Lang in Adults 4-5

Anomia

• Anomia is a difficulty in naming, impacting functional communication.
• It's assessed through confrontation naming tasks, involving picture naming and object naming.
• The lexical retrieval/naming system comprises input and output stages, with input triggering output.
• In confrontation tasks, the focus lies on the type of input that can elicit accurate output.
• The input is presented visually (pictures or written words) facilitating recognition from memory.
• The process involves two stages:
  • Semantic Stage: Input processing with pictures or words
  • Phonological Stage: Retrieving the name (lexical output) for spoken or written language.
• Confrontation tasks focus on visual object recognition (input), while linguistic tasks involve presenting written words (input).

Neurological Underpinnings of Lexical Retrieval/Anomia

• Anomia results from a disruption in the left hemisphere neural network, particularly involving Broca's area.
• This disruption can be caused by lesions in perisylvian and extrasylvian regions.
• The left-inferior temporal region plays a crucial role in semantic (lexical input) processing.

Naming/Lexical Retrieval Assessment

• Formal Methods:

  • Boston Naming Test
  • Object and Action Naming Battery
  • Expressive Vocabulary Test
  • Language Activity Resource Kit

• Informal Methods

  • Standardized tests can be used informally without strict administration or scoring criteria.
  • Language Samples
  • Conversations
  • Response, Convergent, and Divergent Naming

• Modalities

  • Cross-modality naming assessment is essential.
  • Input Modalities:
    • Speech
    • Objects/Pictures
  • Output Modalities:
    • Speech
    • Writing
    • Gesture/Pointing

• General Considerations:

  • Word-finding difficulties should be identified in spontaneous speech and structured tasks.
  • Structured naming tasks provide a comprehensive assessment of naming functions across various input and output modalities.
  • Help to distinguish between impairment at the semantic or phonological stage of processing (or both).

• Factors Impacting Performance

  • Nouns vs. verbs
  • Semantic categories
  • Imageability
  • Length
  • Familiarity
  • Word frequency
  • Age of acquisition

• Error Analysis:

  • Valuable information regarding the nature of impairment can be gleaned by assessing language tasks with a focus on correct/incorrect responses.

Disruptions to Processing Systems

• Semantic Disruptions:
  • Errors in both comprehension and naming tasks, affecting spoken and written word comprehension.
  • Difficulty interpreting the meaning of gestures, objects, and pictures.
  • Oral word reading and writing dictation may remain unaffected.
• Phonological Lexical Output Disruptions:
  • Oral word production is impaired.
  • Comprehension is preserved.
  • Errors in oral naming.
  • Errors in oral word reading.
  • Difficulty activating the output lexicon.

Naming/Lexical Retrieval Treatment

• Cueing Hierarchies:

  • Providing progressively more support as needed.
  • Semantic cues
  • Phonemic cues
  • Presenting the target in different modalities.
  • Providing the target and requesting repetition.
  • Computerized programs.

• Semantic Treatment:

  • Based on the need for a strong semantic system for both comprehension and word retrieval.
  • Utilizing comprehension treatment to facilitate word retrieval.
  • Activities:
    • Sorting pictures into categories
    • Matching auditory words, written words, and pictures (with distractors)
    • Yes/no verification of semantic characteristics of target pictures.
    • Semantic feature analysis.
    • Training patients to employ a matrix of cue words designed to trigger elements or characteristics of the target word.

• Phonological Treatments:

  • Based on phonological representations, involving word repetition tasks.
  • Less effective than comprehension and cueing strategies.
  • No consensus regarding the effectiveness of these treatments for word-finding impairments.

• Re-organizational Approaches to Treatment:

  • Spelling Knowledge:
    • May be preserved in individuals with anomia.
    • Can aid in word retrieval via phonemic self-cueing.
  • Gesture:
    • May facilitate correct word retrieval.
    • Typing two letters into a computer to generate the initial phoneme of the target word, followed by the patient pronouncing the sound to provide a phonemic cue.
    • Results: Improved naming skills, even without comprehension or self-cues.
    • Combining gestures with the target word can elicit production.

• General Factors to Consider

  • Spaced Retrieval Training:
    • Patients produce small sets of personally relevant target words with systematically increasing periods between retrieval.
  • Intensity of Treatment:
    • Influences progress.
  • Generalization:
    • Aim for improved functional communication in conversation contexts.

Auditory Comprehension

• The ability to understand spoken language
• Single-Word Comprehension Assessment:
  • Present a verbal word and give instructions to point to a corresponding object, structure, or picture.
  • Tasks:
    • Matching written words to pictures/objects.
    • Asking "Is this a..." or "book?" (wait for yes/no response - verbal, written, or gestural).
  • Nouns are typically targeted, but verb comprehension can also be assessed with these methods.

Sentence-Level Comprehension

• Factors Impacting Complexity:

  • Semantic Reversibility:
    • The meaning of sentences depends on word knowledge, making reversible sentences (words with interchangeable meaning in a sentence) challenging.
    • Non-reversible sentences are easier as word meaning provides interpretation even without syntax comprehension.
  • Sentence Structure:
    • Complex structures are more difficult to understand.
  • Number of Prepositions:
    • More prepositions or verbs increase complexity.

• Impairment Patterns in Aphasia:

  • Sentence-level comprehension deficits are common in Wernicke's and global aphasia.

• Assessment:

  • Standardized Forms:
    • PALPA
    • Revised Token Test
    • BDAE
  • Informal Assessment:
    • Following commands
  • Tasks:
    • Simple and complex yes/no questions
    • Answering open-ended questions following information presentation (reading or storytelling).

Auditory Comprehension Treatment Approaches

• Based on the stimulation approach, assuming that the language system is not lost but needs to be reactivated efficiently.
• For individuals experiencing comprehension and production deficits.
• Activities:
  • Pointing drills.
  • Following directions/commands.
  • Yes/no questions.
  • Schuell’s Approach:
    • Sentence/phrase completion ("cloze procedure") - filling in predictable words in phrases and sentences.
    • Open-ended questions and retelling.

Sentence-Level Production

• Informal Assessment:
  • Spontaneous speech
  • Sequence Description
  • Picture Description
  • Analysis procedures
• Formal/Standardized Aphasia Batteries
  • PAL: Subtests for production of complex linguistic structures.
  • "Point to the picture that shows the elephant was chased by the lion" (comprehension).
  • "I want you to start talking about the cat. Use the word chase." (production).

Treatment

• Verb-Centered Treatment:
  • Assumes verbs contain information about argument structure.
  • Cueing Verbs Treatment:
    • Verbs as the "core" of a sentence.
    • Structured practice with verb production, arguments, and repetition.
  • Verb Network Strengthening Treatment:
    • Improves the retrieval of content words within simple active sentences.
• Syntactically Oriented Treatment:
  • Sentence Production Program for Aphasia
  • Language Production for Syntax
  • Production of specific sentence types improves with repeated exposure to similar sentence forms with different lexical items.
  • Treatment of Underlying Forms for Functional Morphological Categories:
    • Focuses on less complex structures in functional morphology.
• Functional Morphology:
  • Emphasizes the use and understanding of grammatical morphemes, which are small units of language that carry meaning but are not words themselves (e.g., -ing, -ed, -s).
  • The treatment often focuses on the production and comprehension of these morphemes within simple sentences, using strategies such as sentence completion, picture-based descriptions, and repeated practice.

Naming/Lexical Retrieval Treatment

• Cueing hierarchies provide progressively more support as needed.
• Semantic cues, phonemic cues, target in different modalities, and providing the target and asking for repetition are examples of cueing hierarchies.
• Computerized programs can also be used.

Semantic Treatment

• This treatment focuses on the need for a strong semantic system for both comprehension and word retrieval.
• Comprehension treatment can be used to facilitate word retrieval. This includes tasks like sorting pictures into categories, matching written words to pictures, and answering yes/no questions about semantic characteristics of target pictures.
• Semantic feature analysis involves using a matrix of cue words to trigger elements or characteristics of the target word.

Phonological Treatment

• Phonological treatments involve repeating words to focus on phonological representations.
• These treatments can be less effective than comprehension and cueing strategies.
• There is no consensus on whether semantic or phonological treatment is better for word-finding impairments.

Re-Organizational Approaches to Treatment

• Spelling knowledge: May be preserved in individuals with anomia and can facilitate word retrieval through phonemic self-cueing.
• Gesture: Can facilitate correct word retrieval. For example, typing two letters into a computer to generate the initial phoneme of the target word, and then pronouncing the sound, can provide a phonemic cue.
• Gesture and target word together: This combined approach can elicit word production.

General Factors For Treatment of Naming/Lexical Retrieval

• Spaced retrieval training: Patients produce small sets of personally relevant target words with increasing intervals between retrieval.
• Intensity of treatment: The amount of therapy provided.
• Generalization: The ability of the skills learned in therapy to be applied to everyday situations.
• Goal: Improved functional communication in conversational contexts.

### Auditory Comprehension

•  This refers to the ability to understand spoken language.

Single-Word Comprehension Assessment:

•  Present a word verbally and provide instructions to point to the object, picture, or structure.
•  Potential tasks include matching written words to pictures, asking "Is this a...?" or "book?", and assessing verb comprehension.

### Sentence-Level Comprehension

•   Factors impacting sentence complexity:

  • Semantic Reversibility: Sentences with words that are easily interchangeable are more difficult to understand (e.g., "The cat chased the dog" vs. "The dog chased the cat"). Non-reversible sentences (where word order matters) are easier.
  • Sentence Structure: More complex structures are more difficult to understand.
  • Number of Prepositions: More prepositions and verbs in a sentence increase its complexity.

•  Common impairment patterns in aphasia: - Sentence-level comprehension deficits are common in Wernicke's and global aphasia.

• Assessment: - Standardized forms: PALPA, Revised Token Test, BDAE - Informal assessments: Following commands.

  • Potential tasks: Simple and complex yes/no questions, answering open-ended questions after presentation of information (reading or storytelling).

Auditory Comprehension Treatment Approaches

•  Stimulation Approach: Building on remaining language abilities to improve efficiency.
  • Pointing Drills: For individuals with comprehension and production deficits.
  • Following Directions and Commands: Also for individuals with comprehension and production deficits.
  • Yes or No Questions: Used to assess and improve comprehension.
• Treatment based on Schuells’s Approach:
  • Sentence/phrase completion: "Cloze procedure"- completing common phrases with predictable answers.
  • Open-ended questions and retelling: Encouraging recall and language production.

Sentence-Level Production

• Informal assessments:
  • Spontaneous speech: Analyzing the patient's natural speech patterns.
  • Sequence Description: Describing a series of events.
  • Picture Description: Describing a visual scene.
  • Analysis Procedures: Analyzing the patient's production of specific language elements.
• Formal/Standardized Aphasia Batteries:
  • PAL: Includes subtests for production of complex linguistic structures. (Example task: Point to the picture that shows the elephant was chased by the lion (comprehension) / "I want you to start talking about the cat. Use the word chase" (production)).

Sentence-Level Production Treatment Approaches

• Verb-centered treatment: This approach focuses on the verb as the core of the sentence.
  • Cueing verbs treatment: Using prompts to support verb retrieval and production.
  • Structured practice: Producing sentences by practicing producing verbs, arguments, and repetition.
• Verb network strengthening treatment: Aims to improve retrieval of content words within simple active sentences.
• Syntactically oriented treatment: Focuses on improving the production of specific sentence types.
  • Sentence production program for aphasia: Utilizes repeated exposure and production of sentences with the same form but different lexical items.
• Treatment of underlying forms for functional morphologic categories: This approach addresses less complex structures and functional morphology (e.g., grammatical endings).

Neural Bases of Reading and Writing

• Phonological processing: Primarily located in the large perisylvian area of the brain.
• Semantic processing: Located in the larger extrasylvian areas of the brain.
• Orthographic processing: Located in the extrasylvian areas.

Central Processing Impairments

• Global/Deep Alexia:
  • Patterns in performance: Performance in reading and spelling is influenced by stimuli characteristics (typically better performance with real words than nonwords).
  • Reading and spelling errors: Common errors include substitutions, semantic errors.
  • Treatments: Reestablishing sublexical sound-letter correspondences, strengthening phonological skills, and sentence and paragraph level reading/spelling therapy.
• Surface Alexia and Agraphia:
  • Patterns in performance: Regularity effect: A phonological approach is effective for words spelled regularly and nonwords, but there is difficulty with irregularly spelled words.
  • Treatments: Relies on preserved phonological ability, focuses on retaining irregular orthographic representations, and might use CART (Computer-Assisted Reading Therapy).

Peripheral Impairments

• Pure alexia: Impairment in converting graphemes (letters) into spoken words (letter-by-letter reading) despite relatively preserved verbal/spoken language.
• Allographic alexia: Difficulty in converting graphemes to letter shapes, despite being able to name the letter. The individual can spell a word aloud but cannot write it on paper.
• Apraxic alexia: Poorly formed letters with distortions, additions, and deletions. Letters may be partially correct, but there is inconsistency and errors like adding extraneous letters or shapes.

Pragmatics

• Definition: Pragmatics focuses on how language transmits meaning beyond just structure and semantics.
• Pragmatic competence: The ability to understand the speaker's intended meaning.
• Grice's Maxims:
  • Quality: Be truthful and provide evidence for claims.
  • Quantity: Be informative but avoid being overly verbose.
  • Relevance: Stay on topic and ensure contributions are relevant to the conversation.
  • Manner: Be clear, unambiguous, and concise in communication.
• Assessment:
  • Informal assessment: Narrative analysis, interviews, behavioral observation.
  • Formal/structured assessment: Rating scales, checklists, standardized assessments.
• Treatment:
  • PACE (Promoting Aphasic Communicative Effectiveness): Aims to improve functional communication.

Discourse

• Definition: Discourse refers to any form of communication.
• Genres of discourse: Narrative, procedural, expository, conversation.
• Discourse analysis: Examines the structure and organization of spoken or written language.
  • Psycholinguistic approaches: Often describe aphasic characteristics in a specific and non-contextual way.
  • Sociolinguistic approaches: Focus on the functional use of language in real-world contexts.
• Treatment:
  • Remediation for conversational skills and narrative production: May use technology like aphasia scripts and sentence shapers.
  • Modifications of the communicative environment: Provide a variety of levels of support during therapy.
  • Formulaic language: Overlearned words, phrases, or longer linguistic units that are natural to use in speech, occur naturally, and are important for normal interactions.
  • Neural bases of Formulaic Language: Right hemisphere and subcortical structures.
  • Impact in aphasia: Formulaic language is often a component of aphasia assessment because it helps to identify automatic speech/recitation, acknowledgements of greetings/salutations, and sentence completions with idioms.