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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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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
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
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
  • Sessions

Range: 4-15 Average: 10.4

  • Confrontation writing measures (Avg.)

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

  • Task performance measures (Max = 7)

Baseline: 2.7 Last 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
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
  • 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)

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


1. Sit

2. Buy

3. Eat

4. Drive

5. Sleep

6. Put

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

  • 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


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
  • 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

Task parameters, stimulus parameters, and their dimensions


Multiple Choice Task 2-6 choices

Critical elements Task 1-3 elements

Frequency of Occurrence Stimulus Common, Occasional

Delay of Response Task 0, 5 seconds

Semantic Confusion Stimulus Different, Related

task hierarchy
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 Choice Task 2

Critical elements Task 1

Frequency of Occurrence Stimulus Common

Delay of Response Task 0

Semantic Confusion Stimulus Different

computer says

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 Choice Task 4

Critical elements Task 2

Frequency of Occurrence Stimulus Common

Delay of Response Task 5 seconds

Semantic Confusion Stimulus Related

computer says1

Computer says:

“Fork, Cup”