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Mapping Therapy (MT) 4/19/2017 Assessment and Treatment of Overview Sentences in Aphasia: Evidence into • Background, definitions, and theory Practice • Assessment of sentences Break Jiyeon Lee, PhD, CCC-SLP Department of Speech, Language, and Hearing Sciences Aphasia Research Laboratory • Treatment approaches - MT, TUF, VNeST - critical review Aphasia Language disorder • Acquired • Impaired processing of linguistic rules and • Neurogenic representations • Language disorder – Phonology – Morphology – Lexicon – Syntax Grammaticality Judgment Language Production Model • The man is fixing the car. • The man is fixing. Grammatical Encoding : generation of semantic- • The girl is sleeping the bed. syntactically specified sentence form • The girl is giving the teacher to the apple. • Is melting the snowman. • The dog is barking the man. • The man is sending the letter to the woman. Bock & Levelt (1994); Garret (1988) 1 4/19/2017 Grammatical Encoding Verb Argument Structure (VAS) • Knowing a verb means knowing how many words are “who does what to whom” needed in the sentence and their thematic roles (e.g., Thematic (meaning) roles agent, theme). e.g., Agent (do-er) Patient/Theme (do-ee) e.g., sing [NPAgent [V]] fix [NPAgent [V NPTheme]] VERB Surface structure active: det (N) aux (V) det (N) passive: det (N) aux (V) by det (N) • Successful comprehension and production of sentences require correct assignment of thematic roles to the nouns (arguments) associated with the verb. Bock & Levelt (1994); Garret, 1988 Impaired Grammatical Encoding Agrammatic Aphasia in Aphasia • Pervasive • Often associated with Nonfluent/Broca’s • Multiple underlying causes aphasia • Systematic, rule-governed errors: • Relatively preserved comprehension: – Verb argument structure complexity – Comprehension of syntactically complex sentences is compromised. – Canonicity in the mapping between meaning and word order • Impaired speech marked by reduced grammatical complexity Make a sentence for each picture. Verb Naming A. B. C. A. B. C. 2 4/19/2017 VAS Complexity Effects VAS complexity • Increased number of verb arguments, greater impairment in sentence production and verb naming (DeBlesser & Kauschke, 2003; Dragory & Bastiaanse, 2009; Kim & Thompson, 2000; Kiss, 2000; Luzzatti et al., 2002; Thompson et al., 1997 and others). •The man is sleeping (1-argument) •The man is pulling the woman (2-argument) •The man is giving the flowers to the woman (3-argument) Kim & Thompson (2004) VAS complexity Make a sentence for each picture. A B. Kim & Thompson (2004) Name each action. VAS complexity effects • Non-direct mapping of VAS, greater impairment in A B. both sentence and single verb production (Bastiaanse & van Zonneveld, 2004; Bastiaanse & Jonkers, 2005; Lee & Thompson, 2004; Lee & Thompson, 2011; Kegl, 1995; McAllister et al., 2009; Thompson, 2003) 3 4/19/2017 Production of unaccusative vs. Make a sentence in response to my unergative sentences question. Aphasics Controls Unaccusative (melt) Unergative (bark) Lee & Thompson (2004). J of Neurolinguistics Complex (Non-Canonical) sentences Canonical Sentence: Active • Sentences with syntactic movement, greater impairment (Bastiaanse & van Zonneveld, 2004; Bastiaanse & Jonkers, 2005; Lee & Thompson, 2004; Kegl, 1995; Schwartz et al., 1994; Rochon et al., Functional level: The boy (pull) the girl 2005; Thompson et al., 2003 and others). Thematic roles Agent (do-er) Theme (do-ee) Positional level: the girl • Syntactic movement: the theme (do-ee) is displaced The boy pulled Surface order from its original position (after the verb) and appears Subject position Object position in the subject position. Non-canonical sentence: Passive Complex (Non-Canonical) sentences Simple sentences canonical order: Active: the woman kissed the man. Functional level: The boy (pull) the girl Subject Wh-Q: Who kissed the man? Thematic roles Agent (do-er) Theme (do-ee) Subject Relative: I saw the woman who kissed the man. Subject Cleft: It is the woman who kissed the man. Positional level: The girl was pulled by the boy Surface order Complex sentences with object movement (non- Subject position Object position canonical): Passive: the man was kissed _____ by the woman. Object Wh-Q: Who did the woman kiss _____? * The thematic (meaning) roles of the nouns stay the same. Object Relative: I saw the man who the woman kissed____. Object Cleft: It is the man who the woman kissed____. 4 4/19/2017 Production of Canonical vs. Non- canonical sentences Early encoding of VAS 100 90 • May be crucial for successful sentence 80 production (Lee, 2011; Lee & Thompson, 2011a; 2011b; 70 * 60 accepted; Lee, Yoshida, & Thompson, 2015). 50 40 Older PD Aphasic • ‘Eye-tracking while speaking’ studies to Canonical Non-canonical Dick, Frederick, Man, & Lee (under review) examine ‘when’ verb information is used during sentence production. Thompson et al. (2013), Behavioral Neurology Production of verb arguments vs. adjuncts: Production of verb arguments vs. adjuncts: Eyetracking while speaking Eyetracking while speaking Argument condition Adjunct condition Argument condition Adjunct condition Goal argument Beneficiary adjunct (modifier) Goal argument Beneficiary adjunct (modifier) Lee & Thompson (2011b) Lee & Thompson (2011b), Language and Cognitive Processes Language & Cognitive Processes Gaze shifts between Verb and “baby” Summary Control • GE is impaired in many IWA, characterized by systematic speakers errors • Two important factors in predicting errors are the VAS complexity and (Non) canonicity of the sentences Stimulus “mother.....applying…. lotion…..... baby” • Early encoding of VAS may be critical for successful sentence onset choosing production and more beneficial for IWA with greater syntactic impairments. Agrammatic speakers • The existing research evidence suggests that assessment and treatment of sentence production should take these linguistic variables into consideration. Stimulus “mother..... applying….lotion…......baby” onset choosing 5 4/19/2017 Rationale • Many persons with aphasia (PWA) have ‘syntax’ problem, affecting processing of words, sentences, and conversation in general. Assessment of Syntax • Research support dissociated impairments among different verbs and sentence types in IWA, which in turn inform intervention strategies for these deficits. • Take care in selecting assessment tools for verbs and sentences • The stimuli should be controlled for verb types and sentence types at least. Standardized Tests Standardized Tests • Boston Diagnostic Aphasia Examination (BDAE, Goodglass, Kaplan, & Barresi, 2001) • Comprehensive Aphasia Test (CAT; Swinburn, Porter, & Howard, 2004) • Object & Action Naming Battery (OANB; Druks & Masterson, 2000) • Verb and Sentence Test (VAST; Bastiaanse, Edwards, & Rispens, 2002) • Northwestern Assessment of Verbs and Sentences (NAVS, Thompson, 2011) • Northwestern Anagram Test (NAT; Thompson, Weintraub, & Mesulum, 2012) NAVS • Strengths: – A good test for syntax: selected portions can be used – Good research support – Controlled for word-retrieval difficulty for sentence-level tests by providing written nouns and verbs, and using the same nouns (man, woman, dog, cat) repeatedly. – Affordable • Limitations: – Can be lengthy for administering the entire test (~40 min or more) – Not appropriate for severe patients. 6 4/19/2017 NAVS subtests • Verb Naming Test • Verb Comprehension Test • Argument Structure Production Test • Sentence Priming Production Test • Sentence Comprehension Test Practice: NAVS administration and scoring Argument Structure Production Test (ASPT) Sentence Production Priming Test (SPPT) 7 4/19/2017 Northwestern Anagram Test Treatment Treatments Mapping Therapy (MT) • Mapping Deficit Hypothesis (Schwartz et al., 1987): • Mapping Therapy (MT) Agrammatic deficits arise from impaired • Treatment of Underlying Forms (TUF) mapping between the functional (thematic roles, • Verb Network Strengthening Training e.g., agent/theme) and positional processes (VNeST) (surface word order, e.g., subject/object). MT Protocol - Comprehension MT (Schwartz et al., 1994) • To strengthen mapping between the functional (underlying semantic) and positional (surface • Pt is presented with a written sentence and syntactic) processes. asked to read it aloud. • Focus: identifying thematic roles of the nouns • Pt is trained to identify the verb and the in relation to the verb. thematic roles of each noun in a varying order. • Utilized for both sentence comprehension and • Immediate feedback is provided for each trial. production deficits across various canonical and non-canonical sentences. Byng, 1988; Byng et al., 1994; Rochon, Laird, Bose, & Scofield, 2005; Schwartz, Saffran, Pink, & Meyers, 1994; Marshall, 1995; and others 8 4/19/2017 MT protocol – Comprehension MT protocol - Comprehension (Schwartz et al., 1994) (Schwartz et al., 1994) The woman is kissing the man. • 3 Phases: • Phase A: Canonical sentences with action Clinician prompts: a. Read this sentence aloud. verbs (e.g., call, hug) b. Show me the verb (action word) in this sentence. • Phase B: Canonical sentences with ‘state of c. Who is doing the kissing? mind’ verbs (e.g., like, love) d. Who is being kissed? e. Client color codes the verb and different thematic roles for • Phase C: Noncanonical sentences with action each step. verbs The order of c and d is varied across trials. MT protocol – Production MT protocol – Production (Rochon et al., 2005) Target sentence: “The woman is kissing the man.” Target sentence: “The man is kissed by the woman.” Clinician says: Clinician
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