Treatment and generaliza.on effects of training atypical exemplars of seman.c categories for pa.ents with chronic aphasia

Transcription

1 Treatment and generaliza.on effects of training atypical exemplars of seman.c categories for pa.ents with chronic aphasia Natalie Gilmore, Erin Meier, Jeffrey Johnson, Stefano Cardullo & Swathi Kiran Boston University Aphasia Research Laboratory CSD Research Day, 05/04/2017 1

2 Outline for today s talk 1. Brief background of lexical retrieval difficulty in persons with aphasia (PWA), treatments for anomia and resul.ng generaliza.on pa[erns. 2. Present preliminary behavioral data from a study involving PWA who are receiving typicality-based seman.c feature analysis (SFA) treatment 3. Discuss poten.al mechanisms for the treatment gains and generaliza.on effects demonstrated in PWA as a result of typicality-based SFA treatment 2

3 Background I saw The Girl on the Train this weekend. It was amazing! Have you seen it? uh um...boy uh...watch... great...um... Saturday...ride.. ride bus... uh...you? Most pervasive symptom of aphasia (Goodglass & Wingfield, 1997) Occurs across aphasia types and severi.es 3

4 Background Concept SEMANTIC Vegetable Field Sweet Yellow Lexical selec/on sun carrot corn potato cake Phonological retrieval PHONOLOGICAL /s/ / / /r/ /n/ /ɔr/ /p/ /t/ /ae/ /ə/ /o/ /ei/ /k/ Phonological encoding corn Dell, Schwartz, Mar.n, Saffron, & Gagnon, 1997; Schwartz,

5 Background Seman.c-based approaches Word-to-picture matching (e.g., Grayson, Hilton, & Franklin, 1997) Seman.c judgments (e.g.,visch-brink, Bajema, & Van de Sandt- Koenderman, 1997) Seman.c feature analysis (e.g., Boyle & Coelho, 1995) Facilitate lexical retrieval -> access to phonological word form (Dell et al. 1997) 5

6 Background Seman/c Feature Analysis (SFA) (e.g,. Boyle & Coehlo, 1995) Spreading ac.va.on Mapping between seman.cs and phonology Generaliza.on to untrained items 6

7 Background Generaliza/on paierns from seman/c feature analysis based treatments Untrained items: (e.g., Boyle & Coehlo 1995; Coehlo, McHugh & Boyle 2000) (e.g., Rider, Wright, Marshall & Page 2008; Wambaugh, Mauszycki & Wright 2014) Untrained tasks: (e.g., Coehlo, McHugh & Boyle 2000; Hashimoto & Frome 2011) (e.g., Antonucci 2009; Boyle & Coehlo 1995) Jury is out! 7

8 Background Complexity Account of Treatment Efficacy (CATE) COMPLEX TARGETS GENERALIZATION (Thompson et. al, 2003) SIMPLE TARGETS Syntax (Thompson, Shapiro & Roberts, 1993; Thompson, Shapiro, Ballard, Jacobs, Schneider & Tait, 1997; Thompson, Ballard & Shapiro, 1998; Thompson, Shapiro, Kiran &(Eckman, Bell & Nelson, 1988) Sobecks, 2003) English as a second language (ESL) Phonological disorders in children (Gierut, 1990, 1992, 2001; Gierut & Champion, 2001; Gierut, Elbert & Dinnsen, 1987) Seman/cs (Kiran & Thompson, 2003; Kiran, Kiran & Johnson, 2008, Kiran, Sandberg & Sebas.an, 2011) 8

9 Background Garlic: eaten cooked; has an odor; is nutri.ous; found in a grocery store Cucumber: eaten fresh; put in salad; is nutri.ous; found in a grocery store Prototypical Features: Eaten fresh, put in salad TYPICAL SIMPLE Core Features: Nutri.ous, found in a grocery store ATYPICAL COMPLEX Carrot: eaten fresh; put in salad; is nutri.ous; found in a grocery store Watercress: is spicy; grows in a greenhouse; is nutri.ous; found in a grocery store; Rosch, 1975; Kiran,

10 Background Category Type Animate/Organic (Kiran & Thompson, 2003) (Stanczak, Waters & Caplan, 2006) Well-Defined (Kiran & Johnson, 2008) Inanimate/Inorganic (Kiran, 2008) Ad-Hoc (Kiran, Sandberg & Sebas.an, 2011) Categories Aphasia Type Findings Fluent & Anomic Atypical -> Typical for 4 PWA Typical Atypical for 3 PWA Typical -> Atypical for 1 PWA Anomic Atypical -> Typical for 2 PWA Typical Atypical for 1 PWA Fluent & Nonfluent Atypical -> Typical for 2 PWA Typical Atypical for 4 PWA Anomic & Fluent Atypical -> Typical for 5 PWA Typical Atypical for 2 PWA Typical -> Atypical for 1 PWA Generaliza/on paierns based on the typicality effect have been demonstrated across category and aphasia types but, sample sizes were rela/vely small and not all pa/ents showed the effect. 10

11 Research Ques.ons Do PWA demonstrate greater improvement in their trained categories rela.ve to their monitored categories aqer treatment? TREATMENT EFFECTS Do PWA show greater generaliza.on to untrained typical items than untrained atypical items aqer treatment? GENERALIZATION Do PWA demonstrate near transfer to untrained tasks of seman.c and phonological processing aqer treatment? NEAR TRANSFER Do PWA show far transfer to global language skills aqer treatment? FAR TRANSFER 11

12 Methods 19 PWA received treatment Range of /me post onset, aphasia types and severi/es ID Age YPO Aphasia Type WAB-AQ BU Anomic BU Global BU Conduc.on BU Conduc.on BU Wernicke s BU Broca s BU Broca s BU Anomic BU Anomic BU Anomic BU Anomic BU Broca s BU Anomic BU Broca s BU Anomic BU Broca s BU Anomic BU Anomic BU Broca s M n/a SD n/a Range n/a

13 Methods Pre-Treatment Treatment Post-Treatment BaIery of standardized tests Set of 9 behavioral tasks 180-item naming screener (3x) 2 trained categories 1 monitored category 1 assessed category Typicality-based SFA tx Computer-administered with clinician assistance Trained on 2 categories 2 hour sessions for 12 weeks or un/l accuracy > 90% on 2 consecu/ve probes Weekly naming probes 2 trained categories 1 monitored category BaIery of standardized tests Set of 9 behavioral tasks 180-item naming screener (3x) 2 trained categories 1 monitored category 1 assessed category 13

14 Methods 5 Categories 3 Organic 2 Inorganic 36 items All treatment categories are constructed in this manner. 18 typical 18 atypical 14

15 Methods ID Trained Category 1 Trained Category 2 Untrained Category (Monitored) BU03 Typical Birds Atypical Furniture Vegetables WEEKLY TREATMENT PROBE 36 items 18 typical 36 items 18 atypical 36 items 18 typical (TRAINED) 18 atypical (UNTRAINED) 18 typical (UNTRAINED) 18 atypical (TRAINED) 18 typical (UNTRAINED) 18 atypical (UNTRAINED) 15

16 Methods Treatment categories were quasi-randomly assigned and counterbalanced across par/cipants. ID Trained Category 1 Trained Category 2 Untrained Category (Monitored) Untrained Category (Assessed) BU01 Typical Birds Atypical Vegetables Clothing Furniture BU02 Typical Birds Typical Clothing Furniture Vegetables BU03 Typical Birds Atypical Furniture Vegetables Clothing BU04 Typical Birds Typical Furniture Vegetables Clothing BU05 Typical Vegetables Typical Clothing Furniture Birds BU06 Typical Clothing Typical Furniture Vegetables Birds BU07 Typical Vegetables Atypical Furniture Birds Clothing BU08 Atypical Birds Typical Furniture Clothing Vegetables BU09 Atypical Birds Typical Furniture Vegetables Clothing BU10 Typical Birds Atypical Furniture Clothing Vegetables 16

17 Methods Typicality-Based Seman/c Feature Analysis Treatment Kiran & Thompson, 2003; Kiran & Basse[o, 2008; Kiran & Johnson, 2008; Kiran, 2008; Kiran et al.,

18 Methods SEMANTIC TASKS PHONOLOGICAL TASKS Category Superordinate Category Coordinate Seman5c Feature Syllable Judgment Rhyme Judgment Phoneme VerificaAon Fruit Yes No Yes No Can Fly Yes No Two syllables Yes No Murky Yes No Phoneme /g/ Yes No Record accuracy and response /me to measure processing at the level of seman/cs, phonological output lexicon (POL) and phonological output buffer (Meier, Lo & Kiran, 2015) 18

19 Methods Before and arer treatment BaIery of standardized tests Set of 9 site-specific behavioral tasks 180-item naming screener (3x) 2 trained categories 1 assessed category 1. Revised Western Aphasia BaIery (WAB-R) 2. Cogni/ve Linguis/c Quick Test (CLQT) 3. Boston Naming Test (BNT) 4. Pyramids & Palm Trees (PAPT) 5. PALPA 1 Nonword Minimal Pair Discrimina/on 6. PALPA 51 Word Seman/c Associa/on 7. Northwestern Naming BaIery Confronta/on Naming (NNB-CN) 19

20 Results RQ 1 : Do PWA demonstrate greater improvement in their trained categories rela/ve to their monitored categories arer treatment? Accuracy over /me Q1: SFA-based tx works! Atypical Trained Items Typical Trained Items Trained items improved at a significantly faster rate than monitored items over.me. All Monitored Items Time*Training Interac.on F (4, 1223) = 25.28, p<.001 Trained Typical Items β =.010, SE =.002 t(1,738) = 5.00, p<.001 Trained Atypical Items β =.020, t(1,487) = 8.02, p <

21 Results RQ 2 : Do PWA show greater generaliza/on to untrained typical items than untrained atypical items arer treatment? Accuracy over /me Q2: Typicality effect holds and results in generaliza.on to untrained related items! Untrained Atypical Items Untrained typical items improved at a significantly faster rate over.me than untrained atypical items. Untrained Typical Items Time*typicality interac.on F (1, 580) = 7.49, p=.006 B =.007, SE =.003, t(580) =

22 Results - RQ 3 : Do PWA demonstrate near transfer to untrained tasks of seman/c and phonological processing arer treatment? % 80.00% 60.00% 40.00% 20.00% 0.00% Average Accuracy by Task (%) (n=17) * * Pre Post SCV SFV CCJ SJNN SJNP PVNN PVNP RJNN RJNP Wilcoxon Signed Rank Test -> SJNN: W=20.5, Z= -1.95, p=.048; SJNP: W=25, Z = -1.99, p=.049 KEY: SCV = Superordinate Category Verifica.on CCJ = Category Coordinate Judgment SFV = Seman.c Feature Verifica.on SJ = Syllable Judgment PV = Phoneme Verifica.on RJ = Rhyme Judgment NN = No Name NP = Name Provided Q3: Further evidence of generaliza.on. PWAs accuracy improved significantly on syllable judgment tasks aqer treatment 22

23 Results - RQ 3 : Do PWA demonstrate near transfer to untrained tasks of seman/c and phonological processing arer treatment? Reac/on Time (ms) Mean Reac/on Time on Behavioral Tasks (n=17) * SCV SFV CCJ SJNN SJNP PVNN PVNP RJNN RJNP Pre Post KEY: Wilcoxon Signed Rank Test-> SFV: W=110, Z = 2.17, p=.029 SCV = Superordinate Category Verifica.on CCJ = Category Coordinate Judgment SFV = Seman.c Feature Verifica.on SJ = Syllable Judgment PV = Phoneme Verifica.on RJ = Rhyme Judgment NN = No Name NP = Name Provided Q3: PWA were significantly faster on a seman.c feature task aqer treatment 23

24 Results - RQ4: Do PWA show far transfer to global language skills arer treatment? Accuracy on Standardized Outcome Measures (n=19) * * * * WAB LQ WAB CQ WAB AQ CLQT BNT PAPT PALPA 1 PALPA 51 NNB CN Pre Post Wilcoxon Signed Rank Test -> WAB-LQ: W=27, -2.75, p=.007; WAB-CQ: W=28, -2.70, p=.007; WAB-AQ: W=24, -2.86, p=.005; BNT: W=32.5, -2.52, p=.013 Q4: More evidence of generaliza.on. PWA improved significantly on the WAB and BNT aqer seman.c feature-based analysis treatment. 24

25 Discussion Group-level analysis demonstrate posi.ve acquisi.on effects Consistent with previous studies with larger, more diverse pa.ent sample Individual level analyses Effect Size (ES) = (Mean post-tx Mean pre-tx)/sd pre-tx Average ES: M = 5.60 SD = 3.9 R = Not all par.cipants showed a benefit why? Effect Size & Aphasia Severity Average Effect Size WAB-AQ Correla.on btwn ES & aphasia severity r =.53, p=.02 Impact of apraxia of speech less clear Green = concomitant severe AOS

26 Discussion Untrained Typical = light grey Untrained Atypical = dark grey Generaliza/on Effect Sizes by Par/cipant BU01 BU02 BU03 BU04 BU05 BU06 BU07 BU08c01 BU09 BU10 BU11 BU12 BU13 BU14 BU15 BU16c05 BU17 BU18 BU19c

27 Discussion WHY? Supports the typicality effect and CATE hypothesis Mechanism for generaliza.on Efficient therapy to maximize gains COMPLEX TARGETS SIMPLE TARGETS (Thompson et. al, 2003) 27

28 Discussion % 80.00% 60.00% 40.00% 20.00% 0.00% Syllable Judgment Accuracy (%) * * 10% 10% Pre Post SJNN SJNP Significantly more accurate post-treatment Increased access to phonological word form (Dell et al.,1997) Opportuni.es to repeat target Syllable judgment specifically Be[er lexical access Less complex Seman/c Feature Verifica/on Response Time (ms) Pre ms * Post Pre Post Not surprising Primary focus of treatment Rehearsed this skill during weekly sessions Significantly faster post-treatment 28

29 Discussion Significantly more accurate on standardized tests post-treatment Accuracy on WAB & BNT WAB LQ WAB CQ WAB AQ BNT Pre Post Improved lexical retrieval harnessed by PWA when comple.ng other naming and cogni.ve-linguis.c tasks Changes on WAB-AQ, LQ, CQ and BNT Change on standardized assessments important for clinicians and researchers 29

30 Conclusions Persons with chronic aphasia can improve their naming skills from typicality-based SFA treatment Training features of atypical exemplars -> typical exemplars without direct training! Some generaliza.on to phonological processing and standardized tests Efficient treatment approach 30

31 Acknowledgments: This work was made possible by the Na.onal Ins.tutes of Health/Na.onal Ins.tute on Deafness and Other Communica.on Disorders through grant NIH/NIDCD 1P50DC It is part of a larger mul.-site project conducted through the Center for the Neurobiology of Language Recovery (h[p://cnlr.northwestern.edu/, PI: Cynthia Thompson). I want to extend my gra.tude to all of the individuals with aphasia who par.cipate in our studies and all of the hard-working members of the BU Aphasia Research Laboratory who make this work possible especially my mentor, Dr. Swathi Kiran and my collaborators on this project, Erin Meier, Stefano Cardullo, Jeffrey Johnson and our lab manager, Carrie Des Roches. THANK YOU for your aien/on! 31