Language and Cognition Colombo June 2011

1. Language and CognitionColombo June 2011 Day 5 Psycholinguistic Assessments of Language Processing in Aphasia Producing Words Acknowledgement to Jane Marshall

2. Overview • This lecture aims to give you an understanding of: • A model of word retrieval • Patterns of word retrieval deficit • Methods of investigation • Therapy approaches • Therapy outcomes

3. Aphasic word retrieval difficulties

4. Aphasic word retrieval difficulties

5. To name a seen object involves: Spoken word Written word Visual Analysis Auditory Analysis Object Recognition AIL VIL Grapheme to Phoneme Conversion Semantics POL Buffer Motor speech production

6. Failure in Object/Picture Recognition Visual Agnosia ‘A continuous surface infolded on itself. It appears to have .. five outpouchings’ (re glove) Item later recognised through touch: ‘it’s a glove’

7. Spoken word Written word Visual Analysis Auditory Analysis Object Recognition AIL VIL Grapheme to Phoneme Conversion Semantics POL Buffer speech

8. Effects of a Semantic Deficit • Poor understanding of both written and spoken words (semantic errors in testing) • Impaired word production, with semantic errors • Production affected by semantic factors, like imageability • Poor performance on non-verbal semantic tasks, like the Pyramids and Palm Trees Test

10. Spoken word Written word Visual Analysis Auditory Analysis Object Recognition AIL VIL Grapheme to Phoneme Conversion Semantics POL Buffer speech

11. Effects of Deficit at POL • Knowledge of word meaning is retained, may circumlocute • May produce a phonologically related word/non word • High frequency words may be named better than low frequency words • May produce a semantically related word, but should know that this is not the target

12. Loss of Entries in POL or Impaired Access? Evidence: • Naming is often inconsistent • Cues assist naming, such as providing the first phoneme Argues for access problem

13. Phonological Assembly Whole word phonology has to be ‘assembled’ prior to speech Assembly failure: - Phoneme omissions, substitutions and exchanges - Conduite d’approche – sequence of phonological errors getting closer to the target - Length effect (short words easier than long)

14. Factors Affecting Naming • Frequency/familiarity • Age of acquisition • Word class (noun>verbs) • Word category (animate > inanimate) • Note these variables can interact e.g. Common words may be acquired early

15. Investigating a Word Retrieval Impairment

16. Questions to Ask • Is word retrieval failing? • What is the extent of the problem? • Does it impede everyday communication? • Is it a therapy priority for the aphasic person? • Why is word retrieval failing: what is the level of breakdown? • What helps? • Is the person using any strategies?

17. RS (Marshall et al 1990) J Can you tell me how far you have got with selling your business R? R er ………… Mr N Mrs S: Your accountant R Yes … I’ve left it to him J And how far has he got with it? R er … one chap has come up with a er …………… fee … but there’s three more coming J That’s quite good isn’t it? Are they offers that you can accept? R Not really J So you want slightly more? R Yes J How quickly do you want to sell it? R As soon as possible … just for me to …. Call it a day … but it could take as long as three months J What will you do with the capital? R Put it into the …… one in the …. What’s name …… bank J What’s happening to the staff? R er …….. (waves) goodbye … goodbye

18. Assessment Plan • Aims to find out: • The extent of R’s naming problem • Whether he can be cued • Where word retrieval is breaking down • Semantics • Phonology

19. Semantic Tests: PALPA Spoken word to picture matching Pyramids and Palm Trees

20. Semantic Tests: • Synonym Judgement (PALPA) • Shovel Spade • Shovel Tale • Menace Threat • Menace Discovery • Judging Picture Names (Informal Task) Is this a banana? Is this an apple?

21. Results • Pyramids and Palm Trees 3 errors • Spoken word to picture matching 98% • Synonym judgements (concrete) 95% • Judging picture names 100%

22. Naming Test Say the names of 30 pictures • If cannot is given phonological cue • Target (/t/ for tiger) • Miscue (/l/ for tiger) Results • 10 pictures named • Correct cues elicit correct names • Miscues elicit no response

23. Interpretation Word retrieval is not failing at semantics: • R has good understanding of concrete words and pictures • He can understand words that he cannot name • He cannot be miscued into making semantic errors Phonological Representations are retained • R responds to target phonological cues

24. More Evidence re Phonology Reading aloud 100%: • Concrete words • Abstract words • Spell regular words (rabbit) • Spell irregular words (yacht) • The phonologies of words are available and can be accessed from the written word

25. Problem is connection between semantics and phonology: Spoken word Written word Visual Analysis Auditory Analysis Object Recognition AIL VIL Grapheme to Phoneme Conversion Semantics POL Buffer speech

26. Therapy • Treatment needs to help RS reconnect semantic with phonological representations • Treatment exploits two strengths: reading aloud and semantic discrimination • 3 hours therapy using word to picture matching

27. Therapy Example Radio Television Hi Fi Computer Camera Task: Find the correct word and read it aloud Discuss differences between target and foils

28. Results: % correct in picture naming

29. Conclusions from RS • Therapy improves naming of treated words • Effects are very well maintained (still evident one year later) • There may be some generalisation to related words that appeared in therapy as foils

30. GF (Robson et al 1998) • L CVA • Jargon Speaker • Very incomprehensible speech I was quite erm that’s why I can’t get weyerd keep ... erm makes me very um here up here makes him all /s/ all mingsing but these come and I can’t it might be because I had another setoid no sort of um I mean but when you cough you different but when you right you lie to her ...’ (replying to a question about her holiday)

31. Input Tests • Pyramids and Palm Trees 4 errors • Auditory lexical decision 100% • Spoken word to picture match 98% • Spoken synonym judgements 87% Conclusions: GF can access semantic representations of pictures and concrete words

32. Production Naming pictures 1/40 • Some help from phonological cues (5/15) • Not helped by semantic cues (irritated by them!) Her comments: ‘I had it there and then it went’ • Reading aloud 10/40 (regular and irregular words equal success)

33. Conclusions • Naming is not failing at the semantic level (input tests) • Entries are retained in POL, since GF can read some words • Words/non-words same: not reliant on GPC • The problem is mainly between semantics and phonology

34. Objects/pictures Spoken word Written word Auditory Analysis Visual Analysis Object/Picture Recog AIL VIL Semantics GPC POL Buffer speech

35. Therapy Decisions • Help GF access POL • Use good input skills/monitoring • Help GF use any partial phonological knowledge about words • Aim to develop a phonological self cueing strategy • Tasks: making phonological judgements about target words

36. Therapy Example 1 Task: How many syllables (‘beats’) i) ‘Carrot’ 1 2 ii) 1 2

37. Therapy Example 2 Task: Initial phoneme judgement: • ‘carrot’ /k/ /m/ • ‘carrot’ /b/ /k/ iii) /k/ /m/ /m/ /l/ /k/ /b/ iv)

38. Therapy Example 3 • Indicate number of syllables • Indicate first phoneme • Produce first phoneme • Attempt to name picture

39. Results: % correct in picture naming

40. Conclusions from GF • Phonological therapy has improved naming of treated words • Good generalisation to untreated words • Stable baseline and no change in unrelated tasks (therefore effects can be attributed to therapy) Why is generalisation achieved? • Self cueing strategy (but little evidence of this in testing) • Generalised recovery of access to POL

41. Conclusions • Using careful assessment we can try to pin point why word retrieval is failing • This can inform our therapy with clients • A number of studies show that therapy can improve picture naming, with variable generalisation to untreated words • Hickin et al (2007) suggest that therapy may also improve everyday speech, but only when effects generalise beyond treated words

42. References • Hickin J, Herbert R, Best W, Howard D, and Osborne F (2007) Efficacy of treatment: effects on word retrieval and conversation. In S Byng, K Swinburn and C Pound (eds) The Aphasia Therapy File, Psychology Press. • Marshall J, Pound C, White-Thomson M, Pring T (1990) The use of picture/word matching tasks to assist word retrieval in aphasic patients. Aphasiology 4, 167 - 184. • Robson J, Marshall J, Pring T and Chiat S (1998) Phonological naming therapy in jargon aphasia: Positive but paradoxical effects. Journal of the International Neuropsychological Society, 4, 675 - 686. (available from Jane)