1. MossTalk Training for Word Retrieval Across Semantic Categories Tiffany Johnson, Erin Todd, & Anastasia Raymer* Old Dominion University, Norfolk VA; *Brain Rehabilitation Research Center, Gainesville, FL ABSTRACT Few studies have examined the ability of patients to work independently with computer training programs to improve word retrieval in aphasia. In a single-participant design, we investigated effects of independent computerized training with MossTalk multi-mode matching exercises in two individuals with severe word retrieval impairments. We examined effects of treatment for trained words and untrained words from the trained semantic categories and untrained categories. Both participants improved in picture naming for trained words. One showed limited generalization to untrained words and gains in standardized testing. Improvements were smaller than those reported for patients in a prior clinician-assisted MossTalk study. INTRODUCTION Large word retrieval treatment literature reports largely training specific effects with little generalization to untrained words (Nickels, 2002) Some generalization observed when training within semantic categories; i.e. training of some category members generalizes to improvement in naming other members of the same semantic category (Spencer et al., 2000; Kiran & Thompson, 2004) Training techniques are needed that patients can implement independently to increase opportunity to practice functional vocabulary One means of supporting independent practice is through the use of computers Much training software available for purchase; only limited data on usefulness MossTalk Words (Fink et al., 2001) experimental computer program for word retrieval training Fink et al (2002) showed effectiveness of MossTalk Cueing Hierarchy Training module with partial clinician assistance Raymer et al (2006) showed effectiveness of MossTalk Multimodality Matching Exercises with clinician assistance - patterned after studies of comprehension training for word retrieval in aphasia (Pring et al., 1990; Nickels & Best, 1996) -Effects were greatest when training took place 3-4 times per week as compared to 1-2 times per week METHODS PURPOSE To explore usefulness of MossTalk Words Multimode Matching exercises administered independent of a clinician To examine generalization of treatment effects within and across semantic categories DISCUSSION Why no generalization to untrained items in same semantic category? -Methodologic differences in our study versus others -Although Spencer et al (2000) reported generalization of naming training within a semantic category, they trained only one category at a time for many, many sessions -Kiran & Thompson (2002) reported generalization to untrained category members when training atypical category items, but not when training typical category members -Within constraints of MossTalk Words, we trained items that were fairly typical of the given categories, and we trained 4 categories at one time -In order to promote generalized training effects, suggests need to train one category at a time for many sessions; possibly need to train atypical items References Fink, Brecher, & Schwartz. (2002). Aphasiology, 16, 1061- 1086. Fink, Brecher, Montgomery, & Schwartz (2001). Moss Talk Words. Philadelphia: Albert Einstein Healthcare Network. Kiran, S., & Thompson, C.K. (2002). Journal of Speech-Language-Hearing Research, 46, 608-622. Nickels & Best (1996).Aphasiology, 10, 109-136. Nickels, L. (2002). Therapy for naming disorders: Revisiting, revising, and reviewing. Aphasiology, 16, 935-979. Pring, White-Thomson, Pound, Marshall, & Davis (1990). Aphasiology, 4, 479-483. Raymer, A.M., Kohen, F., & Saffell, D. (2006). Aphasiology, 20, 257-268. Spencer, K.A., Doyle, P.J., McNeil, M.R., Wambaugh, J.L., Park, G., & Carroll, B. (2000). Aphasiology, 14, 567-584. Zingeser, L.B., & Berndt, R.S. (1990). Brain and Language, 39, 14-32. Participants: 2 right handed individuals with stroke leading to right hemiparesis, aphasia, apraxia P1P2 Age:62 yrs52 yrs Gender:MF Education:9 yrs17 yrs Time post CVA: 3 yrs4 1/2 yrs Aphasia Classification Broca Broca Lexical Testing (Zingeser & Berndt, 1990) Pic Naming Nouns 13/6039/60 Wd/Pic Verif Nouns36/6050/60 Breakdown: semanticmild semantic Single Subject Treatment Design: Daily Probe Task/Stimuli: Name to picture confrontation Stimuli: 50 nouns 4 x 6 colored pictures from 4 semantic categories: clothing, vegetables, toiletries, kitchen items Tx Set 1: n=16 - 4 items from 4 categories Tx Set 2: n=16 - 4 items from 4 categories Generalization set: n=8 – 2 items from 4 categories Control set: 10 items from unrelated semantic categories (tools, furniture) matched for frequency Correct responses: recognizable spoken word allowing for articulatory distortions. Dependent variable: # correct Procedure: Single participant treatment design 3-4 Baseline Sessions Training: 5 days per week for 2 weeks Probe sessions: 1-2 times per week Treatment competed after 2 weeks or 2 sessions at 90% accuracy Treatment Protocol: MossTalk Words Multimode Matching Exercises (Fink et al., 2001) Independent practice daily 1)Spoken + Written word/picture matching - computer says word and presents written word; - pt. touches correct picture of 4 related choices 2) Spoken word/picture matching - computer says word - pt. touches correct picture of 4 related choices 3) Written word/picture matching - computer presents written word - pt. touches correct picture of 4 related choices Participant then attempted to say name of target picture. Naming Training (Figures 1 & 2): Both participants demonstrated modest, but significant naming improvements, greater for P2 than for P1; P2 replicated the effect in a second set of training items Very little generalized improvements in untrained items from same semantic categories and from different semantic categories (control set) Improvements in this independent study not as strong as earlier study (Raymer et al., 2006) using MossTalk Words with clinician assistance Standardized Testing Results Both participants improved slightly on BNT, and P2 improved also on WAB – primarily in comprehension tasks Improvement in comprehension compatible with training protocol in which auditory comprehension critical component Alternative Explanations for Results Spontaneous Recovery or Repeated Exposure? Both subjects many years post onset of aphasia Effects for training words surpassed effects for untrained words, suggesting repeated exposure may have contributed to small generalized improvements, but training effects far surpassed simple practice. RESULTS Picture Naming Effect Sizes Phase 1P1P2 Trained 14.03.0* Trained 2(untrained) -.571.19 Generalization.141.29 Control.25.86 Phase 2 Trained 1 (maint)1.07.46 Trained 2 1.012.97 Generalization.651.36 Control.482.16 Acknowledgments: Appreciation to Ruth Fink, of the Albert Einstein Healthcare Network, who generously provided a copy of MossTalk Words. This study was supported in part by the Department of Veterns Affairs Office of Rehabilitation Research and Development. Western Aphasia Battery: P1 PrePost P2 Pre Post Fluency (max 10) 2 33 0 Comprehension (max 10)4.5 5.25.7 7.4 Repetition (max 10)2.2 1.23.4 1.2 Naming (max 10)2.3 2.25.1 4.8 Total AQ (max 100)35.9 33.236.4 48.8 Boston Naming Test (max 60) 2 58 12