “Describe in detail the steps of doing your laundry.”
   • The patient may respond with, “I sort my clothes, I put them in the washer, then I dry them”
2. Positively confirm what they say, then ask for more information
   • “That’s right. Let’s pretend that I’ve never done laundry before. Explain to me step-by-step what to do in detail.”
   • The patient responds, “First, I sort my clothes. I put them into the washer. I add laundry soap in the washer. I turn the washer on the setting I need and press start. When the washer is done, I put the clothes into the dryer. I turn on the dryer and dry my clothes”
3. Give your patient enough time to generate a longer response. After they stop speaking, ask, “Is there anything else?”  
4. Repeat this process with additional auditory prompts

Read More Aphasia Guides

• Aphasia Tx Approaches
• Aphasia Treatment Ideas (55 Activities)

How To Choose Auditory Stimuli

Here are functional scenarios to use during treatment. As always, choose stimuli that are relevant to each patient. 

Tell me in detail how you would go about…

• Buying groceries for dinner
• Taking your medications
• Watering your garden
• Buying a birthday present
• Feeding a pet
• Visiting your daughter
• Playing Rummy

Response Elaboration Training Goals

Here are a few example response elaboration training goals to get you started.

For more tips on writing great goals, see the Adult SLP Goal Bank.

Picture Prompt:

1. The patient will generate sentences with 5 or more words in response to a visual scene given verbal cues.
2. The patient will generate sentences with 10 or more words in response to a visual scene.
3. The patient will generate 2 or more sentences each containing 7 or more words in response to a visual scene.

Auditory Prompt:

1. The patient will generate sentences with 5 or more words in response to an auditory prompt, given verbal cues.
2. The patient will generate sentences with 10 or more words in response to an auditory prompt.
3. The patient will generate 2 or more sentences each containing 7 or more words in response to an auditory prompt.

What Are Other Aphasia Treatment Approaches?

While looser, conversation-based treatment like RET can be very effective, you may want to try different ways of treating aphasia.

Maybe you prefer more structured treatments. Or maybe you want to target naming.

Here are other evidence-supported aphasia treatment techniques:

• Naming therapy
• Constraint-induced language therapy
• Semantic feature analysis
• Phonological components analysis
• Melodic intonation therapy
• Treatment of underlying form
• Supported conversation for adults with aphasia
• Verb network strengthening treatment
• Script training

Visit ASHA’s aphasia practice portal for a complete list. And read Aphasia Treatment Approaches & Protocols for more step-by-step guides.

More Aphasia Materials

See what people are saying about the Aphasia Pack’s print-and-go worksheets and treatment guides!

References

1. American Speech-Language-Hearing Association. (n.d.). Aphasia [Practice Portal]. Retrieved Nov, 20, 2023, from https://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/
2. Bunker, L. D., Nessler, C., & Wambaugh, J. L. (2018). Effect Size Benchmarks for Response Elaboration Training: A Meta-Analysis. https://doi.org/23814764000300140072
3. Wambaugh, Julie and Nesser, Christina and Wright, Sandra (2012) Response Elaboration Training: Application to Procedural Discourse and Personal Recounts. [Clinical Aphasiology Paper] Retrieved from https://aphasiology.pitt.edu/2364/1/202-498-1-RV_%28Wambaugh_Nesser_Wright%29.pdf
4. Wambaugh, J. L., Nessler, C., & Wright, S. (2013). Modified Response Elaboration Training: Application to Procedural Discourse and Personal Recounts. https://doi.org/1058036000220002S409