This paper examines the effects of phonological and orthographic cues on spoken naming in aphasia.
The aim of the study was to determine the relationship between the effects of phonological and orthographic cues and the underlying functional language impairment and to identify the mechanisms by which the cues have their effects within a neurolinguistic word-processing model (Patterson & Shewell, 1987). We present the results from six anomic participants with chronic aphasia using a case-series design. Both effects of a single application and of multiple applications of cues were assessed, as were both immediate and delayed effects

Lorenz, Antje

Nickels, Lyndsey

The Aphasiology Archive

We are going to present the immediate and delayed effects of phonological and orthographiccues on spoken naming in six brain-damaged participants with chronic aphasia using a case-series design (Howard, 2003). All participants had word-retrieval deficits in conversation andpicture naming. Both effects of a single application and of multiple applications of cues andpictures (short-training phase: three sessions) were assessed.The aim of the study was to examine the relationship between the effects of phonological andorthographic cues and the underlying functional impairments in the patients and to interpretthe underlying mechanisms of effectiveness of the different types of prompts in aneurolinguistic word-processing model (Patterson & Shewell, 1987).Research plan and methodologyPrior to the start of the treatment study, the language processing abilities of each participantwere assessed in detail (using, for example selected assessments from PALPA, Kay et al.,1992) so that specific cue-effects could be interpreted with regard to underlying functionaldeficit(s) (cf. Best et al., 2002).Pre-assessment of spoken picture namingParticipants were required to attempt to name a set of 224 pictures of objects, whichcomprised the complete set of treatment and control stimuli. In order to control for stability ofnaming performance prior to treatment, a multiple baseline-design was used.Treatment of spoken picture namingThe set of 224 stimuli were divided into matched subsets of stimuli: 112 items that receivedtreatment and 112 controls that received no treatment (see below for further details ofstimuli). Of the treated items, half received phonological cues and half orthographic cues.The treatment occurred over two phases of three sessions each. Half of the items were treatedin the first phase and half in the second phase.Post-assessmentsAll items were named again following treatment to determine any lasting effects of treatment.Effects of treatment were measured in the end of each training session (15-20 min. afterfacilitation of picture naming), and 24 hours after the end of each training phase. In addition,with three participants, a follow-up test was conducted one week after the end of treatment.StimuliThe whole item set consisted of 224 black-and-white line drawings. All pictures werepresented to a group of 16 language unimpaired adults for spoken naming in order to controlthe set for name agreement (mean 95.2 %, sd. 0.1).We classified the target words as irregular, ambiguous, or regular according to regularity ofletter-sound-conversion for the initial letter. Effects of this parameter (OPC-regularity) onorthographic cueing and spoken naming in general were investigated.Irregular: the most frequent pronunciation of the first letter in isolation did not correspond tothe first sound of the word (for example the first letter-sound conversion in KNIFE is /k/ butthe initial phoneme is /n/).Regular: the sound of the initial letter always corresponded to the first sound of the word (forexample bottle, B > /b/).Ambiguous: the most frequent pronunciation of the initial letter of the word corresponds tothe first sound of the word, but other correspondences exist (e.g. “cat”, C > /k/ but in ceiling,church, C does not correspond to /k/).The whole item-set was divided into 8 sets of 28 items each (see table 1). The sets werematched individually for each participant, considering pre-treatment accuracy of spokenpicture naming as well as word frequency (Baayen et al., 1995), word length, animacy, andarticulatory complexity. The latter factors can be significant predictors of word retrieval inaphasic patients (Nickels & Howard, 1995). Furthermore, the different sets were matchedaccording to OPC-regularity.<Table 1>For each participant, two sets were treated using phonological cues (the first sound in theword; phonological 1 & phonological 2), another two sets were treated using orthographiccues (the first letter in the word, orthographic 1 & orthographic 2), and four sets consisted ofuntreated control pictures.Half of the control pictures (‘seen’ controls) were presented as often as the treated pictures(Sets: Control seen 1 and 2) – ie they were presented for naming with no additional cuesduring the therapy sessions. The other ‘unseen’ control-sets (Sets: Control unseen 1 andControl unseen 2) were only presented in the pre-assessment and in the post-assessment (24hrs after facilitation).Both phonological (initial sound of target word: wav-files) and orthographic cues (initialletter of target word: bmp-files) were prepared. Furthermore, cues and target pictures wereimplemented into a PC-based programme (Universal Data Acquisition Program (UDAP),Zierdt, 1998-2005).TreatmentIn both the phonological and the orthographic treatment condition, the initial segment of thetarget word was presented immediately before the target picture. The picture remained on thescreen for 6 seconds. Within the orthographic cue-condition, the initial grapheme waspresented immediately before the target picture, within the phonological cue-condition, theinitial phoneme was presented once and the target picture remained on the screen for 6seconds. If a picture could not be named by a patient within this time frame, no further helpor feedback was given, and the next picture (in combination with a cue) was presented fornaming. Similarly, in the control condition, each picture was presented for spoken namingwith a time out of 6 seconds. No cue or feedback was given here.Preliminary resultsThis is an ongoing study and results of four of the six participants are currently available.In two participants, the orthographic cue-condition was superior to the phonological cue-condition. In both patients, the orthographic cue effects were still present 20 min. and 1 dayafter presentation of the cues. In contrast, the phonological cues did not produce any effectsin these cases.Various authors have proposed that orthographic cues are especially effective in patients withpreserved sublexical transcoding abilities for written material (e.g. Best et al., 2002).However, it turned out that pseudoword reading and transcoding of single letters was severelyimpaired in both participants. One possible conclusion is that orthographic cues can alsobecome effective by reliance on a direct-lexical processing mechanism.The other two participants improved both with cued and with uncued pictures that werepresented as frequently as the cued pictures (seen control pictures). Following this, nospecific cue effects were present in these patients but repeated attempts to name a pictureover several sessions resulted in an improvement. This improvement was item-specificbecause the patients did not improve with a second control set which was only presented oncebefore and once after the whole facilitation phase (unseen control set). This improvementcould either be the result of using a combination of different self-cueing strategies or anexample of improved word retrieval from repeated attempts at recall (see also Nickels, 2002,Rapp et al., 2005).The influence of OPC-regularity of first letter-sound-conversion on orthographic cueing andspoken naming in general will be discussed.Table 1: Stimulus-sets and methodN224 (whole set)Set A (N112) Set B (N112)Set A (N56): cuedTREATMENTSet A (N56): uncuedCONTROLSet B (N56): cuedTREATMENTSet B (N56): uncuedCONTROLPhonological1(N28)Orthographic1(N28)irreg.: N7ambig.: N7reg.: N14Controlseen 1(N28)Controlunseen 1(N28)Phonological2(N28)Orthographic2(N28)irreg.: N7ambig.: N7reg.: N14Controlseen2(N28)Controlunseen2(N28)ReferencesBaayen R. H., Piepenbrock R., & van Rijn H. (1995) The Celex Lexical Database. CD-ROM.Philadelphia, PA, Linguistic data consortium.Best W., Herbert R., Hickin J., Osborne F., & Howard D. (2002) Phonological andorthographic facilitation of word-retrieval in aphasia: immediate and delayed effects.Aphasiology 16: 151-168.Howard D. (2003) Single cases, group studies and case series in aphasia therapy. In: TheSciences of Aphasia: From therapy to theory (eds R. De Bleser and I. Papathanasiou),Elsevier Science ltd., Oxford.Kay J., Lesser R., & Coltheart M. (1992) Psycholinguistic assessment of language processesin aphasia (PALPA). Lawrence Erlbaum Associates, Hove, U.K.Nickels L. & Howard D. (1995) Aphasic naming: what matters? Neuropsychologia 33: 1281-1303.Nickels L. A. (2002) Improving word-finding: Practice makes (closer to) perfect?Aphasiology, 16, 1047-1060.Patterson K. E. & Shewell C. (1987) Speak and spell: dissociations and word-class effects.In: The Cognitive Neuropsychology of Language (eds M. Coltheart, G. Sartori, and R. Job)Lawrence Erlbaum, London.Rapp B., Glucroft B., & Urrutia J. (2005) The protective effects of behavioral intervention ina case of primary progressive aphasia. Brain and Language 95, 18–19.Zierdt A. (1998-2005) Universal Data Acquisition Program (UDAP) V3.22, ClinicalNeuropsychology Research Group (EKN), City Hospital Bogenhausen, Munich, Germany.

Comparing phonological and orthographic cues in the treatment of word retrieval disorders in aphasia

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Comparing phonological and orthographic cues in the treatment of word retrieval disorders in aphasia

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