aphasia treatment overviews spring 2017 cueing hierarchies for
- Slides: 14
aphasia treatment overviews spring 2017 cueing hierarchies for naming oral reading approaches response elaboration treatment (RET)
cueing hierarchies process oriented approach for naming client profile: naming difficulty significantly impacts content in everyday conversation; may be a semantic or phonological source to naming problem target: increased content units in conversational speech (impairment) rationale: appropriate cues facilitate naming of targets; repeated naming strengthens the network and improves access to the lexicon
cueing hierarchies What are cueing hierarchies? Systematic, individualized hierarchies targeting either semantic and/or phonological information Protocol: in session, present target picture • if the client is able to name the picture, move to the next target • if the client is unable to name the picture, present cues until correct response is obtained, then move to next target Important: • choose personally relevant words • divide words into sets and train sequentially • reserve a set of words for probe of untrained words
example: semantic categories target word: carrot 1. 2. 3. 4. present picture “It’s a type of vegetable. ” superordinate “It’s similar to celery. ” coordinate “Rabbits eat them. ” associated
example: combined semantic/phonological • target word: table 1. 2. 3. 4. 5. present picture it’s a piece of furniture superordinate “It sounds like fable. ” rhyming you eat dinner there associated “It starts with /t/. ” initial phoneme
measurement • in session data: o number of words named without cues (1 step of protocol) o performance at each step o use a modified SOAP note (current and last session data) and report accuracy on on each set • use information about performance that you collected to assess performance variables (e. g. , does she always get it on the last step? Does it vary? ) • outcome measures o impairment: Boston Naming Test; conversational sample; untrained word probes o activity/participation: self report of increased naming (e. g. , fewer communication repairs needed with partner; efficiency; successful phone call, etc. )
oral reading approaches process oriented client profile: may experience inability to read any whole words (letter by letter reading; pure alexia) or able to read some words, but overall difficulty with connected text o not for decoding issues target: increased reading rate and comprehension rationale: repeated oral reading strengthens access to, or representations of, words in the lexicon; faster rate results in better comprehension
oral reading What are oral reading approaches? repeated oral reading of systematically selected passages with clinician cueing Protocol: see next slides Important: • choose appropriate level of text • homework is essential
oral reading Basic MOR procedure 1. determine rate and accuracy for a passage 2. have patient re-read text, cueing to correct reading errors 3. set up homework – copied text and log ---4. review homework log 5. probe rate and accuracy of practiced passage 6. determine target rate (e. g. , 75 wpm); provide new passage when criterion is reached
ORLA protocol (Cherney, 2004)
measurement • in session data: o reading rate (wpm) and accuracy (% words accurate) o comprehension probes o qualitative data about cueing responsiveness • outcome measures o impairment: Gray Oral Reading Test; probes of untrained text o activity/participation: self report of improved/increased reading of everyday reading material (varies widely)
response elaboration training (RET) process oriented approach for oral expression client profile: variety of aphasia profiles and severities target: oral discourse increased content units and length of utterance rationale: combining behavioral techniques of modeling and forward chaining with cognitive stimulation using loose training results in expanded oral expressive output • loose training - uses the client’s response as stimulus
Protocol: uses simple line drawings RET important: used modified RET (m. RET) for clients with significant apraxia
measurement • in session data: o o content: number of information units produced (steps 1 and 6) may vary based on severity of client possibly grammatical production: number of morphemes, nouns, verbs, and modifiers • outcome measure: increased MLU in everyday conversation; measure of impact (e. g. , questionnaire, GAS)
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