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Dr. John C. Rosenbek Professor & Chair, Department of Communicative Disorders Harrison Jones, M.S. RSD/Doctoral Student Department of Communicative Disorders.

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Presentation on theme: "Dr. John C. Rosenbek Professor & Chair, Department of Communicative Disorders Harrison Jones, M.S. RSD/Doctoral Student Department of Communicative Disorders."— Presentation transcript:

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2 Dr. John C. Rosenbek Professor & Chair, Department of Communicative Disorders Harrison Jones, M.S. RSD/Doctoral Student Department of Communicative Disorders

3 APROSODIA Definition, Theory, Evaluation, Treatment

4 OR It don’t mean a thing if it ain’t got that swing Or worse in some ways it means the wrong thing

5 CHALLENGES Realizing this outline is a difficult talk Because prosody and its disorder-aprosodia- are difficult to define, describe, evaluate (reliably) and treat (effectively)

6 NONETHELESS Certain general notions are robust enough for us to make a beginning Common to think of linguistic prosody And emotional prosody

7 BUT FIRST what is prosody? – The suprasegmental features (segments are sounds) of speech conveyed perceptually by pitch stress and duration – And acoustically as changes in frequency, intensity and timing

8 VALUE OF ACOUSTIC Aids in quantification of perceptual judgement Especially critical in area such as aprosodia where diagnosis is so difficult

9 WAY TO THINK ABOUT DIFFICULTY Segmentals are the prose suprasegmentals are the poetry

10 CONSIDER I took my shotgun from the corner and slipped out the door as fast as I could. When mama talked about praying fir me it was time to go. –This Rock by Robert Morgan

11 AND THIS Behold the moralist hildago Whose whore is morning star Dressed in metal, silk and stone Syringa, cicada, his flea –A Thought Revolved by Wallace Stevens

12 DIFFERENCES Meaning is less transparent in one than the other This captures the huge difficulty of assessing, diagnosing and treating aprosodia But progress has been made Agreed upon types

13 LINGUISTIC Disambiguates words (black bird and blackbird) and Sentences (He wrote poetry. He wrote poetry?) Also called intrinsic prosody Thought to be primarily the product of left hemisphere mechanisms

14 AFFECTIVE Conveys a speaker’s emotions and attitudes I missed spending time with my father in law uttered with joy or great sorrow Sometimes called extrinsic prosody Thought to be primarily the product of right hemisphere mechanisms Depends heavily on changes in fundamental frequency

15 APROSODIA Our emphasis Ross in 1981 referred to deficits in expression and reception of affective or emotional prosody as the aprosodias He said “their functional-anatomic organization in the right hemisphere (mirrors) that of propositional language in the left..) P. 561

16 THEREFORE He identified a motor aprosodia in which reception of emotional prosody was intact A receptive in which reception was inordinately impaired And counter parts of global, transcortical motor, transcortical sensory and so on

17 VALIDITY These are notions in search of data Nonetheless clinicians know right hemisphere damage (especially) can effect the processing of emotional prosody Ross describes divorce as a consequence of a patient’s not being able to express emotion Clinicians have other similar tales

18 HOWEVER Until our recent work no therapies In general clinicians were likely to throw up their hands when confronted with the multiple problems of right hemisphere damage

19 THE PROBLEMS Limited measurement tools or tests Non-data based cutoffs of normal and abnormal for those that do exist Variability in the emotional prosody of the population The thorny problem of laboratory versus true emotional prosody

20 DESPITE ALL THIS Theories have begun to emerge Evaluation procedures likewise Treatment techniques have begun to appear With the deepest roots right here at the University of Florida Nourished by our own Ken Heilman

21 THEORIES Against the background that Myers (1999) establishes with her comment that “Mechanisms of RHD prosodic deficits are not presently understood” Heilman and his colleagues have proposed some – One is a motor theory – In simplest form the notion is that (especially expressive aprosodia) results from a deficit of execution or of programming

22 `THE SECOND Degredation of a modality specific affect lexicon Clearly this is the right hemisphere equivalent of the verbal lexicon in the left hemisphere

23 NADEAU EXPANSION The affective lexicon “may be instantiated in a pattern associator network linking predominately right hemisphere association cortices and limbic structures and limbic structures with right prefrontal and and premotor cortex”

24 EXCLUDED EXPLANATIONS Depression Agnosognosia Neglect Dysarthria

25 EVALUATION Here is where challenge of poetry is most acute Judgment of presence of both expressive and receptive aprosodia is subjective Tools have been developed to standardize the stimuli Response evaluation is still subjective

26 THE FAB Bowers, Blonder, Heilman, 1998 Assesses ability to identify spoken prosody And facial expression And interesting notion is the relationship of facial and spoken expression

27 THE FEEB Not yet non-standardized Assesses spontaneous and and imitative prosody, both affective and linguisitic Evaluation is perceptual Meaning judges say aprosodic or not.

28 COMING TOGETHER The theories, primarily, generated two treatments One called Imitative The other called cognitive-linguistic Both comprised six steps Both are loosely based on notions of errorless learning In that they go from maximum to minimum cueing Both motivated by theories of pathophysiology

29 IMITATIVE TREATMENT Step One: Cl models the requested emotional utterance and then cl and pt say together Step Two: cl models and the pt produces after delay finally, Produce the sentence in target tone of voice while imagining speaking to a family member

30 COGNITIVE-LINGUISTIC Step One: Pt given a written description of characteristics of a given tone of voice Step Two: Pt given cards listing names of emotions and asked to pick which emotion matches the tone of voice just described Advances to Step six in which pt is asked to produce tone of voice based on all written cues previously provided

31 RESEARCH Heilman and colleagues won a program project grant from NIH

32 THE DESIGN Heilman and colleagues chose the replication of an ABAC design A equals baseline B equals one of the two treatments chosen randomly The second A is baseline after one month “wash out” period C is the second treatment

33 DETAILS Stable baseline confirmed with C statistic 20 sessions of the first treatment selected randomly Post test One month “washout” Pretest 20 sessions of treatment two Post test immediately and at one and three months

34 DEPENDENT MEASURE Participants were shown a card with a sentence and asked to utter the senteNce in a particular tone of voice Adequacy of emotion judged by naïve person Knew nothing of stage or treatment

35 EMOTIONS Treated – Sad – Happy – Angry Control – Fearful

36 PROGRESS TO DATE 14 pts treated The data are informative Data are in the form of effect size and visual analysis Consider the data

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40 Statistical Analysis Visual Analysis

41 CONCLUSIONS The treatments seem to have an effect Analysis underway to determine if one more influential than the other And to determine responders and non- responders Submitted another grant and got butchered So more work to do

42 BUT Hope is the thing with feathers That perches in the soul And sings the tune without the words And never stops at all


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