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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.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

  • Assistive & Augmentative Communication Devices (AACD)

  • Computer-Assisted Treatment (CAT)

  • Computer-Only Treatment (COT)

Computer-Only Treatment

  • Automated, rapid presentation

  • Hierarchically arranged cues

  • Randomized stimuli

  • Corrective feedback specific to response

    • Teach correct response

    • Limited number of stimuli

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.



  • 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


  • 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

  • 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



  • 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

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

  • 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

  • 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


  • 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

  • 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)


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








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

Mean percentile change in PICA OA

Mean percentile change in PICA VRB

Mean change in WAB AQ


  • 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

  • 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

Richard C. Katz, Ph.D.

VA Medical Center, Phoenix

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

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.

Frequency of occurrence

Semantic confusion/distance

Parts of speech

Word length

Phonemic/Spelling complexity

Visual similarity (confusion)

Auditory confusion (discrimination)

Grammatical complexity


Redundant information

Vocal stress/emphasis

Stimulus 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

  • Is treatment active?

  • Small subject sample (N = 10)

  • No control subjects

  • Develop hypothesis for further refinement in Phase II


  • 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

  • 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

  • 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


Task parameters, stimulus parameters, and their dimensions


Multiple ChoiceTask2-6 choices

Critical elementsTask1-3 elements

Frequency of OccurrenceStimulus Common, Occasional

Delay of ResponseTask0, 5 seconds

Semantic ConfusionStimulusDifferent, Related

Task Hierarchy

  • 5 parameters

  • 14 dimensions

  • 90 stimulus sets (10 stimulus per set)

  • 900 stimulus item presentations

Example of item from Task #1

 (The first item in the hierarchy)

Digitized speech: “Chair”

Monitor: Picture of a car and a chair


Multiple ChoiceTask2

Critical elementsTask1

Frequency of OccurrenceStimulus Common

Delay of ResponseTask0

Semantic ConfusionStimulusDifferent

Computer says:


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


Multiple ChoiceTask4

Critical elementsTask2

Frequency of OccurrenceStimulus Common

Delay of Response Task5 seconds

Semantic Confusion StimulusRelated

Computer says:

“Fork, Cup”

Please Wait . . .

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