Welcome | Aphasia Research Project

[Pages:18]Beeson & Rising ASHA 2011

P?lagie M. Beeson, Ph.D., CCC-SLP Kindle Rising, M.S., CCC-SLP

Department of Speech, Language, & Hearing Sciences

Bobo ... one ... Bobo one ... bye... bye

Written language is betterpreserved than spoken language

Broca's Aphasia with severe apraxia of speech

Tell me what's going on in the picture.

A Picnic at My Parents. Biff and Heidi are having a picnic. And Max is flying a kite. And Devon is playing in the sand. And, no... Poppi's fishing... It's a lovely day.

Spoken language is betterpreserved than written

BHreoicdai'sanAdphRaosibaeervt oalrveedwtaoyAanomic Apipchnaics.iaMax is fling a kite. Devon is make is a sand castle. Ed and Chris are sailing a boat. Shech is fishing. It is ____ day.

No aphasia but persistent spelling and reading difficulties.

First, let's consider how spoken and written language skills develop

We derive meaning from what we hear and see.

Concepts

Audition

Vision

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We derive meaning from what we hear and see.

Concepts

Acoustic Representations

Visual Representations

Beeson & Rising ASHA 2011

Knowledge of lexical representations develops

Concepts (word meanings)

... for spoken words

"dog"

PAhuodniotolorgy y R(sepporkeesnenwtaotriodns)s

"mommy"

"Jake"

"car"

"hammer"

"flower"

"house"

Visual Representations

Knowledge of lexical representations develops

Concepts (word meanings)

... for spoken words

... for written words

"dog"

PAhuodniotolorgy y R(sepporkeesnenwtaotriodns)s

"mommy"

"Jake"

"car"

"hammer"

"flower"

"house"

(wOrrittVhteoisngiowranoprhdys) dog

mommy Jake

flower

car hammer

house

Knowledge of lexical representations develops

Concepts (word meanings)

... for spoken words

... for written words

PAhuodniotolorgy y R(sepporkeesnenwtaotriodns)s

"dog" "hammer" "car" "mommy" "Jake"

(wOrrittVhteoisngiowranoprhdys)

dog hammer car mommy Jake

Knowledge of lexical representations develops

Concepts (word meanings)

... for spoken words

... for written words

PAhuodniotolorgy y Re(prheosneenmtaetiso)ns

(OgrrtaVhpoishgieormanpehsy)

/d/

/h/ ... and sublexial /k/ knowledge as well

d

h c, k

/m/

m

/dj/

j

Viewed as a cognitive model

"apple"

apple

words sounds

Semantics

Phonological Lexicon

Phonemes

lexical sublexical

Orthographic Lexicon

Graphemes

words letters

"apple"

apple

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Beeson & Rising ASHA 2011

Left perisylvian damage impairs phonological processing

Phonology Semantics

Phonology

Semantics

Ortho g

? Resulting in Broca's, Wernicke's, Conduction, and Global Aphasia

? Mostly due to left middle cerebral artery stroke

100

Percent Correct

80

60

40

? Marked impairment of spelling

20

knowledge for words (< 30% correct)

? Marked impairment of phonology

0

(unable to spell nonwords)

Regular Irregular Nonwords

Lexical Sub-lexical

Global Alexia

"apple"

apple

Semantics

Phonologic Lexicon

Phonemes

?

Orthographic Lexicon

Graphemes

Lexical Sub-lexical

Global

sopt

Agraphia

Real Words

stop pillow doubt castle type

Large MCA stroke

Nonwords

flig hoach snite glope boak

"apple"

apple

with semantic errors

Lexical Sublexical

Phonologic Lexicon

Phonemes

Semantics

Orthographic Lexicon

Graphemes

Lexical Sublexical

Deep Alexia

"o"arpapnlge"e"

oraapnpglee

Deep Agraphia

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Writing to Dictation (semantic errors)

hard shrug summer debt

enough bake worm

talk develop

grab bride

shove outside

Beeson & Rising ASHA 2011

single letter error multiple errors

single letter error

semantic error

multiple errors

Arizona Battery for Reading and Spelling* 40 regular, 40 irregular words

balanced for length, frequency, imageability 20 pronounceable nonwords

Regular Words

broom mile spring branch hunch fact slate

Irregular Words

yacht circuit doubt choir sword island debt

Nonwords flig hoach snite glope boak cheed merber

* _Project/Welcome.html

"apple"

apple

Semantics

Phonologic Lexicon

Phonemes

"apple"

sound-letter letter-sound

Orthographic Lexicon

Graphemes

apple

retrain spellings for specific words

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Beeson & Rising ASHA 2011

Purpose

Strengthen lexical-semantic and orthographic representations for specific words

Goal

To retrain single-word written vocabulary for use in communicative interactions

To establish written "key words" for use in later stages of treatment

Approach

Train 24 written words using Copy and Recall Treatment approach (CART)

Trained as 4 groups of 6 words

leaf

net

chin

cake

Copy and Recall Treatment (CART) book

"Book." "Write `book'?"

book book

? Correct: present next word ? Incorrect: proceed

Beeson, 1999, Aphasiology Beeson, Rewega, Hirsch, 2002, Aphasiology Beeson, Rising, & Volk, 2003, JSLHR

Video

Homework for Copy and Recall Treatment Listen, repeat word, copy word.

"talking" photo album

Daily homework pages for repeated copy practice

Review each session for accountability

Homework is fun!

4 sets/6 words trained to >80% accuracy. Treatment duration ~ 6-8 weeks

Set 1 6 5 4 3 2 1 0

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 2 6 5 4 3 2 1 0

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 3 6 5 4 3 2 1 0

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 4 6 5 4 3 2 1 0

1 2 3 4 5 6 7 8 9 10 11 12 13

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Beeson & Rising ASHA 2011

Global Agraphia

Aphasia Aph Q Read

Spell

G1 Wernicke

61.8 2.5 0

G2 Broca* 45.2

0 0

G3 Broca* 22.1

0 0

G4 Broca* 27.6

0 0

G5 Wernicke

35.2 0 2.5

G6 Broca* 51.7

10 0

G7 Wernicke

51.8 60 6.25

Aphasia Aph Q Read Spell

G8 Wernicke

58.7 5 0

G9 Broca 36.6 11.25

0

G10 Broca* 41.0

7.5 2.5

G11 Cond 53.9 16.25 30

G12 Cond 49.5

0 11.25

G13 Cond 74.3 93.75

5

* with apraxia of speech

G14 Broca/A

79.1 61.67

6.7

Percent Correct

Group Performance on Trained Items Pre-Post Treatment (14 participants; 24 spellings each)

100

90

80

70

60

50

Gain

40

Pre

30

20

10

Lesion overlay

0

Spelling

Naming

All but 1 of 14 participants met criterion for spellings of

targeted words. Spoken naming also improved.

Personally relevant words

Work with patient and family to select words

Select words that are not easily communicated by pointing or gesture

Include important people, places, and things (including proper names)

T-CART (texting)

Cell phone with a slide-out QWERTY keyboard

Individual with severe Broca's aphasia and apraxia of speech

CART (written)

T-CART (typed)

Treatment Baseline

5

Maintenance

Followup

5

Treatment Baseline

Maintenance

Followup

4

4

Set 31

3

2

2

1

1

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 0

5

5

Set 2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

4

4

Set 33

3

2

2

Set 4

1

1

0

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

5

5

4

4

Set 53

3

2

2

Set 6

1

1

0

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Criterion: 4+ words spelled correctly in 2 probes

Average # of Items Correct

Spelling and Spoken Naming Accuracy

5

4

3

Pre-tx

2

Maintenance

1

Follow Up

0

CART spelled

d=4.50

CART spoken

d=3.81

T-CART spelled

d=6.12

T-CART spoken

d=4.25

Better long-term retention for CART vs T-CART

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Beeson & Rising ASHA 2011

100

Percent Correct

80

60

40 Relatively preserved lexical

knowledge with marked impairment

20

of phonological skills (e.g., nonword

0

spelling)

Regular Irregular Nonwords

words sounds

"dusp"

dusp

Semantics

difficulty with nonwords

Phonologic Lexicon

Phonemes

lexical sublexical

Orthographic Lexicon

Graphemes

words letters

Phonological "dust?" Alexia

druffs Phonological Agraphia

Difficulty with nonwords compared to regular & irregular words

Regular Words bake + count + platform +

Irregular Words

walk + blood + castle +

Nonwords flig glope merber -

*Stimuli available at _Project/Welcome.html

Writing to dictation

drive

choir

flig

spring

circuit

wape

grave

yacht

snite

Also associated with poor written performance at the sentence level. Difficulty with functors & verb inflections.

Functional implications of phonological impairment (10 years post stroke)

Phonological Agraphia

Aphasia

P1 Conduction

Aphasia Q Read Words Spell Words

66.7 27.5 27.5

P2 Broca/A

82.2 97.17 36.66

P3 Anomic

73.6 80.0 50.0

P4 Conduction/

A 76 83.33 60.0

P5 Anomic*

83.5 93.75 60.0

Aphasia Aphasia Q Read Words Spell Words

P6 Broca/A

93.8 97.5 68.75

P7

P8

Anomic Anomic

96.4

83

96.6

96.25

78.33

85

* with apraxia of speech

P9 Anomic

93.5 97.5 92.5

P10 Anomic

88.4 92.5 96.25

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Beeson & Rising ASHA 2011

"apple"

apple

Semantics

Phonologic Lexicon

Phonemes

"apple"

sound-letter letter-sound

Orthographic Lexicon

Graphemes

retrain soundletter correspondences

apple

Purpose

To strengthen sound-letter correspondences Improve phonological manipulation abilities.

Goal

To use phonological information to assist in reading and spelling.

Approach

Establish "Key Words" to assist in relearning sound-letter and lettersound correspondences (20 consonants, 12 vowels)

Re-train sound-letter correspondences for each targeted phoneme

fire --- /f/ --- f

Prerequisite skills

Able to read, write, and name 24 key words high frequency, concrete, regularly spelled nouns used to retrain sound-letter (and letter-sound) correspondences

Train with lexical approach if necessary

Set 1 Set 2 Set 3 Set 4

Key words-Consonants rug, top, leaf, safe, net cake, fire, moon, pie, dog book, goat, zoo, ship, van hat, web, chin, judge, three

Key words-Vowels Set 1 hat/van, cake/safe, ship/chin

fire/pie, net/web, leaf/three Set 2 top/dog, bone/goat, rug/judge

moon/zoo, cow/mouth, foot/book

Clinician Say /p/ What is your key word for /p/? (Show picture if necessary). Write your key word for /p/

Underline /p/ in your word

Now say the sound

Patient /p/ "pie"

pie

pie /p/

Clinician

? Show the letter "s"

s

? What is your key word for this ?

? Show the picture if necessary

? Your key word is "safe", write "safe" ?What's the 1st sound?

? Show the letter "s"

s

?What is this sound?

Patient "safe"

safe "ssss"

"ssss"

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