treatment and generalizaon effects of training atypical ... · treatment and generalizaon effects...
TRANSCRIPT
Treatmentandgeneraliza.oneffectsoftrainingatypicalexemplarsofwell-definedcategoriesfor
pa.entswithchronicaphasia
NatalieGilmore,ErinMeier,JeffreyJohnson,StefanoCardullo&SwathiKiran
BostonUniversityAphasiaResearchLaboratory
IARCDecember15,2016
Outlinefortoday’stalk
Briefbackgroundoflexicalretrievaldifficultyinpersonswithaphasia(PWA),differenttherapyapproachesforanomiaandgeneraliza.oninaphasiabroadly.
1.
PresentpreliminarybehavioraldatafromanongoingstudyinvolvingPWAwhoarereceivingseman.cfeatureanalysis-basedtreatment
2.
Discusspoten.almechanismsforthetreatmentgainsandgeneraliza.oneffectsdemonstratedinPWAasaresultofseman.cfeatureanalysis-basedtreatment
3.
Background
Most“pervasive”symptomofaphasia(Goodglass&Wingfield,1997)
“uh…um...boy…uh...watch...great...um...
Saturday....ride..ridebus...uh...you?”
“IsawTheGirlontheTrainthisweekend.Itwasamazing!Haveyouseenit?”
Occursacrossaphasiatypesandseveri.es
Background
Concept
Lexicalselec/on
Phonologicalretrieval
Phonologicalencoding
sun carrot cakecorn potato
/eI/ /k//o//p/ /t//ɔr//n/ /ə//ae//s/ /∧/ /r/
FieldVegetable Sweet Yellow
“corn”
SEMANTIC
PHONOLOGICAL
Dell,Schwartz,Mar.n,Saffron,&Gagnon,1997;Schwartz,2013
BackgroundManydifferentstudiesexaminingapproachestowordretrievaldifficulty
Seman/capproaches(e.g.,seman/cfeatureanalysis)
Antonucci(2009);Behrman&Lieberthal(1989);Bas/aanse,Hurkmans&Links(2006);Bierdermann&Nickels(2008);Boyle(2004);Boyle&Coehlo(1995);Byng(1988);Byng&Coltheart(1986);Coehlo,McHugh&Boyle(2000);Conley&Coehlo(2003);Cubelli,Fores.,&Consolini(1988);Davis&Stanton(2005);Delong,Nessler,Wright&Wambaugh(2015);Edmonds&Kiran(2006);Falconer&Antonucci(2012);Fisher,Wilshire&Ponsford(2009);Franklin,Buerk,&Howard(2002);Grayson,Hilton&Franklin(1997);Hashimoto&Frome(2011);Hickin,Best,Herbert,Howard&Osborne(2002);Hillis(1991);Hillis(1998);Hough(1993);Howard,Hickin,Redmond,Clark&Best(2006);Kendall,Oelke,Brookshire&Nadeau(2015);Kendall,Rosenbek,Heilman,Conway,Klenberg,Gonzalez-Rothi&Nadeau(2008);Kiran&Roberts(2010);Kiran&Thompson(2001);Kiran&Thompson(2003);Kristensson,Behrns&Saldert(2015);LeDorze,Boulay,Gaudreau&Brassard(1994);Leonard,Rochon&Laird(2008);Links,Hurkmans&Bas/aanse(2010);Lowell,Beeson&Holland(1995);Marshall,Pound,White-Thompson&Pring(1990);Nickels&Best(1996);Peach&Reuter(2010);Pring,Hamilton,Harwood&MacBride(1993);Nefleton&Lesser(1991);Raymer,Thompson,Jacobs&LeGrand(1993);Rider,Wright,Marshall&Page(2008);Robson,Marshall,Pring&Chiat(1998);Waldron,Whitworth,Howard(2011);Wambaugh&Ferguson(2007);Wambaugh,Mauszycki,Cameron,Wright,Nessler(2013);Visch-Brink,Bajema,VanDeSandt-Koenderman(1997)
Background
Phonologicalapproaches(e.g.,phonologicalcomponentsanalysis)
Antonucci(2009);Behrman&Lieberthal(1989);Bas.aanse,Hurkmans&Links(2006);Bierdermann&Nickels(2008);Boyle(2004);Boyle&Coehlo(1995);Byng(1988);Byng&Coltheart(1986);Coehlo,McHugh&Boyle(2000);Conley&Coehlo(2003);Cubelli,Fores/,&Consolini(1988);Davis&Stanton(2005);Delong,Nessler,Wright&Wambaugh(2015);Edmonds&Kiran(2006);Falconer&Antonucci(2012);Fisher,Wilshire&Ponsford(2009);Franklin,Buerk,&Howard(2002);Grayson,Hilton,&Franklin(1997);Hashimoto&Frome(2011);Hickin,Best,Herbert,Howard&Osborne(2002);Hillis(1991);Hillis(1998);Hough(1993);Howard,Hickin,Redmond,Clark&Best(2006);Kendall,Oelke,Brookshire&Nadeau(2015);Kendall,Rosenbek,Heilman,Conway,Klenberg,Gonzalez-Rothi&Nadeau(2008);Kiran&Roberts(2010);Kiran&Thompson(2001);Kiran&Thompson(2003);Kristensson,Behrns&Saldert(2015);LeDorze,Boulay,Gaudreau&Brassard(1994);Leonard,Rochon&Laird(2008);Links,Hurkmans&Bas.aanse(2010);Lowell,Beeson&Holland(1995);Marshall,Pound,White-Thompson&Pring(1990);Nickels&Best(1996);Peach&Reuter(2010);Pring,Hamilton,Harwood&MacBride(1993);Nejleton&Lesser(1991);Raymer,Thompson,Jacobs&LeGrand(1993);Rider,Wright,Marshall&Page(2008);Robson,Marshall,Pring&Chiat(1998);Waldron,Whitworth,Howard(2011);Wambaugh&Ferguson(2007);Wambaugh,Mauszycki,Cameron,Wright,Nessler(2013);Visch-Brink,Bajema,VanDeSandt-Koenderman(1997)
Manydifferentstudiesexaminingapproachestowordretrievaldifficulty
BackgroundManydifferentstudiesexaminingapproachestowordretrievaldifficulty
Reorganiza/onalapproaches(e.g.,traininglefer-soundcorrespondence)
Annoni,Khater,Custodi,DeBeauvais,Michel&Landis(1998);Abel,Shultz,Radermacher,Willmes&Huber(2005);Bachy-Langedock&DeParz(1989);Basso,Marangolo,Piras&Galluzi(2001);Bachy-Langedock&DePartz(1989);Bas/aanse,Bosje&Franseen(1996);Best,Howard,Bruce&Gatehouse(1997);Best&Nickels(2000);Best,Herbert,Hickin,Osborne&Howard(2008);Best,Greenwood,Grassly,Herbert,Hickin,Howard(2013);Boo&Rose(2011);Bruce&Howard(1987);Carlomagno,Pandolfi,Labruna,Colombo&Razzano(2001);Conroy,Sage&LambonRalph(2009);Davis&Pring(1991);DeLoche,Dordain&Kremin(1993);DeLocheetal.,(1997);Doesborgh,VanDeSandt-Koenderman,Dippel,VanHarskamp,Koudstaal&Visch-Brink(2004);Drew&Thompson(1999);Eales&Pring(1998);Fink,Brecher,Schwartz&Robey(2002);Fillingham,Sage&LambonRalph(2006);Greenwald,Raymer,Richardson&Rothi(1995);Greenwood,Grassly,Hickin&Best(2010);Hashimoto(2012);Herbert,Best,Hickin,Howard,Osborne(2003);Hillis(1989);Hillis&Caramazza(1994);Holland(1998);Howard(1994);Howard&Harding(1998);Howard,Pajerson&Franklin(1985);Kiran,Thompson&Hashimoto(2001);Linebaugh,Shisler&Lehner(2005);LeDorze(1991);LeDorze&Pijs(1995);Lorenz&Ziegler(2009);Mar.n,Fink,Laine&Ayala(2004);Milman,Vega-Mendoza&Clendenen(2014);Murray&Karcher(2000);Nejleton&Lesser(1991);Nickels(1992);Pashek(1997);Pashek(1998);Raymer,Ciampin,Holloway,Singletary&Blonder(2007);Raymer&Ellsworth(2002);Raymer,McHose,Smith,Iman,Ambrose&Casselton(2012);Raymer,Singletary,Rodriguez,Ciampin,Heilman&Rothi(2006);Renvall,Laine&Mar.n(2007);Renvall,Laine,Laakso&Mar.n(2003);Rose&Douglas(2008);Rose,Douglas,&Matyas(2002);Rose&Sussmilch(2008);Shisa,D’Andrea,Semenza&Tabossi(2001);Silkes,Dierkes,Kendall(2013);Spencer,Doyle,McNeil,Wambaugh,Park&Carroll(2000);Sugishita,Seki,Kabe&Yunoki(1993);Thompson,Hall&Simpson(1986);Thompson&Kearns(1981);vanHees,Angwin,McMahon&Copland(2013);Wambaugh,Linebaugh,Doyle,Mar.nez&Kalinyak-Fliszar(2001);Wambaugh(2003)
Background
Otherapproaches(e.g.,facilita/on,gesture,errorless)
Annoni,Khater,Custodi,DeBeauvais,Michel&Landis(1998);Abel,Shultz,Radermacher,Willmes&Huber(2005);Bachy-Langedock&DeParz(1989);Basso,Marangolo,Piras&Galluzi(2001);Bachy-Langedock&DePartz(1989);Bas.aanse,Bosje&Franseen(1996);Best,Howard,Bruce&Gatehouse(1997);Best&Nickels(2000);Best,Herbert,Hickin,Osborne&Howard(2008);Best,Greenwood,Grassly,Herbert,Hickin,Howard(2013);Boo&Rose(2011);Bruce&Howard(1987);Carlomagno,Pandolfi,Labruna,Colombo&Razzano(2001);Conroy,Sage&LambonRalph(2009);Davis&Pring(1991);DeLoche,Dordain&Kremin(1993);DeLocheetal.,(1997);Doesborgh,VanDeSandt-Koenderman,Dippel,VanHarskamp,Koudstaal&Visch-Brink(2004);Drew&Thompson(1999);Eales&Pring(1998);Fink,Brecher,Schwartz&Robey(2002);Fillingham,Sage&LambonRalph(2006);Greenwald,Raymer,Richardson&Rothi(1995);Greenwood,Grassly,Hickin&Best(2010);Hashimoto(2012);Herbert,Best,Hickin,Howard,Osborne(2003);Hillis(1989);Hillis&Caramazza(1994);Holland(1998);Howard(1994);Howard&Harding(1998);Howard,Pajerson&Franklin(1985);Kiran,Thompson&Hashimoto(2001);Linebaugh,Shisler&Lehner(2005);LeDorze(1991);LeDorze&Pifs(1995);Lorenz&Ziegler(2009);Mar/n,Fink,Laine&Ayala(2004);Milman,Vega-Mendoza&Clendenen(2014);Murray&Karcher(2000);Nejleton&Lesser(1991);Nickels(1992);Pashek(1997);Pashek(1998);Raymer,Ciampin,Holloway,Singletary&Blonder(2007);Raymer&Ellsworth(2002);Raymer,McHose,Smith,Iman,Ambrose&Casselton(2012);Raymer,Singletary,Rodriguez,Ciampij,Heilman&Rothi(2006);Renvall,Laine&Mar/n(2007);Renvall,Laine,Laakso&Mar/n(2003);Rose&Douglas(2008);Rose,Douglas,&Matyas(2002);Rose&Sussmilch(2008);Shisa,D’Andrea,Semenza&Tabossi(2001);Silkes,Dierkes,Kendall(2013);Spencer,Doyle,McNeil,Wambaugh,Park&Carroll(2000);Sugishita,Seki,Kabe&Yunoki(1993);Thompson,Hall&Simpson(1986);Thompson&Kearns(1981);vanHees,Angwin,McMahon&Copland(2013);Wambaugh,Linebaugh,Doyle,Mar.nez&Kalinyak-Fliszar(2001);Wambaugh(2003)
Manydifferentstudiesexaminingapproachestowordretrievaldifficulty
Background
Annoni,Khater,Custodi,DeBeauvais,Michel&Landis(1998);Abel,Shultz,Radermacher,Willmes&Huber(2005);Bachy-Langedock&DeParz(1989);Basso,Marangolo,Piras&Galluzi(2001);Bachy-Langedock&DePartz(1989);Bas.aanse,Bosje&Franseen(1996);Best,Howard,Bruce&Gatehouse(1997);Best&Nickels(2000);Best,Herbert,Hickin,Osborne&Howard(2008);Best,Greenwood,Grassly,Herbert,Hickin,Howard(2013);Boo&Rose(2011);Bruce&Howard(1987);Carlomagno,Pandolfi,Labruna,Colombo&Razzano(2001);Conroy,Sage&LambonRalph(2009);Davis&Pring(1991);DeLoche,Dordain&Kremin(1993);DeLocheetal.,(1997);Doesborgh,VanDeSandt-Koenderman,Dippel,VanHarskamp,Koudstaal&Visch-Brink(2004);Drew&Thompson(1999);Eales&Pring(1998);Fink,Brecher,Schwartz&Robey(2002);Fillingham,Sage&LambonRalph(2006);Greenwald,Raymer,Richardson&Rothi(1995);Greenwood,Grassly,Hickin&Best(2010);Hashimoto(2012);Herbert,Best,Hickin,Howard,Osborne(2003);Hillis(1989);Hillis&Caramazza(1994);Holland(1998);Howard(1994);Howard&Harding(1998);Howard,Paferson&Franklin(1985);Kiran,Thompson&Hashimoto(2001);Linebaugh,Shisler&Lehner(2005);LeDorze(1991);LeDorze&Pijs(1995);Lorenz&Ziegler(2009);Mar.n,Fink,Laine&Ayala(2004);Milman,Vega-Mendoza&Clendenen(2014);Murray&Karcher(2000);Nejleton&Lesser(1991);Nickels(1992);Pashek(1997);Pashek(1998);Raymer,Ciampij,Holloway,Singletary&Blonder(2007);Raymer&Ellsworth(2002);Raymer,McHose,Smith,Iman,Ambrose&Casselton(2012);Raymer,Singletary,Rodriguez,Ciampin,Heilman&Rothi(2006);Renvall,Laine&Mar.n(2007);Renvall,Laine,Laakso&Mar.n(2003);Rose&Douglas(2008);Rose,Douglas,&Matyas(2002);Rose&Sussmilch(2008);Shisa,D’Andrea,Semenza&Tabossi(2001);Silkes,Dierkes,Kendall(2013);Spencer,Doyle,McNeil,Wambaugh,Park&Carroll(2000);Sugishita,Seki,Kabe&Yunoki(1993);Thompson,Hall&Simpson(1986);Thompson&Kearns(1981);vanHees,Angwin,McMahon&Copland(2013);Wambaugh,Linebaugh,Doyle,Mar/nez&Kalinyak-Fliszar(2001);Wambaugh(2003)
Comparingapproaches(e.g.,phonologicvsseman/c)
Manydifferentstudiesexaminingapproachestowordretrievaldifficulty
Background
ComplexityAccountofTreatmentEfficacy(CATE)• Syntax(Thompson,Shapiro&Roberts,1993;Thompson,Shapiro,
Ballard,Jacobs,Schneider&Tait,1997;Thompson,Ballard&Shapiro,1998;Thompson,Shapiro,Kiran&Sobecks,2003)
• Englishasasecondlanguage(ESL)(Eckman,Bell&Nelson,1988)
• Phonologicaldisordersinchildren(Gierut,1990,1992,2001;Gierut&Champion,2001;Gierut,Elbert&Dinnsen,1987)
• Seman/cs(Kiran&Thompson,2003;Kiran,2008.Kiran&Johnson,2008,Kiran,Sandberg&Sebas.an,2011)
COMPLEXTARGETS
SIMPLETARGETS
GENERALIZATION
(Thompsonet.al,2003)
Seman/cFeatureAnalysis(SFA)(Boyle&Coehlo,1995;Coehlo,McHugh&Boyle,2000;Boyle,2004,Boyle,2010)
– “Spreadingac.va.on”– Mappingbetweenseman.cs
andphonology(Howard,2000)– Generaliza.ontountrained
items
Background
Vegetables
MORETYPICAL
LESSTYPICAL
FEATURES
GrowsCrispEatenfreshNutri.ousFoundinagrocerystoreUsedasagarnishStrongflavorGrowningreenhouse
ATYPICALITEMSTYPICALITEMS
ATYPICALITEMS TYPICALITEMS
TYPICALITEMS ATYPICALITEMS
COMPLEXTARGETS(ATYPICAL)
SIMPLETARGETS(TYPICAL)
GENERALIZATION
Thompsonet.al,2003
Rosch,1975;Kiran&Thompson,2003;Kiran,Ntourou,Eubank&Shamapant,2005;Kiran&Allison,2005
Background
Animate/Organic(Kiran&Thompson,2003)
(Stanczak,Waters&Caplan,2006)
Well-Defined(Kiran&Johnson,2008)
Inanimate/Inorganic(Kiran,2008)
Ad-Hoc(Kiran,Sandberg&Sebas.an,2011)
CategoryType Categories AphasiaType Findings
Fluent&Anomic
Anomic
Fluent&Nonfluent
Anomic&Fluent
Atypical->Typicalfor4PWATypical≠Atypicalfor3PWATypical->Atypicalfor1PWA
Atypical->Typicalfor5PWATypical≠Atypicalfor2PWATypical->Atypicalfor1PWA
Atypical->Typicalfor2PWATypical≠Atypicalfor1PWA
Atypical->Typicalfor2PWATypical≠Atypicalfor4PWA
Generaliza/onpafernsbasedonthetypicalityeffecthavebeendemonstratedacrosscategoryandaphasiatypesbut,samplesizeswererela/velysmallandnotallpa/entsshowedtheeffect.
Generaliza/onpafernsfromseman/cfeatureanalysisbasedtreatments
(e.g.,Boyle&Coehlo1995;Coehlo,McHugh&Boyle2000)
(e.g.,Coehlo,McHugh&Boyle2000;Hashimoto&Frome2011)
Background
Juryisout!
(e.g.,Rider,Wright,Marshall&Page2008;Wambaugh,Mauszycki&Wright2014)
(e.g.,Antonucci2009;Boyle&Coehlo1995)
Untraineditems:
Untrainedtasks:
ResearchQues.ons
1
DoPWAnamemoreitemsintheirtrainedcategoriesaccuratelyaterSFA-basedtreatment?
2
DoPWAdemonstratethetypicalityeffectaterSFA-basedtreatment?
3
DoPWAshowbeferseman/candphonologicalprocessingskillsaterSFA-basedtreatment?
4
DoPWAdemonstrategainsingloballanguageskillsaterSFA-basedtreatment?
HA:Yes–Priorworkhasdemonstratedtheefficacyofthisapproach(Kiran&Thompson,2003;Kiran,2008).However,thisstudyhasalargersamplesize,amixofaphasiatypes&includesbothorganicandinorganiccategories.
HA:Yes–IfPWAdemonstrategainsinlexicalretrieval,seman.c&phonologicalprocessingskillsthen,theyshouldalsoshowgainsinotherlanguagetasksandmodali.es(Kiran&Thompson,2003;Kiran,2008).
HA:Yes–Trainingatypicalitemsshouldimproveuntrainedtypicalitems.(Rosch,1975,Thompsonetal.,2003).
HA:Yes–PWAshouldshowimprovementsonthesetasksbasedonthe2-stepinterac.vemodel(Delletal,1997;Schwartz,2013).
GENERALIZATION
GENERALIZATION
GENERALIZATION
TREATMENTEFFECTS
ID Age YPO AphasiaType WAB-AQ BNT CLQT PAPTBU01 55.91 1.05 Anomic 87.20 82% 85% 96%BU02 50.54 2.63 Global 25.20 2% 50% 94%BU03 63.86 5.34 Conduc.on 52.00 17% 55% 88%BU04 79.23 1.09 Conduc.on 74.10 87% 80% 94%BU05 67.88 0.79 Wernicke’s 30.80 7% 50% 92%BU06 50.02 9.46 Broca’s 66.60 73% 80% 92%BU07 55.31 11.55 Broca’s 48.00 10% 60% 88%BU08 49.90 4.81 Anomic 82.80 85% 90% 92%BU09 72.01 3.30 Anomic 95.20 75% 95% 96%BU10 53.07 0.95 Anomic 80.40 62% 80% 94%BU11 78.70 1.95 Anomic 92.10 68% 75% 94%BU12 68.91 8.69 Broca’s 40.00 2% 60% 88%BU13 42.65 1.56 Anomic 92.70 72% 95% 94%BU14 64.51 1.95 Broca’s 64.40 68% 80% 94%BU15 71.31 6.19 Anomic 87.20 72% 60% 85%BU16 50.25 5.89 Broca’s 33.60 2% 70% 79%BU17 61.38 12.89 Anomic 74.30 90% 90% 98%BU18 70.46 13.39 Anomic 78.00 40% 85% 96%BU19 80.27 1.82 Broca’s 28.90 2% 70% 83%
M 62.43 5.02 n/a 64.92 48% 74% 92%SD 11.43 4.25 n/a 24.06 35% 15% 5%
Range 42.65-80.27 .79-13.39 n/a 25.2-95.2 2%-90% 50%-95% 79%-98%
Methods
Rangeof/mepostonset
19PWAreceivedtreatment
andseveri/es.Rangeof/mepostonset,aphasiatypes,
Methods
Treatment Post-TreatmentPre-Treatment
• Baferyofstandardizedtests • Setof9site-specificbehavioraltasks
• 180-itemnamingscreener(3x)
• SFA-basedtreatment
• Computer-administeredwithclinicianassistance
• Trainedon2categories
• 2hoursessionsfor12weeksorun/laccuracy>90%on2consecu/veprobes
• Weeklynamingprobes
• 2trainedcategories• 1monitoredcategory• 1assessedcategory
• 2trainedcategories
• 1monitoredcategory
• 1assessedcategory
• Baferyofstandardizedtests • Setof9site-specificbehavioraltasks
• 180-itemnamingscreener(3x)
• 2trainedcategories
• 1monitoredcategory
5Categories
3Organic 2Inorganic
36items
18typical 18atypical
Methods
Alltreatmentcategoriesareconstructedinthismanner.
18typical
Methods
18atypical
TREATMENTWEEKLYPROBE
36items
18typical(UNTRAINED)
18atypical(TRAINED)
36items
18typical(UNTRAINED)
18atypical(UNTRAINED)
36items
18typical(TRAINED)
18atypical(UNTRAINED)
ID TrainedCategory1 TrainedCategory2 UntrainedCategory(Monitored)
BU03 TypicalBirds AtypicalFurniture Vegetables
Methods
Treatmentcategorieswerequasi-randomlyassignedandcounterbalancedacrosspar/cipants.
ID TrainedCategory1 TrainedCategory2UntrainedCategory
(Monitored)
UntrainedCategory(Assessed)
BU01 TypicalBirds AtypicalVegetables Clothing FurnitureBU02 TypicalBirds TypicalClothing Furniture VegetablesBU03 TypicalBirds AtypicalFurniture Vegetables ClothingBU04 TypicalBirds TypicalFurniture Vegetables ClothingBU05 TypicalVegetables TypicalClothing Furniture BirdsBU06 TypicalClothing TypicalFurniture Vegetables BirdsBU07 TypicalVegetables AtypicalFurniture Birds ClothingBU08 AtypicalBirds TypicalFurniture Clothing VegetablesBU09 AtypicalBirds TypicalFurniture Vegetables ClothingBU10 TypicalBirds AtypicalFurniture Clothing Vegetables
Methods
WrifenFeatureVerifica/on
Haswings?
1stNamingafempt
Whatisitcalled?
AuditoryFeatureVerifica/on
Isedible?
2ndNamingafempt
Whatisitcalled?
CategorySor/ng
Whatcategorydoesitbelongto?Animal Furniture
Vegetable
FeatureReview• Isedible• Grows• Issweet• Growsin
afield• Isyellow
Seman/cFeatureAnalysis-BasedTreatment
Kiran&Thompson,2003;Kiran&Johnson,2008;Kiran,2008;Kiranetal.,2011
Methods
Recordaccuracyandresponse/metomeasureprocessingatthelevelofseman/cs,phonologicaloutputlexicon(POL)andphonologicaloutputbuffer(Meier,Lo&Kiran,2015)
PHONOLOGICALTASKSSyllableJudgment
TwosyllablesYesNo
RhymeJudgment
‘Murky’YesNo
PhonemeVerificaAon
Phoneme/g/YesNo
SEMANTICTASKSCategorySuperordinate
FruitYesNo
CategoryCoordinate
YesNo
Seman5cFeature
CanFlyYesNo
Methods
Beforeandatertreatment
• Baferyofstandardizedtests
• Setof9site-specificbehavioraltasks
• 180-itemnamingscreener(3x)
• 1assessedcategory
• 2trainedcategories
1. RevisedWesternAphasiaBafery(WAB-R)2. Cogni/veLinguis/cQuickTest(CLQT)3. BostonNamingTest(BNT)4. Pyramids&PalmTrees(PAPT)5. PALPA1NonwordMinimalPairDiscrimina/on6. PALPA51WordSeman/cAssocia/on7. NorthwesternNamingBaferyConfronta/onNaming(NNB-CN)8. NorthwesternNamingBaferyAuditoryComprehension(NNB-AC)9. CinderellaStory10. PALPA35SpeechSoundRegularityandReading11. PALPA40ImageabilityandFrequencyinSpelling12. NorthwesternAssessmentofVerbsandSentencesSentence
Produc/onPrimingTest(NAVS-SPPT)13. NorthwesternAssessmentofVerbsandSentencesSentence
ComprehensionTest(NAVS-SCT)14. GeometricControlTask-Matching15. GeometricControlTask-FormInclusion16. CorsiBlockTappingTest17. SerialResponseTimeTask(SRTT)18. WechslerDigitSpanSubtest19. TheDoorsandPeopleTest
Results–RQ1:ArePWAbejeratnamingtheirtraineditemsayertreatment?
Time*TrainingInterac.onF(4,1223)=25.28,p<.001
Q1:SFA-basedtxworks!
Traineditemsimprovedatasignificantlyfasterratethanmonitoreditemsover.me.
Accuracyover/me
AtypicalTrainedItems
TypicalTrainedItems
AllMonitoredItems
Q2:Typicalityeffectholdsandresultsingeneraliza.onto
untrainedrelateditems!
Untrainedtypicalitemsimprovedata
significantlyfasterrateover.methanuntrained
atypicalitems.
Accuracyover/me
UntrainedTypicalItems
UntrainedAtypicalItems
Time*typicalityinterac.onF(1,580)=7.49,p=.006
Results–RQ2:ArePWAbejeratnaminguntrainedtypicalitemsthanuntrainedatypicalitems?
Results-RQ3:DoPWAshowimprovedseman.candphonologicalprocessingskills?(ACCURACY)
Q3:Furtherevidenceofgeneraliza.on.PWAs’accuracyimprovedsignificantlyonsyllablejudgmenttasksayertreatment
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
SCV SFV CCJ SJNN SJNP PVNN PVNP RJNN RJNP
AverageAccuracybyTask(%)(n=17)
Pre
Post
*
*
WilcoxonSignedRankTest->SJNN:V=20.5,p=.0477SJNP:V=24,p=.043
SCV=SuperordinateCategoryVerifica.onCCJ=CategoryCoordinateJudgmentSFV=Seman.cFeatureVerifica.on
SJ=SyllableJudgmentPV=PhonemeVerifica.onRJ=RhymeJudgment
NN=NoNameNP=NameProvided
KEY:
0
2000
4000
6000
8000
SCV SFV CCJ SJNN SJNP PVNN PVNP RJNN RJNP
AverageResponseTimebyTask(ms)(n=17)
Pre
Post
*
Q3:PWAweresignificantlyfasteronaseman.cfeaturetaskayertreatment
Results-RQ3:DoPWAshowimprovedseman.candphonologicalprocessingskills?(REACTIONTIME)
WilcoxonSignedRankTest->SFV:V=110,p=.029
SCV=SuperordinateCategoryVerifica.onCCJ=CategoryCoordinateJudgmentSFV=Seman.cFeatureVerifica.on
SJ=SyllableJudgmentPV=PhonemeVerifica.onRJ=RhymeJudgment
NN=NoNameNP=NameProvided
KEY:
Q4:Moreevidenceofgeneraliza.on.PWAimprovedsignificantlyontheWABandBNTayerseman.cfeature-basedanalysistreatment.
WilcoxonSignedRankTest->WAB-LQ:V=27,p=.007WAB-CQ:V=28,p=.007WAB-AQ:V=24,p=.005BNT:V=32.5,p=.013
Results-RQ4:DoPWAdemonstrategainsingloballanguageskillsayerSFA-basedtreatment?
0
20
40
60
80
100
WABLQ WABCQWABAQ CLQT BNT PAPT PALPA1PALPA51NNBCN
AccuracyonStandardizedOutcomeMeasures(n=19)
Pre
Post
*
*
*
*
SummaryofResults
1
DoPWAnamemoreitemsintheirtrainedcategoriesaccuratelyaterSFA-basedtreatment?
2DoPWAdemonstratethetypicalityeffectaterSFA-basedtreatment?
3
DoPWAshowbeferseman/candphonologicalskillsaterSFA-basedtreatment?
4
DoPWAdemonstrategainsingloballanguageskillsaterSFA-basedtreatment?
GENERALIZATION
GENERALIZATION
GENERALIZATION
PWAsignificantlyimprovedintheiraccuracyonbothsyllablejudgmenttasks PWAweresignificantlyfasteronaseman/cfeatureverifica/ontask.
Untrainedtypicalitemsimprovedatasignificantlygreaterratethanuntrainedatypicalitemsover/me.
Traineditemsimprovedatasignificantlygreaterratethanmonitoreditemsover/me.
TREATMENTEFFECTS
PWAsignificantlyimprovedintheiraccuracyontheWABandBNTatertherapy.
DiscussionAccuracyover/me
AtypicalTrainedItems
TypicalTrainedItems
AllMonitoredItems
Accuracyover/me
UntrainedTypicalItems
UntrainedAtypicalItems
Traineditems>MonitoredItems UntrainedTypical>UntrainedAtypical
Mechanismsforgeneraliza.on=efficienttherapy
COMPLEXTARGETS
SIMPLETARGETS
(Thompsonet.al,2003)
• SupportsthetypicalityeffectandCATEhypothesis• Mechanismforgeneraliza.on• Efficienttherapytomaximizegains
WHY?
DiscussionWhy?• Bejerlexicalaccess• Lessprocessingstepsthanother
phonologicaltasks• Strongerconnec.onsbetween
seman.csandphonology(Howard,2006)
Notsurprising…• Primaryfocusoftreatment• Rehearsedthisskillduringweekly
sessions
Significantlymoreaccuratepost-treatment
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
SJNN SJNP
SyllableJudgmentAccuracy(%)
Pre
Post10% 10%
Significantlyfasterpost-treatment
010002000300040005000600070008000
Pre Post
Seman5cFeatureVerifica5onResponseTime(ms)
Pre
Post
*
575ms
Discussion
0.0020.0040.0060.0080.00100.00
WABLQ WABCQ WABAQ BNT
AccuracyonWAB&BNT
Pre
Post
Significantlymoreaccurateonstandardizedtestspost-treatment
Whydidweseethistransfer?
Whynotothermeasures?
• GainsmadeonPALPAs&NNB–notsignificant
• Ceilingeffects–highonPAPTatbaseline
ATYPICALITEMS
TYPICALITEMS
TYPICALITEMS ATYPICALITEMS
• Capitalizedonfactorsoftypicalityandcomplexity
• Bidirec.onalmovementbetweenseman.cs&phonology
• Auditory&readingcomprehensioncomponents
• PersonswithchronicaphasiacanimprovetheirnamingskillsfromSFA-basedtreatment
• Trainingatypicalexemplars->typicalexemplarswithoutdirecttraining!
• Somegeneraliza.ontophonologicalprocessingandstandardizedtests
• Efficienttreatmentapproach• Futureresearch:assessforpajernsbasedonaphasiatype,severity&lociofunderlyingdeficit
Conclusions
Acknowledgments: ThisworkwasmadepossiblebytheNa.onalIns.tutesofHealth/Na.onalIns.tuteonDeafnessandOtherCommunica.onDisordersthroughgrantNIH/NIDCD1P50DC012283.Itispartofalargermul.-siteprojectconductedthroughtheCenterfortheNeurobiologyofLanguageRecovery(hjp://cnlr.northwestern.edu/,PI:CynthiaThompson). Iwanttoextendmygra.tudetoalloftheindividualswithaphasiawhopar.cipateinourstudiesandallofthehard-workingmembersoftheBUAphasiaResearchLaboratorywhomakethisworkpossibleespeciallymymentor,Dr.SwathiKiranandmycollaboratorsonthisproject,ErinMeier,StefanoCardullo,JeffreyJohnsonandourlabmanager,CarrieDesRoches.
THANKYOUforyourafen/on!