Learn more about VA Pittsburgh's PIRATE (Program for Intensive Residential Aphasia Treatment & Education) program, which provides treatment to people with aphasia.
VA Pittsburgh’s Program for Intensive Residential Aphasia Treatment and Education (PIRATE) provides treatment to Veterans and active duty service members with aphasia. Aphasia is a language disorder that limits a person’s ability to understand language, speak, read, and write.
Treatment through PIRATE can help patients improve their listening, speaking, reading, or writing abilities, and may include the use of communication technology.
PIRATE is offered throughout the year with a maximum of six sessions per year. Each session is four weeks long, and therapy takes place on weekdays during business hours. Patients’ family members can participate in select educational and therapy sessions.
PIRATE philosophy of care
Our integrated team of clinical providers, educators, and scientist-practitioners is dedicated to improving the functioning and well being of people with aphasia.
We believe that:
- Aphasia recovery continues for many years beyond the time of stroke or brain injury.
- Aphasia therapy should focus on improving impaired language functions, training the use of compensatory strategies, or both.
- Aphasia therapy is effective whether provided one-on-one or in a group setting.
- Intensive aphasia therapy can help bring about the most treatment-related gains in the shortest amount of time.
- Each person with aphasia, along with their significant others and their providers, should determine their own treatment goals.
- Creating a supportive environment and community for people with aphasia enhances the recovery process.
- When people with aphasia are able to use newly acquired skills and strategies outside of the therapy room, their confidence and ability to communicate effectively improve.
- Assistive technologies— for example, social media and apps for tablet computers and smartphones — can provide opportunities for communication support and continued practice of treatment activities.
We strive to:
- Increase access to evidence-based, individualized intensive aphasia treatment, counseling, and education.
- Help people with aphasia improve their ability to communicate both with people at home and in the community.
- Empower people with aphasia to become strong self-advocates so they can clearly communicate their needs, act to help others with aphasia, and raise public aphasia awareness.
- Provide social and emotional support to people with aphasia and their significant others.
- Improve clinical care and contribute to the existing evidence base by conducting controlled clinical trials and fostering a collaborative clinician/researcher environment.
- Engage with and educate community members and other healthcare professionals through the use of sponsored summits and conferences.
Apply for PIRATE
If you or a family member is interested in participating in the PIRATE program, please complete an application and return it to Mary Sullivan. You may fax or mail your completed application.
VA Pittsburgh Healthcare System
PIRATE, ATTN Mary Sullivan
University Drive, 112 SP-U
Pittsburgh, PA 15240
Your VA primary care physician must also submit a consult request to PIRATE.
- Outside of VISN 4, the physician should use an e-consultation request form.
- Within VISN 4, the physician should send an electronic speech pathology consult through VISTA/CPRS for “Residential Aphasia Treatment and Education.”
PIRATE staff will review your application materials and VA medical records to determine whether you’re eligible for an application; participation in an evaluation doesn’t guarantee acceptance into PIRATE.
PIRATE speech-language pathologists, medical staff, and occupational therapists will also evaluate you before you’re allowed to participate in the program.
What our clients are saying
We gauge our success based on our clients’ progress and their satisfaction with the treatment they receive. Here’s what some of our former participants have said about the PIRATE program:
"I am sure that this program did make me better to use writing and reading. I will have it for forever and ever." — A former participant
"For us, PIRATE is much more than speech pathology. So far you and the others have performed a minor miracle in Dan's personal life. We hope to continue the gains." — Father of a former participant
"It was great. I'll recommend it to everyone. Thank you so much for sending me there." — A former participant
"Thanks for giving me my life back." — A former participant
One of the ways we measure the success of the PIRATE program is using outcome tools. We collect two kinds of data. First, we ask participants to rate their own effectiveness in communicating using the Aphasia Communication Outcome Measure (ACOM; Hula et al., 2015).
Second, we collect a performance-based measure of participants’ communication ability using the Comprehensive Aphasia Test (CAT; Swinburn et al., 2004). This test asks participants to perform specific communication tasks, such as naming objects, pointing to pictures named by the examiner, or reading aloud.
We collect data on both types of outcome measures before they begin PIRATE (baseline measurement), at PIRATE Entry, PIRATE Exit, and again 3-4 weeks after PIRATE completion for PIRATE Follow-up (ACOM only at Follow-up).
In response to the COVID-19 pandemic, we began offering virtual PIRATE sessions. The outcomes from these sessions are not included in those reported in Figures 1 and 2. However, we are also collecting ACOM and CAT data on these virtual sessions, with preliminary results also showing improvements in participants who have completed the PIRATE program virtually.
Figure 1. Percentage of PIRATE patients demonstrating positive outcomes on each of three kinds of measures.
Figure 2 shows the average score on each measure at each time point. The scores in Figure 2 are given on a percentile scale, meaning that the observed score is equal to or higher than the corresponding percentage of patients from a large reference sample.
For example, the surrogate-reported scores on the SUR-ACOM were at the 28th percentile at PIRATE entry and were at the 49th percentile at follow-up. This means that, on average, Veterans participating in PIRATE scored higher than 28% of patients in a large reference sample before PIRATE and higher than 49% of patients after PIRATE.
Figure 2. Average percentile scores on PIRATE outcome measures by measurement point.
1. Doyle PJ, Hula WD, Austermann Hula SN, Stone CA, Wambaugh JL, Ross KB, Schumacher JG. Self- and surrogate-reported communication functioning in aphasia. Quality of Life Research 2012.
2. Porch B. Porch index of communicative ability. Albuquerque, NM: PICA Programs; 2001.
3. Swinburn, K, Porter, G, Howard, D. Comprehensive Aphasia Test. New York, NY: Psychology Press: 2004.
Frequently asked questions
Who is eligible for PIRATE?
Veterans enrolled in VA health care and Active Duty service members diagnosed with aphasia may be eligible for the program.
Applicants must be medically stable and able to participate in intensive aphasia therapy. They must be independent with mobility and activities of daily living, including bathing/showering, dressing, toileting, meal preparation, medication management, and community navigation via shuttle.
In some cases, people who are not independent in these areas can attend PIRATE if a family member, friend, or significant other stays with them for the entire program.
See the aphasia-friendly eligibility page below.
What does the program cost?
If you don’t make co-payments for outpatient visits at your local VA, you will not have co-payments for PIRATE. Please confirm your co-payment status with your local VA.
If you do make co-payments, the total cost of PIRATE treatment is approximately $1,150.
PIRATE participants are responsible for the cost of food and other daily expenses.
See the aphasia-friendly cost information page below.
What will I do in the PIRATE program?
Our daily schedule is subject to change, but most days will include:
- 3 hours of one-on-one, individual treatment in the morning, which is personalized based on your abilities, goals, and interests
- 2 hour break for lunch
- 2 hours of customized programming in the afternoon – this can include group treatment, group education, participation in research, technology lab, and other activities.
See the aphasia-friendly daily schedule page below.
Where do I stay during treatment?
PIRATE provides free housing in the Pittsburgh community. Each PIRATE participant has a private bedroom, bathroom, and television, and a family member, caregiver, or friend can stay with you free of charge.
The housing facility also has a communal kitchen and dining area, living room, and laundry facility. PIRATE provides courtesy transportation to and from aphasia therapy sessions.
See the aphasia-friendly housing page below.
How are family members expected to participate?
Before you begin the program, you will identify one family member, caregiver, or friend as your emergency contact. This person can accompany you to PIRATE and reside with you free of charge.
In addition, your family members, friends, or caregivers may need to help you arrange travel to Pittsburgh and provide information to PIRATE staff.
See the aphasia-friendly family responsibility page below.
What do past participants say about the program?
“Words flow more easily. He’s not as frustrated when he can’t get a word. He has more confidence in himself!” — Wife of a Veteran
“The program exceeded my expectations with the outcome of my dad’s ability to communicate and confidence.” — Daughter of a Veteran
“I understand his condition and symptoms clearly.” — Daughter of a Veteran
“[Staff member] knows what she’s doing and is excellent at it.” — Veteran
“It’s hard to bartend when you have something like aphasia, but now it’s going to be fun. I have aphasia but I can bartend.” — Veteran
“I can express myself. I can read and speak and spell a little better.” — Veteran
“I loved it here.They helped me a lot.” — Veteran
“The clinicians made [veteran] feel very confident and enthusiastic. He enjoyed the experience very much and we appreciate all the hard work and planning that went into helping him improve.” — Wife of a Veteran
“My husband was very pleased with his treatment. He says the therapists were ‘very good!’.” — Wife of a Veteran
“People say that I sound a lot better than before.” — Veteran
“[Family] made many comments on his speaking and general confidence level.” — Wife of a Veteran
“[Veteran] is starting conversations and using his iPad and cell phone to prompt words or spelling.” —Wife of a Veteran