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Intensive Auditory Comprehension Treatment for People with Severe Aphasia

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Intensive Auditory Comprehension Treatment for People with Severe Aphasia Intensive Auditory Comprehension Treatment for People with Severe Aphasia: Outcomes and Use of Self-Directed Strategies A dissertation proposal submitted to the Division of Graduate Education and Research Of the University of Cincinnati in partial fulfillment of the requirements of the degree of DOCTOR OF PHILOSOPHY In the Department of Communication Sciences and Disorders In the College of Allied Health Sciences Dissertation Committee: Aimee Dietz, Ph D., chair Lisa Kelchner, Ph.D. Robin Thomas, Ph.D. Pete Scheifele, Ph.D 2012 by Kelly Knollman-Porter Intensive Auditory Comprehension Treatment Abstract The purpose of this study was to determine the efficacy of an intensive (2 hours/day, 5 days/week for 3 weeks) treatment protocol on individuals with severe, chronic speech perception or auditory comprehension deficits associated with aphasia. Two experiments were implemented to examine this purpose. Experiment I: Single Word Comprehension Approach (SWCA) established the effectiveness of an intensive treatment protocol on single word auditory comprehension (n = 6). Alternatively, Experiment II: Speech Perception Approach (SPA) examined the outcomes of an intensive treatment protocol on speech perception in individuals with profound global aphasia (n = 2). The researcher employed an ABA single subject design for both experiments, and examined the following variables: (1) changes in single word comprehension (SWCA) or speech perception (SPA); (2) the number of self-initiated requests for repetition and lip-reading cues; (3) the effectiveness of repetition and lip-reading cues; (4) the indirect effects of the protocols on verbal expression (SWCA – naming; SPA – repetition; Both – narrative skills); (5) and generalization to functional communication environments. Results revealed that all participants enrolled in the SWCA or SPA exhibited a lack of awareness regarding their comprehension impairment at the onset of treatment. Despite this reduced awareness, 7 of the 8 demonstrated a large effect on either single word comprehension or speech perception. A generalization effect to untrained stimuli was also exhibited by these participants. The use of repetition successfully improved speech perception and single word comprehension in all participants; however lip-reading was beneficial in only 1 of the 8 participants. An indirect effect on verbal expression naming ability was demonstrated by 5 of the 6 SWCA participants; this effect was not observed in the SPA participants. Carryover of these skills to functional communication situations was reported by one of the eight caregivers. These finding suggest that ii Intensive Auditory Comprehension Treatment individuals with severe to profound, deficits have the potential for continued improvements in speech perception or auditory comprehension, even in the chronic stages of recovery. However, caregiver involvement, use of personally relevant stimuli and rehabilitation protocols designed to increase self-awareness of speech perception and single word comprehension impairments may be a crucial link to generalization of communication gains to functional situations with this population. iii Intensive Auditory Comprehension Treatment iv Intensive Auditory Comprehension Treatment Acknowledgements This work is dedicated to the men and women with aphasia who have willingly and openly allowed me to be a part of their lives. Without hesitation, they have been my true teachers. These individuals and their families have not only demonstrated to me the unique, complex world of aphasia, but more so, the true meaning of perseverance, dedication, and strength. They have and continue to inspire and challenge me as a clinician, researcher and as a human being. I would also like to specifically thank my mentor, Dr. Lisa Kelchner, who has been and continues to be a role model for me in the field. Her passion and depth of knowledge are astounding. Even with these skills, she consistently displays humility and grace; never demeaning or critical. Words cannot thank her enough for the many years of training, advice, and guidance she has provided me over the past 15 years. Three years ago, I had the pleasure of meeting Dr. Aimee Dietz. Little did I know at the time, she would play such a crucial role in the success of my program. Even through pregnancy and the birth of her beautiful son, she continued to challenge and encourage me to develop my skills as a clinical researcher. She supported me in my belief that clinical research, while time intensive, can make a difference in the lives of individuals with aphasia. My sincere thanks goes to her for the many hours of editing and guidance provided through this journey. I will forever be indebted to my parents, Don and Doris Knollman. From a very young age, they instilled in me the importance of education, integrity, and hard work. During every stage in my life, they have been a constant source of assistance and encouragement. I thank them v Intensive Auditory Comprehension Treatment for standing in the gap while I chased yet another dream. I couldn’t ask for a better Mom and Dad. In addition, one of my greatest blessings are my children. Both Anna and Eric have been a constant support for me along this long journey. More than once, they used my own words against me when the more challenging phases of the Ph.D. program arose. It was a joy to watch them grow and mature through this process. It is my hope, that through my experiences they can realize that with persistence and dedication anything in life is possible. Finally, over twenty years ago, God brought an amazing man into my life. Never have I known anyone as self-sacrificing and supportive as my husband, Randy Porter. He was my midnight tech support, statistics and excel tutor, my cheerleader and my counselor when the challenges of the program became overwhelming. Without hesitation, he is the best thing that ever happened to me. I love him very much and am forever grateful for his never ceasing, unconditional support. This dissertation is truly not my own; and could not have been initiated or completed without the support of many other wonderful individuals. To the following I am also thankful: Dr. Pete Scheifele, Dr. Robin Thomas, Miami University Aphasia Support Group members and their families, my wonderful colleagues at Miami University, my students, and my church family. “We are like clay jars in which this treasure is stored. The real power comes from God and not from us.” 2 Corinthians 4:7 vi Intensive Auditory Comprehension Treatment Table of Contents List of Tables xvii List of Figures xx Chapter 1 Introduction 1 Purpose of the Investigation 5 Chapter 2 Review of the Literature 7 Normal Comprehension: The Process 7 Acoustic phonetic analysis 8 Phonological processing 8 Lexical semantic system 9 Speech Perception/Auditory Comprehension Deficits Associated with Aphasia 10 The Influence of Short-Term Working Memory on Comprehension 11 Short-term working memory: Normal Comprehension 11 Short-term working memory: Comprehension in aphasia 12 Self-Awareness 13 Self-Awareness in Aphasia 14 Assessment of Comprehension Deficits in Aphasia 18 Assessment of short-term working memory and comprehension 19 Therapeutic Management of Comprehension Deficits in Aphasia 20 Intensity of treatment 22 Utilization of repetition cues 23 Utilization of lip-reading cues 24 Research Questions and Research Hypothesis: Experiment I - SWCA 25 Research Questions and Research Hypothesis: Experiment II – SPA 27 vii Intensive Auditory Comprehension Treatment Chapter 3 Methods 29 Participants 31 Setting 34 Design 34 Screening and Cognitive-Linguistic Assessment Materials 34 Equipment 34 Audio and video equipment 34 Audiometer 35 Screening 35 Social and medical history survey 35 Hearing screening 35 Visual acuity screening 35 Response screening 36 Comprehension severity screening 36 Cognitive-Linguistic Assessment 36 Phonological processing 36 Semantic processing 37 Working memory 37 Non-linguistic cognitive assessment tools 37 Screening and Cognitive-Linguistic Assessment Procedures 38 Video recording protocol 38 Screening 38 Medical and social history survey 38 Hearing screening 38 Visual acuity screening 39 Response screening 39 Comprehension severity screening 40 Neuroimaging 40 Cognitive-Linguistic Assessment 40 Measurement of phonological processing and working memory 41 Measurement of semantic comprehension and working memory 43 Non-linguistic cognitive assessment protocol 44 viii Intensive Auditory Comprehension Treatment Assessment of Experimental Complexity Stimuli Materials 44 Experiment I: SWCA assessment materials 44 Experiment II: SPA assessment materials 46 Assessment of Experimental Stimuli Complexity Procedures 46 Experiment I: SWCA assessment procedures 47 Experiment II: SPA assessment procedures 50 Experimental Materials 53 Experiment I: SWCA 53 Equipment 53 Single word comprehension stimuli 53 Verbal naming stimuli 54 Experiment II: SPA 54 Speech perception stimuli 54 Verbal repetition stimuli 55 Common experimental materials 55 Audio and video equipment 55 Picture description 55 Communication history survey 55 Frustration/fatigue monitoring 55 Experimental Procedures 55 Experiment I: SWCA 56 SWCA baseline phase 56 Single word comprehension 56 Verbal naming measures 56 SWCA treatment phase 56 SWCA probe data 59 SWCA maintenance phase 59 Experiment II: SPA 60 SPA baseline phase 60 Speech perception 60 Verbal repetition measures 60 SPA treatment phase 61 SPA probe data 62 ix Intensive Auditory Comprehension Treatment
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