aphasia treatment overviews spring 2017 cueing hierarchies for naming oral reading approaches response elaboration treatment (RET)

cueing hierarchies process oriented approach for naming client profile: naming difficulty significantly impacts content in everyday conversation; may be a semantic or phonological source to naming problem target: increased content units in conversational speech (impairment) rationale: appropriate cues facilitate naming of targets; repeated naming strengthens the network and improves access to the lexicon

cueing hierarchies What are cueing hierarchies? Systematic, individualized hierarchies targeting either semantic and/or phonological information Protocol: in session, present target picture if the client is able to name the picture, move to the next target if the client is unable to name the picture, present cues until correct response is obtained, then move to next target Important: choose personally relevant words divide words into sets and train sequentially reserve a set of words for probe of untrained words systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

example: semantic categories target word: carrot present picture “It’s a type of vegetable.” superordinate “It’s similar to celery.” coordinate “Rabbits eat them.” associated purpose: to increase specificity of semantic processing/distinctions in order to improve naming

example: combined semantic/phonological target word: table present picture it’s a piece of furniture superordinate “It sounds like fable.” rhyming you eat dinner there associated “It starts with /t/.” initial phoneme

measurement in session data: outcome measures number of words named without cues (1 step of protocol) performance at each step use a modified SOAP note (current and last session data) and report accuracy on on each set use information about performance that you collected to assess performance variables (e.g., does she always get it on the last step? Does it vary?) outcome measures impairment: Boston Naming Test; conversational sample; untrained word probes activity/participation: self report of increased naming (e.g., fewer communication repairs needed with partner; efficiency; successful phone call, etc.)

oral reading approaches process oriented client profile: may experience inability to read any whole words (letter by letter reading; pure alexia) or able to read some words, but overall difficulty with connected text not for decoding issues target: increased reading rate and comprehension rationale: repeated oral reading strengthens access to, or representations of, words in the lexicon; faster rate results in better comprehension

oral reading What are oral reading approaches? repeated oral reading of systematically selected passages with clinician cueing Protocol: see next slides Important: choose appropriate level of text homework is essential systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

oral reading Basic MOR procedure determine rate and accuracy for a passage have patient re-read text, cueing to correct reading errors set up homework – copied text and log ---- review homework log probe rate and accuracy of practiced passage determine target rate (e.g., 75 wpm); provide new passage when criterion is reached systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

ORLA protocol (Cherney, 2004)

measurement in session data: outcome measures reading rate (wpm) and accuracy (% words accurate) comprehension probes qualitative data about cueing responsiveness outcome measures impairment: Gray Oral Reading Test; probes of untrained text activity/participation: self report of improved/increased reading of everyday reading material (varies widely)

response elaboration training (RET) process oriented approach for oral expression client profile: variety of aphasia profiles and severities target: oral discourse  increased content units and length of utterance rationale: combining behavioral techniques of modeling and forward chaining with cognitive stimulation using loose training results in expanded oral expressive output loose training - uses the client’s response as stimulus

RET Protocol: uses simple line drawings important: used modified RET (mRET) for clients with significant apraxia systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

measurement in session data: content: number of information units produced (steps 1 and 6) - may vary based on severity of client possibly grammatical production: number of morphemes, nouns, verbs, and modifiers outcome measure: increased MLU in everyday conversation; measure of impact (e.g., questionnaire, GAS)