TRAINED MODALITY USE IN AN ADULT WITH EXPRESSIVE APHASIA

1
TRAINED MODALITY USE IN AN ADULT WITH
EXPRESSIVE APHASIA

• Barbara A. Braddock, Ph.D.,
• Filip Loncke, Ph.D.,
• Stephanie Borg, B.A.,
• John Bonvillian, Ph.D.,
• and Vanessa Mayer, B.A.
• Curry School of Education, Program of
  Communication Disorders and School of Arts and
  Sciences, Department of Psychology
• University of Virginia

2
Todays Presentation

• Brief literature review Manual sign-learning
  and AAC use in aphasia
• Two trained modality interventions Simplified
  Sign System and Speech-generating Barcode reader
  AAC device
• Study participant Method and procedures
• Research findings
• Implications in aphasia management

3
Sign-Learning in Aphasia

• Few studies have examined sign-learning
  capabilities in adults with aphasia
  (Christopoulou Bonvillian, 1985)
• Results indicated that individuals with aphasia
  may acquire communicative signs (Rose, 2006
  Peterson Kirshner, 1981 Skelly, 1979
  Bonvillian Friedman, 1978)
• Manual signs may facilitate spoken word
  production in persons with aphasia (Rao, 2001
  Raymer Thompson, 1991)

4
AAC Use in aphasia

• Clinical research on the use of AAC technology
  for individuals with chronic aphasia is evolving
  (Koul Harding, 1998)
• Persons with severe Brocas aphasia can learn to
  use graphic symbols to produce phrases or
  sentences (Steele et al., 1989)
• Reports of improved oral production of words and
  sentences after AAC training (Aftonomos, Steele,
  Appelbaum Harris, 2001)

5
Trained modality interventions

• Simplified Sign System (Bonvillian and associates
  at the UVa, in press) http//www.simplifiedsigns.o
  rg
• Speech-generating Barcode reader (known as the BA
  Bar Swiss Foundation for Assistive Technology
  Loncke and associates at the UVa, 2006)
  http//www.fst.ch

6
Simplified sign system

• Simplified Sign System (Bonvillian and
  associates, 2008)
• Highly Iconic (Transparent Meanings)
• Motorically Easy to Produce
• Approximately 1000 signs, mostly modified signs
  from established sign languages
• Manual communication system for persons with
  communication difficulties

7
Speech-generating Barcode Reader

• Speech-generating Barcode reader (BA Bar Swiss
  Foundation for Assistive Technology Loncke and
  associates at the UVa, 2006)
• Electronic AAC device
• Spoken language is recorded and stored on the
  device and linked to barcode stickers
• Scanning each barcode with the device generates a
  segment of speech which the user can repeatedly
  access for functional communication

8
(No Transcript)
9
Aim of the present study

• To determine if an individual with nonfluent
  Brocas aphasia is able to utilize two trained
  modalities to communicate action and affective
  information
• Simplified Sign System
• Speech-generating Barcoder reader

10
Research Questions

• Can an individual with nonfluent Brocas aphasia
  make use of signs from the Simplified Sign System
  to communicate action and affective information
  following a training period?
• Can an individual with nonfluent Brocas aphasia
  make use of Speech- generating Barcode reader to
  communicate action and affective information
  following a training period?

11
Participant

• 61-year-old right-handed female
• Diagnosis of nonfluent Brocas aphasia
• Left temporoparietal cerebrovascular accident
• Approximately 5 years post
• Dutch primary language learned English as a
  young adult

12
Western aphasia Battery-Revised (Kertesz, 2006)
13
Method and Procedures

• ABA single case study
• Baseline measurement (3 sessions)
• Nine intervention sessions (15-20 minutes each)
• Each intervention session was directly followed
  by an assessment ( correct use)
• Maintenance measurement (3 sessions)

14

• Phase I 15 Trained Action Words
• Pushing (practice item),Wiping, Giving,
  Looking, Hiking, Smoking, Bending, Climbing,
  Lowering, Reading, Standing, Holding,
  Talking, Patting, Going Down, Going Up
• Phase II 15 Trained Affective Words
• Afraid (practice item),Embarrassed, Bored,
  Shy, Confused, Excited, Surprised, Crazy, Hurt,
  Sad, Angry, Dislike, Different, Happy, Concerned,
  Focused

15
(No Transcript)
16
PHASE I Percent Correct Use of the
Speech-generating Barcode Reader and Simplified
Sign System for Trained Action Items
17
Action Training Results Simplified Sign System

• Number of training sessions 9
• Mean training accuracy 67
• Mean training accuracy range (33-93)
• Cohens d 17.90

18
Action Training Results BA BAR

• Number of training sessions 9
• Mean training accuracy 89
• Mean training accuracy range (27-100)
• Unable to calculate Cohens d, complete effect
  from 0 (baseline) to 100 (maintenance)

19
PHASE II Percent Correct Use of the
Speech-generating Barcode Reader and Simplified
Sign System for Trained Affective Items
20
Affective Training Results Simplified Sign
System

• Number of training sessions 9
• Mean training accuracy 38
• Mean training accuracy range (20-60)
• Busk and Serlins d2 10.0

21
Affective Training Results BA BAR

• Number of training sessions 9
• Mean training accuracy 100
• Maintained 100 accuracy over 9 sessions
• Unable to calculate effect-size, given lack of
  baseline variability

22
Conclusions

• Participant demonstrated ability to communicate
  action and affective information through both
  trained modalities manual sign system and AAC
  device
• However, training profiles, accuracy of use, and
  learnability of action vs. affective items
  differed between trained modalities

23
(No Transcript)
24
These data suggest that cognitive and/or language
processes underlying the use of Simplified Sign
and the Speech-generating Barcode reader differ

• The use of the Speech-generating Barcode reader
  may draw from relatively spared cognitive
  resources, such as visual processing and implicit
  memory
• The production of Simplified Sign may be more
  closely tied to the underlying language and/or
  motor disturbance (i.e., symbolic nature of the
  sign itself shared neural architecture)

25
The principal goal of aphasia treatment is to
enhance Language ability, therefore, there are
good reasons to include Manual Sign Training
and/or AAC in the Communication Therapy Program

• 1. Trained modality use may offer improved
  Communication, regardless of modality, to make
  life more fulfilling and less frustrating2.
  The Use of Manual Sign and/or AAC may result in
  improved oral language skills

26
References

• Aftonomos, L.B., Steele, R.D., Appelbaum, J.S.,
  Harris, V.M. (2001). Relationships between
  impairment level assessments and functional-level
  assessments in aphasia Findings from LCC
  treatment programmes. Aphasiology, 15 (10-11),
  951-964.
• Bonvillian, J.D., Friedman, R.J. (1978).
  Language development in another mode The
  acquisition of signs by a brain-damaged adult.
  Sign Language Studies, 19, 111-120.
• Bonvillian, J.D., Kissane, N.A., Dooley, T.T.,
  Loncke, F.T. (in press). Simplified signs A
  manual sign-communication system for special
  populations.
• Christopoulou, C., Bonvillian, J.D. (1985).
  Sign language, pantomime, and gestural processing
  in aphasic persons A review. Journal of
  Communication Disorders, 18, 1, 1-20.

27

• Busk, P.L., Serlin, R. (1992). Meta-analysis
  for sinble case research. In T.R. Kratochwill
  J.R. Levin (Eds.), Single-case research design
  and analysis New directions for psychology and
  education. Hillsdale NJ Lawrence Erlbaum
  Associates.
• Cohen, J. (1988). Statistical power analysis for
  the behavioral sciences, Second edition.
  Hillsdale, NJ Lawrence Erlbaum Associates.
• Kertesz, A. (2006). Western Aphasia Battery-
  Revised. San Antonio, TX Psychological
  Corporation.
• Koul, R.K., Harding, R. (1998). Identification
  and production of graphic symbols by individuals
  with aphasia Efficacy of software application.
  Augmentative and Alternative Communication, 14,
  11-23.

28

• Loncke, F.T. (2006). BA Bar, Swiss Foundation
  for Rehabilitation Technology. FST.
• Rao, P. (2001). The use of Amer-Ind code by
  persons with severe aphasia. In R. Chapey (Ed.),
  Language intervention strategies in aphasia and
  related neurogenic communication disorders (4th
  ed., pp. 688-701). Baltimore, MD Lippincott
  Williams and Wilkins.
• Raymer, A.M., Thompson, C.K. (1991). Effects
  of verbal plus training treatment in a patient
  with aphasia and severe apraxia of speech. In
  T.E. Prescott (Ed.), Clinical Aphasiology, 12
  (pp. 524-550). Philadelphia, PA Lippincott
  Williams Wilkins.

29

• Rose, M. (2006). The utility of arm and hand
  gestures in the treatment of aphasia. Advances
  in Speech Language Pathology, 8, 2, 92-109.
• Skelly, M. (1979). Amer-Ind gestural code based
  on universal American Indian hand talk.
  Elsevier New York.
• Steele, R., Weinrich, M., Wertz, R., Kleczewska,
  M., Carlson, G. (1989). Computer-based visual
  communication in aphasia. Neuropsychologia, 27,
  409-426.