Constraint-Induced aphasia therapy: Three single case studies.

TITLE OF POSTER: CONSTRAINT INDUCED APHASIA THERAPY - THREE SINGLE CASE STUDIES INTRODUCTION This research project was inspired by the Specific Interest Group in Aphasia study day given by Professor Pulvermuller in January 2011. Constraint Induced Aphasia Therapy (CIAT) is sometimes referred to as Intensive Language Action Therapy (ILAT). This technique has an impressive research base to support its use for people with aphasia (PWA) and the evidence base includes both single case and randomised control trial evidence (Pulvermuller, Neininger, Elbert, Mohr, Rockstroh, Koebbl & Taub, 2001). Pulvermuller et al (2001) describe CIAT as a game of pairs. The game is normally played by four players: a therapist and three PWA. A 32 pack of cards consisting of 16 pairs is shuffled and divided equally between the four players. No one can see anyone else’s cards. The aim of the game is to win the most pairs of cards. Clients can win a pair by asking each of the other players in turn, for a matching card. All requests and responses should be verbal but participants may describe the target word or use a gesture in order to achieve saying the word. An essential part of the game is that each player should see and hear the name of the card in play. RESEARCH METHOD Three PWA were prioritised from a typical general hospital SLT caseload. All three clients were one to two years post onset of their aphasia and had already been provided with impairment focussed, functional and psychosocial SLT input. They had moderate to severe aphasia, had difficulties at several levels of single word processing and frequently failed to convey their message despite having a degree of linguistic competence and an ability to use alternative communication strategies. Accessible formal assessment measures (Kaplan, Goodglass & Weintraub 1983, Goodglass, Kaplan & Barresi 2000 & Swinburn, Porter & Howard 2004) were used to evaluate the success of therapy in a four step repeated measures research design: Baseline 1, 30 hours CIAT therapy, Baseline 2, Baseline 3. SUMMARY OF RESULTS For 2/3 clients, assessment results suggested that participation in the CIAT programme resulted in a positive measurable change in language behaviour. This positive change was not apparent in assessments of understanding. Selective improvement of language ability suggests that the therapy directed at language output had resulted in improved word and sentence level skills for 2/3 of our clients. There were also positive changes that were not captured by the assessment data: reduced use of written and therapist cues, improved repetition skills, improved self-monitoring and a reduced tendency to produce jargon type utterances. Relatives corroborated therapist perceptions. CONCLUSIONS In 2006 Beeson & Robey (2006, p162) proposed that rehabilitation outcome research should be conducted in five phases. Our study is one of the first to provide evidence to support the use of intensive CIAT therapy in the community (phase 4 – an effectiveness study). Other studies have assessed the usefulness of the therapeutic effect of ILAT (phase 1), optimised the ILAT procedure (phase 2) and tested its usefulness under ideal conditions (phase 3). The final phase outlined by Beeson & Robey (2006) is the cost-benefit analysis (phase 5) and we would welcome debate within the profession on improving this type of input and the role of Speech and Language Therapists in intensive aphasia therapy provision. REFERENCES Pulvermuller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbl,P. & Taub, E. (2001) Constraint induced therapy for chronic aphasia after stroke. Stroke, 1621-1626. Beeson, P. M. & Robey, R.R. (2006) Evaluating single-subject treatment research: Lessons learnt from the aphasia literature. Neuropsychological Review, 16, 161-169. KAPLAN, E., GOODGLASS, H. and WEINTRAUB, S. (1983) The Boston Naming Test. Philadelphia: Lea and Febiger. Goodglass, H., Kaplan, E. & Barresi, B. (2000) Boston Diagnostic Aphasia Examination. 3rd Edition. San Antonio: Pearson. Swinburn, K., Porter, G., & Howard, D. (2004). The Comprehensive Aphasia Test. Hove: Psychology Press

The Sensitivity of Auditory-Motor Representations to Subtle Changes in Auditory Feedback While Singing

Singing requires accurate control of the fundamental frequency (F0) of the voice. This study examined trained singers’ and untrained singers’ (nonsingers’) sensitivity to subtle manipulations in auditory feedback and the subsequent effect on the mapping between F0 feedback and vocal control. Participants produced the consonant-vowel /ta/ while receiving auditory feedback that was shifted up and down in frequency. Results showed that singers and nonsingers compensated to a similar degree when presented with frequency-altered feedback (FAF); however, singers’ F0 values were consistently closer to the intended pitch target. Moreover, singers initiated their compensatory responses when auditory feedback was shifted up or down 6 cents or more, compared to nonsingers who began compensating when feedback was shifted up 26 cents and down 22 cents. Additionally, examination of the first 50 ms of vocalization indicated that participants commenced subsequent vocal utterances, during FAF, near the F0 value on previous shift trials. Interestingly, nonsingers commenced F0 productions below the pitch target and increased their F0 until they matched the note. Thus, singers and nonsingers rely on an internal model to regulate voice F0, but singers’ models appear to be more sensitive in response to subtle discrepancies in auditory feedback

Using Adobe Flash Lite on mobile phones for psychological research: reaction time measurement reliability and inter-device variability

Mobile telephones have significant potential for use in psychological research, possessing unique characteristics—not least their ubiquity—that may make them useful tools for psychologists. We examined whether it is possible to measure reaction times (RTs) accurately using Adobe Flash Lite on mobile phones. We ran simple and choice RT experiments on two widely available mobile phones, a Nokia 6110 Navigator and a Sony Ericsson W810i, using a wireless application protocol (WAP) connection to access the Internet from the devices. RTs were compared within subjects with those obtained using a Linux-based millisecond-accurate measurement system. Results show that measured RTs were significantly longer on mobile devices, and that overall RTs and distribution of RTs varied across device

A comparative study of the physiological effects of immersion and bed rest

Human physiological response during periods of silicone immersion and bed res

Millisecond accuracy video display using OpenGL under Linux

To measure people’s reaction times to the nearest millisecond, it is necessary to know exactly when a stimulus is displayed. This article describes how to display stimuli with millisecond accuracy on a normal CRT monitor, using a PC running Linux. A simple C program is presented to illustrate how this may be done within X Windows using the OpenGL rendering system. A test of this system is reported that demonstrates that stimuli may be consistently displayed with millisecond accuracy. An algorithm is presented that allows the exact time of stimulus presentation to be deduced, even if there are relatively large errors in measuring the display time

Factors Influencing the Impact of Aggressive and Violent Media on Children and Adolescents

The influence of aggressive and violent media on children and adolescents has been a topic of concern for several decades. Research on this topic has suggested that both short term and long term exposure to aggressive/violent media can negatively impact this population. The purpose of this literature review is to discuss relevant research on the topic and examine various factors that may impact the risk of being influenced by this type of media. These factors can include time spent viewing media, content of the media viewed, gender, age, psychological characteristics, family, and peers. Various theoretical approaches to explaining the influence of violent media are also examined, as well as directions for future research

You Can't Get There From Here: Hubble Relaxation in the Local Volume

A beginning end-point for galaxy motions within the 10-Mpc Local Volume is constructed by requiring a smooth distribution of (luminous) mass at the time of recombination, which is shown to be equivalent to a smooth Hubble flow at early times. It is found, by this purely kinematical method, that present peculiar motions are too small by a factor of at least several (and largely in the wrong direction) to have produced the observed structures within the age of the universe. Known dynamical effects are inadequate to remove the discrepancy. This result is different in origin from previously known ``cold flow'' problems. The simple dynamical picture often used within the Local Volume (for instance, in deriving masses through calculation of a zero-velocity surface) is thus called into question. The most straightforward explanation (though not the only possible) is that there exists a large quantity of baryonic matter in this region so far undetected, and unassociated with galaxies or groups.Comment: 23 pages, accepted by the Astronomical Journa