language and cognition colombo june 2011
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Language and CognitionColombo June 2011
Day 5Psycholinguistic Assessments of Language Processing in Aphasia
Producing Words
Acknowledgement to Jane Marshall
Overview
• This lecture aims to give you an understanding of:– A model of word retrieval– Patterns of word retrieval deficit– Methods of investigation– Therapy approaches– Therapy outcomes
Aphasic word retrieval difficulties
Target Production Classification
anchor For holding the sleep steady when its sunk in water
iron hoover
bus sarabang
dart dark
table Kurzle, kazle, tazle, tayzle, table
jacket helicopter
onion thustle
Aphasic word retrieval difficulties
Target Production Classification
anchor For holding the sleep steady when its sunk in water
circumlocution
iron hoover Semantic error
bus sarabang Mixed error
dart dark Phonological error
table Kurzle, kazle, tazle, tayzle, table
Conduite d’approche
jacket helicopter Verbal paraphasia
onion thustle neologism
Written word
Visual Analysis
VIL
Semantics
POL
Buffer
Grapheme to Phoneme
Conversion
Motor speech production
Spoken word
Auditory Analysis
AIL
Object Recognition
To name a seen object involves:
Failure in Object/Picture Recognition
Visual Agnosia‘A continuous surface infolded on itself. It appears to have .. five outpouchings’ (re glove)
Item later recognised through touch: ‘it’s a glove’
Intact Impaired
Vision Object recognition
Semantic knowledge
Language
Written word
Visual Analysis
VIL
Semantics
POL
Buffer
Grapheme to Phoneme
Conversion
speech
Spoken word
Auditory Analysis
AIL
Object Recognition
Effects of a Semantic Deficit
• Poor understanding of both written and spoken words (semantic errors in testing)
• Impaired word production, with semantic errors
• Production affected by semantic factors, like imageability
• Poor performance on non-verbal semantic tasks, like the Pyramids and Palm Trees Test
Written word
Visual Analysis
VIL
Semantics
POL
Buffer
Grapheme to Phoneme
Conversion
speech
Spoken word
Auditory Analysis
AIL
Object Recognition
Effects of Deficit at POL
• Knowledge of word meaning is retained, may circumlocute
• May produce a phonologically related word/non word
• High frequency words may be named better than low frequency words
• May produce a semantically related word, but should know that this is not the target
Loss of Entries in POL or Impaired Access?
Evidence:• Naming is often inconsistent• Cues assist naming, such as providing the first
phoneme
Argues for access problem
Phonological Assembly
Whole word phonology has to be ‘assembled’ prior to speech
Assembly failure:
- Phoneme omissions, substitutions and exchanges
- Conduite d’approche – sequence of phonological errors getting closer to the target
- Length effect (short words easier than long)
Factors Affecting Naming
• Frequency/familiarity
• Age of acquisition
• Word class (noun>verbs)
• Word category (animate > inanimate)
• Note these variables can interact e.g. Common words may be acquired early
Investigating a Word Retrieval Impairment
Questions to Ask
• Is word retrieval failing?• What is the extent of the problem?• Does it impede everyday communication?• Is it a therapy priority for the aphasic person?• Why is word retrieval failing: what is the level of
breakdown?• What helps?• Is the person using any strategies?
RS (Marshall et al 1990)J Can you tell me how far you have got with selling your
business R?R er ………… Mr N Mrs S: Your accountantR Yes … I’ve left it to himJ And how far has he got with it?R er … one chap has come up with a er …………… fee …
but there’s three more comingJ That’s quite good isn’t it? Are they offers that you can
accept?R Not reallyJ So you want slightly more?R YesJ How quickly do you want to sell it?R As soon as possible … just for me to …. Call it a day …
but it could take as long as three monthsJ What will you do with the capital?R Put it into the …… one in the …. What’s name ……
bankJ What’s happening to the staff?R er …….. (waves) goodbye … goodbye
Assessment Plan
• Aims to find out:
• The extent of R’s naming problem
• Whether he can be cued
• Where word retrieval is breaking down– Semantics– Phonology
Semantic Tests: PALPA Spoken word to picture matching
Pyramids and Palm Trees
Semantic Tests:
• Synonym Judgement (PALPA)– Shovel Spade– Shovel Tale– Menace Threat– Menace Discovery
• Judging Picture Names (Informal Task)
Is this a banana?
Is this an apple?
Results
• Pyramids and Palm Trees 3 errors
• Spoken word to picture matching 98%
• Synonym judgements (concrete) 95%
• Judging picture names 100%
Naming Test
Say the names of 30 pictures• If cannot is given phonological cue
– Target (/t/ for tiger)– Miscue (/l/ for tiger)
Results• 10 pictures named• Correct cues elicit correct names• Miscues elicit no response
Interpretation
Word retrieval is not failing at semantics:• R has good understanding of concrete words
and pictures• He can understand words that he cannot name• He cannot be miscued into making semantic
errors
Phonological Representations are retained• R responds to target phonological cues
More Evidence re Phonology
Reading aloud 100%:• Concrete words• Abstract words• Spell regular words (rabbit)• Spell irregular words (yacht)
• The phonologies of words are available and can be accessed from the written word
Written word
Visual Analysis
VIL
Semantics
POL
Buffer
Grapheme to Phoneme
Conversion
speech
Spoken word
Auditory Analysis
AIL
Object Recognition
Problem is connection between semantics and phonology:
Therapy
• Treatment needs to help RS reconnect semantic with phonological representations
• Treatment exploits two strengths: reading aloud and semantic discrimination
• 3 hours therapy using word to picture matching
Therapy Example
Radio
Television
Hi Fi
Computer
Camera
Task: Find the correct word and read it aloud
Discuss differences between target and foils
Results: % correct in picture naming
010203040
5060708090
100
treated words untreated words foils
pre
post
f up
Conclusions from RS
• Therapy improves naming of treated words
• Effects are very well maintained (still evident one year later)
• There may be some generalisation to related words that appeared in therapy as foils
GF (Robson et al 1998)
• L CVA• Jargon Speaker• Very incomprehensible speech
I was quite erm that’s why I can’t get weyerd keep ... erm makes me very um here up here makes him all /s/ all mingsing but these come and I can’t it might be because I had another setoid no sort of um I mean but when you cough you different but when you right you lie to her ...’ (replying to a question about her holiday)
Input Tests
• Pyramids and Palm Trees 4 errors• Auditory lexical decision 100%• Spoken word to picture match 98%• Spoken synonym judgements 87%
Conclusions: GF can access semantic representations of pictures and concrete words
Production
Naming pictures 1/40– Some help from phonological cues (5/15)– Not helped by semantic cues (irritated by them!)
Her comments:
‘I had it there and then it went’
• Reading aloud 10/40 (regular and irregular words equal success)
Conclusions
• Naming is not failing at the semantic level (input tests)
• Entries are retained in POL, since GF can read some words
• Words/non-words same: not reliant on GPC• The problem is mainly between semantics and
phonology
Written word
Visual Analysis
VIL
Semantics
POL
Buffer
GPC
speech
Spoken word
Auditory Analysis
AIL
Object/Picture Recog
Objects/pictures
Therapy Decisions
• Help GF access POL• Use good input skills/monitoring• Help GF use any partial phonological knowledge
about words• Aim to develop a phonological self cueing
strategy
• Tasks: making phonological judgements about target words
Therapy Example 1
i) ‘Carrot’ 1 2
ii) 1 2
Task: How many syllables (‘beats’)
Therapy Example 2
i) ‘carrot’ /k/ /m/
ii) ‘carrot’ /b//k/
iii) /k/ /m/
iv) /m/ /l/ /k/ /b/
Task: Initial phoneme judgement:
Therapy Example 3
i) Indicate number of syllables
ii) Indicate first phoneme
iii) Produce first phoneme
iv) Attempt to name picture
Results: % correct in picture naming
0
10
20
30
40
50
60
70
80
treated words phon relatedcontrols
unrelatedcontrols
pre
post
f up
Conclusions from GF
• Phonological therapy has improved naming of treated words
• Good generalisation to untreated words• Stable baseline and no change in unrelated tasks
(therefore effects can be attributed to therapy)
Why is generalisation achieved?• Self cueing strategy (but little evidence of this in testing)• Generalised recovery of access to POL
Conclusions
• Using careful assessment we can try to pin point why word retrieval is failing
• This can inform our therapy with clients• A number of studies show that therapy can
improve picture naming, with variable generalisation to untreated words
• Hickin et al (2007) suggest that therapy may also improve everyday speech, but only when effects generalise beyond treated words
References
• Hickin J, Herbert R, Best W, Howard D, and Osborne F (2007) Efficacy of treatment: effects on word retrieval and conversation. In S Byng, K Swinburn and C Pound (eds) The Aphasia Therapy File, Psychology Press.
• Marshall J, Pound C, White-Thomson M, Pring T (1990) The use of picture/word matching tasks to assist word retrieval in aphasic patients. Aphasiology 4, 167 - 184.
• Robson J, Marshall J, Pring T and Chiat S (1998) Phonological naming therapy in jargon aphasia: Positive but paradoxical effects. Journal of the International Neuropsychological Society, 4, 675 - 686. (available from Jane)
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