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Effects of video modelling on emerging speech in an adult with traumatic brain injury: Preliminary findings

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Primary objective: Research has shown that traumatic brain injury (TBI) can affect a person's ability to perform previously learned skills. Dysexecutive syndrome and inattention, for example, alongside a number of other cognitive and behavioural impairments such as memory loss and lack of motivation, significantly affect day-to-day functioning following TBI. This study examined the efficacy of video modelling in emerging speech in an adult male with TBI caused by an assault. Research design: In an effort to identify functional relations between this novice intervention and the target behaviour, experimental control was achieved by using within-system research methodology, overcoming difficulties of forming groups for such an highly non-homogeneous population. Methods and procedures: Across a number of conditions, the participant watched a videotape in which another adult modelled a selection of 19 spoken words. When this modelled behaviour was performed in vivo, then generalization across 76 other words in the absence of a videotape took place. Main outcomes and results: It was revealed that video modelling can promote the performance of previously learned behaviours related to speech, but more significantly it can facilitate the generalization of this verbal behaviour across untrained words. Conclusions: Video modelling could well be added within the rehabilitation programmes for this population.
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ISSN: 0269-9052 (print), 1362-301X (electronic)
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2013 Informa UK Ltd. DOI: 10.3109/02699052.2013.809550
ORIGINAL ARTICLE
Effects of video modelling on emerging speech in an adult with
traumatic brain injury: Preliminary findings
Christos K. Nikopoulos
1
, Panagiota Nikopoulou-Smyrni
1
, & Kostas Konstantopoulos
2
1
School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex, UK,
2
School of Humanities and Social Sciences, European
University Cyprus, Cyprus
Abstract
Primary objective: Research has shown that traumatic brain injury (TBI) can affect a person’s
ability to perform previously learned skills. Dysexecutive syndrome and inattention, for
example, alongside a number of other cognitive and behavioural impairments such as memory
loss and lack of motivation, significantly affect day-to-day functioning following TBI. This study
examined the efficacy of video modelling in emerging speech in an adult male with TBI caused
by an assault.
Research design: In an effort to identify functional relations between this novice intervention
and the target behaviour, experimental control was achieved by using within-system research
methodology, overcoming difficulties of forming groups for such an highly non-homogeneous
population.
Methods and procedures: Across a number of conditions, the participant watched a videotape in
which another adult modelled a selection of 19 spoken words. When this modelled behaviour
was performed in vivo, then generalization across 76 other words in the absence of a videotape
took place.
Main outcomes and results: It was revealed that video modelling can promote the performance
of previously learned behaviours related to speech, but more significantly it can facilitate the
generalization of this verbal behaviour across untrained words.
Conclusions: Video modelling could well be added within the rehabilitation programmes for this
population.
Keywords
Speech, traumatic brain injury, video
modelling
History
Received 28 March 2012
Revised 19 February 2013
Accepted 7 May 2013
Published online 2 August 2013
Introduction
Traumatic brain injury (TBI) is considered the leading cause
of death and disability in people under 40 years of age
worldwide [1, 2], severely disabling 150–200 people per
million annually [3, 4]. In the US, the number of people with
TBI-related disability has been estimated at 5.3 million,
with 1.4 million new cases each year [5] and, thus, TBI is
regarded as one of the most common causes of disability and
even death among adults [6]. The prevalence of TBI in
Europe is 6.2 million, whilst 200–300 per 100 000 of the
population in the UK have a significant disability as a result
of head injury [7, 8]. The major causes of TBI are linked with
motor vehicle accidents, falls, sports injuries, violent crimes
and child abuse across the lifespan [9, 10].
Individuals with TBI present with impairments ranging
from mild-to-severe that can affect a variety of domains
including cognition, sensory-motor, adaptive behaviours,
social skills and communication [11]. Communication
deficits, in particular, result in difficulties in the production
and comprehension of spoken and written language [12] and
may include aphasia (or dysphasia), apraxia, anomia, dys-
arthria or deficits in the social use of language (pragmatics)
[13, 14]. Further, executive functions, attention and memory
are frequently affected [15, 16]. In fact, memory and
especially working memory is considered as one of the
most impaired of cognitive skills [17–19] and has a direct
impact on the well-being, quality-of-life and emotional
stability of patients [20, 21] leading to limitation of their
independence [22]. In addition to information processing
speed, language also requires some degree of working
memory and, hence, the latter two are closely inter-related
[23]. For example, individuals with TBI perform particularly
poorly in language comprehension tasks which typically place
high working memory demands [24].
Communication interventions for individuals with TBI can
be classified into two main categories; pharmacological and
non-pharmacological. Non-pharmacological treatments con-
sist of behavioural or psychological interventions [14], whilst
speech-language therapy (SLT) is regarded as the core
behavioural approach provided by speech-language patholo-
gists (SLPs) [25]. Although there is currently no consistent
Correspondence: Christos K. Nikopoulos, PhD, School of Health
Sciences & Social Care, Mary Seacole Building, Brunel University,
Uxbridge, Middlesex UB8 3PH, UK. Tel: 01895 268811. E-mail:
christos.nikopoulos@brunel.ac.uk
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evidence indicating an advantage of one speech-language
intervention over another, the majority of them are based on
extensive practice and repetition exercises [26]. There are also
a number of different approaches targeting at specific
individualized needs of people with TBI such as the
metacognitive strategy instruction (MSI) for difficulties
related to problem-solving, planning and organization [27],
the application of support-oriented intervention that combines
behavioural, cognitive and executive function components for
dealing with behaviour disorders in people with TBI [28] or
the use of a self-coaching approach to social communication
after TBI [29] to name a few. SLT, however, may be impeded
by behavioural excesses like physical and verbal aggression,
difficulty concentrating or attending and other neurobeha-
viours such as depression, amnesia, anosognosia, compre-
hension failure or dysfunction in executive functions;
planning, abstract thinking, flexibility and behavioural control
[30–32]. A common consequence is the presence of non-
compliance with the suggestions of the therapist or reduction
in motivation that can challenge and prolong the rehabilitation
process [33].
Technological advances have dynamically entered in the
rehabilitation programmes for people with TBI, mainly as
electronic assistive devices for facilitation and increase of
their independence (e.g. expert systems, NeuroPage, compu-
ter-based activities/programmes, virtual reality) [34–43].
Another significant example should be the application of
telecommunications technology—telepractice—to deliver
SLT services at a distance, using a real-time audio and
visual connection between a client (or group of clients) and a
clinician [44]. A few studies have examined the effectiveness
of this method of delivering SLT services in individuals with
brain injury or speech difficulties with promising results [45–
47]. Interestingly enough, a recent study by Schoenberg et al.
[48] showed that a computer-based teletherapy cognitive
rehabilitation programme for adults with TBI produced not
only similar functional outcomes as face-to-face SLT but also
at a similar total cost. Nevertheless, video technology as a
therapeutic device has rarely been investigated for training
patients to perform previously learned skills. In fact, there has
been only one study by McGraw-Hunter et al. [49] in which
the effectiveness of video technology in a form of self-
modelling to teach individuals with TBI cooking skills was
examined. In that study, a multi-component treatment package
that, apart from self-modelled videos, also included system-
atic provision of feedback (graduated prompting system,
praise and corrective feedback), was shown to be an effective
instructional technique for three out of the four participants.
Videos for self-modelling can be accomplished by taping
the individual’s behaviour over time and editing the tape so
that only examples of appropriate target behaviours are on the
final tape [50]. This can become a long and even complicated
process for some individuals with TBI who may experience
difficulties with attention, motivation, remaining on task and,
especially, when they present non-compliance or physical and
verbal aggression. An alternative would be the use of video
modelling in which another person acts as a model [51, 52].
Video modelling has been widely used to teach people with
disabilities a variety of skills in a variety of different forms,
uses, and contexts, in combination with and without other
behavioural procedures [53–57]. Accordingly, the present
study was designed to: (i) provide preliminary data about the
effectiveness of video modelling in promoting the perform-
ance of previously learned verbal behaviours of a person with
TBI, and (ii) examine whether generalization across stimuli
and maintenance of any behaviour changes remained after
1- and 2-week follow-up periods.
Method
Participant
John (pseudonym), a 34-year-old right-handed man with a
multiple diagnosis of brain injury, bacterial encephalitis,
abdominal injuries and right hemiplegia caused by an assault,
participated in the study. At a functioning level, he presented
dyspraxia affecting his ability to perform activities of daily
living as well as short-term memory impairments. From the
language perspective, he had mainly features of Broca’s
dysphasia [58]. Thus, John did not have any obvious difficulty
in understanding spoken language, as evidenced by his ability
to follow instructions and make efforts to communicate, but
major difficulties in expressing language (non-fluent speech
output) as a result of damage to parts in the lower area of the
premotor cortex of his brain. His performance across all
spoken language tasks suggested an impairment involving
phonological representations. That is, in tasks requiring
spoken output, the vast majority of errors were phonologically
related to their targets. In more details, verbal comprehension
was considerably less impaired than production, as indicated
by his tendency to read or even to follow written instructions.
John manifested very marked difficulties in the repetition of
words, non-words and sentences. His repetition impairment
was further influenced by word frequency and also by word
length. Reading performance was relatively preserved com-
pared to repetition; however, some elements of surface
dyslexia were observed. At the time of the study, he had
been receiving a standard rehabilitation programme as an in-
patient for 4 months. Individual SLT was provided to
address communication deficits related to dysphasia and to
maximize functional abilities to increase independence and
participation in the home and community activities. However,
he rarely attended his therapeutic sessions during the last
month, showing severe signs of loss of motivation and high
rates of non-compliance with all therapists.
Setting
This study was conducted in a rehabilitation centre in the
participant’s bedroom. A 17-inch television and a chair placed
2 metres away from it were mainly used.
Stimulus materials
Videotape
An unfamiliar adult was used as the model for the construc-
tion of a videotape, 2 minutes long. In the video, the model
was shown saying the training words (i.e. ‘days and
‘months’) at a normal pace. The video presentation avoided
any exaggeration in the lip movements of the model; however,
only the face of the model was shown.
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Papers
All words, those used for training and for generalization, were
printed on papers (size: 297 210 mm), using large fonts (i.e.
48pt). The training words were selected in agreement with the
participant and comprised of the 7 days of the week and the 12
months of the year. Fifty-seven other words which started with
the same syllable as the training ones (i.e. three different words
for each day/month) were used as the generalization words. For
example, the three words corresponding to ‘Monday’ were
‘Monkey’, ‘Money’ and ‘Monk’, to ‘Thursday’ were ‘Thirty’,
‘Theft and ‘Thirsty’, to ‘March’ were ‘Mark’, ‘Marvel’ and
‘Mars, etc.
Response measurement and inter-observer
agreement
A correct response was defined as emission of the target
vocalization within 5 seconds following the respective verbal
stimulus and, on some occasions, prompt (i.e. a written word)
[59]. Paper-and-pencil data were recorded for each trial by the
experimenter and a second observer. These observers scored
the participant’s verbal responses on a data sheet indicating
whether he emitted the correct response or not; hence, event
recording was used. The second observer independently
collected data during 38% of sessions to provide inter-
observer agreement. Agreement was calculated for each
session by dividing the number of agreements by the total
number of agreements and disagreements and then multiply-
ing by 100%. Mean agreement was 100% for all responses.
Experimental design
The effects of video modelling on response acquisition were
assessed using an AB design, replicated 18 times [60].
Procedure
In any of the following conditions, each session consisted of a
set of five trials with the exception of the generalization probe
sessions which each consisted of three trials. In each trial the
participant was given up to 5 seconds to repeat the word just
heard in the absence of any further instruction or assistance.
Baseline
During the baseline, the participant was requested to repeat
each word that the experimenter had previously said in a clear
voice and at a normal pace. Each word was also presented
simultaneously on the paper, written in large fonts.
Video modelling
In the video modelling condition, the participant watched a
videotape showing only the face of an unfamiliar model
saying each training word in a clear voice, but at a normal
pace. Then, the respective word appeared on the screen for 2
seconds in a similar font size as it was presented on the paper.
No particular instructions (e.g. ‘watch’ carefully the mouth or
‘look’ at the mouth of the model) or consequences were given
to the participant during any condition. However, the
participant was occasionally provided with a simplified
graph similar to Figures 2–4 below showing his progress
during a preceding session.
Generalization
When the participant reached the criterion of repeating each
respective word four out of five times correctly (80%), he was
assessed in the absence of any video, as it occurred in baseline,
during one session (5 trials). Following an absolute successful
performance (5 out of 5 correctly), generalization probes
(3 trials) using the word which would subsequently be shown in
the video took place. These probes assessed whether a video
presentation was necessary for the participant to repeat the
modelled word. When all training words were performed
successfully in vivo, then generalization across the 57 other
words was assessed. Only one session (5 trials) was conducted
for each of these words in an identical way as at baseline.
Overall, intervention (video modelling and generaliztion
probes/sessions) was implemented for 14 non-consecutive
days and for 10–15 minutes each day.
Follow-up
Follow-up measures were obtained 1 and 2 weeks after the
final measurements for the training words had been taken.
The setting and the procedures during follow-up sessions were
identical to those used during all the baseline sessions.
Results
Table I presents the overall mean percentages of the correct
responses for John across the training and generalization
words. During the baseline, John demonstrated an average of
17.9% 14.9 % (range ¼ 0–60%) correct responses for the
training words and 15.7% 15.4% (range ¼ 0–60%) for the
generalization words, respectively. Then, during the interven-
tion, video modelling was introduced for the training words
only and the mean percentage of correct responses showed an
increase of 41.6% (range ¼ 0–100%). An increase of 39.2%
(range ¼ 0–100%) was shown for the generalization words, for
which video modelling was not used. Even better results were
obtained at follow-up, where mean percentages of correct
responses for both the training and generalization words were
importantly higher than those obtained during baseline.
Examples of detailed data collected during video model-
ling procedures can be seen in Figures 1 and 2 for 2 training
days (i.e. Tuesday and Saturday) and in Figures 3 and 4 for 2
training months (i.e. January and September). Thus, during
baseline, John did not meet the criterion of repeating the word
‘Tuesday’ four out of five times correctly (i.e. 80%) in any of
the three sessions. When video modelling was introduced, his
performance improved, reaching the criterion within two
sessions (10 trials). However, in the next set of five trials (one
session), wherein video modelling was withdrawn, his
performance deteriorated and, therefore, video modelling
was introduced again. Criterion was met within the minimum
of one session but, again, this criterion failed to remain at the
Table I. Mean percentages of correct responses.
Baseline Intervention Follow-up
Training words 17.9 14.9 59.5 22.3 77.4 13.9
Generalization words 15.7 15.4 54.9 19.4 72.1 14.5
Values are mean SD.
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required level during the subsequent session when video
modelling had been removed. Video modelling was re-
introduced and once again the criterion was reached within
one session. When video presentation was removed again,
successful performance remained at the highest level of
100%; however, this responding did not generalize to a
different training word (session 11), indicating that video
modelling would have to be used for that respective word as
well. Successful responding for the training word ‘Tuesday’
was maintained at 1- and 2-weeks follow-up. Similar results
were also obtained for the training of the word ‘Saturday’
(Figure 2), where video modelling was also introduced
3-times before successful performance in the absence of it
occurred at session 13. John’s performance was similar for the
training months during intervention and at follow-up
(Figures 3 and 4); however, successful responding was
achieved within fewer sessions.
Discussion
Previous research using individuals with TBI has shown that
video technology, as part of a multi-component treatment
package, can be an effective teaching tool [49]. The results of
the current study showed that video modelling can promote
the performance of previously learned verbal behaviours in an
adult with TBI, whose spontaneous speech was non-fluent
Figure 2. Percentages of correct responses for
the training word ‘Saturday’ during all con-
ditions. GP indicates the generalization probe
sessions.
Figure 1. Percentages of correct responses for
the training word ‘Tuesday’ during all con-
ditions. GP indicates the generalization probe
sessions.
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and sparse in nature with significant word finding difficulties,
greatly reduced phrase length and a paucity of spontaneous
utterances. Most importantly, this brief intervention facilitated
the generalization across a number of untrained words. That
is, the participant became able to say a new word which
started with the same syllable with the ones that he had been
taught during the video modelling with less effort and in the
absence of any specific training. These results were main-
tained at 1- and 2-week follow-ups.
This success could be attributed to a number of possible
factors. First, the use of videos as therapeutic means can bring
the relevant situational cues closer together within a visual
frame (e.g. settings, models, stimuli, etc.), helping individuals
with cognitive impairments to follow the respective cues.
Second, it has been well reported in the literature that visual
input processing is vastly superior to auditory processing in
cases with evident cognitive impairments [51]. Reduction in
motivation has also been associated with TBI. Since patient
involvement has a positive influence on patient outcomes, this
is an important aspect that can affect different types of
rehabilitation programmes [61–63]. The participant in the
current study was not an exception; he rarely attended his
therapeutic sessions for a significant period of time. However,
his motivation levels seemed to be enhanced, as evidenced by
his participation in the video modelling intervention, possibly
because he obtained instant access to his progress rate through
the use of the simplified graphs. Finally, literature has
suggested that video modelling may generally be an effective
teaching strategy for rapidly acquiring high levels of gener-
alization and maintenance, at least for individuals with
intellectual and developmental disabilities [64–66].
Inevitably, although essential if one is to ensure that high
quality evidence-based practice is delivered to the patients,
conducting research within a real world setting with multiple
changing variables presents challenges to the researcher and
this study was not without its limitations that inform routes for
further research. For example, whilst lowered motivation
following brain injury is an important determinant for the
outcomes of the rehabilitation progress, currently, there is not
any available tool which reliably assesses motivation levels
among individuals with TBI [33]. Hence, it remains rather
unclear whether video modelling without the provision of
intermittent feedback (i.e. graphs) would have been sufficient
for producing the desirable behaviour changes.
Although single-case research designs have been suggested
as a powerful set of tools for the clinicians to evaluate their
practice and make data-driven decisions [67–69], questions
regarding sample size are often raised in relation to these
methods. The search for functional relations between depend-
ent and independent variables is advanced if experimental
control over behaviour can be demonstrated. This was
demonstrated for this participant and his individual differ-
ences were not masked by group averages. Moreover, there
are particular difficulties in applying group methodologies to
the study of behaviour change of individuals with TBI, since
they comprise a highly non-homogeneous population and,
hence, a highly individualized approach to treatment is
essential [70]. Similarly, it could be argued that the selection
of the participant and in the absence of any formal linguistic
and cognitive measurements prior to the study, invoked some
sort of bias for the success of this study. However, the
comparisons of baseline performances with experimental
conditions counter this suggestion [71]. Furthermore, these
methods can offer immediate feedback to the treatment
provider regarding treatment effectiveness based on direct and
repeated measurements of the target behaviour, which can be
shared with the service user as it occurred in the present study.
Of course, replication with additional individuals needs to be
addressed in future studies.
Future research would also examine alternative ways of
designing video modelling procedures, particularly for patients
who present difficulties to repeat lengthy words and sentences
(longer words may be more difficult) and paraphasias in their
language. Initially, video modelling could be structured to
teach the person short words with a meaning and gradually
Figure 4. Percentages of correct responses for the training word
‘September’ during all conditions. GP indicates the generalization
probe sessions.
Figure 3. Percentages of correct responses for the training word
‘January’ during all conditions. GP indicates the generalization probe
sessions.
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increasing their length. Such words might include verbs like
put, keep, eat, want or nouns like pot, bet, tap, cup, day, etc.
After the person has become able to produce such words, at a
next stage, longer words or phrases such as pottery (pot), cup of
coffee (cup), keep the money (keep), eat food (eat), tap water
(tap), I want food (want), etc., may be used. Further, the
effectiveness of video modelling would be assessed in a variety
of areas such as self-care, social, vocational and even more
complex communication skills. It could also be argued that,
although video modelling may be appropriate in some settings,
it might not be practical in community settings such as
supported employment. The use of mobile computing devices
(e.g. iPod, iPad, etc.) would facilitate the broad use of video
modelling and preliminary evidence with students with autism
has been encouraging [72]. Certainly, more research towards
that direction is needed.
In recent years and due to advances in acute care, survival
rates following severe brain injury have improved dramatic-
ally [31]. Hence, the requirements for rehabilitation of
patients after TBI who present with deficits in communication
including speech and language have increased dramatically
[73]. Video modelling could well be added within the
rehabilitation programmes for this population. The positive
effects of this intervention are usually immediate and
dramatic and, therefore, less treatment time is required. It
has also a unique advantage over other types of interventions
in that it does not require extensive staff training prior to
implementation, making it particularly cost effective.
Declaration of interest
The authors report no conflicts of interest. The authors alone
are responsible for the content and writing of the paper.
References
1. De Silva MJ, Roberts I, Perel P, Edwards P, Kenward MG,
Fernandes J, Shakur H, Patel V. Patient outcome after traumatic
brain injury in high-, middle- and low-income countries analysis of
data on 8927 patients in 46 countries. International Journal of
Epidemiology 2009;38:452–458.
2. Truelle JL, Koskinen S, Hawthorne G, Sarajuuri J, Formisano R,
Von Wild K, Neugebauer E, Wilson L, Gibbons H, Powell J, et al.
Qolibri Task Force. Quality of life after traumatic brain injury: The
clinical use of the QOLIBRI, a novel disease-specific instrument.
Brain Injury 2010;24:1272–1291.
3. Dickmen SS, Machamer JE, Powell JM, Temkin NR. Outcome 3 to
5 years after moderate to severe traumatic brain injury. Archives of
Physical Medicine & Rehabilitation 2003;84:1449–1457.
4. Fleminger S, Ponsford J. Long-term outcome after traumatic brain
injury. British Medical Journal 2005;331:1419–1420.
5. Cohen BA, Inglese M, Rusinek H, Babb JS, Grossman RI, Gonen O,
Proton MR. Spectroscopy and MRI-volumetry in mild traumatic
brain injury. American Journal of Neuroradiology 2007;28:907–913.
6. Brain Injury Association of America [Internet]. Facts about
traumatic brain injury. Brain Injury Association of America; 2011.
Available online at: http://www.biausa.org, accessed 15 July 2011.
7. Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A
systematic review of brain injury epidemiology in Europe. Acta
Neurochirurgica 2006;148:255–268.
8. Tennant A. Admission to hospital following head injury in England:
Incidence and socio-economic associations. BMC Public Health
2005;5:21.
9. Gangoiti L. Brain damage. Rehabilitation 2004;38:313–317.
10. Hellawell DJ, Taylor R, Pentland B. Cognitive and psychosocial
outcome following moderate or severe traumatic brain injury. Brain
Injury 1999;13:489–504.
11. Bernabeu M, Laxe S, Lopez R, Stucki G, Ward A, Barnes M,
Kostanjsek N, Reed G, Tate R, Whyte J, et al. Developing core sets
for persons with traumatic brain injury based on the international
classification of functioning, disability, and health.
Neurorehabilitation & Neural Repair 2009;23:464–467.
12. Angeleri R, Bosco FM, Zettin M, Sacco L, Colle L, Bara BG.
Communicative impairment in traumatic brain injury: A complete
pragmatic assessment. Brain & Language 2008;107:229–245.
13. Channon S, Watts M. Pragmatic language interpretation after
closed head injury: Relationship to executive functioning.
Cognitive Neuropsychiatry 2003;8:243–260.
14. Rispoli MJ, Machalicek W, Lang R. Communication interventions
for individuals with acquired brain injury. Developmental
Neurorehabilitation 2010;13:141–151.
15. Barca L, Cappelli FR, Amicuzi I, Apicella MG, Castelli E, Stortini
M. Modality-specific naming impairment after traumatic brain
injury (TBI). Brain Injury 2009;23:920–929.
16. Douglas JM. Relation of executive functioning to pragmatic
outcome following severe traumatic brain injury. Journal of
Speech, Language, and Hearing Research 2010;53:365–382.
17. Hoskison MM, Moore AN, Hu B, Orsi S, Kobori N, Dash PK.
Persistent working memory dysfunction following traumatic brain
injury: Evidence for a time-dependent mechanism. Neuroscience
2009;159:483–491.
18. Olsson E, Wik K, Ostling A-K, Johansson M, Andersson G.
Everyday memory self-assessed by adult patients with acquired
brain damage and their significant others. Neuropsychological
Rehabilitation 2006;16:257–271.
19. Trovato M, Slomine B, Pidcock F, Christensen J. The efficacy of
donepezil hydrochloride on memory functioning in three adolescents
with severe traumatic brain injury. Brain Injury 2006;20:339–343.
20. Teasdale TW, Engberg AW. Subjective well-being and quality of
life following traumatic brain injury in adults: A long-term
population-based follow-up. Brain Injury 2005;19:1041–1048.
21. Winkler PA. Traumatic brain injury. In: Umphred DA, editor. 6th
ed. Neurological rehabilitation. USA: Mosby; 2001. p 753–790.
22. Fleming JM, Shum D, Strong J, Lightbody S. Prospective memory
rehabilitation for adults with traumatic brain injury: A compensa-
tory training programme. Brain Injury 2005;19:1–13.
23. Bittner R, Crowe SF. The relationship between working memory,
processing speed and verbal comprehension and FAS performance
following traumatic brain injury. Brain Injury 2006;20:971–980.
24. Moran M, Gillon G. Language and memory profiles of adolescents
with traumatic brain injury. Brain Injury 2004;18:273–288.
25. Hicks EJ, Larkins BM, Purdy SC. Fatigue management by speech-
language pathologists for adults with traumatic brain injury.
International Journal of Speech-Language Pathology 2011;13:
145–155.
26. Demir SO, Altinok N, Aydin G, Koseoglu F. Functional and
cognitive progress in aphasic patients with traumatic brain injury
during post-acute phase. Brain Injury 2006;20:1383–1390.
27. Kennedy MR, Coelho C, Turkstra L, Ylvisaker M, Moore Sohlberg
M, Yorkston K, Chiou HH, Kan PF. Intervention for executive
functions after traumatic brain injury: A systematic review, meta-
analysis and clinical recommendations. Neuropsychological
Rehabilitation 2008;18:257–299.
28. Feeney T, Ylvisaker M. Context-sensitive cognitive-behavioural
supports for young children with TBI: A replication study. Brain
Injury 2006;20:629–645.
29. Ylvisaker M. Self-coaching: A context-sensitive, person-centred
approach to social communication after traumatic brain injury.
Brain Impairment 2006;7:246–258.
30. Gentry B, Smith A, Dancer J. Relation of orientation, verbal
aggression, and physical aggression to compliance in speech-
language therapy for adults with traumatic brain injury. Perceptual
and Motor Skills 2003;96:1311–1313.
31. Miotto EC, Cinalli FZ, Serrao VT, Benute GG, Lucia MC, Scaff M.
Cognitive deficits in patients with mild to moderate traumatic brain
injury. Arquivos de Neuro-psiquiatria 2010;68:862–868.
32. Godefroy O, Azouvi P, Robert P, Roussel M, LeGall D, Meulemans
T. Dysexecutive syndrome: Diagnostic criteria and validation study.
Annals of Neurology 2010;68:855–864.
33. Oddy M, Cattran C, Wood R. The development of a measure of
motivational changes following acquired brain injury. Journal of
Clinical and Experimental Neuropsychology 2008;30:568–575.
6 C. K. Nikopoulos et al. Brain Inj, Early Online: 1–7
Brain Inj Downloaded from informahealthcare.com by 178.146.43.235 on 08/05/13
For personal use only.
34. Man DWK, Tam SF, Hui-Chan CWY. Learning to live independ-
ently with expert systems in memory rehabilitation.
Neurorehabilitation 2003;18:21–29.
35. Wilson BA, Scott H, Evans J, Emslie H. Preliminary report of a
NeuroPage service within a health care system.
NeuroRehabilitation 2003;18:3–8.
36. O’Neil-Pirozzi TM, Kendrick H, Golstein R, Glenn M. Clinician
influences on use of portable electronic memory devices in traumatic
brain injury rehabilitation. Brain Injury 2004;18:179–189.
37. Rose FD, Brooks BM, Rizzo AA. Virtual reality in brain damage
rehabilitation: Review. Cyberpsychology & Behavior 2005;8:
241–262.
38. Scherer M. Assessing the benefits of using assistive technologies
and other supports for thinking, remembering and learning.
Disability and Rehabilitation 2005;27:731–739.
39. Wright P, Rogers N, Hall C, Wilson B, Evans J, Ems Lie H,
Bartram C. Comparison of pocket-computer memory aids for
people with brain injury. Brain Injury 2001;15:787–800.
40. Tam S, Man W. Evaluating computer-assisted memory retraining
programmes for people with post-head injury amnesia. Brain Injury
2004;18:461–470.
41. Montero F, Lopez-Jaquero V, Navarro E, Sanchez E. Computer-
aided relearning activity patterns for people with acquired brain
injury. Computers & Education 2011;57:1149–1159.
42. Johnson P, Thomas-Stonell N, Shein F. Development of a
computer-based program for the remediation of cognitive-commu-
nication skills in young people with head injuries. Journal of
Cognitive Rehabilitation 1994;12:10–16.
43. Chen SHA, Thomas JD, Glueckauf RL, Bracy OL. The effective-
ness of computer-assisted cognitive rehabilitation for persons with
traumatic brain injury. Brain Injury 1997;11:197–209.
44. American Speech-Language-Hearing Association (ASHA).
Professional issues in telepractice for speech-language pathologists.
Practice Policy. 2010. Available online at: http://www.asha.org/
docs/html/PI2010–00315.html#r42, accessed 15 October 2012.
45. Brennan DM, Georgeadis AC, Baron CR, Barker LM. The effect of
videoconference-based telerehabilitation on story retelling perform-
ance by brain-injured subjects and its implications for remote
speech-language therapy. Telemedicine Journal and e-Health 2004;
10:147–154.
46. Hill AJ, Theodoros DG, Russell TG, Cahill LM, Ward EC, Clark
KM. An Internet-based telerehabilitation system for the assessment
of motor speech disorders: A pilot study. American Journal of
Speech-Language Pathology 2006;15:45–56.
47. Grogan-Johnson S, Alvares R, Rowan L, Creaghead N. A pilot
study comparing the effectiveness of speech language therapy
provided by telemedicine with conventional on-site therapy. Journal
of Telemedicine and Telecare 2010;16:134–139.
48. Schoenberg MR, Ruwe WD, Dawson K, McDonald NB, Houston
B, Forducey PG. Comparison of functional outcomes and treatment
cost between a computer-based cognitive rehabilitation teletherapy
program and a face-to-face rehabilitation program. Professional
Psychology: Research and Practice 2008;39:169–175.
49. McGraw-Hunter M, Faw GD, Davis PK. The use of video self-
modelling and feedback to teach cooking skills to individuals with
traumatic brain injury: A pilot study. Brain Injury 2006;20:
1061–1068.
50. Collier-Meek MA, Fallon LM, Johnson AH, Sanetti LMH,
Delcampo MA. Constructing self-modeling videos: Procedures
and technology. Psychology in the Schools 2012;49:3–14.
51. Cream A, O’Brian S, Jones M, Block S, Harrison E, Lincoln M,
Hewat S, Packman A, Menzies R, Onslow M. Randomized
controlled trial of video self-modeling following speech restructur-
ing treatment for stuttering. Journal of Speech, Language &
Hearing Research 2010;53:887–897.
52. Martin GL, Pear J. Behavior modification: What it is and how to do
it. 9th ed. Upper Saddle River, NJ: Pearson-Prentice Hall; 2011.
53. Gul S, Vuran S. An analysis of studies conducted video modeling in
teaching social skills. Educational Sciences: Theory & Practice
2010;10:249–274.
54. Baker S, Lang R, O’Reilly M. Review of video modeling with
students with emotional and behavioral disorders. Education &
Treatment of Children 2009;32:403–420.
55. Rehfeldt R, Dahman D, Young A, Cherry H, Davis P. Teaching a
simple meal preparation skill to adults with moderate and severe
mental retardation using video modeling. Behavioral Interventions
2003;18:209–218.
56. Nikopoulos CK, Canavan C, Nikopoulou-Smyrni P. Generalized
effects of video modeling on establishing instructional stimulus
control in children with autism: Results of a preliminary study.
Journal of Positive Behavior Interventions 2009;11:198–207.
57. Mechling LC, Gast DL, Gustafson MR. Use of video modeling to
teach extinguishing of cooking related fires to individuals with
moderate intellectual disabilities. Education and Training in
Developmental Disabilities 2009;44:67–79.
58. Keller SS, Crow T, Foundas A, Amunts K, Roberts N. Brocas area:
Nomenclature, anatomy, typology and asymmetry. Brain and
Language 2009;109:29–48.
59. Sundberg ML. Verbal behavior. In: Cooper JO, Heron TE, Heward
WL, editors. Applied behavior analysis. 2nd ed. Upper Saddle
River, NJ: Merrill/Prentice Hall; 2007. p 526–547.
60. Gast DL, Hammond D. Withdrawal and reversal designs. In: Gast
DL, editor. Single subject research methodology in behavioral
sciences. New York: Routledge; 2010. p 234–275.
61. Cullen N, Chundamala J, Bayley M, Jutai J. The efficacy of
acquired brain injury rehabilitation. Brain Injury 2007;21:113–132.
62. Aadal L, Kirkevold M. A model for neurorehabilitation after severe
traumatic brain injury facilitating patient participation and learning.
Advances in Nursing Science 2011a;34:E1–E17.
63. Aadal L, Kirkevold M. Integrating situated learning theory and
neuropsychological research to facilitate patient participation and
learning in traumatic brain injury rehabilitation patients. Brain
Injury 2011b;25:717–728.
64. Bellini S, Akullian J. A meta-analysis of video modeling and video
self-modeling interventions for children and adolescents with
autism spectrum disorders. Exceptional Children 2007;73:264–287.
65. Nikopoulos CK. Use of video modeling to increase generalization
of social play by children with autism. The Journal of Speech-
Language Pathology and Applied Behavior Analysis 2007;2:
195–212.
66. Taylor BA, DeQuinzio JA. Video modeling. In: Luiselli JK, editor.
Teaching and behavior support for children and adults with autism
spectrum disorder: A practitioner’s guide. New York, NY US:
Oxford University Press; 2011. p 204–211.
67. Duff MC, Proctor A, Haley K. Mild traumatic brain injury (MTBI):
Assessment and treatment procedures used by speech-language
pathologists (SLPs). Brain Injury 2002;16:773–787.
68. Kelly F, Nikopoulos CK. Facilitating independence in personal
activities of daily living after a severe traumatic brain injury.
International Journal of Therapy and Rehabilitation 2010;17:
474–481.
69. Morgan DL, Morgan RK. Single-participant research design:
Bringing science to managed care. American Psychologist 2001;
56:119–127.
70. Wood RL, Alderman N. Applications of operant learning theory
to the management of challenging behavior after traumatic brain
injury. Journal of Head Trauma & Rehabilitation 2011;26:
202–211.
71. Cooper JO, Heron TE, Heward WL. Applied behaviour analysis.
2nd ed. Upper Saddle River, NJ: Merrill/Prentice Hall; 2007.
72. Cihak D, Fahrenkrog C, Ayres KM, Smith C. The use of video
modeling via a video iPod and a system of least prompts to improve
transitional behaviors for students with autism spectrum disorders
in the general education classroom. Journal of Positive Behavior
Interventions 2010;12:103–115.
73. National Institute for Health and Clinical Excellence (NICE). Head
injury: Triage, assessment and early management of head injury in
infants, children and adults. London: National Collaborating Centre
for Acute Care; 2007.
DOI: 10.3109/02699052.2013.809550 Video modelling 7
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... The present study revealed that the video-based approaches, as well as clinicians modeling, were effective in improving naming deficit of patients with aphasia.In this study, the positive effects of video-based modeling on naming skills of aphasic patients are consistent with other studies, which have shown the video-based modeling is effective for teaching new skills or behaviors [3-6, 8, 18-22]. Additionally, our finding shows that the video-based approaches were most effective intervention method in acquiring language disorder population that also coincides with the results of previous studies [23,24]. The possible explanation for improved naming scores could be due to selective focus on relevant stimuli and reduce distraction and increase learning [25]. ...
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Background: Aphasia is the most frequent disorder that could occur following a stroke. Aphasia has a negative impact on the patient's communication ability through language. One of the common consequences of aphasia is naming deficits that can lead to communication disorders. Therefore, the treatment of aphasia is necessary. The aim of the current study was to investigate the effect of video modeling and clinician modeling on naming skills of patients with chronic aphasia. Materials and methods: The design of this prospective single subject study was ABA that performed on four patients with chronic aphasia. participated. This study was administered during three phases including the baseline (three sessions); the intervention (nine sessions); and a follow-up phase (three sessions). The outcome measure was taken in three phases including baseline, intervention, and follow-up. For each patient, the naming score for items modeled by the clinician, the naming score for items modeled video modeling by other, the naming score for self-video modeling, and the reaction time score were recorded. Results: A total of three patients complete the study and one of them refused to continue treatment. The naming score of all modeling types increased in all patients. In the other words, the intervention helped the patients be improved in naming. Also, the results of the reaction time indicated that the video modeling, as well as clinician modeling, could decrease the response time that means the intervention could increase the speed of retrieval processes. Conclusion: In our study, all three types of modeling could improve the naming scores in patients with chronic aphasia. Additionally, the findings demonstrate that the clinician and video modeling might increase mental processing for naming verbally.
... De fato, a modelação em vídeo vem sendo utilizada com sucesso no contexto de intervenção com crianças com TEA visando aumentar interações sociais positivas entre essas crianças e seus pares típicos (Nikopoulos & Keenan, 2003;Nikopoulos & Keenan, 2004;Nikopoulos & Keenan, 2007;Nikopoulos, Nikopoulou-Smyrni, & Konstantopoulos, 2013, Wang & Parrila, 2011. ...
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The present study aims to use video modeling to teach typically developing peers in a peer-mediated intervention (PMI) as a strategy to promote social skills in children with Autism Spectrum Disorders (ASD). Video modeling is frequently implemented to promote appropriate behavior in children with ASD, but have not been used to teach typical peers in a PMI. The participants included two six years old children with ASD and six typically-developing peers. Each group of four children, which included one participant with ASD and three typically-developing children, performed activity sessions with free-play time during fifteen minutes. The target behaviors were initiating and responding to interactions. Before each intervention session, the typically-developing peers watched short videos in which actors interacted with a classmate with ASD. The intervention was evaluated in multiple baseline design across typical peers. The results showed increase in interactions initiated by typical peers and an increase tendency in responding interactions by children with ASD, but those changes were not stable through sessions. There was no increase in the responses of initiating by children with ASD, so there were no opportunities for the typical peers to respond to them. Increase in corresponded interaction, in which the initiation was followed by a response of the target children, was also found. Further, interactions that included playing with toys were observed. Those changes in interactions quality could be evidence of improvement in the inclusive setting dynamic. Moreover, higher concentration of interactions in the first minutes of the sessions, after the video presentations, was found. These results suggest that video modeling might be an effective strategy to teach typical peers in PMIs. The decrease in the frequency of interactions through the session may be due to the low frequency of responses by the children with ASD. Future studies should evaluate the use of feedback during the initial phase of the procedure as a strategy to maintain behavior of the typical peers until the responses of children with ASD are shaped and/or strengthened. © 2018 Universidad Nacional Autonoma de Mexico. All rights reserved.
... De fato, a modelação em vídeo vem sendo utilizada com sucesso no contexto de intervenção com crianças com TEA visando aumentar interações sociais positivas entre essas crianças e seus pares típicos (Nikopoulos & Keenan, 2003;Nikopoulos & Keenan, 2004;Nikopoulos & Keenan, 2007;Nikopoulos, Nikopoulou-Smyrni, & Konstantopoulos, 2013, Wang & Parrila, 2011. ...
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O presente estudo propõe a utilização da modelação em vídeo no ensino de pares típicos em uma Intervenção Mediada por Pares (IMP) como estratégia para promover habilidades sociais em crianças com Transtorno do Espectro Autista (TEA). Participaram do trabalho duas crianças de seis anos diagnosticadas com TEA e seis crianças com desenvolvimento típico. Cada grupo de quatro crianças, incluindo um participante com TEA e três pares típicos, realizou sessões de brincadeira livre durante quinze minutos. Foram contabilizadas as respostas de "iniciar" e "responder interação". Antes de cada sessão de intervenção, os pares típicos assistiram vídeos apresentando estratégias para interagir com seus colegas com TEA. A intervenção foi planejada em sistema de linha de base múltipla entre pares típicos. Os resultados demonstraram aumento no número de respostas de "iniciar interação" realizadas por pares típicos e tendência de aumento no "responder interação" das crianças com TEA. Interações envolvendo brinquedos também foram mais frequentes. Houve, entretanto, variação individual e ao longo das sessões. Além disso, verificou-se maior concentração de interações nos minutos iniciais da sessão, logo após a exibição dos vídeos. Esses resultados indicam que a modelação em vídeo pode ser uma estratégia efetiva para o ensino de pares típicos em IMPs. Palavras-chave: Transtorno do Espectro Autista, modelação em vídeo, treinamento de pares , interações sociais, intervenções socialmente mediadas.
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The video model method is an application with evidence basis, defined as watching and taking as a model the target behavior exhibited by the person on the videotape. The video model method is a teaching method that can be used in teaching many different skills to children displaying normal development and to children with developmental disabilities. This study aimed to examine and analyze studies in which the video modeling was used in teaching social skills to individuals with developmental disabilities. The present study is a qualitative document analysis. Documents (research) which were gathered according to certain criteria were analyzed by the authors. A total of 21 studies, 2 of which were conducted in Turkey, that met the criteria offset by the present study were analyzed according to the certain criteria. The reason why subjects in 3-15 years of age diagnosed with autism and Asberger's syndrome were selected in 97% of the studies and why social skills were analyzed in 81% of the studies was not explained. In addition, social validity data were collected only in 33% of all studies. This is a quite low rate for the studies focused on teaching of social skills. © 2010 Eǧitim Danişmanliǧi ve Araştirmalari İletişim Hizmetleri Tic. Ltd. Şti.
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