LUNA: Intervention for Personal Storytelling in …...JB Word (Ns, Vs, Adjs) Word (pronouns,...
Transcript of LUNA: Intervention for Personal Storytelling in …...JB Word (Ns, Vs, Adjs) Word (pronouns,...
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LUNA: Intervention for Personal
Storytelling in Aphasia
Lucy Dipper, Jennifer O’Grady, Madeline Cruice
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Acknowledgements
The LUNA Team
MSc Research Student: Jennie O’Grady
BSc Student Research Therapists: Amy McClean
Emily Wakefield, Alice Gardner, Emma Rhodes
& Alice Thompson
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What is LUNA?
Linguistics Underpins Narrative in Aphasia
Linguistic analysis to identify treatment targets
Multiple linguistic levels targeted
Personal narratives to support everyday talk
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Aims & Research Questions
We aimed to improve personal storytelling in order to bridge
from clinical to real-life talk.
RQs
1. Is LUNA feasible and acceptable to participants?
2. Does LUNA therapy improve linguistic features and
discourse structure of a treated personal story?
3. Do gains generalise to an untreated fairy-tale?
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Methods - Participants
Gender 4 male: 1 female
Age 36-61 years
Time Post Onset 3 – 14 years
Aphasia Type 3 anomic,1 conduction, 1Broca
WAB Aphasia Quotient 62.7-81.1 (M = 78.02)
Spontaneous Speech 13-18 (M = 15.2)
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Methods - Therapy
“Tell a story that is meaningful for you and that you might
want to tell to family or friends.”
Narrative analysed using a step-by-step protocol of linguistic
analysis to generate a list of treatment targets
60 minutes of 1:1 therapy, once per week, x7 weeks
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Methods - Analysis Protocol
Colour code the lexical categories (N, V, P, A, Adv)
Mark the phrases (NP, PP, AP)
Mark the simple & complex sentences
Identify the connectives (and, or, but, because, so)
Highlight the reference chains
Identify story grammar elements (setting, events, resolution)
Throughout: summarise strengths and difficulties
And: identify targets for therapy (words, phrases,
sentences, connectives, pronouns, story elements)
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Methods – Participant profiles
Strengths Difficulties
JB Word (Ns, Vs, Adjs) Word (pronouns, function words)
simple sentence, narrative
JS Simple sentence, narrative Word (phonological errors and
neologisms), complex sentences
JW Simple sentences Word (lack of variety, light verbs),
narrative
MS Word (Ns, some Adjs) Word (Vs), simple sentence, narrative
SM Word (Ns, Adj, Adv), simple
sentences
Word (Vs, pronouns), complex
sentences, narrative
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Methods - Participant Stories
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Methods –example therapy
Intervention Target
Intervention Activity
Word Creation of list of key words relevant to storyNaming key words from pictures
Generating synonyms using SFA
Simple Sentence
Mapping Therapy activities – generating sentences using key words and colour-coded sentence frames.
Complex Sentence
Discussion of cause and effect & relevant connectivesLinking sentences using connective prompt cards
Narrative Creating list of Story Grammar elementsLinking elements to key words and practiced sentencesPracticing story using Story Grammar prompt cards
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Outcome Measures
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Results – Word Level (% narrative words)Significant gain
pre intervention (Mdn=71.43, IQR=57.44-75.59);
post intervention (Mdn=72.51, IQR=65.26-
83.71); P < 0.05 reflecting a shift in IQR
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Results – Sentence Level (PAS)
% PAS as a total of
verb structures
No significant change
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Results – Sentence Level (%complete utterances)Significant gain
pre intervention (Mdn=63.01, IQR=17.38-
83.82); post (Mdn=77.42, IQR=36.44-88.48);
W=0.00, p=0.04, reflecting increase in
median %.
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Results – Story Level (local coherence)
significant increase in the presence of entirely related utterances post
intervention
(Mdn=58.14, IQR=48.75-67.55) compared to pre-intervention (Mdn=52.27,
IQR=33.08-55.73; W=0.00, p=0.04
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Results – Story Level (Story Grammar)
Gains were variable across individuals
and were not significant for the group
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Results - SUMMARY
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Results - Generalisation to untreated Cinderella
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Discussion:
1. Is LUNA feasible and acceptable to participants?
Feasibility: • stories told spontaneously & with relative ease;
• Stories produced enough language for analysis
• Stories produced (more than) enough language for identifying
treatment targets and for generating therapy materials
• 7 week multi-level intervention resulted in improvement
Acceptability to participants
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Discussion:
2. Does LUNA therapy improve linguistic features and
discourse structure of a treated personal story?
3. Do gains generalise to an untreated fairy-tale?
The ‘worked-on’ language improved for all participants at
three levels – word, sentence, story
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Conclusion
relatively low dose and non-intensive treatment (7 hrs)
produces significant change for these 5 individuals on
treated narrative
Improvements did not generalise to an untreated fairytale,
but would they have generalised to an untreated personal
story?
Changes reported here are statistically significant at the
group level, but do they constitute clinically significant
and personally meaningful change?
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it’s mine isn’t it…it’s a proper…it’s a
cruise…it’s a proper…if it was just fiction it
would be a fiction story but this is proper, so I
was pleased about that…it was good
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City, University of London
Northampton Square
London
EC1V 0HB
United Kingdom
T: +44 (0)20 7040 5060
www.city.ac.uk/department
Thank you