which words are most important for people with aphasia to ... · rebecca palmer, helen hughes, tim...
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Which words are most important for people with aphasia to relearn?
Rebecca Palmer, Helen Hughes, Tim Chater
@RPalmer SLT
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Background
• Word retrieval often targeted in speech and language therapy for aphasia
• Use picture material of words to be retrieved in therapy
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Does it matter which words we use in therapy?
Generalisation
• Only 1 in 4 patients generalise word finding from treated to untreated words (Nickels et al 2002, Best
2013)
• Phonological output deficits
Semantic difficulties
(Best 2013)
Salience
Suggests: To maximise impact of therapy, need to target words that patients identify as personally relevant
0
2
4
6
8
10
12
14
standard words personally chosen words
Ave
rage
nu
mb
er
wo
rds
lear
ne
d
Average number of words learned in CACTUS computerised word finding therapy
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Big CACTUS
• NIHR HTA & Tavistock Trust for Aphasia funded project
• Pragmatic RCT to evaluate clinical and cost effectiveness of computer word finding therapy for aphasia
• 278 participants with aphasia chose 100 words each to learn
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Computer aphasia therapy: approach to word finding therapy
StepByStep© software
Patients carry out regular independent self-managed practice
Volunteer to support language practice and computer use
SLT tailors software
100 words of personal interest
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Questions
1) What are the topics that people with aphasia are interested in talking about?
2) What are the most common words
selected for practice by people with aphasia?
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Method
• Use of data from first 100 participants randomised to Big CACTUS.
• Two SLT researchers conducted a quantitative
content analysis of 9999
– Identified word ‘types’ and number of ‘tokens’ e.g. banana, banana, banana, bananas, bananas
– Coded word types into topics and subtopics – Frequency counts of topics and words – Subgroup analysis: age and gender
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Participants
63 Male 37 Female
49 mild 27 moderate 25 severe
Age range 23-85, median 64
52 <65 years, 48 65 years or above
All >4 months post stroke
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Word selection
• SLT asked participant to think of 100 words
• 18 Prompt cards – informed by pilot study and StepbyStep content (35,000 words)
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What are the topics of interest?
Food & drink Nature & gardening Entertainment Places People House Clothes Travel Actions Money & numbers Personal care Shopping Time
Health Work & education Personal items Maths & science Descriptive terms Organisations & groups Feelings & senses Weather Technology & equipment Non content words Stationery Events Religion
3095 different words in 27 categories 79.4% words from 8 categories
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[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
[CATEGORY NAME]
[PERCENTAGE]
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Distribution of popular topics across participants
Foo
d &
Dri
nk
Nat
ure
&
Gar
de
nin
g
Ente
rtai
nm
ent
Pla
ces
Peo
ple
Ho
use
Clo
thes
Trav
el
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Male/female differences
>
• Nature & gardening (11.7% vs
7.7%)
• Travel (4.5% vs 1.7%)
>
• Clothes (7.5% vs 3.8%)
• Money & Numbers (3% vs 1.5%)
• Personal care (3% vs 1.5%)
• Shopping (2.5% vs 1.7%)
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Age differences
• 3 topics chosen more by those <65 years
• Travel (4% vs 2.8%)
• Actions (2.8% vs 1.8%)
• Time (2.6% vs 1.1%)
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100 words chosen with greatest frequency
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Key learning points
• It is important that words used in word finding therapy are
functionally useful for the individual with aphasia.
• Although likely to require some specific/specialist words, there is some commonality in words selected by PWA.
• Pre-prepared pictures of commonly chosen words could:
– Reduce time taken to prepare sets of words individuals wish to work on
– Enable therapy to focus on words likely to be useful for those unable to choose for themselves.
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Impact
• Commonly chosen words identified could inform evidence based content of pre-prepared resources (apps/software/colour flash cards)
• These could facilitate use of salient practice material increased impact of word finding therapy
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• This presentation presents independent research commissioned by the National Institute for Health Research (NIHR) under its Health Technology Assessment Programme (Grant Reference Number HTA 12/21/01 ). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
• This study was part funded by the Tavistock Trust for Aphasia • We also wish to thank:
– The 100 participants with aphasia – 21 SLTs who recruited participants and collected words PWA want
to be able to say
Acknowledgements
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Full study details and word lists available:
Palmer R, Hughes H, Chater T (2017)
What do people with aphasia want to be able to say? A content analysis of words identified as personally relevant by people with aphasia.
PLoS ONE 12(3): e0174065.
https://doi.org/10.1371/journal.pone.0174065