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)