dr. john c. rosenbek professor & chair, department of communicative disorders harrison jones,...
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Dr. John C. RosenbekDr. John C. RosenbekProfessor & Chair,Professor & Chair,
Department of Communicative DisordersDepartment of Communicative Disorders
Harrison Jones, M.S.RSD/Doctoral Student
Department of Communicative Disorders
APROSODIAAPROSODIA
Definition, Theory, Evaluation, Treatment
OROR
It don’t mean a thing if it ain’t got that swing
Or worse in some ways it means the wrong thing
CHALLENGESCHALLENGES
Realizing this outline is a difficult talkBecause prosody and its disorder-
aprosodia-are difficult to define, describe, evaluate (reliably) and treat (effectively)
NONETHELESSNONETHELESS
Certain general notions are robust enough for us to make a beginning
Common to think of linguistic prosodyAnd emotional prosody
BUT FIRSTBUT FIRST
what is prosody?– The suprasegmental features (segments are
sounds) of speech conveyed perceptually by pitch stress and duration
– And acoustically as changes in frequency, intensity and timing
VALUE OF ACOUSTICVALUE OF ACOUSTIC
Aids in quantification of perceptual judgement
Especially critical in area such as aprosodia where diagnosis is so difficult
WAY TO THINK ABOUT WAY TO THINK ABOUT DIFFICULTYDIFFICULTY
Segmentals are the prosesuprasegmentals are the poetry
CONSIDERCONSIDER
I took my shotgun from the corner and slipped out the door as fast as I could. When mama talked about praying fir me it was time to go.
– This Rock by Robert Morgan
AND THISAND THIS
Behold the moralist hildagoWhose whore is morning starDressed in metal, silk and stoneSyringa, cicada, his flea
– A Thought Revolved by Wallace Stevens
DIFFERENCESDIFFERENCES
Meaning is less transparent in one than the other
This captures the huge difficulty of assessing, diagnosing and treating aprosodia
But progress has been madeAgreed upon types
LINGUISTICLINGUISTIC
Disambiguates words (black bird and blackbird) and
Sentences (He wrote poetry. He wrote poetry?)
Also called intrinsic prosody Thought to be primarily the product of left
hemisphere mechanisms
AFFECTIVEAFFECTIVE
Conveys a speaker’s emotions and attitudesI missed spending time with my father in
law uttered with joy or great sorrowSometimes called extrinsic prosodyThought to be primarily the product of right
hemisphere mechanismsDepends heavily on changes in fundamental
frequency
APROSODIAAPROSODIA
Our emphasisRoss in 1981 referred to deficits in
expression and reception of affective or emotional prosody as the aprosodias
He said “their functional-anatomic organization in the right hemisphere (mirrors) that of propositional language in the left..) P. 561
THEREFORETHEREFORE
He identified a motor aprosodia in which reception of emotional prosody was intact
A receptive in which reception was inordinately impaired
And counter parts of global, transcortical motor, transcortical sensory and so on
VALIDITYVALIDITY
These are notions in search of dataNonetheless clinicians know right
hemisphere damage (especially) can effect the processing of emotional prosody
Ross describes divorce as a consequence of a patient’s not being able to express emotion
Clinicians have other similar tales
HOWEVERHOWEVER
Until our recent work no therapiesIn general clinicians were likely to throw up
their hands when confronted with the multiple problems of right hemisphere damage
THE PROBLEMSTHE PROBLEMS
Limited measurement tools or testsNon-data based cutoffs of normal and
abnormal for those that do existVariability in the emotional prosody of the
populationThe thorny problem of laboratory versus
true emotional prosody
DESPITE ALL THISDESPITE ALL THIS
Theories have begun to emergeEvaluation procedures likewiseTreatment techniques have begun to appearWith the deepest roots right here at the
University of FloridaNourished by our own Ken Heilman
THEORIESTHEORIES
Against the background that Myers (1999) establishes with her comment that “Mechanisms of RHD prosodic deficits are not presently understood”
Heilman and his colleagues have proposed some– One is a motor theory– In simplest form the notion is that (especially
expressive aprosodia) results from a deficit of execution or of programming
`THE SECOND`THE SECOND
Degredation of a modality specific affect lexicon
Clearly this is the right hemisphere equivalent of the verbal lexicon in the left hemisphere
NADEAU EXPANSIONNADEAU EXPANSION
The affective lexicon “may be instantiated in a pattern associator network linking predominately right hemisphere association cortices and limbic structures and limbic structures with right prefrontal and and premotor cortex”
EXCLUDED EXPLANATIONSEXCLUDED EXPLANATIONS
DepressionAgnosognosiaNeglectDysarthria
EVALUATIONEVALUATION
Here is where challenge of poetry is most acute
Judgment of presence of both expressive and receptive aprosodia is subjective
Tools have been developed to standardize the stimuli
Response evaluation is still subjective
THE FABTHE FAB
Bowers, Blonder, Heilman, 1998Assesses ability to identify spoken prosodyAnd facial expressionAnd interesting notion is the relationship of
facial and spoken expression
THE FEEBTHE FEEB
Not yet non-standardizedAssesses spontaneous and and imitative
prosody, both affective and linguisiticEvaluation is perceptualMeaning judges say aprosodic or not.
COMING TOGETHERCOMING TOGETHER
The theories, primarily, generated two treatments One called Imitative The other called cognitive-linguistic Both comprised six steps Both are loosely based on notions of errorless
learning In that they go from maximum to minimum cueing Both motivated by theories of pathophysiology
IMITATIVE TREATMENTIMITATIVE TREATMENT
Step One: Cl models the requested emotional utterance and then cl and pt say together
Step Two: cl models and the pt produces after delay
finally, Produce the sentence in target tone of voice while imagining speaking to a family member
COGNITIVE-LINGUISTICCOGNITIVE-LINGUISTIC
Step One: Pt given a written description of characteristics of a given tone of voice
Step Two: Pt given cards listing names of emotions and asked to pick which emotion matches the tone of voice just described
Advances to Step six in which pt is asked to produce tone of voice based on all written cues previously provided
RESEARCHRESEARCH
Heilman and colleagues won a program project grant from NIH
THE DESIGNTHE DESIGN
Heilman and colleagues chose the replication of an ABAC design
A equals baselineB equals one of the two treatments chosen
randomlyThe second A is baseline after one month
“wash out” periodC is the second treatment
DETAILSDETAILS
Stable baseline confirmed with C statistic 20 sessions of the first treatment selected
randomly Post test One month “washout” Pretest 20 sessions of treatment two Post test immediately and at one and three months
DEPENDENT MEASUREDEPENDENT MEASURE
Participants were shown a card with a sentence and asked to utter the senteNce in a particular tone of voice
Adequacy of emotion judged by naïve person
Knew nothing of stage or treatment
EMOTIONSEMOTIONS
Treated– Sad– Happy– Angry
Control– Fearful
PROGRESS TO DATEPROGRESS TO DATE
14 pts treatedThe data are informativeData are in the form of effect size and
visual analysisConsider the data
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Baseline Baseline Imitative TreatmentPT PT 1m 3mCognitive Linguistic Treatment
Baseline Imitative Treatment 1m 3mPT
Baseline Baseline Imitative Treatment 1m 3mCognitive Linguistic Treatment PT
Baseline Baseline Imitative Treatment 1m 3mCognitive Linguistic Treatment PT
Baseline 1m 3mCognitive Linguistic Treatment PT
Baseline 1m 3mCognitive Linguistic Treatment PT
Baseline Baseline Imitative Treatment 1m 3mCognitive Linguistic Treatment PT
PT
PT
PT
Percent correct on treated emotions by session for all participants receiving Cognitive Linguistic treatment followed by Imitative treatment. PT = Post Testing, 1m = 1 month follow up, 3m = 3 month follow up.
BaselineCognitive Linguistic Treatment
Participant Treatment #2
Baseline 2
Mean
Baseline 2
SD
Therapy 2
Mean
Z score for
Tx 2
R1 R2 R3
01 Cog-Ling 56.62 13.74 74.5 1.3 + + +
02 Imitative 56.87 16.36 73 0.98 + + +
03 Imitative 53.87 13.63 70 1.18 + + +
04 Imitative 28.5 4.07 38.85 2.54 + + -
05 Imitative 81.35 6.11 93.7 2.01 + + +
06
07 Cog-Ling 39 6 42.77 0.62 + + +
08 Cog-Ling 37.62 9.31 45.5 0.84 + + +
09 Cog-Ling 42.37 8.79 66.68 2.76 + + +
10 Cog-Ling 14 3.2 13.95 -0.01 - - -
11 Cog-Ling 81.62 5.73 87.3 0.99 + + +
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No Second Treatment
No Second Treatment
No Second Treatment
No Second Treatment
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Baseline BaselineImitative Treatment PT PT 1m 3mCognitive Linguistic Treatment
Baseline Imitative Treatment 1m 3mPT
Baseline BaselineImitative Treatment 1m 3mCognitive Linguistic TreatmentPT
Baseline BaselineImitative Treatment 1m 3mCognitive Linguistic TreatmentPT
Baseline BaselineImitative Treatment 1m 3mCognitive Linguistic TreatmentPT
Baseline BaselineImitative Treatment 1m 3mCognitive Linguistic TreatmentPT
Baseline BaselineImitative Treatment 1m 3mCognitive Linguistic TreatmentPT
PT
PT
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PT
PT
Percent correct on treated emotions by session for all participants receiving Imitative treatment followed by Cognitive Linguistic treatment. PT = Post Testing, 1m = 1 month follow up, 3m = 3 month follow up.
ParticipantTreatment
#1
Baseline 1
Mean
Baseline 1
SD
Therapy 1
Mean
Z score for
Tx 1R1 R2 R3
01 Imitative 56 7.17 57 0.139 - - -
02 Cog-Ling 33 4.69 56.5 5.01 + + +
03 Cog-Ling 42.62 8.07 52.5 1.22 - - -
04 Cog-Ling 23.62 4.5 26.6 0.66 + + +
05 Cog-Ling 30.5 3.58 71.8 11.51 + + +
06 Imitative 14 3 20.95 2.16 + + +
07 Imitative 18.12 4.79 32.63 3.02 + + +
08 Imitative 14.15 2.59 21 2.64 + + +
09 Imitative 16.14 4.06 31.13 3.68 + + +
10 Imitative 14.37 3.74 14.15 -0.06 - - -
11 Imitative 57.37 6.09 82.66 4.15 + + +
12 Imitative 16.12 4.73 23.1 1.47 + + +
13 Cog-Ling 16.5 4.17 30.85 3.44 + + +
14 Cog-Ling 17 6 15.7 -0.22 - - +
Statistical Analysis Visual Analysis
CONCLUSIONSCONCLUSIONS• The treatments seem to have an effect
•Analysis underway to determine if one more influential than the other
•And to determine responders and non- responders
•Submitted another grant and got butchered
•So more work to do
BUTBUT
• Hope is the thing with feathers
• That perches in the soul
• And sings the tune without the words
• And never stops at all