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Transcript of Treatment of Word retrieval impairments: Do we know which tasks work for whom and why? Associate...
Treatment of Word retrieval impairments:
Do we know which tasks work
for whom and why?
Associate Professor Lyndsey Nickels
National Health and Medical Research Council
Senior Research Fellow,
Macquarie Centre for Cognitive Science (MACCS),
Macquarie University, Sydney, Australia
Aim & Structure
This presentation will…• address the systematic research on treatment for
word retrieval disorders• Focus on word retrieval disorders in aphasia
Structure• define the problem & how to assess it• discuss the evidence on treatment approaches
Defining the problem
What do we mean by word retrieval?
• successfully accessing the phonological form of a word from semantics
• exclude impairments of phonological processes and articulation
Phonological Output Lexicon
Speech output
Phonological Buffer / Phonemes
Semantics
Writing
Heard SpeechPrint
Idea, picture or
seen object
Phonological Output Lexicon
Speech output
Phonological Buffer / Phonemes
Semantics
Writing
Heard SpeechPrint
Idea, picture or
seen object
Store of word
meanings
Store of phonological word forms
Phonemes
Assemble phonemes into syllables.Retrieve articulatory plans.
visual object representations; nonlinguistic concepts
Semantics
Object, picture or idea
Phonological Lexicon
PhonologicalBuffer/
Phonemes
Semantics
Object, picture or idea
purrs barksfur pet4-legs scales
Phonological Lexicon
PhonologicalBuffer/
Phonemes
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemes
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Phoneme assembly; Articulatory plan
retrieval
How do you know what level the impairment is?
Why does it matter?
Different levels of impairment
require different
treatment
How do you know what level the impairment is?
Observe behaviour & relate to the model of language processing
What errors do they make in
speech production? What factors
affect the accuracy of their speech production?
How do they do on other tasks that share the
same processing
components?
3 people with aphasia and
word retrieval impairments
Picture naming
Playing instrumenttrumpetAER54% correct
A dog’s residenceGSW52%
correct
A clarinet
/efl .. efltn lfnnt lfnnt lftn lfnt elfn eflnt /
CI58%
correct /su:pbnn sbbri: sb mri:n/
Different error types in word retrieval
AER & GSW : semantic errors
e.g. Saxophone -> trumpet
CI : phonological errors
e.g. Submarine -> /su:pbnn/
How do you know what level the impairment is for AER & GSW?
Observe behaviour & relate to the model of language processing
What errors do they make in
speech production?
Semantic errors
Semantic impairment?
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Sem impairment
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
How can we confirm what level the impairment is for AER & GSW?
Observe behaviour & relate to the model of language processing
What errors do they make in
speech production?
How do they do on other tasks that share the
same processing
components?Semantic errors
Semantic impairment?
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
Writing
Heard SpeechPrint
Idea, Picture, or seen object
Semantic impairment
Lexical Semantics
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
Writing
Heard SpeechPrint
Idea, Picture, or seen object
Semantic impairment
Lexical Semantics
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
Writing
Heard SpeechPrint
Idea, Picture, or seen object
Semantic impairment
Lexical Semantics
Semantic impairment
Speech output:(semantic errors)
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Idea, Picture, or seen object
Semantic impairment
Lexical Semantics
Semantic impairment
Speech output:(semantic errors)
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Semantic impairment
Speech output:(semantic errors)
Written output:
Speech comprehension:
Written comprehension:
Lexical Semantics
Semantic errors in all modalities
Idea, Picture, or seen object
How can we confirm what level the impairment is for AER & GSW?
Observe behaviour & relate to the model of language processing
What errors do they make in
speech production?
How do they do on other tasks that share the
same processing
components?Semantic errors
Semantic impairment?
Impaired comprehension & written naming
How do they do when you
test comprehension & written naming?
Assessment of semantic
processing in comprehension
• Require an assessment that has semantically related distractors
• Perform the assessment in both spoken and written forms
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Pictures, seen objects
Lexical Semantics
Assessing semantics: PALPA Spoken Word-Picture matching
No. correct (n=40)
AER 37
GSW 38
Controls
Mean 39.29 (SD:1.07; Range 35-40)
2 SDs below the mean = 37.15
37 is considered outside normal limits
“carrot”
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
Writing
Heard SpeechPrint
Idea, Picture, or seen object
Semantic impairment
Lexical Semantics
Assessing semantics: PALPA Written Word-Picture matching
No. correct (n=40)
AER 38
GSW 39
Controls
Mean 39.29 (SD:1.07; Range 35-40)
2 SDs below the mean = 37.15
37 is considered outside normal limits
carrot
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
Writing
Heard SpeechPrint
Idea, Picture, or seen object
Semantic impairment?
Pyramids & Palm trees (Howard & Patterson, 1992)
pyramid “pyramid”
AER:
3 picture version: 87%
1 written word-2 pictures: 87%
1 spoken word-2 pictures: 85%
N=52Controls score 94% correct or higher Sem
antic
impa
irmen
t
Does AER have a semantic
impairment?
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Speech output:(semantic errors)
Written output:
Speech comprehension:
Written comprehension:
Lexical Semantics
?
Does AER have a semantic
impairment?
YES!
Maybe… but it’s a very easy
task
What about GSW?
He can do word-picture matching….
does that mean he has
intact semantics?
Assessing semantics
PALPA wd-pic match
(n=40)
High Image.
Synonym Judgements
“Marriage – lamp”
“Marriage – wedding”
AER 37/38
GSW 38/39
Low Image.
“reality - truth”
“reality-notion”
Assessing semantics
PALPA wd-pic match
(n=40)
High Image.
Synonym Judgements
AER 37
GSW 38
Low Image.
87%^
100%*
63%
90%
Lower limit 38 .98 (37/38)^ .88 (34/38)
of ‘normal’ .93 (28/30)* .83 (25/30)
Maybe… but it’s a very easy
task
What about GSW?
He can do word-picture matching….
does that mean he has
intact semantics?
But he can do synonym
judgements too – so maybe his semantics is
intact
But didn’t we say
semantic errors
were a result of
semantic impairments !
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
How can we confirm what level the impairment is?
Observe behaviour & relate to the model of language processing
What errors do they make in
speech production?
How do they do on other tasks that share the
same processing
components?Semantic errors
Post-Semantic impairment?
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Pictures, seen objects
Post-Semantic impairment
Speech output:
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Pictures, seen objects
Post-semantic impairment
Speech output:(semantic errors)
Written output:
Speech comprehension:
Written comprehension:
(assuming no additional impairments)
ok
ok
ok
What is GSW’s impairment?
Observe behaviour & relate to the model of language processing
What errors do they make in
speech production?
How do they do on other tasks that share the
same processing
components?Semantic errors
Post-Semantic
impairment
Intact comprehension
Summary
Semantic impairment (AER)
Post-semantic impairment
(GSW)
Speech output semantic errors semantic errors
Written output semantic errors ok
Speech comprehension semantic errors ok
Written comprehension semantic errors ok
Heard SpeechPrint
Semantics
Phonological Output Lexicon
Speech output
Phonological Buffer / Phonemes
Writing
Idea, picture or
seen object
Impairments of word retrieval
Semantic impairment
Post-semantic lexical retrieval
impairment
What about CI?
What errors does she make
in speech production?
/efl .. efltn lfnnt lfnnt lftn lfnt elfn eflnt /
/su:pbnn sbbri: sb mri:n/
Phonological errors
Observe behaviour & relate to the model of language processingWhat errors
does she make in speech
production?
What about CI?
Phonological errors
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Impaired phoneme activation
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Impaired phoneme activation
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Impaired phoneme activation
Rapid decay of phoneme activation
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Rapid decay of phoneme activation
Phoneme activation noise
Semantics
Object, picture or idea
purrs
cat dog rabbit fish
barksfur pet4-legs scales
houserobin
Phonological Lexicon
PhonologicalBuffer/
Phonemesæ td o gk
Phoneme activation noise
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Pictures, seen objects
Phoneme level impairment
Speech output:(Phonological errors)
Written output:
Speech comprehension:
Written comprehension:
(assuming no additional impairments)
ok
ok
ok
Phoneme level impairment
Phonological Output Lexicon
Speech output
Phonological Output Buffer
Lexical Semantics
OrthographicOutput Lexicon
Graphemic Output Buffer
Writing
Heard SpeechPrint
Pictures, seen objects
Repetition of nonwords
Sublexical reading
CI – examples of errors across tasks
Submarine Pyramid
Naming su:pbnn prmnt
Reading sbrli:n prmdd
Repetition sbmn prmmm
Semantic impairment
Post-semantic /lexical access
Phoneme level
Speech outputErrors
Semantic
Semantic
Phonological
Written output semantic ok
Speech comp. semantic ok
Written comp. semantic ok
Errors in repetition & reading
No No
ok
ok
ok
Yes
Observe behaviour & relate to the model of language processing
What errors does she make
in speech production?
What about CI?
Phonological errors
Phoneme level
impairment
How do they do on other tasks that share the
same processing
components?
Intact comprehension
& written naming but
impaired repetition and
reading of words and nonwords
What factors affect the
accuracy of their speech production?
Semantic impairment
Post-semantic /lexical access
Phoneme level
Speech outputErrors
Semantic
Semantic
Phonological
Written output semantic ok
Speech comp. semantic ok
Written comp. semantic ok
Phonologicalerrors in repetition & reading
No No
ok
ok
ok
Yes
FrequencyImageabilitySemantic category
Effects of.. Frequency Number of phonemes
CI 1 syllable: 86%3 syllable: 23%
Aim & Structure
This presentation will…• address the systematic research on treatment for
word retrieval disorders• Focus on word retrieval disorders in aphasia
Structure
• define the problem & how to assess it
• discuss the evidence on treatment approaches
Done!
Defining the problem
What do we mean by word retrieval?
• successfully accessing the phonological form of a word from semantics
• exclude impairments of phonological processes and articulation
i.e. Semantic impairments & post-semantic impairmentsDifferent levels of impairment
require different
treatment
How do we decide which treatment?
Each different level of breakdown in word production will be best remediated by a different type of treatment
(e.g. Hillis & Caramazza, 1994; Nettleton & Lesser, 1991)
• impaired word meaning (semantics)
→ treatment focusing on meaning
• impaired retrieval of the phonological form from semantics
→ treatment focusing on providing/accessing the phonological form
• impaired phoneme level/phonological encoding→ treatment focusing on phonemes
We’ll discuss the evidence for which kinds
of treatment are most effective for each level of
impairment.
In other words … what works!
But how can we tell if it works?
Use some straightforwar
d methodological
controls
Eh????
What do we need to know?
Is there any change in performance?
What do we need to know?
Test naming before (preferably more than once)
and after treatment ….
has it improved?
Is there any change in performance?
Is the change due to your therapy?
And then swap and treat the other half …
do they improve now?
What do we need to know?
Test naming before (preferably more than once)
and after treatment ….
has it improved?
Treat half the items and not
another half … do the ones you treat improve and not the others (or not
as much)?
And then swap and treat the other half …
do they improve now?
What do we need to know?
Test naming before (preferably more than once)
and after treatment ….
has it improved?
Treat half the items and not
another half … do the ones you treat improve and not the others (or not
as much)?
Test other tasks that you would predict would
improve (generalisation) …. have they?
Test other tasks that you would predict would NOT improve
(control task) ….have they?
How do we know if it works?
• We can only tell if our therapy works if we use good methodological controls
• these are not just for researchers – they are for everybody
• Use enough items that you can tell if the change is real (8 items is not enough!)
• To examine effects at other levels (e.g. connected speech, conversation, quality of life) use measures that will be sensitive to your intervention.
Time for a break!