Melodic Intonation Treatment - Nova Scotia Health Authority · 2014-01-20 · 10/30/2013 72 Semantic feature analysis • Semantic Feature Analysis (SFA) builds on the interconnections

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Melodic Intonation Treatment

© J. J. Hinckley, 2013

Elementary level


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Intermediate Level


Advanced level


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Semantic feature analysis

• Semantic Feature Analysis (SFA) builds on the interconnections of semantic features and knowledge, and provides an elaborated network of cues that can strengthen association with the targeted items. SFA has been shown to be successful in patients with aphasia who have a semantic impairment. This could be patients with fluent-type aphasias, but some patients with nonfluent-type aphasias also benefit.



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Food and Drink


Food and Drink Drink


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Food and Drink Drink Drink



Hot

Black


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Hot

Black

Kitchen

Cafe



Hot

Black

Kitchen

Cafe

Cup

Mug


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Discussion

• Do the cognitive requirements for these treatments differ? (Task-specific training, MIT, SFA)?

• Discuss the language or cognitive characteristics of a client that would lead you to select either task-specific training, MIT, or SFA.


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Focus on single words

• Phonological/semantic cueing (task-specific)

• Melodic Intonation Treatment

• Semantic Feature Analysis


Aphasia treatments that meet these criteria

(Hinckley, 2011; Salter et al, 2012; Allen et al, 2012)

Oral expression focus

• Phonological/semantic cueing

• Task-specific training (phonological/semantic cueing)

• PACE

• Verb Network Strengthening Treatment

• Response Elaboration Training

• Constraint-induced aphasia tx

• Melodic Intonation Training

• Semantic Feature Analysis

• Script training


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VNeST: Edmonds, Nadeau, & Kiran, 2009



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VNeST: Step 4

• Semantic judgment of sentences

• All cards are removed. Twelve sentences are read aloud to patient and pt judges whether they are accurate/appropriate. Four are correct, four have inappropriate agent, four with inappropriate patient, and four with agent-patient switched.

• “The dentist measures the door.” (inappropriate agent)


VNeST: Step 5

• Generation of 3 agent-patient pairs (repeating steps 1-2)

• No cards presented in this step. “Tell me who can verb (be verbed).” “Tell me what can be verbed.”

• “Who measures things?” – Chef

• “What does a chef measure?”

• - Sugar


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VNeST: Candidacy

• Improves verb production/sentence production

• Moderate non-fluent aphasia

• Within the context of a functional/personally relevant activity goal, could improve verb/sentence production

– Select verbs, agent-patient pairs that are relevant to the activity


Response Elaboration Training

RET is a type of “loose training” which works to improve lexical retrieval and the number of content words produced by an individual with aphasia (Conley & Coelho, 2003). This treatment method focuses on initiation of responses and conversation through the use of forward chaining, or elaboration of the client’s responses by the clinician. Kearns (1985) has demonstrated that RET is an effective intervention program for improving verbal production in conversation and for generalization of improved skills across types of aphasia.


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RET has been found to have positive generalization of responses and stimuli, as well as positive acquisition on the behalf of patients with aphasia (Wambaugh, Martinez, & Alegre, 2001). Conley and Coelho (2003) found that a combination of RET with semantic feature analysis (a more instructive type of lexical retrieval treatment) aided response elaboration as well as word retrieval. Since the participants did not have restrictions to their use of language, it was found that creative utterances facilitated word retrieval through patient-initiated carrier phrases. The result of this combination of treatment methods was found to promote more effective generalization of learned skills.



As stated by Wambaugh and Martinez (2000, p. 614), “there is more empirical support for the

use of RET than for the majority of aphasia treatments”.


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Response Elaboration Training (RET)

1. Elicit initial verbal response to picture

2. Reinforce, model, and shape initial response

3. Wh- cue to elicit elaboration of initial response

4. Reinforce, model, and shape the two patient responses combined

5. Second model and request repetition

6. After reinforcement, elicit delayed initiation of the combined response.



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Script training

• Script training is reminiscent of “dialogue training” in foreign language learning. A specific dialogue or script is trained. This is based on theoretical and conceptual models in which scripts run automatically as part of how we respond to particular contexts. A script can be a prayer, an explanation about the client’s stroke and aphasia, a description about a special interest – but in all cases it should be something that will be very important to the person with aphasia, and something that can be used across a variety of social contexts or occasions. Script training is effective and has been associated with transfer and generalization of phrases learned within a particular script to other contexts.



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Example script (monologue):

I had a stroke two years ago. I have problems speaking, but I understand everything. Please

give me more time to answer you.


Intensive Language Action Therapy

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Intensive Language Action Therapy Participants are required to use only verbal output to complete communicative acts during the language game across three levels of difficulty, following the modified protocol of Maher et al., (2006). Materials: Pairs of matching semantic categories cards; each item could be described by a descriptor noun: e.g., a red book, or an old shoe, but these descriptors are only required later in the treatment once participants are successful in levels 1 and 2. Level 1: Shaping rule constraints: Object Request: Speaker communicates: “book?” Response: Opponent communicates: “yes + book” or “no + book” Level 2: Shaping rule constraints: Carrier phrase + object Request: Speaker communicates: “Sue, Do you have a book?” Response: Opponent communicates: “Yes, Sue, Have a book.” Or “No Sue, I do not have a book.” Level 3: Shaping rule constraints: Carrier phrase + number + object Request: Speaker communicates: “Sue, Do you have two books?” Response: Opponent communicates: “Yes, Sue, I do have two books.” Level 4: Shaping rule constraint: Carrier phrase + number + description + object Request: Speaker communicates: “Sue, Do you have two red books?” Response: Opponent communicates: “No, Sue, I do not have two red books.”

Discussion

• Do the cognitive requirements for these treatments differ? (VNeST, RET, ILAT)?

• Discuss the language or cognitive characteristics of a client that would lead you to select either VNeST, RET, or ILAT.


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Aphasia treatments that meet these criteria

(Hinckley, 2011; Salter et al, 2012; Allen et al, 2012)

Reading/writing focus

• Multiple Oral Re-reading/ORLA

• Anagram Copy and Recall Treatment

Multi-modality

• PACE

• Task-specific training

• Communication Partner Training

• Spaced retrieval


Promoting Aphasics’ Communicative Effectiveness (PACE) (Davis & Wilcox, 1985; Davis, 2005, 2007)

Overview: A conversational treatment in which any modality can be used to communicate ideas from one partner to the other. The client and clinician take equal turns in the sender and receiver roles, and this promotes conversational participation.

Candidacy: Procedures can be adapted to specific linguistic impairments, thus people with a variety of types and severities of aphasia can benefit from this treatment.

Goals and Expected Outcomes: Use appropriate communication modalities (speaking, writing, drawing, gesturing, communication notebook or other AAC strategies) to effectively participate as sender and receiver.


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Four principles of PACE:

1. The clinician and patient exchange new information.

2. The clinician and patient participate equally as senders and receivers of messages.

3. The patient has a free choice as to the communicative modes used to convey a message.

4. The clinician’s feedback as a receiver is based on the patient’s success in conveying the message.


Promoting Aphasics’ Communicative Effectiveness (PACE)

(Davis & Wilcox, 1978)

Advantage of modelling

Gives clinician the opportunity to model relevant communication behavior

Cognitive requirement

Probably requires relatively good cognitive abilities, like executive functions, for client to achieve independent success in transferring the targeted strategies to a variety of communication settings.


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The four principles and essential procedures of

PACE

Principle

The clinician and patient exchange new information.

Procedures

Instead of having a picture of an object or event (called the message) in simultaneous view of the clinician and patient, a stack of message stimuli is placed face down to keep messages from the view of a message receiver. A client selects a card and attempts to convey the message on the card.



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PACE

Principle

The clinician and patient participate equally as senders and receivers of messages.

Procedures

This principle puts the turn-taking feature of conversation into the interaction. The clinician and client simply alternate in drawing a card and sending messages.



PACE

Principle

The patient has a free choice as to the communicative modes used to convey a message.

Procedures

Contrary to training one modality such as gesture or drawing, the patient is left to choose the mode that is used for any message. We do not tell a client to perform in a particular way.


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Melodic Intonation Treatment - Nova Scotia Health Authority · 2014-01-20 · 10/30/2013 72 Semantic feature analysis • Semantic Feature Analysis (SFA) builds on the interconnections