1. ADULT LANGUAGE EVIDENCE BASED PRACTICE GROUP 2008 Extravaganza ADULT LANGUAGE EVIDENCE BASED PRACTICE GROUP Anika Roseby and Kate Schuj Group Co- Leaders with Lyndsey Nickels Academic Member

2. Clinical Question Last year the Group completed a CAT on repetition as a treatment for word retrieval problems in aphasia. This lead to a new question…

3. Question “How and in what circumstances does orthographic cueing as therapy improve later spoken word retrieval in aphasia?”

4. CAPping the Articles 16 possible articles were found Only 5 actually answered our clinical question and were included in our CAT Some articles were not included because we couldn’t be sure that orthographic cueing alone assisted verbal naming (combination of cueing types used e.g. semantic or repetition).

5. Exploring the Question.. How does Orthographic Cueing work? Why does it work? Who does it work for? Are the effects lasting? Is there more than one way that orthographic cueing works?

6. Approaches to rehabilitation: Restoration vs. compensation Restoration Improving the functioning of defective processes Re-teaching of missing information, rules or procedures (or regaining retrieval of that information)

7. Approaches to rehabilitation: Restoration vs. compensation Compensation Teaching a different way to perform the same function – using intact skills within the same cognitive domain Teaching a way to compensate for the lost function using different skills.

8. Cueing, Facilitation, Therapy K kangaro o

9. Cueing, Facilitation, Therapy “k” (spoken by SP) kangaroo ….later

10. Cueing, Facilitation, Therapy “k” kangaroo

11. Use of orthography to facilitate retrieval of phonological form most beneficial when written naming is less impaired than spoken naming: Someone else cueing – priming for that item only Self-cueing – generalises and compensatory

12. How does orthographic cueing work? Two methods we discuss: Generating phonemic cues from the initial letter Using direct orthographic route

13. Method 1: Generating phonemic cues from the initial letter Nickels (1992) 1. Spoken naming  2. Written naming 3. Convert letters to sounds  dog TC

14. Generating phonemic cues from the initial letter Nickels (1992) 1. Spoken naming  2. Visualise written word 3. Sound out initial letter & cue word production retaught letter-sound correspondences d dog

15. This means…. This improved TC’s spoken naming to almost the same level as his written naming. He used this spontaneously in conversation. Could be used for any word he was trying to retrieve (and was) (only fails for words with irregular initial letters e.g. onion, Cinderella)

16. Who will this work with? Requires access to the written form when the spoken form is unavailable Requires phonological cueability Requires an ability to convert letters into sounds Can be retaught Can use a computer cueing aid to do the conversion Phonologically-mediated self-cueing (e.g.; Nickels, 1992)

17. Using a computer to generate phonemic cues from the initial letter Best et al. (1997)    /d/ dog d 3. Press letter 2. Visualise first letter 4. Computer produces phoneme 5. Cue word production 1. Spoken naming 

18. Generating phonemic cues from the initial letter – who? If they are phonemically cueable They may be able to use a computer to generate the cues If they can (or be taught to) convert letters to sounds They may be able to generate their own phonological cues

19. Method 2: Self-generated orthographic cues When spoken naming  IF individuals can identify initial letter They may be able to use direct orthographic cueing (without needing to convert letters into phonemes)

20. Print How does direct orthographic cueing work? Phonological Output Lexicon Speech Lexical Semantics Orthographic Output Lexicon Writing Orthographic Input Lexicon K knife kick king etc knifeKnife Point to “ K ” “knife” Knife kick king etc Visualise K

21. Cueing aid reorganising the naming system: JOW Best et al, 1997 A direct orthographic cueing mechanism Substantial and long-lasting effects of treatment Improvement in treated and untreated items Treatment drew attention to the relationship between orthography and phonology

22. CAT Clinical bottom line: The use of orthography to facilitate retrieval of phonological form is most beneficial when written naming is less impaired than spoken naming. Using orthographic cues in therapy can lead to lasting improvements in naming treated items (just like repetition in our last CAT). Remember …. Treatment tasks can work in different ways for different people

23. Acknowledgements All the Adult Language EBP group members for all their hard work, dedication and contributions Lyndsey Nickels, our academic link; whose expertise has been invaluable!

24. References Basso A, Marangolo P, Piras F, Galuzzi C (2001) Acquisition of new "words" in normal subjects: A suggestion for the treatment of anomia. Brain and Language. Vol. 77(1), 45-59. Best W, Herbert R, Hickin J, Osborne F, Howard D.(2002) Phonological and orthographic facilitation of word-retrieval in aphasia: Immediate and delayed effects. Aphasiology, Volume 16 Issue 1 & 2 January, pages 151-168 Best W, Howard D, Bruce C, Gatehouse C. (1997) Cueing the Words: A Single Case Study of Treatments for Anomia. Neuropsychological Rehabilitation 7 (2) 105-141 Nickels, Lyndsey, (1992), The Autocue? Self-generated Phonemic Cues in the Treatment of a Disorder of Reading and Naming. Cognitive Neuropsychology, 9 (2) 155-182 Lorenz, A, Nickels, L.( 2007), Orthographic cueing in anomic aphasia: How does it work? Aphasiology. Vol 21(6-8) Aug, 670-686.