1. aphasia treatment overviews spring 2017
cueing hierarchies for naming
oral reading approaches
response elaboration treatment (RET)

2. 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

3. 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
systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing
traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required
modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

4. example: semantic categories
target word: carrot
present picture
“It’s a type of vegetable.” superordinate
“It’s similar to celery.” coordinate
“Rabbits eat them.” associated
purpose: to increase specificity of semantic processing/distinctions in order to improve naming

5. example: combined semantic/phonological
target word: table
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

6. measurement in session data: outcome measures
number of words named without cues (1 step of protocol)
performance at each step
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
impairment: Boston Naming Test; conversational sample; untrained word probes
activity/participation: self report of increased naming (e.g., fewer communication repairs needed with partner; efficiency; successful phone call, etc.)

7. 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
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

8. 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
systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing
traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required
modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

9. oral reading Basic MOR procedure
determine rate and accuracy for a passage
have patient re-read text, cueing to correct reading errors
set up homework – copied text and log
----
review homework log
probe rate and accuracy of practiced passage
determine target rate (e.g., 75 wpm); provide new passage when criterion is reached
systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing
traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required
modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

10. ORLA protocol (Cherney, 2004)

11. measurement in session data: outcome measures
reading rate (wpm) and accuracy (% words accurate)
comprehension probes
qualitative data about cueing responsiveness
outcome measures
impairment: Gray Oral Reading Test; probes of untrained text
activity/participation: self report of improved/increased reading of everyday reading material (varies widely)

12. 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

13. RET Protocol: uses simple line drawings
important: used modified RET (mRET) for clients with significant apraxia
systematic, individualized hierarchies targeting either semantic and/or phonological information – the “and” is because we can’t rule out that semantic processing is being stimulated even when the task explicitly targets phonological processing
traditional cueing hierarchies - the clinician applies descending and ascending cues; that is , once a client can not name the stimulus, the cues applied become increasingly powerful (descending) until a correct response occurs; then the cues are reversed and applied so that the cues become decreasingly powerful – move up and down until the least facilitative cue is required
modified cueing hierarchies – go only in one direction, descending; the cues become increasingly powerful until a correct response is obtained; the trial ends and you move to the next stimulus

14. measurement in session data:
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)