Wahn 2005 Turku Lexicon and Speech Production in Aphasia: An Empirical Study with AAC Lexicon and...

Wahn 2005 Turku

Lexicon and Speech ProductionLexicon and Speech Productionin Aphasia:in Aphasia:

An Empirical Study with AAC An Empirical Study with AAC

Lexicon and Speech ProductionLexicon and Speech Productionin Aphasia:in Aphasia:

An Empirical Study with AAC An Empirical Study with AAC

Wahn 2005 Turku

University of Cologne, University of Cologne, GermanyGermany

Pedagogics and Therapy ofPedagogics and Therapy ofSpeech-Language DisordersSpeech-Language Disorders

Claudia Wahn, Ph. D.Claudia Wahn, Ph. D.

University of Cologne, University of Cologne, GermanyGermany

Pedagogics and Therapy ofPedagogics and Therapy ofSpeech-Language DisordersSpeech-Language Disorders

Claudia Wahn, Ph. D.Claudia Wahn, Ph. D.

Wahn 2005 Turku

Aphasia:Aphasia:

„„One in a group of speech [and One in a group of speech [and language] disor-language] disorders in which there is a defect or ders in which there is a defect or loss of the loss of the power of expression by speech, power of expression by speech, writing, or signs, writing, or signs, or a defect or loss of the power of or a defect or loss of the power of comprehension comprehension of spoken or written language of spoken or written language [resulting from a[resulting from a damage to the brain caused by damage to the brain caused by injury or injury or disease].“ disease].“

(Medical dictionary 2005)(Medical dictionary 2005)

Aphasia:Aphasia:

„„One in a group of speech [and One in a group of speech [and language] disor-language] disorders in which there is a defect or ders in which there is a defect or loss of the loss of the power of expression by speech, power of expression by speech, writing, or signs, writing, or signs, or a defect or loss of the power of or a defect or loss of the power of comprehension comprehension of spoken or written language of spoken or written language [resulting from a[resulting from a damage to the brain caused by damage to the brain caused by injury or injury or disease].“ disease].“

(Medical dictionary 2005)(Medical dictionary 2005)

Wahn 2005 Turku

Aphasia eligibility criteria:

Brain injury: Influence on speech production and speech perception,

Clearly defined, e.g. lesion in the brain,

Acquired speech and language disorder (does not include developmental disorders),

After primary language acquisition,

Affects all modilities: speech productionspeech production, , speech perception,speech perception, reading and spelling, reading and spelling,

Differential diagnosis: Dysarthria.

Aphasia eligibility criteria:

Brain injury: Influence on speech production and speech perception,

Clearly defined, e.g. lesion in the brain,

Acquired speech and language disorder (does not include developmental disorders),

After primary language acquisition,

Affects all modilities: speech productionspeech production, , speech perception,speech perception, reading and spelling, reading and spelling,

Differential diagnosis: Dysarthria.

Wahn 2005 Turku

Electronical devices and Electronical devices and intervention:intervention:

„„No research to date has documented a No research to date has documented a decrease in functional decrease in functional speech potential as a result of the use of speech potential as a result of the use of augmentative augmentative techniques; in fact, studies have documented techniques; in fact, studies have documented increases in increases in functional speech potential.“ functional speech potential.“

(VANDERHEIDEN & YODER, 1986)(VANDERHEIDEN & YODER, 1986)

The application of electronical devices has to be The application of electronical devices has to be considered in considered in the context of development of Augmentative and the context of development of Augmentative and Alternative Alternative Communication (AAC). Communication (AAC).

Current situation:Current situation: „Multi-Component „Multi-Component Communication System Communication System

for Disabled Persons“ for Disabled Persons“

(VANDERHEIDEN, 1986) (VANDERHEIDEN, 1986)

Electronical devices and Electronical devices and intervention:intervention:

„„No research to date has documented a No research to date has documented a decrease in functional decrease in functional speech potential as a result of the use of speech potential as a result of the use of augmentative augmentative techniques; in fact, studies have documented techniques; in fact, studies have documented increases in increases in functional speech potential.“ functional speech potential.“

(VANDERHEIDEN & YODER, 1986)(VANDERHEIDEN & YODER, 1986)

The application of electronical devices has to be The application of electronical devices has to be considered in considered in the context of development of Augmentative and the context of development of Augmentative and Alternative Alternative Communication (AAC). Communication (AAC).

Current situation:Current situation: „Multi-Component „Multi-Component Communication System Communication System

for Disabled Persons“ for Disabled Persons“

(VANDERHEIDEN, 1986) (VANDERHEIDEN, 1986)

Wahn 2005 Turku

Portable Communication Assistant Portable Communication Assistant for People for People with Acquired Dysphasiawith Acquired Dysphasia (PCAD):

PCAD was a TIDE-Project, sponsored by the PCAD was a TIDE-Project, sponsored by the EU in coope-EU in coope-ration with the following partners (1997-ration with the following partners (1997-2002/04):2002/04):

Thames Valley University, Slough (UK), Thames Valley University, Slough (UK), Speech and Language Therapy Research Speech and Language Therapy Research Unit, Bristol (UK),Unit, Bristol (UK), Toby Churchill Ltd. (UK),Toby Churchill Ltd. (UK), Stichting Afasie-Therapiezentrum, Stichting Afasie-Therapiezentrum, Rotterdam (NL)Rotterdam (NL) Kompagne (NL),Kompagne (NL), University Hospital of Lund (S),University Hospital of Lund (S), University of Leipzig (D).University of Leipzig (D).

Portable Communication Assistant Portable Communication Assistant for People for People with Acquired Dysphasiawith Acquired Dysphasia (PCAD):

PCAD was a TIDE-Project, sponsored by the PCAD was a TIDE-Project, sponsored by the EU in coope-EU in coope-ration with the following partners (1997-ration with the following partners (1997-2002/04):2002/04):

Thames Valley University, Slough (UK), Thames Valley University, Slough (UK), Speech and Language Therapy Research Speech and Language Therapy Research Unit, Bristol (UK),Unit, Bristol (UK), Toby Churchill Ltd. (UK),Toby Churchill Ltd. (UK), Stichting Afasie-Therapiezentrum, Stichting Afasie-Therapiezentrum, Rotterdam (NL)Rotterdam (NL) Kompagne (NL),Kompagne (NL), University Hospital of Lund (S),University Hospital of Lund (S), University of Leipzig (D).University of Leipzig (D).

Wahn 2005 Turku

Research questions:Research questions:

Can AAC (electronical device) Can AAC (electronical device) be used to be used to close the gap between lexicon close the gap between lexicon and speech-and speech- output (overt speech)?output (overt speech)?

Research questions:Research questions:

Can AAC (electronical device) Can AAC (electronical device) be used to be used to close the gap between lexicon close the gap between lexicon and speech-and speech- output (overt speech)?output (overt speech)? Can AAC be used for Can AAC be used for functional conver-functional conversation? sation?

Can AAC be used for Can AAC be used for functional conver-functional conversation? sation? How effective is AAC, How effective is AAC, especially PCAD? especially PCAD? How effective is AAC, How effective is AAC, especially PCAD? especially PCAD?

Wahn 2005 Turku

Research population:Research population:

25 German adults (13 male; 12 female) 25 German adults (13 male; 12 female) identified with identified with aphasia AAT (HUBER et al., 1983), aphasia AAT (HUBER et al., 1983), mean age: 57mean age: 57

11stst group (p1-p12): status of chronic aphasia group (p1-p12): status of chronic aphasia (2-24 years (2-24 years post insult) post insult) 22ndnd group (p13-p24): status of acute aphasia group (p13-p24): status of acute aphasia (3-7 weeks (3-7 weeks post insult) post insult)

Saxonia, GermanySaxonia, Germany

No treatment with AAC (Augmentative No treatment with AAC (Augmentative Alternative Alternative Communication) as a part of speech and Communication) as a part of speech and language language therapy.therapy.


25 German adults (13 male; 12 female) 25 German adults (13 male; 12 female) identified with identified with aphasia AAT (HUBER et al., 1983), aphasia AAT (HUBER et al., 1983), mean age: 57mean age: 57

11stst group (p1-p12): status of chronic aphasia group (p1-p12): status of chronic aphasia (2-24 years (2-24 years post insult) post insult) 22ndnd group (p13-p24): status of acute aphasia group (p13-p24): status of acute aphasia (3-7 weeks (3-7 weeks post insult) post insult)

Saxonia, GermanySaxonia, Germany

No treatment with AAC (Augmentative No treatment with AAC (Augmentative Alternative Alternative Communication) as a part of speech and Communication) as a part of speech and language language therapy.therapy.

Wahn 2005 Turku


Etiology:Etiology:

Vascular lesion/Intracranial insult (stroke): Vascular lesion/Intracranial insult (stroke): 1313

Emboli, Thrombosis: 7Emboli, Thrombosis: 7

Traumatic brain injury (closed head injury): Traumatic brain injury (closed head injury): 11

Aneurysm: 1Aneurysm: 1

Hematom/Sub Arachnoidal Bleeding (SAB): Hematom/Sub Arachnoidal Bleeding (SAB): 33


Etiology:Etiology:

Vascular lesion/Intracranial insult (stroke): Vascular lesion/Intracranial insult (stroke): 1313

Emboli, Thrombosis: 7Emboli, Thrombosis: 7

Traumatic brain injury (closed head injury): Traumatic brain injury (closed head injury): 11

Aneurysm: 1Aneurysm: 1

Hematom/Sub Arachnoidal Bleeding (SAB): Hematom/Sub Arachnoidal Bleeding (SAB): 33

Wahn 2005 Turku

Test instruments (Germany):Test instruments (Germany):Stage of acute onset Aachen Aphasia Bedside-Test – AABT (Biniek 1993), Frenchay Aphasia Screening – FAST (Enderby et al. 1987).

Chronic stage Language-structured: Aachen Aphasia Test – Aachen Aphasia Test – AAT (HUBER et al. 1983), Aphasia Check List – ACL (KALBE et al. 2004).

Conversational: Amsterdam-Nijmegen-Everyday-Language-Test (BLOMERRT 1997)

Neuropsychological: Tübinger-Luria-Christensen Neuropsychological Diagnosis – TÜLUC (HAMSTER et al. 1980)

Test instruments (Germany):Test instruments (Germany):Stage of acute onset Aachen Aphasia Bedside-Test – AABT (Biniek 1993), Frenchay Aphasia Screening – FAST (Enderby et al. 1987).

Chronic stage Language-structured: Aachen Aphasia Test – Aachen Aphasia Test – AAT (HUBER et al. 1983), Aphasia Check List – ACL (KALBE et al. 2004).

Conversational: Amsterdam-Nijmegen-Everyday-Language-Test (BLOMERRT 1997)

Neuropsychological: Tübinger-Luria-Christensen Neuropsychological Diagnosis – TÜLUC (HAMSTER et al. 1980)

Wahn 2005 Turku

Hypotheses:Hypotheses:

Hypothesis 1:Hypothesis 1: 11stst group (p1-p12) status of chronic group (p1-p12) status of chronic aphasia: aphasia: AAT-expressive Subtests not significiantAAT-expressive Subtests not significiant precondition hypotheses 2, 3 and 4 precondition hypotheses 2, 3 and 4

22ndnd group (p13-p24): status of acute group (p13-p24): status of acute aphasia: aphasia: all AAT-expressive Subtests significiantall AAT-expressive Subtests significiant


Hypothesis 1:Hypothesis 1: 11stst group (p1-p12) status of chronic group (p1-p12) status of chronic aphasia: aphasia: AAT-expressive Subtests not significiantAAT-expressive Subtests not significiant precondition hypotheses 2, 3 and 4 precondition hypotheses 2, 3 and 4

22ndnd group (p13-p24): status of acute group (p13-p24): status of acute aphasia: aphasia: all AAT-expressive Subtests significiantall AAT-expressive Subtests significiant Hypothesis 2:Hypothesis 2: significiance in AAT-Subtest significiance in AAT-Subtest NamingNaming in in both groupes both groupes closing gap between lexicon and closing gap between lexicon and overt speechovert speech (oral language); condition: without/with (oral language); condition: without/with PCAD)PCAD) evaluation of PCAD possible evaluation of PCAD possible (effectiveness)(effectiveness)

Hypothesis 2:Hypothesis 2: significiance in AAT-Subtest significiance in AAT-Subtest NamingNaming in in both groupes both groupes closing gap between lexicon and closing gap between lexicon and overt speechovert speech (oral language); condition: without/with (oral language); condition: without/with PCAD)PCAD) evaluation of PCAD possible evaluation of PCAD possible (effectiveness)(effectiveness)

Wahn 2005 Turku


Hypothesis 3:Hypothesis 3: Significiant difference between the Significiant difference between the condition without condition without PCAD and with PCAD observing PCAD and with PCAD observing conversational skillsconversational skills in both groupes (functional use of PCAD)in both groupes (functional use of PCAD) increasing conversational skills in increasing conversational skills in both groupesboth groupes evaluation of PCAD possible evaluation of PCAD possible (effectiveness)(effectiveness)


Hypothesis 3:Hypothesis 3: Significiant difference between the Significiant difference between the condition without condition without PCAD and with PCAD observing PCAD and with PCAD observing conversational skillsconversational skills in both groupes (functional use of PCAD)in both groupes (functional use of PCAD) increasing conversational skills in increasing conversational skills in both groupesboth groupes evaluation of PCAD possible evaluation of PCAD possible (effectiveness)(effectiveness) Hypothesis 4:Hypothesis 4: Appliance of PCAD: patients and relativesAppliance of PCAD: patients and relatives PCAD should be used functionally PCAD should be used functionally and increaseand increase conversation.conversation.

Hypothesis 4:Hypothesis 4: Appliance of PCAD: patients and relativesAppliance of PCAD: patients and relatives PCAD should be used functionally PCAD should be used functionally and increaseand increase conversation.conversation.

Wahn 2005 Turku

Test instruments – Empirical Study:Test instruments – Empirical Study:

General communicative level (hypothesis 1):General communicative level (hypothesis 1): Aachen Aphasia Test – Aachen Aphasia Test – AAT (HUBER et al. 1983), PACD-Screening Tool (HARDY & DAVIS 2000).

Specific lexical level (hypothesis 2):Specific lexical level (hypothesis 2): AAT-Subtest AAT-Subtest NamingNaming (HUBER et al. 1983)

Functional conversational level (hypothesis 3):Functional conversational level (hypothesis 3): semi-standardised semi-standardised Beobachtungsbogen zur Beobachtungsbogen zur funktionalen funktionalen SprachverwendungSprachverwendung including a communication including a communication profile profile (STACHOWIAK & WAHN 1992/1999/2002)

Appliance of PCAD (hypothesis 4):Appliance of PCAD (hypothesis 4): Communication Partner Questionnaire (HARDY 2000)

Test instruments – Empirical Study:Test instruments – Empirical Study:

General communicative level (hypothesis 1):General communicative level (hypothesis 1): Aachen Aphasia Test – Aachen Aphasia Test – AAT (HUBER et al. 1983), PACD-Screening Tool (HARDY & DAVIS 2000).

Specific lexical level (hypothesis 2):Specific lexical level (hypothesis 2): AAT-Subtest AAT-Subtest NamingNaming (HUBER et al. 1983)

Functional conversational level (hypothesis 3):Functional conversational level (hypothesis 3): semi-standardised semi-standardised Beobachtungsbogen zur Beobachtungsbogen zur funktionalen funktionalen SprachverwendungSprachverwendung including a communication including a communication profile profile (STACHOWIAK & WAHN 1992/1999/2002)

Appliance of PCAD (hypothesis 4):Appliance of PCAD (hypothesis 4): Communication Partner Questionnaire (HARDY 2000)

Wahn 2005 Turku

Procedure (flowchart and time Procedure (flowchart and time scale):scale):Procedure (flowchart and time Procedure (flowchart and time scale):scale):

first contact first contact

diagnosis (t1)

• PCAD-Screening Tool• AAT without PCAD

• role play without PCAD/BEOBACHTUNGSBOGEN: Funktionale Sprachverwendung without PCAD

diagnosis (t1)

• PCAD-Screening Tool• AAT without PCAD

• role play without PCAD/BEOBACHTUNGSBOGEN: Funktionale Sprachverwendung without PCAD

interview – case historyinterview – case history

goal settinggoal setting

video of the patient/

and the therapistacting

in the role play



in the role play

day 1

day 2

day 3-5

day 6

Wahn 2005 Turku


vocabulary selection – family, hobbies, profession...

vocabulary selection – family, hobbies, profession...

development of hierarchies (navigation)and semantic fields

development of hierarchies (navigation)and semantic fields

functional training and vocabulary training with PCAD

functional training and vocabulary training with PCAD

functional use at homefunctional use at home

day 7-10

day 11-12

day 13-18

day 19-33

Wahn 2005 Turku


statistical analysisstatistical analysis

planing future goalsplaning future goals day 36

diagnosis (t2)

• AAT-Subtests: Token Test, Repetition and Naming without PCAD and with PCAD

• role play with PCAD/BEOBACHTUNGSBOGEN: Funktionale Sprachverwendung with PCAD

• Communication Partner Questionnaire

diagnosis (t2)

• AAT-Subtests: Token Test, Repetition and Naming without PCAD and with PCAD

• role play with PCAD/BEOBACHTUNGSBOGEN: Funktionale Sprachverwendung with PCAD

• Communication Partner Questionnaire

day 34-35

day 37-38



in the role play



in the role play

Wahn 2005 Turku

Results:Results:

table 1:table 1: Token Test, Repetition, Naming (AAT): Token Test, Repetition, Naming (AAT): p1-p3 in t1/t2 p1-p3 in t1/t2

(p < .05)(p < .05)

Results:Results:

table 1:table 1: Token Test, Repetition, Naming (AAT): Token Test, Repetition, Naming (AAT): p1-p3 in t1/t2 p1-p3 in t1/t2

(p < .05)(p < .05)

Statistik für Testb

-,045a -2,121a -,936a

,964 ,034 ,349

Z

AsymptotischeSignifikanz (2-seitig)

TOKEN2 -TOKEN1

REPET2 -REPET1

NAMING2 -NAMING1

Basiert auf negativen Rängen.a.

Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:

table 2: table 2: Token Test, Repetition, Naming (AAT): Token Test, Repetition, Naming (AAT): p13-p25 in t1/t2 p13-p25 in t1/t2

(p < .01, p < .05)(p < .01, p < .05)

Results:Results:

table 2: table 2: Token Test, Repetition, Naming (AAT): Token Test, Repetition, Naming (AAT): p13-p25 in t1/t2 p13-p25 in t1/t2

(p < .01, p < .05)(p < .01, p < .05)

Statistik für Testc

-3,185a -2,697b -3,112b

,001 ,007 ,002

Z


TOKEN2 -TOKEN1

REPET2 -REPET1

NAMING2 -NAMING1

Basiert auf positiven Rängen.a.

Basiert auf negativen Rängen.b.

Wilcoxon-Testc.

Wahn 2005 Turku

Results:Results:

table 3: table 3: Naming (AAT): p1-p12 in t1/t2 (p < .05)Naming (AAT): p1-p12 in t1/t2 (p < .05)

Results:Results:

table 3: table 3: Naming (AAT): p1-p12 in t1/t2 (p < .05)Naming (AAT): p1-p12 in t1/t2 (p < .05)


-2,807a

,005

Z


MITPCAD -OHNEPCAD


Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:

table 4: table 4: Naming (AAT): p13-p25 in t1/t2 (p Naming (AAT): p13-p25 in t1/t2 (p < .05)< .05)

Results:Results:

table 4: table 4: Naming (AAT): p13-p25 in t1/t2 (p Naming (AAT): p13-p25 in t1/t2 (p < .05)< .05)


-3,078a

,002

Z


MITPCAD -OHNEPCAD


Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:

table 5: open the conversation, developing themes, turn-taking p1-p12 in t1/t2 (p < .05)

Results:Results:



-2,739a -3,000a -3,000a

,006 ,003 ,003

Z


B1 - A1 B2 - A2 B3 - A3


Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:

table 6: responsivity, attitudes, closing conversation p1-p12 in t1/t2 (p < .05)

Results:Results:



-2,121a -1,633a -1,890a

,034 ,102 ,059

Z


B7 - A7 B8 - A8 B9 - A9


Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:


Results:Results:



-3,162a -3,464a -2,000a

,002 ,001 ,046

Z


B1 - A1 B2 - A2 B3 - A3


Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:


Results:Results:



-2,714a -2,111a -2,271a

,007 ,035 ,023

Z


B7 - A7 B8 - A8 B9 - A9


Wilcoxon-Testb.

Wahn 2005 Turku

Results:Results:

table 9: Using the aid (6 Switch the aid on/off? 7 Use the pen to

select a word/picture? 8 See the display? 9 Hear the

output? 10 Find the correct word/picture?)

Results:Results:

table 9: Using the aid (6 Switch the aid on/off? 7 Use the pen to

select a word/picture? 8 See the display? 9 Hear the

output? 10 Find the correct word/picture?)

Fälle gewichtet nach HFGKT

A

neinja

Abso

lute

Wer

te30

20

10

0

ITEM

6,00

7,00

8,00

9,00

10,00

4

21

8

17

3

22

5

20

25

Wahn 2005 Turku

Conclusion:Conclusion:

Hypothesis 1 is proofed for both groupsHypothesis 1 is proofed for both groups 11st st group (p1-p12) status of chronic group (p1-p12) status of chronic aphasia: aphasia: AAT-expressive Subtests not significiantAAT-expressive Subtests not significiant


Hypothesis 2 is proofed for both groupsHypothesis 2 is proofed for both groups closing gap between lexicon and closing gap between lexicon and overt speechovert speech (oral language)(oral language) PCAD is very effective for increasing PCAD is very effective for increasing namingnaming (accessing lemmas) (accessing lemmas)


Hypothesis 1 is proofed for both groupsHypothesis 1 is proofed for both groups 11st st group (p1-p12) status of chronic group (p1-p12) status of chronic aphasia: aphasia: AAT-expressive Subtests not significiantAAT-expressive Subtests not significiant


Hypothesis 2 is proofed for both groupsHypothesis 2 is proofed for both groups closing gap between lexicon and closing gap between lexicon and overt speechovert speech (oral language)(oral language) PCAD is very effective for increasing PCAD is very effective for increasing namingnaming (accessing lemmas) (accessing lemmas)

Wahn 2005 Turku


Hypothesis 3 is proofed for main parts of Hypothesis 3 is proofed for main parts of conversation, conversation, e.g. opening and closing conversation, e.g. opening and closing conversation, developing developing themes, turn-taking etc. in both groupsthemes, turn-taking etc. in both groups Hypothesis 4 is proofed for both groups: Hypothesis 4 is proofed for both groups: PCAD is veryPCAD is very effective and functional (Hypotheses 2 effective and functional (Hypotheses 2 and 3 and 3 precondition) precondition)

Limitations:Limitations: population (number), population (number), heterogeneity, control heterogeneity, control

of variables of variables


Hypothesis 3 is proofed for main parts of Hypothesis 3 is proofed for main parts of conversation, conversation, e.g. opening and closing conversation, e.g. opening and closing conversation, developing developing themes, turn-taking etc. in both groupsthemes, turn-taking etc. in both groups Hypothesis 4 is proofed for both groups: Hypothesis 4 is proofed for both groups: PCAD is veryPCAD is very effective and functional (Hypotheses 2 effective and functional (Hypotheses 2 and 3 and 3 precondition) precondition)

Limitations:Limitations: population (number), population (number), heterogeneity, control heterogeneity, control

of variables of variables

Wahn 2005 Turku

Implications for therapy:Implications for therapy:

Functional appliance of electronical Functional appliance of electronical Aids, e.g Aids, e.g PCAD in everyday-life situations,PCAD in everyday-life situations,

Integration in speech and language Integration in speech and language therapy therapy (functional appliance):(functional appliance): Increasing lexicon access,Increasing lexicon access, Increasing functional Increasing functional conversation,conversation, Supporting activities of Supporting activities of listeners.listeners.

Importance of practise Importance of practise and repetition and repetition

Implications for therapy:Implications for therapy:

Functional appliance of electronical Functional appliance of electronical Aids, e.g Aids, e.g PCAD in everyday-life situations,PCAD in everyday-life situations,

Integration in speech and language Integration in speech and language therapy therapy (functional appliance):(functional appliance): Increasing lexicon access,Increasing lexicon access, Increasing functional Increasing functional conversation,conversation, Supporting activities of Supporting activities of listeners.listeners.

Importance of practise Importance of practise and repetition and repetition

Wahn 2005 Turku

Thank you for your interest! Thank you for your interest! Thank you for your interest! Thank you for your interest!

Wahn 2005 Turku Lexicon and Speech Production in Aphasia: An Empirical Study with AAC Lexicon and...

Documents

Transcript of Wahn 2005 Turku Lexicon and Speech Production in Aphasia: An Empirical Study with AAC Lexicon and...