EVIDENCE-BASED PRACTICE IN APHASIA REHABILITATION

EVIDENCE-BASED PRACTICE IN APHASIA REHABILITATION Ohio Speech-Language & Hearing Association Annual Convention March 12-13, 2010 Columbus, OH Presented by: Aimee Dietz, Ph.D., CCC-SLP Julie Griffith, M.A.,CCC-SLP Jennifer Keelor, M.Ed. Purpose To review evidence regarding aphasia interventions for Verbal expression Written expression Reading Comprehension Auditory Comprehension For Monday Morning You will have the following in your bag of tricks: 2 verbal expression intervention techniques 1 written expression intervention technique 1 reading comprehension intervention technique 2 auditory comprehension intervention techniques 1 idea to facilitate personalization of each interventions 1

Organization Overview Verbal Expression--Jennifer Written Expression --Aimee Reading Comprehension--Aimee Auditory Comprehension--Julie Summary Q & A Verbal Expression Verbal Expression ANOMIA Discourse? Confrontation/generative naming tasks? 2

Error Forms Semantic in nature Phonological in nature (Raymer, 2005; Hillis,2001) Target Words Grammatical Categories Semantic Categories Imageability Length Familiarity/Personal Relevance Frequency (Raymer, 2005) CUING HIERARCHY It s clothing You can button it It starts with /bl/ It sounds like mouse Written word: Here is the word. Blouse say blouse (Linebaugh, 1997, Raymer et al., 1993) 3

Phonological Treatments Semantic Category Rhyme Therapy (SCRT) BIKE VEHICLE HIKE (Spencer et al.,, 2000) Semantic Treatments Semantic Feature Analysis (SFA) GROUP USE ACTION TARGET PICTURE PROPERTIES LOCATION ASSOCIATION (Boyle, 2001; Boyle, 2004; Coelho, McHugh, & Boyle, 2004; Kiran, & Johnson, 2008; Kiran, 2008; Rider, Wright, Marshall & Page, 2008) Personalization of Techniques W HO W H A T W H E N (rela t io n s hip s) (ac t io n ) ( t ime of year) O CCA SSIO N WHE R E WH Y ( i m p orta n ce ) ( l ocat i o n ) (me m ory) (Adapted from Boyle & Coelho, 1995) 4

SFA: Limitations Word level data Tx Goal = discourse Written Expression Anagram, Copy, & Recall Treatment (ACRT/CART) Repeated copying of target words in response to pictured items Confrontation spelling task If incorrect ANAGRAM PUZZLE COPY 3 times Scrabble tiles Clinician cues, if necessary Homework program Consider errorless learning principles (Beeson, 1999; Beeson, Hirsch, & Rewega, 2002; Beeson, Rising, & Volk, 2003; Orjada & Beeson, 2005) 5

Target: S L E E P CUE (SEE RIGHT) 1 copy Sleep. Can you write sleep. INCORRECT: Anagram**: P L S E E COPY 3 times INCORRECT: Anagram + Foils**: P E B L S E F COPY 3 times (Beeson, 1999; Beeson, Hirshc,, & Reweaga, 2002; Beeson, Rising, & Volk, 2003; Orjada & Beeson, 2005) 2 recall Sleep. Can you write sleep. REMOVE written work RECALL INCORRECT: present written model of the word. (Beeson, 1999; Beeson, Hirshc,, & Reweaga, 2002; Beeson, Rising, & Volk, 2003; Orjada & Beeson, 2005) Homework SLEEP Check homework for accuracy each session Daily practice packet with picture and model Mastered words Copy words 20 times Cover & test (Beeson, Hirsch,, & Reweaga, 2002; Beeson, Rising, & Volk, 2003) COPY RECALL 6

Reading Comprehension Reading Routes 1. LETTER RECOGNITION. SEMANTIC ROUTE 2. GRAPHEMIC LEXICON PHONOLOGIC ROUTE 2. GRAPHEME- PHONEME CONVERTER 3. SEMANTICS 3. BUFFER 4. PHONOLOGY 5. BUFFER read aloud ORLA: 4 stages Repeated oral reading Chorally independently Stages at graded reading levels: Sentences Level 1: Simple 3-5 words; 1 st grade Level 2: 8-12 words; 3 rd grade Paragraphs Level 3: 15-30 words; 6 th grade Level 4: 50-100 words;6 th grade (Cherney, Merbitz, & Grip, 1985; Cherney, 1995; 2004, 2007) 7

Measuring Reading Levels in Microsoft Word (Cherney, Merbitz, & Grip, 1985; Cherney, 1995; 2004, 2007) Garfield is sleeping on the pillow. (4 th grade) SLP READS TARGET CHORAL READING PT POINTS TO WORDS REPEAT SLP READ WORD FOR PT TO I.D. SLP POINTS TO WORD PT READS 8

Auditory Comprehension Comprehension Approaches Bottom Up Top Down 1. Context based approach 2. Computer Applications Context Based Approach When: Early Patients deficits are severe Premise: Use a conversational context to facilitate comprehension Uses a Top Down Model (Marshall,2008) 9

Context Based Approach 3 steps 1) Identify and manipulate linguistic and temporal variables 2) Encourage the patient to take responsibility 3) Instruct family and caregivers (Marshall,2008) Context Based Approach Consider the type of context presented Auditory Visual Context helps convey the main idea of a message through a top-down method (Marshall,2008) Context Based Approach Visual Stimuli Auditory Stimuli Dimensionality Syntax Size Stress on Key Words Color Slowing Rate of Context Speech Size and Form of Use Scripts written materials Aphasia Friendly (Coelho, Sinotte & Duffy,2008 & Brennan, Worrall & McKenna, 2005) 10

Context Based Approach and AAC Low-tech AAC Methods Augmented Comprehension techniques Writing Key Words Yes / No Drawing / Picture Supports Gestures ( Beukelman, Garrett & Yorkston. 2007 & Garret & Huth, 2002) Computer Applications What is it? Who benefits? Mild-mod impairments in auditory comprehension Individuals who can Self-Monitor (Katz, 2008) Computer Applications Parrot Software http://www.parrotsoftware.com/ Bungalow http://www.bungalowsoftware.com/ How do these programs target auditory comprehension? Limitations (Parrot Software, 2007-2009; Bungalow Software Inc. 1995-2010) 11

Computer Applications Wii - Wii habilitation How do these games target auditory comprehension? (Wii -habilitation & Aphasia Groups, 2009) Summary Errors: semantic or phonological? Helps guide treatment Speaking SFA, SCRT Writing CART/ACRT Reading ORLA Listening Wii??QUESTIONS?? Make it personally relevant. Pictures Life goals Instruct communication partners References Beeson, P. M. (1999). Treating acquired writing impairments: Strengthening graphemic representations. Aphasiology, 7, 767-758,. Beeson, P. M., Hirsch, F. M., & Rewega, M.A. (2002 ). Successful single-word written treatment: Experimental analysis of four cases. Aphasiology, 16(4), 473-491. Beeson, P. M.; Rising, K.; Volk, J. (2003). Writing treatment for severe aphasia: Who benefits? Journal of Speech, Language and Hearing, 46, 1038-160. Beukelman, D. R., Garrett, K. L., & Yorkston, K.M. (2007). Augmentative communication strategies for adults with acute or chronic medical conditions. Baltimore, ML: Paul H. Brookes Publishing Co. Inc.. Boyle, M. (2001). Semantic feature analysis: The evidence for treating lexical impairments in aphasia. Neurophysiology and Neurogenic Speech and Language Disorders, 11 (2), 23-28. Boyle, M. (2004). Semantic feature analysis treatment for anomia in two fluent aphasia syndromes. American Journal of Speech Language Pathology, 13, 236-249. Boyle, M., & Coelho, C. A. (1995). Application of semantic feature analysis as a treatment for aphasic dysnomia. American Journal of Speech Language Pathology, 4, 94-98. Bungalow Software Inc. (2010). Bungalow Software [computer software]. Blacksburg, VA. Brennan, A., Worrall, L., & McKenna, K.(2005).The relationship between specific features of aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study. Aphasiology, 19:8,693 711 12

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