Studied by 2 people
Principles in the Stimulation Approach
Stimulation, NOT teaching
Stimulation should be carefully planned and controlled (not just talking to patient)
Stimulus must be adequate to elicit the target
REPETITIVE
Maximize # of responses -> critical for RET, VNeST, CILT
Provide consistent feedback (type of feedback may vary based on patient)
Systematic presentation of material
Begin sessions with relatively easy, familiar tasks
Abundant and varied materials should be used
Provide support necessary for successful elicitation
Stimulus variables to consider
Auditory perceptual clarity: -Volume and noise -Method of delivery
Non-linguistic visual-perceptual clarity -Dimensionality -Size -Color -Context -Ambiguity -Operativity
Linguistic visual perceptual clarity -Size and form
Discriminability
Combining sensory modalities
Stimulus repetition
Rate and pause
Length and redundancy
Frequency and redundancy personal factors
Cues
Sequencing targets
Select targets "where slight deficiencies exist and never where performance is completely inadequate." Chapey , 2001
TOO HARD: <40% accuracy
GOOD TARGETS: 60 80% responses are correct
TOO EASY: 90% accuracy (Ms. F says consider these for homework)
Cueing hierarchy
DELAY
Semantic cue
Gestural cue
Written letter
Phonemic cue
Written word
Sentence
completion
Model
Salient Feature Analysis
SFA in conversation (Rider, Wright, Marshall, & Page, 2008)
Modified SFA with individuals with AOS ( Wambaugh , Wright, & Nessler, 2012)
Phonological components analysis (Leonard, Rochon, & Laird, 2007)
-if you start with a harder target -> you might be able to bring up the easier words connected to it
Group, Use, Action, Properties (it has/is_), Location, Association (reminds me of a_)
Response Elaboration Training Kearns (1985)
Loose training procedure incorporating the principles of "incidental teaching" and an emphasis of function over form.
The SLP shapes and requests elaboration of the spontaneously produced utterances rather than targeting pre selected response. A six step forward chaining training procedure was used
Subjects: The subject was a 50 year old, grade school educated male 3 years s/p left CVA. His clinical profile was consistent with moderately severe Broca's aphasia and apraxia.
Intensity & Duration of Treatment: Treatment sessions were conducted three times weekly for approximately 22 sessions. Ten sessions were required to reach criteria on set 1, and 5 sessions were required on set 2.
Outcome Measures: Experimental probe measures of the number of relevant "content" words produced to picture stimuli and the Porch Index of Communicative Ability (PICA, Porch, 1981) were used.
Results: -Probe measures of the number of relevant "content" words produced to picture stimuli increased when treated and were maintained post treatment. These improvements were observed to generalize somewhat to untrained familiar items. -PICA scores reflected minimal change in overall scores, with some increases on the verbal subtests.
RET steps
Step 1: Verbal instruction and stimulus presentation "Tell me what's happening." "Man...
Step 2: Expansion, model, reinforce " Th e man on a bench. Say, "the man on the bench.'"
Step 3: WH cue for more information "The man on the bench why?" " Tired"
Step 4: Combine new subject response with previous response; model "The tired man is on the
Step 5: Request repetition of above "Say, 'the tired man is on the
Step 6: Reinforce and re model "What's happening here? The tired man is on the bench. Tell me
Modified RET Wambaugh & Martinez (2000)
Examined the effect of a modified RET procedure on individuals with aphasia and AOS
Wambaugh & Martinez (2000)
Subjects: Subjects (n=3) were >1 year s/p left CVA and presented with chronic Broca's aphasia and moderate to severe AOS
Intensity & Duration of Treatment: Sessions were 1 hour in length, 3 times per week.
Outcome Measure: -Average number of correct information units (CIUs) in response to picture stimuli -Number of CIUs produced per minute in 3 minute personal recount samples was obtained at baseline.
Modified RET Wambaugh et al. (2001)
Documented the qualitative changes in aphasic spoken productions following application of a modified response elaboration training (RET) procedure previously reported in Wambaugh and Martinez (2000).
Subjects: -Subject 1 was a premorbidly right handed, male, age 64, with chronic Broca's aphasia, and moderate AOS. -Subject 2 was a premorbidly right handed, male, age 63, with chronic Broca's aphasia, and moderate severe AOS. -Both participants were aphasic and apraxic subsequent to a left hemisphere stroke.
Wambaugh et al. (2001)
Length of Treatment: one hour of therapy three times weekly Outcome Measures: The subjects' responses for each probe sample (picture description or personal recount) were transcribed orthographically and analyzed for:
number of narrative words, number of words belonging to each lexical type -nouns, verbs, adjectives, etc. -number of different nouns and verbs, and, for the personal recount samples, -mean length of utterance
Subject 1 Increase in: -total number of narrative words (3.8 to 203) -total nouns (3.8 to 198) -total verbs (0 to5) -different nouns (3.6 to 45) -different verbs (0 to 5) -MLU (0.4 to 1.4)
Subject 2 Increase in: -total number of narrative words (37 to 113) -total nouns (33 to 87) -total verbs (2 to 8) -different nouns (14 to 31) -different verbs (2 to 5) -MLU (3.3 to 4.35)
Verb Network Semantic Treatment Edmonds & Babb, 2011
Purpose: To determine whether VNeST results in improvement in individuals with moderate to severe aphasia (prior study examined benefit for individuals with more moderate aphasia), and specifically to examine whether improvements were treatment specific, whether generalization was noted, and whether treatment resulted in change in performance on assessment measures to
include: Object & Action Naming Battery, Argument Structure Production Test (ASPT), correct information units (CIU's), and ratings of communication on the CETI.
Subjects: two subjects w/ moderate-to-sever aphasia
Edmonds & Babb, 2011
Treatment: Participants completed multiple baseline probes of treated and un treated stimuli, then engaged in treatment, followed by post treatment measures and 1 month follow up measures. Treatment administered was VNeST , the design of which is to generate agent and patient pairs to a target verb (e.g., chef/sugar, carpenter/lumber, surveyor/land for measure ) with the intent of strengthening the connections between the verb and its thematic roles.
Length of Treatment: Participants completed 5 baseline sessions, VNeST 2times/week and 2 hrs /session for 15 sessions, post treatment assessment, and 1 month follow up assessment.
Primary Outcome Measures: Performance on treatment probes (for both trained and untrained items).
Secondary Outcome Measures: Performance on Western Aphasia Battery, Argument Structure Production Test (ASPT), correct information units (CIU's), and ratings of communication on the CETI
Results: Pattern of performance differed between the two participants, as follows:
Participant 1 (P1): Small effect size for trained items, no/negligible generalization, improvement on WAB, increased production of CIU's, improvements on CETI as reported by a family member.
Participant 2 (P2): Large effect size for trained items, large effect size for un trained items (generalization), improvement on WAB, improvements on CETI as reported by participant and family member.
Semantic treatments reviewed
SFA
RET
VNeST
