adult language evidence based practice group 2008 extravaganza adult language evidence based...
TRANSCRIPT
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2008 Extravaganza
ADULT LANGUAGEADULT LANGUAGEEVIDENCE BASED PRACTICE EVIDENCE BASED PRACTICE
GROUPGROUP
Anika Roseby and Kate Schuj
Group Co- Leaders
with
Lyndsey NickelsAcademic Member
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Clinical Question
Last year the Group completed a CAT on repetition as a treatment for word retrieval problems in aphasia.
This lead to a new question…
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Question
“How and in what circumstances does orthographic cueing as therapy improve later spoken word retrieval in aphasia?”
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CAPping the Articles16 possible articles were found
Only 5 actually answered our clinical question and were included in our CAT
Some articles were not included because we couldn’t be sure that orthographic cueing alone assisted verbal naming (combination of cueing types used e.g. semantic or repetition).
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Exploring the Question..
How does Orthographic Cueing work?
Why does it work?
Who does it work for?
Are the effects lasting?
Is there more than one way that orthographic cueing works?
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Approaches to rehabilitation:Restoration vs. compensation
Restoration
• Improving the functioning of defective processes
• Re-teaching of missing information, rules or procedures (or regaining retrieval of that information)
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Approaches to rehabilitation:Restoration vs. compensation
Compensation
• Teaching a different way to perform the same function – using intact skills within the same cognitive domain
• Teaching a way to compensate for the lost function using different skills.
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Cueing, Facilitation, Therapy
K
kangaroo
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Cueing, Facilitation, Therapy
“k” (spoken by SP)
kangaroo
….later
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Cueing, Facilitation, Therapy
“k”“k”
“k”“k”
“k”“k”
“k”“k”
“k”
kangaroo
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Use of orthography to facilitate retrieval of phonological form
most beneficial when written naming is less impaired than spoken naming:
Someone else cueing – priming for that item only
Self-cueing – generalises and compensatory
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How does orthographic cueing work?Two methods we discuss:
Generating phonemic cues from the initial letter
Using direct orthographic route
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Method 1: Generating phonemic cues from
the initial letter Nickels (1992)
1. Spoken naming
2. Written naming
3. Convert letters to sounds
dog
TC
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Generating phonemic cues from the initial letter Nickels (1992)
1. Spoken naming
2. Visualise written word
3. Sound out initial letter
& cue word production
retaught letter-sound correspondences
ddog
dog
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This means….
This improved TC’s spoken naming to almost the same level as his written naming. He used this spontaneously in conversation. Could be used for any word he was trying to retrieve (and was)(only fails for words with irregular initial letters e.g. onion, Cinderella)
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Who will this work with?
Requires access to the written form when the spoken form is unavailable
Requires phonological cueability
Requires an ability to convert letters into sounds
Can be retaught
Can use a computer
cueing aid to do the
conversion
Phonologically-mediated self-cueing (e.g.; Nickels, 1992)
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Using a computer to generate phonemic cues from the initial letter Best et al. (1997)
/d/
dog
d
3. Press letter 2. Visualise first letter
4. Computer produces phoneme
5. Cue word production
1. Spoken naming
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Generating phonemic cues from the initial letter – who?If they are phonemically cueable
They may be able to use a computer to generate the cues
If they can (or be taught to) convert letters to sounds
They may be able to generate their own phonological cues
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Method 2: Self-generated orthographic cues
When spoken naming
IF individuals can identify initial letter
They may be able to use
direct orthographic cueing (without needing to convert letters into phonemes)
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How does direct orthographic cueing work?
Phonological Output Lexicon
Speech
Lexical Semantics
OrthographicOutput Lexicon
Writing
Orthographic Input Lexicon
K
knife kick king etc
knifeKnife
Point to “K”“knife”
Knife kick king etc
Visualise K
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Cueing aid reorganising the naming system: JOW Best et al, 1997
A direct orthographic cueing mechanism
Substantial and long-lasting effects of treatment
Improvement in treated and untreated items
Treatment drew attention to the relationship between orthography and phonology
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CATClinical bottom line:
The use of orthography to facilitate retrieval of phonological form is most beneficial when written naming is less impaired than spoken naming.
Using orthographic cues in therapy can lead to lasting improvements in naming treated items (just like repetition in our last CAT).
Remember …. Treatment tasks can
work in different ways for different people
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Acknowledgements
All the Adult Language EBP group members for all their hard work, dedication and contributions
Lyndsey Nickels, our academic link; whose expertise has been invaluable!
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ReferencesBasso A, Marangolo P, Piras F, Galuzzi C (2001) Acquisition of new "words" in normal subjects: A suggestion for the treatment of anomia. Brain and Language. Vol. 77(1), 45-59.
Best W, Herbert R, Hickin J, Osborne F, Howard D.(2002) Phonological and orthographic facilitation of word-retrieval in aphasia: Immediate and delayed effects. Aphasiology, Volume 16 Issue 1 & 2 January, pages 151-168
Best W, Howard D, Bruce C, Gatehouse C. (1997) Cueing the Words: A Single Case Study of Treatments for Anomia. Neuropsychological Rehabilitation 7 (2) 105-141
Nickels, Lyndsey, (1992), The Autocue? Self-generated Phonemic Cues in the Treatment of a Disorder of Reading and Naming. Cognitive Neuropsychology, 9 (2) 155-182
Lorenz, A, Nickels, L .( 2007), Orthographic cueing in anomic aphasia: How does it work? Aphasiology. Vol 21(6-8) Aug, 670-686.