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Treatment of Word retrieval impairments: Do we know which tasks work for whom and why?

Treatment of Word retrieval impairments: Do we know which tasks work for whom and why?. Associate Professor Lyndsey Nickels National Health and Medical Research Council Senior Research Fellow, Macquarie Centre for Cognitive Science (MACCS), Macquarie University, Sydney, Australia.

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Treatment of Word retrieval impairments: Do we know which tasks work for whom and why?

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  1. Treatment of Word retrieval impairments:Do we know which tasks work for whom and why? Associate Professor Lyndsey Nickels National Health and Medical Research Council Senior Research Fellow, Macquarie Centre for Cognitive Science (MACCS), Macquarie University, Sydney, Australia

  2. Aim & Structure This presentation will… • address the systematic research on treatment for word retrieval disorders • Focus on word retrieval disorders in aphasia Structure • define the problem & how to assess it • discuss the evidence on treatment approaches

  3. Defining the problem What do we mean by word retrieval? • successfully accessing the phonological form of a word from semantics • exclude impairments of phonological processes and articulation

  4. Print Heard Speech Idea, picture or seen object Semantics Phonological Output Lexicon Phonological Buffer / Phonemes Writing Speech output

  5. Print Heard Speech visual object representations; nonlinguistic concepts Idea, picture or seen object Store of word meanings Store of phonological word forms Semantics Phonological Output Lexicon Phonological Buffer / Phonemes Assemble phonemes into syllables. Retrieve articulatory plans. Phonemes Writing Speech output

  6. Object, picture or idea Semantics Phonological Lexicon PhonologicalBuffer/ Phonemes

  7. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon PhonologicalBuffer/ Phonemes

  8. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes

  9. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  10. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  11. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  12. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  13. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  14. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  15. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  16. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  17. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d Phoneme assembly; Articulatory plan retrieval

  18. How do you know what level the impairment is? Why does it matter? Different levels of impairment require different treatment

  19. How do you know what level the impairment is? Observe behaviour & relate to the model of language processing How do they do on other tasks that share the same processing components? What errors do they make in speech production? What factors affect the accuracy of their speech production? 3 people with aphasia and word retrieval impairments

  20. Picture naming AER 54% correct trumpet Playing instrument GSW 52% correct A dog’s residence A clarinet CI 58% correct /efl .. efltn lfnnt lfnnt lftn lfnt elfn eflnt / /su:pbnn sbbri: sb mri:n/

  21. Different error types in word retrieval AER & GSW : semantic errors e.g.Saxophone -> trumpet CI : phonological errors e.g. Submarine -> /su:pbnn/

  22. How do you know what level the impairment is for AER & GSW? Observe behaviour & relate to the model of language processing Semantic impairment? What errors do they make in speech production? Semantic errors

  23. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  24. 4-legs pet barks scales fur Sem impairment Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  25. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k d æ o g t

  26. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k d æ o g t

  27. How can we confirm what level the impairment is for AER & GSW? Observe behaviour & relate to the model of language processing Semantic impairment? How do they do on other tasks that share the same processing components? What errors do they make in speech production? Semantic errors

  28. Print Heard Speech Semantic impairment Idea, Picture, or seen object Lexical Semantics Lexical Semantics Phonological Output Lexicon Phonological Output Buffer Writing Speech output

  29. Print Heard Speech Semantic impairment Idea, Picture, or seen object Lexical Semantics Lexical Semantics Phonological Output Lexicon Phonological Output Buffer Writing Speech output

  30. Print Heard Speech Semantic impairment Semantic impairment Speech output: (semantic errors) Idea, Picture, or seen object  Lexical Semantics Lexical Semantics Phonological Output Lexicon Phonological Output Buffer Writing Speech output

  31. Print Heard Speech Semantic impairment Semantic impairment Speech output: (semantic errors) Idea, Picture, or seen object  Lexical Semantics Lexical Semantics Phonological Output Lexicon Orthographic Output Lexicon Phonological Output Buffer Graphemic Output Buffer Writing Speech output

  32. Print Heard Speech Semantic impairment Speech output: (semantic errors) Written output: Speech comprehension: Written comprehension: Idea, Picture, or seen object   Lexical Semantics Lexical Semantics  Phonological Output Lexicon Orthographic Output Lexicon Phonological Output Buffer Graphemic Output Buffer  Semantic errors in all modalities Writing Speech output

  33. How can we confirm what level the impairment is for AER & GSW? Observe behaviour & relate to the model of language processing Semantic impairment? How do they do on other tasks that share the same processing components? What errors do they make in speech production? Impaired comprehension & written naming Semantic errors How do they do when you test comprehension & written naming?

  34. Assessment of semantic processing in comprehension Print Heard Speech • Require an assessment that has semantically related distractors • Perform the assessment in both spoken and written forms Pictures, seen objects Lexical Semantics Lexical Semantics Phonological Output Lexicon Orthographic Output Lexicon Phonological Output Buffer Graphemic Output Buffer Writing Speech output

  35. Assessing semantics: PALPA Spoken Word-Picture matching No. correct (n=40) AER 37 GSW 38   Controls Mean 39.29 (SD:1.07; Range 35-40) 2 SDs below the mean = 37.15 37 is considered outside normal limits “carrot”

  36. Print Heard Speech Semantic impairment Idea, Picture, or seen object Lexical Semantics Lexical Semantics Phonological Output Lexicon Phonological Output Buffer Writing Speech output

  37. Assessing semantics: PALPA Written Word-Picture matching No. correct (n=40) AER 38 GSW 39   carrot Controls Mean 39.29 (SD:1.07; Range 35-40) 2 SDs below the mean = 37.15 37 is considered outside normal limits

  38. Print Heard Speech Semantic impairment? Idea, Picture, or seen object Lexical Semantics Phonological Output Lexicon Phonological Output Buffer Writing Speech output

  39. Pyramids & Palm trees (Howard & Patterson, 1992) pyramid “pyramid” AER: 3 picture version: 87% 1 written word-2 pictures: 87% 1 spoken word-2 pictures: 85% Semantic impairment N=52 Controls score 94% correct or higher

  40. Does AER have a semantic impairment?

  41. Print Heard Speech Speech output: (semantic errors) Written output: Speech comprehension: Written comprehension: Does AER have a semantic impairment?  ? Lexical Semantics Lexical Semantics  Phonological Output Lexicon Orthographic Output Lexicon Phonological Output Buffer Graphemic Output Buffer YES!  Writing Speech output

  42. What about GSW? Maybe… but it’s a very easy task He can do word-picture matching…. does that mean he has intact semantics?

  43. Assessing semantics PALPA wd-pic match (n=40) Synonym Judgements High Image. Low Image. AER37/38 GSW 38/39 “Marriage – lamp” “Marriage – wedding” “reality - truth” “reality-notion”

  44. Assessing semantics PALPA wd-pic match (n=40) Synonym Judgements High Image. Low Image. AER37 GSW 38 87%^ 100%* 63% 90% Lower limit 38 .98 (37/38)^ .88 (34/38) of ‘normal’ .93 (28/30)* .83 (25/30)

  45. What about GSW? But didn’t we say semantic errors were a result of semantic impairments ! Maybe… but it’s a very easy task He can do word-picture matching…. does that mean he has intact semantics? But he can do synonym judgements too – so maybe his semantics is intact

  46. 4-legs pet barks scales fur Object, picture or idea Semantics purrs Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k æ o g t d

  47. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k d æ o g t

  48. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k d æ o g t

  49. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k d æ o g t

  50. Object, picture or idea Semantics purrs 4-legs pet barks scales fur Phonological Lexicon dog rabbit fish house robin cat PhonologicalBuffer/ Phonemes k d æ o g t

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