A Linguistic Analysis of Three People with No Prior AAC Experience Using an AAC Device

Since approximately 50% of people with aphasia experience incomplete restoration of language, augmentative and alternative communication (AAC) for people with aphasia has been used primarily as a compensatory therapeutic intervention. AAC is less frequently considered to restore linguistic functions (Weissling & Prentice 2010). Recently, researchers described the communication patterns used by people with aphasia when they retold personal narratives using four different AAC screen layouts (Dietz, Griffith, & Macke, 2014; Dietz, Weissling, Griffith, & McKelvey, 2014; Griffith, Dietz, & Weissling, 2014). Across these reports, the people with aphasia employed a variety of expressive modality units (i.e., spoken, written, drawn, picture, text box, and speak button) to retell their stories; however, they predominately used the spoken modality to retell each story. Despite the presence of an AAC device, they spoke, on average 70% of the time across all retells, (Dietz et al, 2014a; 2014b; Griffith et al., 2014). The question remains, though, whether these high levels of spoken output translates in to more effective and efficient verbal expression. Therefore, as such, the purpose of this retrospective case series study was to describe and analyze the spoken linguistic output of the people with aphasia and no prior AAC experience from the Dietz et al., (2014a; 2014b) studies

Using Masked Repetition Priming in Treatment of Anomia – A Phase 2 Study

Individuals with anomia often demonstrate preserved lexical knowledge, even when they are unable to produce a lexical item. An interactive spreading activation model of lexical processing explains this dichotomy by suggesting that impaired lexical access can result from deficits in the spread of activation between levels of processing or from the maintenance of activation of target representations long enough for them to be selected [1]. In either case, impaired spreading activation is implicated in lexical retrieval impairments. Spreading activation is a fundamental component of the implicit (unconscious) processing system that supports the rapid, accurate use of language. Implicit and explicit (conscious) processes and representations interact in language production [2], and there is some evidence that the interaction between them may also be impaired in aphasia. For instance, many people with aphasia demonstrate implicit lexical knowledge and/or implicit lexical processing even if they cannot explicitly produce those same items. Most established methods of treatment for anomia are highly explicit, having clients consciously consider a word’s meaning, use, or form. If the implicit processing system and/or the interface between explicit and implicit systems is impaired, however, anomia treatment could benefit from finding ways to also address the implicit system more directly. All treatment approaches recruit both implicit and explicit processes to some extent, due to the highly integrated, interactive nature of the language processing system. The treatment approach described here, however, shifts the therapeutic target from the explicit to the implicit end of the spectrum. We do this by using visual masking to make prime items implicit, and presenting them several times before asking for a naming response to pictures that are presented. While the naming response is an explicit response, the intent of the masked primes is to pre-activate the appropriate implicit lexical representation adequately so that the target word is more readily available when an explicit response is required. This has been demonstrated in principle by a study conducted with a single individual with anomia [3], which showed improved naming when masked primes were presented. The single-subject, multiple baseline study reported here for two participants extends this idea to investigate the effects of masked priming over repeated exposures on 1) trained items; 2) untrained items in the same semantic category; and 3) untrained items across semantic categories. This is an ongoing project. At this time, data have been collected and analyzed for two participants, reported here. Additional participants will be enrolled in the project in early 2014, with those data included in the conference presentation, as well

AAC revolutionizes aphasia therapy: Changes in cortical plasticity and spoken language production

Restorative interventions are frequently preferred as augmentative and alternative communication (AAC) interventions are thought to impede neural recovery (Pulvermuller & Berthier, 2008; Weissling & Prentice, 2010). But, clinical observations suggest AAC interventions may improve aphasia (Dietz, Weissling, Griffith, & McKelvey, 2012). The purpose of this study was to compare the influence of a novel AAC and traditional restorative (TR) intervention on linguistic recovery and neural reorganization

Evolution of language symptoms in narrative production: A single-case study of Broca's aphasia

In producing an oral narrative such as a fairy tale, the content can be expressed in numerous forms. The lexical items depicting the agents, the objects, and the activities which make up the story, the syntactic structures, and the type of speech produced can vary. Narratives produced by persons with aphasia (PWA) reveal features that are intact and others that are indicative of impaired language processing. Thus, long-term analysis of narratives produced by PWAs provides a unique opportunity to examine the evolution of the predominant symptoms affecting narrative production. Initially due to the severity of language impairment, symptoms may overlap and mask specific deficits which are initially difficult to separate from one another and/or required features may be omitted and substituted. The aim of this single case study is to characterize the changes in the use of direct and reported speech in the (re-)telling of the fairy tale ‘Cinderella’ over time in the context of the overall language recovery process. The main question addressed is to what extent the availability of specific structures influences narrative production: Is there a tendency for direct speech to be correctly, differentially used by TH in his production of the fairy tale ‘Cinderella’ at various stages of language recovery in contrast to describing the succession of events not using direct speech

There’s more than one way to skin a cat: Teaching novel idioms

Difficulties with interpretation of non-literal language (e.g., idioms, metaphors) have been reported in adults with brain injury and in second-language learners. This study compared the effectiveness of a traditional definition approach to teaching idioms with learning through supportive contexts. Six healthy older adults learned the meaning of 24 novel idioms; 12 were taught through definitions and the remaining 12 through supportive contexts. Results indicated that participants learned idioms equally well in both conditions, in both immediate and delayed recall. This provides support for the idea that a context-based strategy may be an effective method for teaching novel idioms

Semantic Knowledge Use within Discourse Produced by Individuals with Anomic Aphasia

According to the feature-specific model (Cree & McRae, 2003), semantic knowledge is a distributed network of features that are stored separately and can be impaired separately. These semantic features are the building blocks of the semantic knowledge system and of concepts in general. This has led researchers to using semantic features-based treatments to improve word retrieval abilities in adults with anomic aphasia. Semantic features-based treatments have been used to improve the ability for individuals with aphasia to re-establish connections between the semantic and lexical systems. Researchers have found that semantic features-based treatment, are typically successfully in improving verbal production abilities in adults with aphasia at the word level (Kiran & Roberts, 2010) and discourse (Boyle, 2004; Peach & Reuter, 2010; Rider, Wright, Marshall, & Page, 2008). Recently, researchers have examined the utility of semantic features-based treatment for improving discourse production in adults with aphasia; however, few researchers have examined how the semantic knowledge is used within discourse. Armstrong (2001) examined the lexical patterns of verbs in discourse samples given by four participants with aphasia (PWA) and four healthy participants. Armstrong categorized verbs from personal recounts into one of five semantic-lexical categories (material, relational, mental, verbal, and behavioral). She found that PWA presented with different verb patterns that resulted in restricted communication. Moreover, the PWA had produced few mental and relational verbs. However, Armstrong included only lexical-semantic categories and they are connected by semantic relationships and possibly also grammatical relationships. To expand our knowledge of the appropriateness of using semantic features-based treatments at the discourse level, it important to understand how semantic knowledge is used beyond simply allowing access to lexical items. Unknown is if semantic knowledge use differs in adults with aphasia compared to cognitively healthy adults. These findings could have significant implications for how to apply semantic features-based treatments to improve discourse level abilities in adults with aphasia. To this end, the purpose of the study, then, was to determine if the semantic knowledge and category types used in discourse by participants with anomic aphasia differed from those used by cognitively healthy participants. Certain semantic knowledge types and category types may be more difficult to access, integrate, or maintain in discourse for adults with anomic aphasia because producing discourse is cognitively demanding and requires processes external to lexical and semantic access. Therefore, we hypothesized that the discourse produced by participants with anomic aphasia would differ in the proportion of semantic knowledge and category types used

Thin vs. Thick Description: A Critical Analysis of Representations of PWA in the CSD Literature

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The effects of semantic and orthographic blocking on written word production

In investigating the efficacy of acquired dysgraphia treatments, relatively little attention has been directed to the relationships amongst treated items. Is it beneficial or detrimental to treat together items that belong to the same semantic category or share segments (phonemes or letters)? In spoken production, interference is observed when individuals produce items in the context of other semantically related vs. unrelated items—neurologically normal participants initiate naming more slowly and individuals with aphasia produce more errors (e.g. Damian et al., 2001; Schnur et al., 2006). On the other hand, facilitation is observed for the production of blocks of phonologically related vs. unrelated items— normal participants initiate naming more quickly (e.g. Damian, 2003), although there is some evidence of interference in individuals with aphasia (Hodgson et al., 2005). In the present study, we extend this research to examine the effects of semantic and orthographic blocking on written production in neurologically intact individuals (Experiments 1A and 1B) as well as one individual with acquired dysgraphia (Experiment 2). While the investigation does not involve treatment, the findings may have implications for word retrieval treatment

Script training and its application to everyday life observed in an aphasia center

Script training focuses on improved production of personally relevant monologues and dialogues through intensive practice. Commonly reported components of script training include use of personally relevant or functional scripts, a structured cueing hierarchy, and intensive rehearsal of scripted lines to promote automaticity (Youmans, Holland, Munoz, & Bourgeois, 2005; Lee, Kaye, & Cherney, 2009; Youmans, Youmans, & Hancock, 2011; Goldberg, Haley, & Jacks, 2012; Fridriksson et al., 2012). Fridriksson et al. (2012) also trained a series of common scripts to study neurophysiological changes that result from such training. This proposal presents results from four persons with aphasia (PWA) who received script training in an aphasia center, where there is opportunity to observe the effect of that training on everyday life. A secondary goal is to examine what, if any, individual, intervention, or environmental factors might affect a PWA’s ability to benefit from such training

The thorny issue of choosing outcome measures for aphasia therapy trials: A comparison of discourse and aphasia battery outcomes following Multi-modality and Constraint Induced aphasia therapy

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