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Language-oriented treatment: A psycholinguistic approach to aphasia

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... Two other categories were used as treatment probes (before and after treatment) and generalization probes. To maximize support in a structured way using phonological and semantic stimulation, training utilized a response-contingent hierarchy (Bandur & Shewan, 2001). The clinician presented a picture and guided the participant through a semantic and phonological cueing hierarchy (starting with the least effective and moving to the most effective). ...
... The clinician's response to the participant's naming failure is important because it could affect the outcome. This is because it provides information about the response so that the patient can better understand the information and can learn to self-evaluate (Bandur & Shewan, 2001). ...
... It has been suggested that providing feedback is an important part of the learning process (Bandur & Shewan, 2001). Repetition has been used as a training task, and found to be effective in obtaining a treatment effect (Fuller et al., 2001;Mayer et al., 2004;Patterson et al., 1983;Pring et al., 1993;Rothi et al., 2005). ...
... However, despite an increased communicative load, some researchers suggest that the flexibility involved in producing discourse may provide an advantage to people with aphasia in lexical retrieval measures of discourse relative to constrained tasks, such as confrontation naming and picture-based sentence production (e.g., Edmonds et al., 2014Edmonds et al., , 2015Faroqi-Shah, 2012;Ingles et al., 1996) because there are generally numerous ways to express a given idea, story, instruction or opinion (e.g., Armstrong, 2000;Bandur & Shewan, 2008). Due to individual differences among people with aphasia, together with specific language impairments that they demonstrate relative to their type of aphasia, some participants may benefit from this flexibility when producing discourse while others may benefit from tasks involving more constraint (e.g., Edmonds et al., 2014). ...
Article
Background Chronic severe Wernicke’s aphasia has a poor prognosis and is challenging to treat. Furthermore, even when there is potential for improvement, formal assessments using accuracy scores only to measure changes in language abilities after treatment may not be sensitive enough to capture improvements. Less-constrained language tasks, such as discourse analysis, may be more sensitive to measuring change than more standard constrained tasks, such as confrontation naming and picture-based sentence construction. Aims In this study, we asked whether it is possible to rehabilitate language abilities in a participant with severe Wernicke’s aphasia using a verb-based sentence-level treatment (Verb Network Strengthening Treatment – VNeST) that has been successful for moderate Wernicke’s aphasia, as well as other types of moderate to severe aphasia. Furthermore, we investigated whether using less-constrained language tasks would be more, less or equally sensitive to measuring any treatment effects than more-constrained language tasks. Methods and procedures In this case study, we compared post-treatment language abilities to pre-treatment language abilities by analysing comprehension and production at the word, sentence and discourse levels, using both quantitative analyses (e.g., accuracy scores) and qualitative analyses (e.g., error analyses). Outcomes and results We found that discourse analysis was sensitive enough to identify improvements in quality of production concomitant with an overall reduction of output. Furthermore, in certain more-constrained tasks, a reduction in the production of neologistic jargon was observed, as well as stable comprehension requiring less repetition of stimuli, indicating improvement that was not captured by accuracy scores. Conclusions People with chronic severe Wernicke’s aphasia may improve after treatment but formal assessments are not always sensitive enough to identify these improvements. Speech-language therapists are encouraged to include discourse analysis in their assessments as well as the analysis of more formal assessments qualitatively as well as quantitatively.
... It is generally assumed that people with aphasia are able to process and comprehend pictures. This is evident in the use of pictures in aphasia assessments to elicit verbal responses, such as in the Western Aphasia Battery-Revised (WAB-R) (Kertesz, 2007), Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983), the Aphasia Diagnostic Profile (Helm-Estabrooks, 1992), and in aphasia therapy (i.e., word or sentence to picture matching, eliciting a narrative discourse) (Bandur & Shewan, 2008;Nicholas & Brookshire, 1995). The ability to comprehend pictorial material is an important faculty that allows us to easily move about within our environmental niches. ...
Article
Full-text available
Some research suggests that people with aphasia may have deficits in processing pictorial materials; other studies suggest this is contradictory. Moreover, it is not known how these potential deficits compare to deficits in graphemic processing. The purpose of this study was to examine pictorial processing in individuals with fluent aphasia, and how it compares to their graphemic processing. Three people with fluent aphasia were administered three computer based expectation tasks. Participants were required to determine if the final stimulus in a sequence of four was congruent or incongruent with the preceding three stimuli. Two tasks were administered, one using simple object pictures, and the other using pictorial action scenes. A corresponding graphemic condition was also administered that was composed of category words. The dependant variables analyzed were percent correct and reaction time. Overall, the participants performed more accurately on both pictorial conditions as compared to the graphemic condition. Contrasting reaction time and accuracy patterns are noted for each type of fluent aphasia represented in the study. It is necessary to investigate the pictographic competency of each individual with aphasia to determine relative strengths and weaknesses. It appears that in some people with aphasia, language is not the only modality to suffer damage following a stroke. Investigation of therapeutic uses for pictographs and other nonverbal materials may provide an opportunity to reduce frustration associated with other modalities such as reading, writing, and verbal comprehension in people with fluent aphasia.
... In treatment of aphasic naming disorders, stimulation of word access by use of increasing cues (INC) is well known and effective (e.g., Shewan, & Bandur, 1994). An alternative is offered by the method of vanishing cues (VAN) which is an effective means of teaching new knowledge to amnesic patients (see Riley, & Heaton, 2000). ...
Article
The study for the first time compared the well-known method of increasing cues to the method of vanishing cues (adaptive increasing-decreasing cueing) which was novel in aphasia rehabilitation (and SLT) and was based on the theoretical underpinnings by Abel (2001, Magisterarbeit). Vanishing cues feature errorless learning. The study was supported by the Helmut-Bauer Prize for Rehabilitation (German Society of Neurology).
... The application of cueing hierarchies is a well-established approach in the treatment of naming disorders (for overviews, see Nickels, 2002; Raymer & Gonzalez Rothi, 2003; Shewan & Bandur, 1994; Whitworth et al., 2005). Cues are priming techniques that entail semantic, phonological, and/or syntactic information about the target word. ...
Article
Background: The two versions of the connectionist model of Dell and colleagues offer alternative explanations of aphasic naming disorders (Dell, Schwartz, Martin, Saffran, & Gagnon, 1997 Dell, G. S., Schwartz, M. F., Martin, N., Saffran, E. M. and Gagnon, D. A. 1997. Lexical access in aphasic and nonaphasic speakers.. Psychological Review, 104: 801–838. [CrossRef], [PubMed], [Web of Science ®] [Google Scholar]; Foygel & Dell, 2000 Foygel, D. and Dell, G. S. 2000. Models of impaired lexical access in speech production.. Journal of Memory and Language, 43: 182–216. [CrossRef], [Web of Science ®], [CSA] [Google Scholar]). The semantic‐phonological (SP) model hypothesises impairments in lexical‐semantic or lexical‐phonological connections, and the weight‐decay (WD) model assumes global impairments in either connection weights or activation decay. In each version, a patient's error pattern in picture naming is simulated to assess the underlying disorder (connectionist “diagnosis”). A systematic comparison of both model versions in model‐oriented naming therapy has not yet been performed. Moreover, if the normalisation of the error pattern during recovery is lesion‐specific, as suggested in the SP model (Schwartz, Dell, Martin, Gahl, & Sobel, 2006 Schwartz, M. F., Dell, G. S., Martin, N., Gahl, S. and Sobel, P. 2006. A case‐series test of the interactive two‐step model of lexical access: Evidence from picture naming.. Journal of Memory and Language, 54: 223–264. [Google Scholar]), this should be observable in the patient data. Aims: Predictions were made and tested regarding the relation between (1) connectionist diagnosis and therapy outcome, and (2) connectionist diagnosis and error pattern development. For example, patients with phonological disorders in the SP model should (1) benefit more from phonological as compared to semantic therapy, and (2) present a decrease of nonwords in their naming responses. Methods & Procedures: The connectionist diagnosis and a 4‐week therapy with cueing hierarchies (Howard, 2000 Howard, D. 2000. “Cognitive neuropsychology and aphasia therapy: The case of word retrieval.”. In Acquired neurogenic communication disorders: A clinical perspective, Edited by: Papathanasiou, I. London: Whurr. [Google Scholar]; Wambaugh et al., 2001 Wambaugh, J. L., Linebaugh, C. W., Doyle, P. J., Martinez, A. L., Kalinyak‐Fliszar, M. and Spencer, K. A. 2001. Effects of two cueing treatments on lexical retrieval in aphasic speakers with different levels of deficit.. Aphasiology, 15: 933–950. [Taylor & Francis Online], [Web of Science ®], [CSA] [Google Scholar]) were administered to 10 German‐speaking aphasic patients with naming disorders. Six patients, who had been diagnosed by the SP model, received semantic and phonological therapy. The other four patients, diagnosed by the WD model, received increasing and vanishing therapy (Abel, Schultz, Radermacher, Willmes, & Huber, 2005 Abel, S., Schultz, A., Radermacher, I., Willmes, K. and Huber, W. 2005. Decreasing and increasing cues in naming therapy.. Aphasiology, 19: 831–848. [Taylor & Francis Online], [Web of Science ®] [Google Scholar]). Outcomes & Results: Cueing therapy was generally effective for 9 of 10 patients. The trend of improvement was always found in the direction predicted by the connectionist diagnosis, except for two patients diagnosed by the SP model who presented a numerical trend in the opposite direction. Nevertheless, the SP model offered a more plausible explanation of lesion‐specific therapy outcomes, and it properly predicted the error pattern development. Moreover, the errorless learning procedure applied in vanishing therapy was favourable for patients with phonological (SP model) or weight (WD model) lesions, and this may be attributed to their characteristic error types and an impairment of editorial processes. Conclusions: Models can be informative about the effectiveness of potential therapies and error pattern developments. Data from therapy studies can test competing models.
... Based on group study results, cueing techniques can be ordered hierarchically according to their postulated effectiveness in assisting immediate lexical access (e.g., Danz & Lauer, 1997; Shewan & Bandur, 1994). In therapeutic applications, cueing hierarchies are frequently used in phonological word form facilitation, while semantic cueing hierarchies are rarely reported (e.g., Abel, 2001; Greenwald, Raymer, Richardson, & Rothi, 1995; Wambaugh, 2003; Wambaugh et al., 2001). ...
Article
Background: Applying a hierarchy of cues is a well-established method in therapy for aphasic naming disorders (see overview in Nickels, 2002b; and Hillis & Caramazza, 1994; Wambaugh, 2003). Usually, cues are used in the increasing direction. Giving assistance as sparsely as possible, the naming of an individual item remains effortful which enhances the chance to recall it later on. But the high opportunity to make errors may be disadvantageous. As an alternative, the method of vanishing cues (see Glisky, 1992), which was designed for treatment of memory disorders, provides as much assistance as needed, thereby helping patients to avoid errors (see Riley & Heaton, 2000). Therefore, this method complies with “errorless learning” (see Baddeley & Wilson, 1994). It is favoured when amnesic patients have to learn new information. In aphasia therapy, the errorless learning procedure may be interesting for patients with severe naming disorders because it prevents them from producing frequent errors. Aims : The purpose of this study was to compare the effectiveness of increasing and vanishing cues for aphasic patients with naming disorders in a 4-week therapy programme. As patients may differ in the underlying mechanism of impairment, we expected a different therapy effect among and within patients. Furthermore, the importance of errorless learning should increase with severity of impairment because of error opportunity. Methods & Procedures : A total of 100 line drawings were selected and split into four sets of 25 items each. The sets were assigned to four conditions: control (no training), vanishing cue, increasing cue, and both-cue condition (training with both methods). Then 20 therapy sessions were ordered according to the alternating treatments design. During treatment, the patient's attempts to name a picture were assisted by a hierarchy of oral cues given by the therapist. Treatment methods differed in order of application but not in the type of cues used. Outcomes & Results : Cueing therapy in general was effective for 8 of 10 patients. Those patients with moderate naming disorders profited less than those with severe naming disorders. Both methods differed among and within patients. However, in contrast to our prediction, we found no patient who improved only under vanishing cues but several who showed positive effects with increasing cues alone or with both, increasing and vanishing cues. Conclusions : Unlike patients with amnesia, patients with aphasia do not seem to be troubled by their errors and may not require the vanishing cue method.
Thesis
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The thesis presents an aphasiological single case study. The person with aphasia received model-based lexical therapy with increasing cueing hierarchies based on the connectionist model of Gary Dell and colleagues. For the first time, the method of decreasing/vanishing cues - originally established in the learning/memory domain - was introduced to the SLT research area and its significance highlighted (p. 70), and the advantage of the Dell model for therapy planning was empirically examined. The thesis introduces and reviews diagnosis and therapy in cognitive neuropsychology, model-based naming disorders in aphasia, the variety of cueing techniques, the diagnosis in the connectionist Dell model and the analysis of error types. The empirical part of the thesis investigates error types in the course of therapy and the effect of semantic versus phonological cueing-therapy. Due to copyright, figures are not included (they were regularly added as hard-copies those days anyway :-)) and formatting/editing is optimised/adapted.
Article
Background: Linguistic discourse analysis is an assessment method widely applied within aphasia research literature to examine impairments as they affect the language of daily function—discourse. Although this literature suggests that clinical applications do occur, it also identifies barriers that may inhibit the translation of research to practice. Aims: This study aimed to identify the frequency of use and methods of linguistic discourse analysis application by speech pathologists when assessing their clients with aphasia. Methods & Procedures: A survey was distributed electronically to speech pathologists in five English-speaking countries using the online survey management tool Survey Monkey®. Clinical applications of linguistic discourse analysis were examined using descriptive statistics and cross-tabulation analyses. Outcomes & Results: Of 123 valid survey results, 106 clinicians reported use of linguistic discourse analysis to assess language in aphasia. Respondents collected language elicited in conversational contexts and expositional discourse samples most often, and subjected these samples to a range of linguistic measures. Most clinicians applied a judgement-based method of analysis based on clinical observation. Clinicians reported positive attitudes towards the use of linguistic discourse analysis, but were limited from widespread use by barriers such as a lack of available clinical time. Conclusions: Results revealed that speech pathologists defined and therefore implemented linguistic discourse analysis in a variety of ways. The methods used to elicit, prepare and analyse discourse varied among respondents. Further investigation is warranted to examine the effectiveness of clinical discourse analysis applications and to support the translation of evidence-based research methods to clinical practice.
Article
Background: Semantic priming in individuals with anomic aphasia has never been the primary focus of an investigation. To date, one study investigated the effects of semantic priming in individuals with fluent aphasia (including anomic aphasia), revealing an inconsistency in semantic priming in the anomic group. Parallels from Broca’s aphasia and Wernicke’s aphasia literature may be drawn. However, due to the heterogeneity of anomic aphasia, a focused investigation was necessary. Aims: Semantic priming effects were investigated using a cross-modal pairwise paradigm. It was hypothesised that participants with anomic aphasia would demonstrate priming patterns at a stimulus onset asynchrony (SOA) of 500 msec with slower overall reaction times (RTs) than the control participants. It was further hypothesised that the participants with anomic aphasia might show less inhibition effects than the control participants. Methods & Procedures: Participants with anomic aphasia (n = 11) and healthy control participants (n = 16) completed a lexical decision task where prime-target pairs were present in equal proportions (related, unrelated and nonwords). A neutral prime condition was also incorporated. Using a cross-modal pairwise paradigm, participants heard a spoken word then 500 msec later, a written word appeared on screen (for 4000 msec). Participants were required to make a decision as to whether the written word was real and RTs were recorded. Outcomes & Results: Linear mixed model analysis was undertaken and revealed no significant two-way interaction effect, indicating both groups showed priming patterns. A main effect of group, was evident, showing faster RTs by the control participant group, confirming our hypothesis that people with anomic aphasia primed at an SOA of 500 msec in a similar manner to the control participants, with slower RTs. Conclusions: Semantic priming effects were present in anomic aphasia at relatively short SOAs and may be contributed to by automatic processes. Several parameters are proposed that should be adopted for further investigation into semantic priming in anomic aphasia including electrophysiological measures and manipulation of SOAs and relatedness proportions (RPs) to more precisely measure the effects of controlled vs. automatic processes. Such investigation has the potential to inform new assessment and management techniques.
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