CSD 515: Lecture 5 part 2

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:

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