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www.Hildred.com Stimulation Treatment Over the Internet. Richard C. Katz, Ph.D. CCC-SLP, BC-NCD Chair, Audiology and Speech Pathology Carl T. Hayden VA Medical Center Phoenix, Arizona 85012 USA [email protected] Adjunct Professor Department of Speech & Hearing Science

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Hildred Stimulation Treatment Over the Internet

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Www hildred com stimulation treatment over the internet

www.Hildred.comStimulation Treatment Over the Internet

Richard C. Katz, Ph.D. CCC-SLP, BC-NCD

Chair, Audiology and Speech Pathology

Carl T. Hayden VA Medical Center

Phoenix, Arizona 85012 USA

[email protected]

Adjunct Professor

Department of Speech & Hearing Science

Arizona State University

Tempe, Arizona 85287 USA


Technology and treatment

Technology and Treatment

  • Assistive & Augmentative Communication Devices (AACD)

  • Computer-Assisted Treatment (CAT)

  • Computer-Only Treatment (COT)


Computer only treatment

Computer-Only Treatment

  • Automated, rapid presentation

  • Hierarchically arranged cues

  • Randomized stimuli

  • Corrective feedback specific to response

    • Teach correct response

    • Limited number of stimuli


Hildred stimulation treatment over the internet

Katz, R. C., & Nagy, V. T. (1984). An intelligent computer-based task for chronic aphasic patients. In R. H. Brookshire (Ed.), Clinical aphasiology:1984 conference proceedings (pp. 159-165). Minneapolis, MN: BRK.

http://aphasiology.pitt.edu/http://aphasiology.pitt.edu/archive/00000806/


Hildred stimulation treatment over the internet

Task

  • Written confrontation naming

  • Stimuli: 7 pictures

  • Response: Typing name of object

  • Criteria: 6 names on 1st attempt and 7th name on 2nd attempt for 3 consecutive sessions, or 15 sessions


Intervention

Intervention

  • Drill & practice (specific responses)

  • 6 levels of cues

    • Repeat attempt

    • Anagram without feedback

    • Response after model

    • Anagram with feedback

    • Multiple choice

    • Copy from model


Phase ii study

Phase II Study

  • 8 subjects

    • chronic aphasia

    • Occlusive CVA

    • Different types of aphasia

    • All had reading & writing problems

  • Performance measures

    • Pre/post writing confrontation naming task

    • Treatment task performance


Scores and corresponding cues

Scores and Corresponding Cues


Hildred stimulation treatment over the internet

WHAT IS THIS? _


Results

Results

  • Sessions

    Range: 4-15Average: 10.4

  • Confrontation writing measures (Avg.)

    Pre: 34%Post: 85%(Diff: +51%)

  • Task performance measures (Max = 7)

    Baseline: 2.7Last 3 sessions: 6


Hildred stimulation treatment over the internet

Katz, R. C., & Wertz, R. T. (1997). The efficacy of computer-provided reading treatment for chronic aphasic adults. Journal of Speech, Language and Hearing Research, 40(3), 493-507.


Phase iii study

Phase III Study

  • 55 subjects

  • Compared 3 groups of aphasic subjects

    • 21 computerized language (reading) treatment

    • 19 computer nonlanguage (games) stimulation

    • 15 no treatment

  • Computer conditions

    • 78 hours of treatment or stimulation

    • 3 hours per week for 26 consecutive weeks


Subject criteria

Subject Criteria

  • 85 years of age or less

  • at least one year postonset of aphasia

  • performed between the 15th-90th PICA OA %-ile

  • premorbidly right-handed

  • completed at least the eighth grade

  • premorbidly literate in English

  • visual acuity >20/100 corrected in the better eye

  • auditory acuity >40 dB SRT, unaided, in better ear

  • no language treatment 3-month prior to entry

  • living in a non-institutionalized environment


Measurements

Measurements

  • At entry, 3-months, and 6-months

  • Porch Index of Communicative Ability (PICA)

  • Western Aphasia Battery (WAB)

  • 95% (258 out of 330) of tests scored by a second clinician without knowledge of subject or condition for >99% agreement (i.e., single blind condition)


Treatment software

Treatment Software

  • Visual (nonlinguistic) matching and reading comprehension tasks (match-to-sample)

  • Single key (1-6) response

  • 232 different tasks

    • 29 activities (e.g., spelling, naming, sentence completion, grammar, etc.)

    • each containing 8 levels of assumed difficulty (i.e., increase linguistic complexity and/or number of foils)


Hildred stimulation treatment over the internet

FUNCTIONS

Find the word below that goes best with the word in the box.

Restaurant

1.Sit

2.Buy

3.Eat

4.Drive

5.Sleep

6.Put

Select the key (1-6) that goes best with the word:


Mean percentile change in pica oa

Mean percentile change in PICA OA


Mean percentile change in pica vrb

Mean percentile change in PICA VRB


Mean change in wab aq

Mean change in WAB AQ


Conclusion

Conclusion

  • Computerized reading treatment administered with minimal assistance

  • Improvement on reading tasks generalized to non-computerized tasks

  • Improvement resulted from language content and not stimulation of computer

  • Computerized reading treatment provided was efficacious to adult outpatients with chronic aphasia


Early telecommunicology

Early Telecommunicology

  • Vaughn (late ‘70s through the ‘80s)

    • small, microprocessor-driven devices

    • PDP-11 “minicomputers”

    • via telephone lines (similar to modem)

  • Reading, writing, listening, speaking


Internet provided auditory stimulation treatment for aphasic adults

Internet-Provided Auditory Stimulation Treatment for Aphasic Adults

Richard C. Katz, Ph.D.

VA Medical Center, Phoenix

Colleen Karow, Ph.D.University of Tennessee, Knoxville


Stimulation facilitation treatment

Stimulation-Facilitation Treatment

  • Controlled and intensive auditory stimulation of the impaired system to facilitate and maximize language reorganization and recovery.

  • Controlled refers to manipulation of stimulus dimensions to aid the patient in making maximal responses.


Stimulus dimensions

Frequency of occurrence

Semantic confusion/distance

Parts of speech

Word length

Phonemic/Spelling complexity

Visual similarity (confusion)

Auditory confusion (discrimination)

Grammatical complexity

Concrete/Abstract

Redundant information

Vocal stress/emphasis

Stimulus Dimensions


Presentation dimensions

Number of multiple choices

Number of critical elements

Delay of response (retention)

Delay of presentation (anticipation)

Speed of presentation

Competing signal/noise

Alerting signal

Repeat item

Auditory fidelity

Simultaneous visual cue

Presentation Dimensions


Phase i study

Phase I Study

  • Is treatment active?

  • Small subject sample (N = 10)

  • No control subjects

  • Develop hypothesis for further refinement in Phase II


Hildred stimulation treatment over the internet

Task

  • Standard, match-to-sample format

  • Stimuli: spoken (digital) speech

  • 2-6 multiple choices

  • Pictures displayed on monitor

  • Respond using mouse to point and click


Treatment program

Treatment Program

  • 90 hierarchically arranged tasks

  • Performance determines direction

  • Presents stimuli and response array

  • Presents appropriate feedback

    • Correct/Incorrect

    • Treatment for error items when task performance is below criterion

  • Stores performance


Treatment hierarchy

Treatment Hierarchy

  • If criteria is <80% correct for 3 consecutive attempts at a task --

  • Repeat item

  • Alerting signal

  • Slow down rate of presentation

  • Simultaneous visual (printed) cue

  • Back down parameter dimension

  • Flag clinician for monitoring and clinician-provided intervention


Hildred stimulation treatment over the internet

PARAMETER HIERARCHY

Task parameters, stimulus parameters, and their dimensions

PARAMETERTYPEDIMENSIONS

Multiple ChoiceTask2-6 choices

Critical elementsTask1-3 elements

Frequency of OccurrenceStimulus Common, Occasional

Delay of ResponseTask0, 5 seconds

Semantic ConfusionStimulusDifferent, Related


Task hierarchy

Task Hierarchy

  • 5 parameters

  • 14 dimensions

  • 90 stimulus sets (10 stimulus per set)

  • 900 stimulus item presentations


Hildred stimulation treatment over the internet

Example of item from Task #1

 (The first item in the hierarchy)

Digitized speech: “Chair”

Monitor: Picture of a car and a chair

PARAMETERTYPEDIMENSIONS

Multiple ChoiceTask2

Critical elementsTask1

Frequency of OccurrenceStimulus Common

Delay of ResponseTask0

Semantic ConfusionStimulusDifferent


Computer says

Computer says:

“Chair”


Hildred stimulation treatment over the internet

Example of item from Task

(About 1/3 through the hierarchy)

Digitized speech: “Fork and cup”

Monitor: 1) Blank screen for 5 seconds, then 2) display pictures of a fork, spoon, cup and bowl

PARAMETERTYPEDIMENSIONS

Multiple ChoiceTask4

Critical elementsTask2

Frequency of OccurrenceStimulus Common

Delay of Response Task5 seconds

Semantic Confusion StimulusRelated


Computer says1

Computer says:

“Fork, Cup”


Please wait

Please Wait . . .


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