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Treatment of Word retrieval impairments: Do we know which tasks work for whom and why? Associate Professor Lyndsey Nickels National Health and Medical.

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Presentation on theme: "Treatment of Word retrieval impairments: Do we know which tasks work for whom and why? Associate Professor Lyndsey Nickels National Health and Medical."— Presentation transcript:

1 Treatment of Word retrieval impairments: Do we know which tasks work for whom and why? Associate Professor Lyndsey Nickels National Health and Medical Research Council Senior Research Fellow, Macquarie Centre for Cognitive Science (MACCS), Macquarie University, Sydney, Australia

2 Aim & Structure This presentation will… address the systematic research on treatment for word retrieval disorders Focus on word retrieval disorders in aphasia Structure define the problem & how to assess it discuss the evidence on treatment approaches

3 Defining the problem What do we mean by word retrieval? successfully accessing the phonological form of a word from semantics exclude impairments of phonological processes and articulation

4 Phonological Output Lexicon Speech output Phonological Buffer / Phonemes Semantics Writing Heard Speech Print Idea, picture or seen object

5 Phonological Output Lexicon Speech output Phonological Buffer / Phonemes Semantics Writing Heard Speech Print Idea, picture or seen object Store of word meanings Store of phonological word forms Phonemes Assemble phonemes into syllables. Retrieve articulatory plans. visual object representations; nonlinguistic concepts

6 Semantics Object, picture or idea Phonological Lexicon Phonological Buffer/ Phonemes

7 Semantics Object, picture or idea purrs barks fur pet 4-legs scales Phonological Lexicon Phonological Buffer/ Phonemes

8 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes

9 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

10 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

11 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

12 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

13 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

14 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

15 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

16 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

17 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk Phoneme assembly; Articulatory plan retrieval

18 How do you know what level the impairment is? Why does it matter? Different levels of impairment require different treatment

19 How do you know what level the impairment is? Observe behaviour & relate to the model of language processing What errors do they make in speech production? What factors affect the accuracy of their speech production? How do they do on other tasks that share the same processing components? 3 people with aphasia and word retrieval impairments

20 Picture naming Playing instrument trumpet AER 54% correct A dog’s residence GSW 52% correct A clarinet / ef  l.. ef  lt  n  lf  n  nt  lf  n  nt  lf  t  n  lf  nt el  f  n ef  l  nt / CI 58% correct /su:p  b  n  n s  b  bri: s  b m  ri:n/

21 Different error types in word retrieval AER & GSW : semantic errors e.g. Saxophone -> trumpet CI : phonological errors e.g. Submarine -> /su:p  b  n  n/

22 How do you know what level the impairment is for AER & GSW? Observe behaviour & relate to the model of language processing What errors do they make in speech production? Semantic errors Semantic impairment?

23 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

24 Sem impairment Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

25 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

26 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

27 How can we confirm what level the impairment is for AER & GSW? Observe behaviour & relate to the model of language processing What errors do they make in speech production? How do they do on other tasks that share the same processing components? Semantic errors Semantic impairment?

28 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Writing Heard Speech Print Idea, Picture, or seen object Semantic impairment Lexical Semantics

29 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Writing Heard Speech Print Idea, Picture, or seen object Semantic impairment Lexical Semantics

30 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Writing Heard Speech Print Idea, Picture, or seen object Semantic impairment Lexical Semantics Semantic impairment Speech output: (semantic errors) 

31 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Idea, Picture, or seen object Semantic impairment Lexical Semantics Semantic impairment Speech output: (semantic errors) 

32 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Semantic impairment Speech output: (semantic errors) Written output: Speech comprehension: Written comprehension: Lexical Semantics     Semantic errors in all modalities Idea, Picture, or seen object

33 How can we confirm what level the impairment is for AER & GSW? Observe behaviour & relate to the model of language processing What errors do they make in speech production? How do they do on other tasks that share the same processing components? Semantic errors Semantic impairment? Impaired comprehension & written naming How do they do when you test comprehension & written naming?

34 Assessment of semantic processing in comprehension Require an assessment that has semantically related distractors Perform the assessment in both spoken and written forms Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Pictures, seen objects Lexical Semantics

35 Assessing semantics: PALPA Spoken Word-Picture matching No. correct (n=40) AER37 GSW38 Controls Mean39.29 (SD:1.07; Range 35-40) 2 SDs below the mean = 37.15 37 is considered outside normal limits “carrot” 

36 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Writing Heard Speech Print Idea, Picture, or seen object Semantic impairment Lexical Semantics

37 Assessing semantics: PALPA Written Word-Picture matching No. correct (n=40) AER38 GSW39 Controls Mean39.29 (SD:1.07; Range 35-40) 2 SDs below the mean = 37.15 37 is considered outside normal limits carrot

38 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Writing Heard Speech Print Idea, Picture, or seen object Semantic impairment?

39 Pyramids & Palm trees (Howard & Patterson, 1992) pyramid “pyramid” AER: 3 picture version: 87% 1 written word-2 pictures: 87% 1 spoken word-2 pictures: 85% N=52 Controls score 94% correct or higher Semantic impairment

40 Does AER have a semantic impairment?

41 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Speech output: (semantic errors) Written output: Speech comprehension: Written comprehension: Lexical Semantics  ?   Does AER have a semantic impairment? YES!

42 Maybe… but it’s a very easy task What about GSW? He can do word- picture matching…. does that mean he has intact semantics?

43 Assessing semantics PALPA wd-pic match (n=40) High Image. Synonym Judgements “Marriage – lamp” “Marriage – wedding” AER37/38 GSW38/39 Low Image. “reality - truth” “reality-notion”

44 Assessing semantics PALPA wd-pic match (n=40) High Image. Synonym Judgements AER37 GSW38 Low Image. 87% ^ 100% * 63% 90% Lower limit 38.98 (37/38)^.88 (34/38) of ‘normal’.93 (28/30)*.83 (25/30)

45 Maybe… but it’s a very easy task What about GSW? He can do word- picture matching…. does that mean he has intact semantics? But he can do synonym judgements too – so maybe his semantics is intact But didn’t we say semantic errors were a result of semantic impairments !

46 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

47 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

48 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

49 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

50 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

51 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes ætdogk

52 How can we confirm what level the impairment is? Observe behaviour & relate to the model of language processing What errors do they make in speech production? How do they do on other tasks that share the same processing components? Semantic errors Post-Semantic impairment?

53 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Pictures, seen objects Post-Semantic impairment Speech output:

54 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Pictures, seen objects Post-semantic impairment Speech output: (semantic errors) Written output: Speech comprehension: Written comprehension: (assuming no additional impairments)  ok

55 What is GSW’s impairment? Observe behaviour & relate to the model of language processing What errors do they make in speech production? How do they do on other tasks that share the same processing components? Semantic errors Post- Semantic impairment Intact comprehension

56 Summary Semantic impairment (AER) Post-semantic impairment (GSW) Speech output  semantic errors Written output  semantic errors ok Speech comprehension  semantic errors ok Written comprehension  semantic errors ok

57 Heard Speech Print Semantics Phonological Output Lexicon Speech output Phonological Buffer / Phonemes Writing Idea, picture or seen object Impairments of word retrieval Semantic impairment Post-semantic lexical retrieval impairment

58 What about CI? What errors does she make in speech production? / ef  l.. ef  lt  n  lf  n  nt  lf  n  nt  lf  t  n  lf  nt el  f  n ef  l  nt / /su:p  b  n  n s  b  bri: s  b m  ri:n/ Phonologica l errors

59 Observe behaviour & relate to the model of language processing What errors does she make in speech production? What about CI? Phonologica l errors

60 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk

61 Impaired phoneme activation

62 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk Impaired phoneme activation

63 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt d ogk Impaired phoneme activation

64 Rapid decay of phoneme activation

65 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt do gk Rapid decay of phoneme activation

66 Phoneme activation noise

67 Semantics Object, picture or idea purrs cat dog rabbit fish barks fur pet 4-legs scales house robin Phonological Lexicon Phonological Buffer/ Phonemes æt do gk Phoneme activation noise

68 Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Pictures, seen objects Phoneme level impairment Speech output: (Phonological errors) Written output: Speech comprehension: Written comprehension: (assuming no additional impairments)  ok

69 Phoneme level impairment Phonological Output Lexicon Speech output Phonological Output Buffer Lexical Semantics Orthographic Output Lexicon Graphemic Output Buffer Writing Heard Speech Print Pictures, seen objects Repetition of nonwords Sublexical reading

70 CI – examples of errors across tasks SubmarinePyramid Naming su:p  b  n  np  r  m  nt Reading s  b  r  li:npr  m  d  d Repetition sbmnsbmnpr  m  m  m

71 Semantic impairment Post-semantic /lexical access Phoneme level Speech output Errors  Semantic  Semantic  Phonological Written output  semantic ok Speech comp.  semantic ok Written comp.  semantic ok Errors in repetition & reading No ok Yes

72 Observe behaviour & relate to the model of language processing What errors does she make in speech production? What about CI? Phonologica l errors Phoneme level impairment How do they do on other tasks that share the same processing components? Intact comprehension & written naming but impaired repetition and reading of words and nonwords What factors affect the accuracy of their speech production?

73 Semantic impairment Post-semantic /lexical access Phoneme level Speech output Errors  Semantic  Semantic  Phonological Written output  semantic ok Speech comp.  semantic ok Written comp.  semantic ok Phonological errors in repetition & reading No ok Yes Frequency Imageability Semantic category Effects of.. Frequency Number of phonemes CI 1 syllable: 86% 3 syllable: 23%

74 Aim & Structure This presentation will… address the systematic research on treatment for word retrieval disorders Focus on word retrieval disorders in aphasia Structure define the problem & how to assess it discuss the evidence on treatment approaches Done!

75 Defining the problem What do we mean by word retrieval? successfully accessing the phonological form of a word from semantics exclude impairments of phonological processes and articulation i.e. Semantic impairments & post-semantic impairments Different levels of impairment require different treatment

76 How do we decide which treatment? Each different level of breakdown in word production will be best remediated by a different type of treatment (e.g. Hillis & Caramazza, 1994; Nettleton & Lesser, 1991) impaired word meaning (semantics) → treatment focusing on meaning impaired retrieval of the phonological form from semantics → treatment focusing on providing/accessing the phonological form impaired phoneme level/phonological encoding → treatment focusing on phonemes We’ll discuss the evidence for which kinds of treatment are most effective for each level of impairment. In other words … what works! But how can we tell if it works? Use some straightforward methodological controls Eh????

77 What do we need to know? Is there any change in performance?

78 What do we need to know? Test naming before (preferably more than once) and after treatment …. has it improved? Is there any change in performance?

79 Is the change due to your therapy? And then swap and treat the other half … do they improve now? What do we need to know? Test naming before (preferably more than once) and after treatment …. has it improved? Treat half the items and not another half … do the ones you treat improve and not the others (or not as much)?

80 And then swap and treat the other half … do they improve now? What do we need to know? Test naming before (preferably more than once) and after treatment …. has it improved? Treat half the items and not another half … do the ones you treat improve and not the others (or not as much)? Test other tasks that you would predict would improve (generalisation) …. have they? Test other tasks that you would predict would NOT improve (control task) …. have they?

81 How do we know if it works? We can only tell if our therapy works if we use good methodological controls these are not just for researchers – they are for everybody Use enough items that you can tell if the change is real (8 items is not enough!) To examine effects at other levels (e.g. connected speech, conversation, quality of life) use measures that will be sensitive to your intervention.

82 Time for a break!


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