1296 Nicholas Marjorie
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Transcript of 1296 Nicholas Marjorie
Pocket CPocket C--Speak Aphasia:Speak Aphasia: Handheld AAC Program for Handheld AAC Program for
People with AphasiaPeople with Aphasia
Marjorie Nicholas, PhDMarjorie Nicholas, PhD KrystalKrystal Peralta, MSPeralta, MS
Goals of this seminarGoals of this seminar
1. Describe and demonstrate PCSA
2. Show videotapes of people with aphasia learning and using PCSA
3. Discuss factors relating to successful use of PCSA:
• Cognitive requirements- research results from CSA study
• Physical requirements/issues
• Social context issues
PCSA is based onPCSA is based on CC--Speak AphasiaSpeak Aphasia
• Nicholas and Elliott (1998)• CSA was created using Speaking
Dynamically Pro and Boardmaker software (Mayer-Johnson Co.)
• Available as a special set of boards; need SDP/BM software bundle CD to operate it
Features of CFeatures of C--Speak Aphasia Speak Aphasia and the pocket versionand the pocket version
• Direct picture selection method• Minimal reading/writing required• Purposefully agrammatic• Both single icon selection to create
novel, more complex messages and
• Pre-programmed phrases for specific communication situations
CC--Speak Aphasia Main ScreenSpeak Aphasia Main Screen
PocketPocket CC--Speak AphasiaSpeak Aphasia• Software program created with
PTP-Mobile program (Point-to- pictures mobile is available as a download from rjcooper.com)
• Works on several models of Pocket PCs (Dell, HP iPAQs, etc. that operate with Windows CE)
• Designed to be as close as possible to the laptop version of C-Speak Aphasia created with SDPro
PCSA MAIN ScreenPCSA MAIN Screen
Telephone
Autobiog.
People Actions Objects
Topics
Help
PCSA People ScreenPCSA People Screen
“Bill”
Bill added to message display area
cook
cook added to message display area
PCSA Actions ScreenPCSA Actions Screen
PCSA Object Subcategories ScreenPCSA Object Subcategories Screen
food
spaghetti
spaghetti added to message display area
PCSA Food ScreenPCSA Food Screen
Then, click on display area and device speaks the message
Questions about using Questions about using handheld AAC such as PCSAhandheld AAC such as PCSA
• Loudness of voice output- may need a set of mini-speakers (some come prepackaged with the device)
• Small size of buttons and text- may be an issue for some users- need a stylus- these get lost
• Cognitive requirements similar/identical to laptop version
• Is it really true that if it’s more portable, it will be more functional?
CC--Speak Aphasia TrainingSpeak Aphasia Training
• Requires months of training to become a good user
• At first, focuses on dictated Subject- Verb-Object messages
• Progresses to responses to open-ended questions/conversations
• 3 training modules:– Generative language– Telephoning– Assisted writing and e-mailing
Pocket CPocket C--Speak AphasiaSpeak Aphasia Training: Mr. MTraining: Mr. M
Hyperlink to PCSA training session EP.mpg
• Several years post onset Left MCA CVA
• Severe nonfluent aphasia; auditory comprehension fairly good; some deficits in cognitive testing of nonverbal executive functions
•Lives by himself in a retirement community with some services; family in the local area
•Training on PCSA for a few months (2x/weekly sessions)
•Note the contrast on the video- he does well with highly structured stimulus-response “scripted” task; then has difficulty in more real-life communicative context.
Who will become effective Who will become effective users of alternative users of alternative communication systems communication systems like this?like this?
We need more evidence to We need more evidence to show whether these show whether these approaches can be approaches can be
efficacious for people with efficacious for people with severe aphasiasevere aphasia
Using a computer to communicate: Effect of executive function impairments in people with severe aphasia.
Marjorie Nicholas, Michele P. Sinotte, Nancy Helm-Estabrooks, Aphasiology, 2005.
Goals of the StudyGoals of the Study
1. Investigate whether functional communication could be improved via training on an alternate commun- ication system (C-Speak Aphasia)
2. Find out who the good candidates are for such systems, by examining both cognitive and linguistic factors as they relate to response to training.
Hypotheses:Hypotheses:
1. Some patients will improve functional communication via use of C-Speak Aphasia
2.2. Executive functionExecutive function skills will be important to good response
3. Severity of aphasia and specifics of the language impairment will be less important
Overall Design of the Study: Single Subject, Overall Design of the Study: Single Subject,
Multiple Baseline, Repeated MeasuresMultiple Baseline, Repeated Measures
• Baseline testing of:- language and nonverbal cognitive skills- semantic categorical knowledge- functional communication probe tasks
– Off computer– On computer
• Treatment begins: Module 1- Generative language
• Retest functional communication probe tasks every 3-4 weeks, each time
– Off computer– On computer
• Treatment lasts approx. 6 to 12 months
Data from first 5 subjects have been Data from first 5 subjects have been analyzed and published *analyzed and published *
Currently 8 additional subjects also Currently 8 additional subjects also have been treated and data analysis have been treated and data analysis is in progress. is in progress.
3 of these subjects use PCSA3 of these subjects use PCSA
* Nicholas, M., Sinotte, M.P., & Helm-Estabrooks, N. (2005). Using a computer to communicate: Effect of executive function impairments in people with severe aphasia. Aphasiology, 19, (10/11), 1052-1065.
CSA Outcome Measures:CSA Outcome Measures: Five Probe TasksFive Probe Tasks
1.1. Autobiographical questionsAutobiographical questions: answering 7 questions: e.g. “What is your address?”
2.2. Picture descriptionsPicture descriptions: describe 5 simple photos, e.g. a man drinking coffee
3.3. Video event retellingVideo event retelling: describe a video of a kitchen scene with mother, 2 kids, and cat
4.4. Telephone callsTelephone calls: making two short calls with specified information to be exchanged
5.5. Writing tasksWriting tasks: a birthday card and a grocery list, with some specified information
Example of data for scoring of Example of data for scoring of video description taskvideo description task
Off-computer:“Um”, gestures cutting,“um”, gestures falling, “two”, gestures flathand to represent 2 children, gestures drinking, “too dee”, gestures drinkingand eating, “too dee”
On-computer:C: Marjorie cook knife eat cucumber lettuce. Girl eat grapes. Girl fall a little bit. Marjorie eat cookies milk girl. Girl go cat. Boy eat cookies milk.
RESPONSE TO RESPONSE TO TRAININGTRAINING
Response to Training: Response to Training: Sample novel storySample novel story
Performance on Probe Tasks: Performance on Probe Tasks: Answering Autobiographical QuestionsAnswering Autobiographical Questions
•Able to communicate quite a lot at baseline
•On-computer scores only slightly higher
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B1 B2 B3 1 2 3 4 5
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Off-ComputerOn-Computer
Baseline Treatment
Performance on Probe TasksPerformance on Probe Tasks Picture DescriptionsPicture Descriptions
•On-computer scores much higher on this task thanoff-computer scores
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12
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B1 B2 B3 1 2 3 4 5
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Off-Computer
Baseline Treatment
Performance on Probe TasksPerformance on Probe Tasks Telephone callsTelephone calls
Again, on-computer scores are much higher than off-computer
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On-Computer
Off-Computer
Baseline Treatment
Summary score differences (Across all 5 tasks)Mean probe score minus mean baseline score for the
off-computer and on-computer probes.
Off- computer
On- computer
Subject 1 -.03 39.7
Subject 2 2.8 27.7
Subject 3 3.2 13.1
Subject 4 13.8 13.4
Subject 5 7.2 16.8
RESULTS SUMMARYRESULTS SUMMARYDespite similar aphasia profiles, subjects
responded quite differently to C-Speak training.Subject 1, with the most “normal” nonverbal
CLQT scores has shown best response (Graphs) Subject 2, with good Symbol Cancellation and
Design Generation scores on CLQT also has shown improvements on many probe tasks
Subject 3, with the worst CLQT scores overall has NOT shown improvements on most probe tasks.
Subject 4, with poor CLQT scores overall has NOT shown much improvement on probe tasks.
Subject 5, at normal cut-off on 2 CLQT subtests (but not Design Generation) - performance variable; some benefits of using the computer started to emerge
Conclusions From the CSA Conclusions From the CSA research studyresearch study
• Nonverbal cognitive measures, particularly executive function (EF) measures of “creativity” or cognitive flexibility such as Design Generation, may be able to predict who will respond favorably to training on systems like C- Speak Aphasia
• Recommend evaluations of EF be included as part of all assessments for treatment candidacy
Back to Pocket CSABack to Pocket CSAVideo sample: Mr. T• Several years post onset L MCA CVA• Severe nonfluent aphasia- no real words, only
syllable stereotypy; relative preservation of auditory comprehension; relative preservation of nonverbal executive function skills
• Lives with wife• Independent in most life activities• Has been learning PCSA for several months• Video shows combination of treatment tasks and
conversation
Hyperlink to PCSABO.mpg
Back to Pocket CSABack to Pocket CSAVideo sample: Mr. R• Several years post onset L MCA CVA• Severe nonfluent aphasia- stereotypy plus a
developing corpus of words; moderate impairment of auditory comprehension; relative preservation of nonverbal executive function skills
• Lives with wife• Independent in most life activities• Video shows how PCSA augments conversation for
some situations only• Since repetition is relatively preserved, he can use
the computer’s output as a model for natural speech also.
Hyperlink to PCSAconv.EG.mpg
Limitations specific to Limitations specific to Pocket CPocket C--Speak Aphasia and other similar Speak Aphasia and other similar
handheld AAC systems for aphasiahandheld AAC systems for aphasia
• Cognitive issues related to flexibility, switching• Assistant required to personalize boards- must
learn how to do the editing• Semantic issues related to knowledge of
semantic categorization (how the boards are designed)
• Physical limitations of the device-– battery/power limitations – sound – need for assistant who can link to desktop computer
for downloads/back-ups of boards
Social Limitations specific to Social Limitations specific to Pocket CPocket C--Speak Aphasia and other similar Speak Aphasia and other similar
handheld AAC systems for aphasiahandheld AAC systems for aphasia
• User and partner are looking at the device rather than at each other
• AS with any AAC device, using it tends to interfere with the feeling of a spontaneous, naturalistic, give and take interaction.
• This may be particularly true when there is some residual natural language capacity (as in the last sample)
Thank you!Thank you!
Questions?