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The Feasibility of a Multimodal Communication Treatment for Aphasia during Inpatient Rehabilitation
No full textThe purpose of the current study was to explore the feasibility of a multimodal communication training program implemented with people with aphasia during acute stroke rehabilitation. The purpose of the program was to improve production of alternate communication modalities (gesturing, drawing) as well as verbalization, and to facilitate switching among these modalities to resolve communication breakdowns. Two people with aphasia completed the intervention and demonstrated increased accuracy in the production of various alternate communication modalities. However, improvements in the ability to switch to an alternate modality were noted for only one participant. Clinical implications and future research directions are discussed
Construct Validity and Reliability of Working Memory Tasks for People with Aphasia
No full textWorking memory (WM) is a cognitive system that maintains activation of select information in the service of goal-directed behavior (Baddeley, 2003). Previous research suggests that WM contributes to language impairments in aphasia (e.g., Caspari et al., 1998; Friedman & Gvion, 2012). However, the WM measures used in studies of neurologically healthy adults typically involve verbal production and often use digits or letters, both of which may be susceptible to errors in people with aphasia (PWA). Thus, it is difficult to separate WM deficits from general language deficits in PWA. Tasks that have been used to measure WM in PWA include pointing tasks, n-back tasks (e.g., Christensen & Wright, 2010) and non-linguistic tasks such as block span (Lang & Quitz, 2010). To our knowledge, no study has established the construct validity of measures used with PWA by comparing performance on them to measures used more commonly with neurologically healthy populations.
The goals of this study were to (1) develop a battery of measures to assess WM in people across a range of aphasia severities and (2) establish the construct validity of those measures by comparing neurologically healthy adults’ performance on the new battery to a well-established (“gold standard”) measure of WM
Conversation Therapy for Aphasia: A Survey
No full textThere has been a growing interest in the engagement in and management of conversation in aphasia. The literature describes aspects of conversation in aphasia such as nonverbal communication and management of repair (e.g. Ferguson, 1994; Madden, Oelschlaeger & Damico, 2003). Research delineates strategies and resources employed to achieve conversation by people with aphasia and partners (e.g. Beeke, 2003; Beeke, Wilkinson & Maxim, 2001, 2009; Oelschlaeger & Damico, 1998; Wilkinson, Lock, Bryan & Sage, 2011). There is also growing interest in conversation as a target of aphasia treatment. Various approaches related to conversation have been reported such as multimodality training (Purdy & Van Dyke, 2011), discourse treatment for word retrieval (Boyle, 2011), group conversation therapy (Elman & Bernstein-Ellis, 1999; Simmons-Mackie, Elman, Holland & Damico, 2007), interaction-focused intervention (Wilkinson, Lock, Bryan & Sage, 2011), couples therapy (Boles, 2011) and partner training (Kagan et al, 2001). There has also been discussion of the impact of impairment-focused therapy on conversation (Carragher et al. 2012).
Despite this growing knowledge base, there are no data regarding the translation of knowledge into clinical practice. Has conversation therapy become a routine aspect of clinical practice in aphasia? If so, what do clinicians do in conversation therapy for aphasia? In order to explore these questions, a web-based survey was initiated
An Intensive, Interdisciplinary Treatment Program for Persons with Aphasia
No full textTraditionally, much of individual aphasia therapy has been focused on attempts to remediate underlying linguistic deficits. While many treatments have been shown to improve discrete language functions (Robey et al, 1998), those newly learned skills do not always transfer readily to non-trained environments. Over the past two decades, a growing number of aphasiologists have begun to focus their attention on social approaches to aphasia assessment and treatment (Elman, 2007). One such approach, group treatment, serves as a natural and dynamic vehicle to improve social communication, which has been shown to improve discrete language skills in persons with aphasia (pwa), (Elman & Bernstein-Ellis, 1999). Group treatment frequently co-occurs with individual therapy, but is rarely used as a formal mechanism to train generalization.
Another area of broad discussion in aphasia rehabilitation is the concept of treatment intensity. Basso (2005) reported that pwa who received a higher number of therapy sessions improved more than those who received a lower number of therapy sessions. Bhogal et al (2003) found that treatment provided on a more intense level (>8.8 hours/week) for a shorter period of time resulted in stronger improvements compared to treatment provided on a less intense level over a longer period of time.
A final issue is that individuals with stroke-induced aphasia often present with concomitant motor, cognitive and dietary/cardiac issues. Thus it seems that an interdisciplinary approach incorporating physical, occupational and nutritional therapy would also be beneficial.
This paper explores the speech-language effects of a treatment program, which attempts to incorporate evidenced-based treatment, in an intensive, interdisciplinary format. Pilot data from an initial cohort completed June 2011 as well as multiple-baseline data from a second cohort completed June 2012 is presented
Conversation partner responses to problematic talk produced by people with aphasia: Some alternatives to repair
No full textA salient feature of conversations involving people with aphasia is the prevalence and persistence of threats to intersubjectivity (i.e. mutual understanding). Being unable to understand what is being said and its import can be a frustrating and distressing experience for people with aphasia and their conversation partners (cf. Laakso, 2003; Lock, Wilkinson, & Bryan, 2001; Wilkinson, 2007). One reason for the confronting nature of severe problems with intersubjectivity is that they arise infrequently during interactions involving people without communication disorders. That is, for the most part, people have few issues establishing what others are attempting to achieve through talking, be it greeting, arguing, inviting, complaining, or otherwise. When problems do emerge—when a speaker says “cup” when they intended to say “plate”; when an innocent question is heard as a complaint, and so on—social actors have various techniques for revising their conduct, and righting interactional business. Researchers using Conversation Analysis (CA) have described the practices that people employ to “repair” such difficulties with speaking, hearing, and understanding talk in conversation (e.g. Schegloff, Jefferson, & Sacks, 1977). This work has provided a solid foundation for examining fractures to intersubjectivity during conversations involving people with aphasia (e.g. Aaltonen & Laakso, 2010; Ferguson, 1994; Laakso & Klippi, 1999; Oelschlaeger & Damico, 2003). Studies of conversation repair and aphasia have contributed new knowledge about aphasia’s impact on everyday life, and led to the development of assessment and intervention procedures focused on repair (e.g. Lock et al., 2001; Whitworth, Perkins, & Turner, 1997). In particular, studies of conversation repair and aphasia have highlighted the key role of conversation partners in collaboratively resolving problems with intersubjectivity. However, an important feature of repair as an interactional practice is that it is optional. That is, when a listener is confronted with problematic talk from a speaker, they are not compelled to engage in repair, and may choose to elide the trouble altogether, or address it in some other way. For instance, Jefferson (2007) found that listeners occasionally responded to obvious speaker errors with minimal, receipting responses (e.g. mm, yeah) in place of repair. If the conversation partners of people with aphasia resist repair in this fashion, it has the potential to severely curtail the participation of people with aphasia. That is, without the benefit of collaborative repair efforts, the conversational contributions of people with aphasia may be more effortful and less successful, thereby restricting their ability to implement social action efficiently, or at all (see, e.g., Perkins, 2003, and Laakso, 2003, for some preliminary observations)
PWAs and PBJs: Language for describing a simple procedure
No full textThe purpose of this study was to analyze responses to a simple procedural discourse task in persons with aphasia (PWAs n=141) and non-aphasic participants (n=145). Participants described how to make a peanut butter and jelly sandwich. Results showed significant differences between groups on mean length of utterance, total number of words, total number of utterances, and task duration. However, the top 10 verbs and nouns used by both groups were nearly identical and the proportion of nouns, verbs, pronouns, and determiners used by each group was similar. Aphasia severity correlated moderately with total number of words only
Supporting Narrative Retells for People with Aphasia using AAC: Photographs or Line Drawings? Text or No Text?
Get PDFPeople with aphasia (PWAs) have demonstrated the ability to learn augmentative and alternative communication (AAC) devices that employ traditional grid layouts to enhance their communication; however, the process is typically lengthy and yields limited generalization (Fox & Fried-Oken, 2001; Koul & Harding, 1998). In response, researchers have begun to investigate the use of visual scene displays (VSDs) to support the communication interactions of PWAs by capitalizing on their relatively intact episodic memory (Beukelman, Dietz, McKelvey, Hux, & Weissling, in press; Dietz, Beukelman, & McKelvey, 2006a; Dietz, McKelvey, Beukelman, Weissling, & Hux, 2006b; McKelvey, Dietz, Hux, Weissling, & Beukelman, 2007). High-technology VSDs may include various combinations of photographs, text boxes and speak buttons (see Figure 1); however, the specific elements of VSDs that best support the communication of PWAs is unknown. Therefore, the purpose of this investigation was to compare the impact of personally relevant (PR) photographs and line drawings (LDs) as well as the presence of text on four AAC interfaces, on the communication of PWAs during a personal narrative retell task
Development and simulation testing of a computerized adaptive version of the Philadelphia Naming Test
Get PDFImpairment of naming ability is ubiquitous in aphasia and assessment of naming is central to clinical assessment (Nickels, 2002). One prominent naming test is the Philadelphia Naming Test (PNT) (Roach et al., 1996), which has favorable psychometric properties and has been used in many investigations of the theoretical nature of aphasic naming deficits (e.g., Dell et al., 1997; Schwartz et al, 2006). However, the PNT is a long test, limiting its usefulness in clinical settings. Recently, Walker & Schwartz (2012) published two 30-item PNT short forms (PNT30-A, PNT30-B) along with data supporting their reliability and validity. These short forms were developed using classical test theory methods, with attention to items’ lexical characteristics, their overall difficulty, and error type distributions
Implicit Treatment of Underlying Comprehension Processes Improves Narrative Comprehension in Right Hemisphere Brain Damage
Get PDFLanguage comprehension deficits in adults with focal right hemisphere brain damage (RHD) can cause considerable social handicap. To date, however, treatment for these deficits remains almost entirely untested. This abstract reports an investigation of whether Contextual Constraint Treatment (CCT) -- a novel, implicit, stimulation-facilitation treatment for language comprehension processes1,2 -- can yield generalized gains to measures of discourse comprehension in adults with RHD.
The focus of CCT is motivated by two major accounts of typical RHD language comprehension problems: that they are due to coarse coding or suppression deficits. Coarse coding (CC) activates wide-ranging aspects of word meaning independent of surrounding context. In RHD, CC deficits impair processing of distant meanings/features of words (e.g., “rotten” as a feature of “apple”)3. A normal suppression (SUPP) process reduces mental activation of concepts that become less relevant to a current context. RHD SUPP impairment is indexed by prolonged processing interference from contextually-inappropriate interpretations (e.g., the “ink” meaning of the word “pen,” in the sentence “He built a pen”)4,5. CC and SUPP are partially domain-general language comprehension processes. For example, both predict aspects of discourse comprehension and are hypothesized to underpin figurative language comprehension; SUPP is important for resolving lexical and inferential ambiguities; and CC is involved in processing both literal lexical items and phrasal metaphors1,2,6. Thus, treatment that improves CC and SUPP processes may hold promise for improving a broad range of communicative outcomes.
CCT is novel in aiming to facilitate comprehension processes implicitly, through contextual prestimulation. Adults with RHD who perform well on implicit assessments of language processing often have difficulty on metalinguistic assessments of the same operations2. Thus we implemented this approach to avoid confounding treatment of impaired processes with irrelevant, and potentially difficult, task demands
More to Language than Picture Naming: Norms and Patient Data for a Verb Generation Task
No full textStandardized confrontation naming is widely used to measure language impairment in persons with aphasia (PWAs). However, naming often does not reveal severity of language impairment in PWAs. We asked participants to generate verbs, given object picture stimuli. Phase 1 of this study investigates verb generation in 38 non-brain damaged participants (NCs) on 218 objects. Phase 2 examines verb generation performance of three PWAs, post-naming treatment on their subsets of objects (n=60). Preliminary data suggest that domain (i.e., living vs. artifact) affects agreement in NCs. The effects of training and practice on verb generation in PWAs are also discussed