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An Aphasia Mentors' Program in Graduate Speech-Language Pathology Education: Perspectives of Mentors with Aphasia
Get PDFThe need for meaningful engagement for people with chronic aphasia has received increasing attention in recent years with a gradual shift from medical to social models of disability for addressing those needs (Hewitt & Byng, 2003; Byng & Duchan, 2005; Simmons-Mackie, & Damico, 2007). In North America, a growing number of community-based and university-based aphasia centers are evidence of this shift in practice. Aphasia centres offer group programs that share a focus on quality of life, participation, and social support, with a variety of services ranging from conversation groups to drama classes (Simmons-Mackie, 2011; Simmons-Mackie & Holland, 2011). An important aspect of service delivery models within a social framework is that they emphasize involvement of participants as equal partners in program development and delivery, in contrast to models that situate professionals as experts
Apraxia of Speech: Impaired Access to Motor Programs or Damaged Motor Programs?
No full textDefinitions of apraxia of speech (AOS) describe this motor speech disorder as an impairment in planning and programming of speech movements (Duffy, 2005). The exact underlying mechanism of the impairment, however, is not well understood. The purpose of this investigation is to specify the speech planning impairment in AOS by testing two specific hypotheses framed in the DIVA model (Guenther, 2006)
Initiation of communication by persons with severe aphasia during group treatment
No full textThe viability of group treatment in inpatient rehabilitation facilities (IRFs) is at a crossroads. While the Centers for Medicare and Medicaid Services (CMS) has not yet established standards for group therapy in IRFs, they have stated that the standard for care in these settings is individualized therapy (Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2009). CMS limitations of the size and frequency of group therapy in other settings suggests that CMS believes group treatment is of a lesser quality when compared with individual treatment. This is a critical time for research demonstrating the unique benefits of SLP group treatment in acute rehabilitatio
The effects of dual-task conditions on micro- and macro-linguistics aspects of spoken discourse in aphasia
Get PDFCurrently, there is increasing empirical and clinical interest in the integrity of nonlinguistic, cognitive processes (e.g., attention, working memory) in aphasia, and the relationship between these processes and aphasic symptoms and outcomes (Adrover-Roig et al., 2011; Fucetola et al., 2009; Murray, 2012). Indeed, recent findings support an emerging conceptualization of aphasia in which deficits in extra-linguistic cognitive functions may generate or intensify linguistic impairments (Hula & McNeil, 2008; Murray & Kean, 2004). The purpose of the current study was to specify further this processing or resource model of aphasia by examining interactions between spoken discourse and general cognitive skills in aphasic adults using a dual-task paradigm. Previous findings indicate that cognitive factors can negatively influence discourse in healthy, aphasic, and other patient populations (Duong et al., 2005; Plummer-D’Amato et al., 2008; Rogalski et al., 2010). For example, Murray et al. (1998) found that for aphasic adults, aspects of discourse formulation hypothesized to rely on relatively controlled as opposed to automatic processes were most vulnerable under dual-task conditions; however, only the interaction between increased attentional demands and microlinguistic processes were examined, even though aphasia can compromise macrolinguistic abilities (Chapman et al., 1998; Rousseaux et al., 2010). Further, adults with a limited range of aphasia types and severities participated in this study, and whether material-specific limitations (i.e., discourse characteristics during a non-distracting condition), general cognitive abilities (i.e., cognitive test scores), or both are important predictors of dual-task outcomes was not examined
Naming treatment and crosslinguistic generalization
No full textCurrent research on bilingual aphasia has only begun to inform us about the optimal rehabilitation for bilingual aphasic patients and the literature is still sparse in terms of interpreting impairment and recovery in these individuals. Two recent reviews (Faroqi-Shah, Frymark, Mullen, & Wang, 2010; Lorenzen & Murray, 2008) highlight the beneficial effects of rehabilitation in bilingual aphasic patients, however, both reviews underscore the need for theoretically motivated and well controlled rehabilitation studies. There are still several unanswered questions about outcomes in bilingual aphasia rehabilitation, including (a) is it sufficient to rehabilitate only one language, (b) what are the nature of gains in the trained language, and (c) does rehabilitation in one language have beneficial effects in the untreated language? The present experiment attempts to address these questions with a relatively large set of Spanish-English bilinguals with aphasia, all of whom receive therapy in one language at a time. The extent of improvements in the trained language items, semantically related untrained items in the trained language, and between-language transfer to untrained items is examined. In addition to picture naming, changes in the evolution of naming errors and category fluency are also examined in this study
Conflict Resolution and Goal Maintenance Components of Executive Attention are Impaired in Persons With Aphasia: Evidence from the Picture-Word Interference Task
No full textThe relationship between language processing and attention has been a topic of research in linguistics, psychology and speech-language pathology for a very long time. Following the hypothesis that attention (e.g., Kahneman, 1973) may be related to impaired language performance in aphasia (McNeil, 1982), researchers have increasingly investigated this hypothesis (McNeil, Odell, & Tseng, 1991; Murray, 1999; Robin & Rizzo, 1989; Tseng, McNeil, & Milenkovic, 1993)
Response Elaboration Training: Application to Procedural Discourse and Personal Recounts
No full textResponse Elaboration Training (RET; Kearns, 1985) is a verbal production treatment for aphasia that was designed to facilitate increased content and length of utterances. RET was developed on the premise that treatment should encourage the creative use of language rather than restrict the speaker’s productions to predetermined, convergent responses.
RET entails elicitation of verbal productions of the speaker’s choice in response to action pictures. Then, clinician modeling and forward-chaining are employed to assist the speaker in expanding upon his/her original production.
Kearns and colleagues conducted a systematic series of investigations to examine the effects of RET (Gaddie, Kearns, & Yedor, 1991; Kearns, 1985; Kearns, 1986; Kearns & Scher, 1989; Kearns & Yedor, 1991). Wambaugh and colleagues (2000; 2001) modified RET to allow application with persons with apraxia of speech and Conley and Coelho (2003) combined RET with Semantic Feature Analysis (Boyle & Coelho, 1995). Across the relatively numerous RET investigations, 17 persons with aphasia have demonstrated positive effects of treatment (12 with Broca’s aphasia, 3 with anomic aphasia, and 2 with conduction aphasia). Aphasia severity among participants has ranged from relatively mild to severe.
Although strong response generalization effects of treatment have been demonstrated for RET (i.e., improved responding with similar, untrained pictures), stimulus generalization has received relatively limited study. Kearns and Scher (1989) found mixed results with respect to elicited discourse for three speakers. Wambaugh and Martinez (2000) reported modest changes in personal recounts for two of three speakers as a result of picture level RET training. When they modified RET to apply it without pictures in a personal recount condition, slight additional gains were evidenced.
We speculated that application of RET without pictures, but in a more structured condition than personal recounts, may stimulate generalized responding. Consequently, this investigation was designed to explore the effects of RET applied to procedural discourse as well as to personal recounts
The reorganization of proper nouns: treatment of proper noun retrieval deficits in an individual with temporal lobe epilepsy
Get PDFThe neural correlates of proper noun retrieval have been investigated through neuroimaging and lesion approaches. Neuroimaging studies investigating proper noun naming in neurologically healthy individuals have demonstrated the importance of the left anterior temporal lobe (ATL) to the integrity of proper noun naming (Gorno-Tempini, 2001; Grabowski, Damasio, & Tranel, 2000; Nakamura, et al., 2000; Tranel, 2009; Tsukiura, et al., 2002), while studies investigating proper noun production in individuals with left temporal lobe lesions have demonstrated a link between left ATL damage and proper noun retrieval deficits (Damasio, Grabowski, Tranel, Hichwa, & Damasio, 1996; Tranel, 2006, 2009; Tranel, Damasio, & Damasio, 1997; Tranel, Feinstein, & Manzel, 2008; Tsukiura, et al., 2002). Though patients with left temporal lobe epilepsy have mostly normal linguistic abilities, they consistently demonstrate deficits in proper noun retrieval (i.e., famous faces and places; Glosser, Salvucci, & Chiaravalloti, 2003; Griffith, et al., 2006; Seidenberg, et al., 2002; Viskontas, McAndrews, & Moscovitch, 2002)
Cross-linguistic generalization in treatment of bilingual aphasia
No full textFor individuals who speak more than one language, aphasia following left-hemisphere stroke or focal brain injury impacts all of their languages to varying degrees. At this time, there is limited research regarding the most effective form of treatment for bilingual aphasia, specifically whether to target one or all languages. Some research has suggested that treating individuals with bilingual aphasia in their non-dominant language (L2) yields positive results in their dominant language (L1) (e.g., Edmonds & Kiran, 2006; Kiran & Roberts, 2010; Kohnert, 2004; Langanaro & Overton Venet, 2001; Marangolo et al., 2009). These findings derive from the mixed model of bilingual language distribution (de Groot, 1992) and the Complexity Account of Treatment Efficacy (CATE; Thompson et al., 2003). Per de Groot’s model, there is one semantic system with separate lexicons for each language, and the lexicons have direct access both to the semantic system and one another. The strength of the connection between each lexicon and the semantic system, and between the lexicons themselves, depends upon the individual’s proficiency level in each language. Thus, an individual more proficient in Spanish than English would have a weaker link between his/her English lexicon and the semantic system but a stronger link from the English to the Spanish lexicon. The act of speaking English could, therefore, be considered a more complex process than speaking Spanish, as the individual would rely more heavily on the link from the English to the Spanish lexicon to access the semantic system. According to CATE (Thompson, et al., 2003), training an individual on more complex tasks will yield generalization to less complex, related tasks; therefore training this individual in English (more complex process) should yield generalization to Spanish (less complex process).
Edmonds and Kiran (2006) found that treating English-dominant English/Spanish bilinguals in Spanish had positive effects on their English, and that treating an equally proficient Spanish/English bilingual in Spanish had positive effects in both languages. To our knowledge, no studies have specifically examined whether it is effective to treat bilingual individuals whose non-dominant language is English in English only. Considering that fewer than 6% of AHSA-certified SLPs speak a language other than English (ASHA, 2010) while the fastest growing U.S. subgroup is comprised of elderly Hispanic individuals (ASHA, 1991), it is reasonable to assume that monolingual SLPs will increasingly be called upon to treat bilingual individuals with aphasia. The purpose of this study was to determine whether treating Spanish/English bilinguals, whose non-dominant language is English, in English would improve both of their languages
Stability of a Functional Measure of Word Retrieval in Narrative Discourse
No full textInterest in the ability of people with aphasia to communicate in natural contexts has resulted in examination of their discourse production. There is an expectation that changes in discourse production may reflect meaningful treatment-related changes. In a recent special issue of Aphasiology, Wright (2011) stated that it is clinically important for researchers to establish clinician friendly, reliable, and valid methods for analyzing discourse in order to quantify meaningful changes. An important part of this endeavor requires assessment of the stability of such methods. This is important for a number of reasons. Currently, clinical researchers often analyze discourse production only once prior to treatment and again at the end of treatment. This is a risky practice unless the stability of the discourse measurement is known a priori. If the stability is not known, there is no way that change in discourse can be attributed to the treatment with any degree of confidence unless multiple pre-treatment measurements are collected and analyzed. Additionally, if the discourse measurements are not relatively stable before treatment, a relatively large treatment effect may be necessary to demonstrate that change is related to treatment and not to the normal variability of the measurement. Because this may prove to be challenging, a more strategic approach might be to use a measurement that is relatively stable before treatment. Finally, apart from treatment, the issue of stability of discourse measurements is also important if those measurements are used to describe and analyze aspects of an individual’s language impairment. If a measurement is not reasonably stable from session to session, it will probably not contribute to a valid assessment of the individual’s impairment