Lexicon and Speech Production in Aphasia: An Empirical Study with AAC

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

2. University of Cologne, Germany Pedagogics and Therapy of Speech-Language Disorders Claudia Wahn, Ph. D. Wahn 2005 Turku

3. Aphasia: „One in a group of speech [and language] disor- ders in which there is a defect or loss of the power of expression by speech, writing, or signs, or a defect or loss of the power of comprehension of spoken or written language [resulting from a damage to the brain caused by injury or disease].“ (Medical dictionary 2005) Wahn 2005 Turku

4. 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 production, speech perception, reading and spelling, • Differential diagnosis: Dysarthria. Wahn 2005 Turku

5. Electronical devices and intervention: „No research to date has documented a decrease in functional speech potential as a result of the use of augmentative techniques; in fact, studies have documented increases in functional speech potential.“ (VANDERHEIDEN & YODER, 1986) The application of electronical devices has to be considered in the context of development of Augmentative and Alternative Communication (AAC). Current situation: „Multi-Component Communication System for Disabled Persons“ (VANDERHEIDEN, 1986) Wahn 2005 Turku

6. Portable Communication Assistant for People • with Acquired Dysphasia (PCAD): • PCAD was a TIDE-Project, sponsored by the EU in coope- • ration with the following partners (1997-2002/04): • Thames Valley University, Slough (UK), • Speech and Language Therapy Research Unit, Bristol (UK), • Toby Churchill Ltd. (UK), • Stichting Afasie-Therapiezentrum, Rotterdam (NL) • Kompagne (NL), • University Hospital of Lund (S), • University of Leipzig (D). Wahn 2005 Turku

9. Research questions: • Can AAC (electronical device) be used to close the gap between lexicon and speech- output (overt speech)? • Can AAC be used for functional conver- sation? • How effective is AAC, especially PCAD? Wahn 2005 Turku

10. Research population: • 25 German adults (13 male; 12 female) identified with aphasia AAT (HUBER et al., 1983), mean age: 57 • 1st group (p1-p12): status of chronic aphasia (2-24 years post insult) • 2nd group (p13-p24): status of acute aphasia (3-7 weeks • post insult) • Saxonia, Germany • No treatment with AAC (Augmentative Alternative Communication) as a part of speech and language therapy. Wahn 2005 Turku

11. Research population: Etiology: • Vascular lesion/Intracranial insult (stroke): 13 • Emboli, Thrombosis: 7 • Traumatic brain injury (closed head injury): 1 • Aneurysm: 1 • Hematom/Sub Arachnoidal Bleeding (SAB): 3 Wahn 2005 Turku

12. 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 – 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

13. Hypotheses: • Hypothesis 1: 1st group (p1-p12) status of chronic aphasia: AAT-expressive Subtests not significiant precondition hypotheses 2, 3 and 4 2nd group (p13-p24): status of acute aphasia: all AAT-expressive Subtests significiant • Hypothesis 2: significiance in AAT-Subtest Naming in both groupes closing gap between lexicon and overt speech (oral language); condition: without/with PCAD) evaluation of PCAD possible (effectiveness) Wahn 2005 Turku

14. Hypotheses: • Hypothesis 3: Significiant difference between the condition without PCAD and with PCAD observing conversational skills in both groupes (functional use of PCAD) increasing conversational skills in both groupes evaluation of PCAD possible (effectiveness) • Hypothesis 4: Appliance of PCAD: patients and relatives PCAD should be used functionally and increase conversation. Wahn 2005 Turku

15. Test instruments – Empirical Study: • General communicative level (hypothesis 1): • Aachen Aphasia Test – AAT (HUBER et al. 1983), • PACD-Screening Tool (HARDY & DAVIS 2000). Specific lexical level (hypothesis 2): • AAT-Subtest Naming(HUBER et al. 1983) Functional conversational level (hypothesis 3): • semi-standardised Beobachtungsbogen zur funktionalen Sprachverwendung including a communication profile (STACHOWIAK & WAHN 1992/1999/2002) Appliance of PCAD (hypothesis 4): • Communication Partner Questionnaire (HARDY 2000) Wahn 2005 Turku

16. first contact day 1 interview – case history day 2 video of the patient/ and the therapist acting in the role play • diagnosis (t1) • PCAD-Screening Tool • AAT without PCAD • role play without PCAD/ • BEOBACHTUNGSBOGEN: Funktionale Sprachverwendung without PCAD day 3-5 goal setting day 6 Procedure (flowchart and time scale): Wahn 2005 Turku

17. vocabulary selection – family, hobbies, profession... day 7-10 development of hierarchies (navigation) and semantic fields day 11-12 functional training and vocabulary training with PCAD day 13-18 functional use at home day 19-33 Procedure (flowchart and time scale): Wahn 2005 Turku

18. video of the patient/ and the therapist acting in the role play • 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 planing future goals day 36 statistical analysis day 37-38 Procedure (flowchart and time scale): Wahn 2005 Turku

19. Results: table 1:Token Test, Repetition, Naming (AAT): p1-p3 in t1/t2 (p < .05) Wahn 2005 Turku

20. Results: table 2: Token Test, Repetition, Naming (AAT): p13-p25 in t1/t2 (p < .01, p < .05) Wahn 2005 Turku

21. Results: table 3: Naming (AAT): p1-p12 in t1/t2 (p < .05) Wahn 2005 Turku

22. Results: table 4: Naming (AAT): p13-p25 in t1/t2 (p < .05) Wahn 2005 Turku

23. Results: table 5: open the conversation, developing themes, turn-taking p1-p12 in t1/t2 (p < .05) Wahn 2005 Turku

24. Results: table 6: responsivity, attitudes, closing conversation p1-p12 in t1/t2 (p < .05) Wahn 2005 Turku

25. Results: table 7: open the conversation, developing themes, turn-taking p13-p25 in t1/t2 (p < .05) Wahn 2005 Turku

26. Results: table 8: responsivity, attitudes, closing conversation p13-p25 in t1/t2 (p < .05) Wahn 2005 Turku

27. 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?) Wahn 2005 Turku

28. Conclusion: • Hypothesis 1 is proofed for both groups • 1st group (p1-p12) status of chronic aphasia: • AAT-expressive Subtests not significiant • 2nd group (p13-p24): status of acute aphasia: • all AAT-expressive Subtests significiant • Hypothesis 2 is proofed for both groups • closing gap between lexicon and overt speech • (oral language) • PCAD is very effective for increasing naming • (accessing lemmas) Wahn 2005 Turku

29. Conclusion: • Hypothesis 3 is proofed for main parts of conversation, e.g. opening and closing conversation, developing themes, turn-taking etc. in both groups • Hypothesis 4 is proofed for both groups: PCAD is very effective and functional (Hypotheses 2 and 3 precondition) • Limitations: population (number), heterogeneity, control • of variables Wahn 2005 Turku

30. Implications for therapy: • Functional appliance of electronical Aids, e.g PCAD in everyday-life situations, • Integration in speech and language therapy (functional appliance): Increasing lexicon access, Increasing functional conversation, Supporting activities of listeners. • Importance of practise and repetition Wahn 2005 Turku

31. Thank you for your interest! Wahn 2005 Turku