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Language and CognitionColombo 2011
Psycholinguistic Assessments of Language Processing in Aphasia – Word comprehension
With acknowledgement to Jane Marshall
Aims of Lecture
• Clarify processes involved in auditory comprehension
• Introduce other relevant processes (repetition and writing)
• Familiarise students with methods for assessing comprehension
• Develop skills in interpreting test data• Introduce methods for treating
comprehension problems
Auditory Analysis
AIL VIL
Visual Analysis
POL OOL
Semantics
Picture Analysis
Picture Recognition
Buffer Buffer
Speech Writing
Speech Writing
GPC
PGC
Pictures/Objects
Assessing Auditory Input
Minimal Pairs
tack cat farl farltome tome poob poom
• Demonstrates ability to carry out auditory analysis
• Lexical effect? AIL or Semantics prime auditory analysis
• Requires ability to retain and compare two spoken words, and accurate ‘yes’/’no’
Auditory Lexical Decision
hotel priscipledogma trantor
• Assesses ability to access AIL
• Requires ability to hold the word in head and indicate yes/no
• Imageability effect? Suggests that decisions are supported by Semantics
• Be aware of ‘yes’ bias
Word to picture matching
• Tests the person’s ability to access semantics from the spoken word
• Often a good place to start with testing
Synonym Judgements
• Boat ship• Boat flower
• Idea notion• Idea democracy
Imageability effect? Many aphasic individuals find concrete items easier than abstract.
Auditory Analysis
AIL VIL
Visual Analysis
POL OOL
Semantics
Picture Analysis
Picture Recognition
Buffer Buffer
Speech Writing
Speech Writing
GPC
PGC
Pictures/Objects
Repetition
• Supplements input testing. • Words v’s non Words • Concrete words vs abstract words
Words ☺ non words x Non lexical route x
AIL ☺
Note: Any repetition skills show AA ok.
Repetition may occur without comprehension
Spelling to dictation
Words vs non wordsRegular vs irregular words
Note:• Ability to spell indicates that at least AA is functioning• Spelling may occur without comprehension• Failure may be due to writing problems rather than
input difficulties
Testing Issues
Consider other reasons for failure, e.g.: • Attention• ability to point• Auditory short term memory • ability to signal yes/no• comprehension of pictures
Compare spoken with written input, to distinguish central semantic from peripheral problems
Think about chance
How do different impairments manifest?
Auditory Analysis
AIL VIL
Visual Analysis
POL OOL
Semantics
Picture Analysis
Picture Recognition
Buffer Buffer
Speech Writing
Speech Writing
GPC
PGC
Pictures/Objects
PK (Maneta et al 2001)
• Poor discrimination of minimal pairs
• Unable to repeat words
• Poor performance in lexical decision
• Poor at word to picture matching
• Written > Spoken tests
PK (Maneta et al 2001)
Conclusion:
PK has impaired Auditory Analysis • ‘Word sound deafness’• ‘Auditory verbal agnosia’
• If no other language impairments: ‘Pure word deafness’
Features of Pure Word Deafness
Environmental sounds are distinguished
With speech:• Lip reading helps (visual support)• Context helps • Slowed speech helps• Vowel > consonant discrimination • Voices and accents are differentiated
A problem processing rapid auditory information?
Auditory Analysis
AIL VIL
Visual Analysis
POL OOL
Semantics
Picture Analysis
Picture Recognition
Buffer Buffer
Speech Writing
Speech Writing
GPC
PGC
Pictures/Objects
AH (Franklin 1989)
• Good discrimination of minimal pairs• Repetition of words 81%• Repetition of non words 75%• Poor auditory lexical decision 70%• Poor word to picture matching• Poor synonym judgements
• Written lexical decision 94%
AH (Franklin 1989)
• Auditory Analysis is ok (minimal pairs and repetition)
• Access to AIL is impaired (lexical decision)
Word Form Deafness
Auditory Analysis
AIL VIL
Visual Analysis
POL OOL
Semantics
Picture Analysis
Picture Recognition
Buffer Buffer
Speech Writing
Speech Writing
GPC
PGC
Pictures/Objects
Bramwell (1897)
Described a woman with very impaired auditory Comprehension
She could comprehend environmental sounds:‘is it not strange that I can hear the clock ticking and cannot hear you speak’
She could also:SpeakReadWrite
Bramwell (1897)
She could often write to dictation
Example:
‘Do you like to come to Edinburgh?’
Not understood writes ‘Edinburgh’ reads word and understands question
Bramwell (1897): Conclusions
Can write irregular word to dictation:AIL POL OOL Writing
• Confirms that AIL is intact• Comprehension problem is due to impaired access
from AIL to semantics• Reading shows that semantics is intact and can be
accessed from the written word
Word Meaning Deafness
Auditory Analysis
AIL VIL
Visual Analysis
POL OOL
Semantics
Picture Analysis
Picture Recognition
Buffer Buffer
Speech Writing
Speech Writing
GPC
PGC
Pictures/Objects
CJ (Franklin 1989)
• Minimal pairs good• Lexical decision good• Word repetition good• Word to picture match impaired• Synonym judgement impaired
Written synonyms = spoken synonyms
What about therapy?
Impairment in Auditory Analysis
PK Maneta et al (2001)
Jargon speaker with severe impairments in:• Minimal pairs• Auditory lexical decision• Spoken word to picture matching
Problems in following conversation,TV, and using the telephone
Therapy 1
Minimal pair and lip-reading training
Tasks• graded discrimination tasks
Strategies• lip reading• cued articulation• colour coding
Strategies - Lip Reading
• client given pictures of lip to sound correspondences
• Advised to watch the speaker’s mouth
Strategies - Cued Articulation
Hand signals made next to the mouth
Show:• voicing• place of articulation• manner
Strategies - Colour Coding
Used where tasks require selection of written
words
Consistent colours for different places of
articulation:• velar car (brown)• alveolar tar (blue)• labial bar (red)
Task Example: Phoneme to grapheme matching
level 1
targets & distractors differ by 2 distinctive features
/t/ T G B
level 2
targets and distractors differ by 1 distinctive feature
/t/ P T K
Task Example:Matching spoken to written words
Level 1
“man” tan can man
Level 2
“cart” cart tart part
Task Example:Word to Picture Matching (Level 1)
“toy”
Task Example:Word to picture matching (level 2)
“tart”
Did it work?
Auditory Input Tasks (PK can watch face)
Pre Post
Minimal pair discrimination 24/40 29/40
Repetition 5/20 11/20
Word to picture matching 23/40 31/40
Small (but not significant) improvements in
discrimination
Conclusions from PK
• Improving discrimination is difficult (although see Morris et al 1996)
• The nature of the impairment may impede direct work
• Recent research project at UCL/City– No change on outcome measures (e.g. minimal pair
tasks)– Some change in the level of cueing needed during
therapy
Word Meaning Deafness
Impairment in link between AIL and Semantics • Good minimal pairs• Good lexical decision• Poor auditory comprehension
Person can• Write to dictation• Comprehend written words
Therapy ideas for word meaning deafness
Listen to wordWrite it downRead word and understand it Internalise the writing strategy
Give written context (a tool for banging in nails)Say word which is matched to picture (‘hammer’) Reduce context
Central Semantic Problems
Therapy aims to improve semantic processing
Possible tasks:
• Word to picture matching (semantic distractors)
• Categorisation
• Picture/word association tasks
Grayson et al 1997: semantic tasks on a jargon aphasic. Improved performance in spoken and written tasks.
General Therapy Issues
Practising input may recover or restore damaged processing
ButImpaired comprehension may prevent understanding of therapy
Input tasks are less amenable to strategies than output tasks
So : Therapists often work through other channels
Conclusions
• Understanding of speech can fail for different reasons
• Assessment aims to determine the level of the impairment
• Assessment findings influence therapy decisions, such as the selection of therapy tasks
• ‘Direct’ therapy needs to be supplemented with indirect approaches aiming to modify the environment