ADULT LANGUAGE EVIDENCE BASED PRACTICE GROUP 2008 Extravaganza ADULT LANGUAGE EVIDENCE BASED PRACTICE GROUP Anika Roseby and Kate Schuj Group Co- Leaders.

2008 Extravaganza

ADULT LANGUAGEADULT LANGUAGEEVIDENCE BASED PRACTICE EVIDENCE BASED PRACTICE

GROUPGROUP

Anika Roseby and Kate Schuj

Group Co- Leaders

with

Lyndsey NickelsAcademic Member

Clinical Question

Last year the Group completed a CAT on repetition as a treatment for word retrieval problems in aphasia.

This lead to a new question…

Question

“How and in what circumstances does orthographic cueing as therapy improve later spoken word retrieval in aphasia?”

CAPping the Articles16 possible articles were found

Only 5 actually answered our clinical question and were included in our CAT

Some articles were not included because we couldn’t be sure that orthographic cueing alone assisted verbal naming (combination of cueing types used e.g. semantic or repetition).

Exploring the Question..

How does Orthographic Cueing work?

Why does it work?

Who does it work for?

Are the effects lasting?

Is there more than one way that orthographic cueing works?

Approaches to rehabilitation:Restoration vs. compensation

Restoration

• Improving the functioning of defective processes

• Re-teaching of missing information, rules or procedures (or regaining retrieval of that information)

Approaches to rehabilitation:Restoration vs. compensation

Compensation

• Teaching a different way to perform the same function – using intact skills within the same cognitive domain

• Teaching a way to compensate for the lost function using different skills.

Cueing, Facilitation, Therapy

K

kangaroo

Cueing, Facilitation, Therapy

“k” (spoken by SP)

kangaroo

….later

Cueing, Facilitation, Therapy

“k”“k”

“k”“k”

“k”“k”

“k”“k”

“k”

kangaroo

Use of orthography to facilitate retrieval of phonological form

most beneficial when written naming is less impaired than spoken naming:

Someone else cueing – priming for that item only

Self-cueing – generalises and compensatory

How does orthographic cueing work?Two methods we discuss:

Generating phonemic cues from the initial letter

Using direct orthographic route

Method 1: Generating phonemic cues from

the initial letter Nickels (1992)

1. Spoken naming

2. Written naming

3. Convert letters to sounds

dog

TC

Generating phonemic cues from the initial letter Nickels (1992)

1. Spoken naming

2. Visualise written word

3. Sound out initial letter

& cue word production

retaught letter-sound correspondences

ddog

dog

This means….

This improved TC’s spoken naming to almost the same level as his written naming. He used this spontaneously in conversation. Could be used for any word he was trying to retrieve (and was)(only fails for words with irregular initial letters e.g. onion, Cinderella)

Who will this work with?

Requires access to the written form when the spoken form is unavailable

Requires phonological cueability

Requires an ability to convert letters into sounds

Can be retaught

Can use a computer

cueing aid to do the

conversion

Phonologically-mediated self-cueing (e.g.; Nickels, 1992)

Using a computer to generate phonemic cues from the initial letter Best et al. (1997)

/d/

dog

d

3. Press letter 2. Visualise first letter

4. Computer produces phoneme

5. Cue word production

1. Spoken naming

Generating phonemic cues from the initial letter – who?If they are phonemically cueable

They may be able to use a computer to generate the cues

If they can (or be taught to) convert letters to sounds

They may be able to generate their own phonological cues

Method 2: Self-generated orthographic cues

When spoken naming

IF individuals can identify initial letter

They may be able to use

direct orthographic cueing (without needing to convert letters into phonemes)

Print

How does direct orthographic cueing work?

Phonological Output Lexicon

Speech

Lexical Semantics

OrthographicOutput Lexicon

Writing

Orthographic Input Lexicon

K

knife kick king etc

knifeKnife

Point to “K”“knife”

Knife kick king etc

Visualise K

Cueing aid reorganising the naming system: JOW Best et al, 1997

A direct orthographic cueing mechanism

Substantial and long-lasting effects of treatment

Improvement in treated and untreated items

Treatment drew attention to the relationship between orthography and phonology

CATClinical bottom line:

The use of orthography to facilitate retrieval of phonological form is most beneficial when written naming is less impaired than spoken naming.

Using orthographic cues in therapy can lead to lasting improvements in naming treated items (just like repetition in our last CAT).

Remember …. Treatment tasks can

work in different ways for different people

Acknowledgements

All the Adult Language EBP group members for all their hard work, dedication and contributions

Lyndsey Nickels, our academic link; whose expertise has been invaluable!

ReferencesBasso A, Marangolo P, Piras F, Galuzzi C (2001) Acquisition of new "words" in normal subjects: A suggestion for the treatment of anomia. Brain and Language. Vol. 77(1), 45-59.

Best W, Herbert R, Hickin J, Osborne F, Howard D.(2002) Phonological and orthographic facilitation of word-retrieval in aphasia: Immediate and delayed effects. Aphasiology, Volume 16 Issue 1 & 2 January, pages 151-168

Best W, Howard D, Bruce C, Gatehouse C. (1997) Cueing the Words: A Single Case Study of Treatments for Anomia. Neuropsychological Rehabilitation 7 (2) 105-141

Nickels, Lyndsey, (1992), The Autocue? Self-generated Phonemic Cues in the Treatment of a Disorder of Reading and Naming. Cognitive Neuropsychology, 9 (2) 155-182

Lorenz, A, Nickels, L .( 2007), Orthographic cueing in anomic aphasia: How does it work? Aphasiology. Vol 21(6-8) Aug, 670-686.