Language and Cognition
Colombo 2011
Psycholinguistic Assessments of Language Processing
in Aphasia – Word comprehension
With acknowledgement to
Jane Marshall
Aims of Lecture
• Clarify processes involved in auditory
comprehension
• Introduce other relevant processes (repetition
and writing)
• Familiarise students with methods for
assessing comprehension
• Develop skills in interpreting test data
• Introduce methods for treating
comprehension problems
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Assessing Auditory Input
Minimal Pairs
tack cat
tome tome
farl
farl
poob poom
• Demonstrates ability to carry out auditory analysis
• Lexical effect? AIL or Semantics prime auditory
analysis
• Requires ability to retain and compare two spoken
words, and accurate ‘yes’/’no’
Auditory Lexical Decision
hotel
dogma
prisciple
trantor
• Assesses ability to access AIL
• Requires ability to hold the word in head and indicate
yes/no
• Imageability effect? Suggests that decisions are
supported by Semantics
• Be aware of ‘yes’ bias
Word to picture matching
• Tests the person’s ability to access semantics
from the spoken word
• Often a good place to start with testing
Synonym Judgements
• Boat
• Boat
ship
flower
• Idea
• Idea
notion
democracy
Imageability effect? Many aphasic
individuals find concrete items easier
than abstract.
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Repetition
• Supplements input testing.
• Words v’s non Words
• Concrete words vs abstract words
Words ☺ non words x
Non lexical route x
AIL ☺
Note: Any repetition skills show AA ok.
Repetition may occur without comprehension
Spelling to dictation
Words vs non words
Regular vs irregular words
Note:
• Ability to spell indicates that at least AA is functioning
• Spelling may occur without comprehension
• Failure may be due to writing problems rather than
input difficulties
Testing Issues
Consider other reasons for failure, e.g.:
• Attention
• ability to point
• Auditory short term memory
• ability to signal yes/no
• comprehension of pictures
Compare spoken with written input, to distinguish
central semantic from peripheral problems
Think about chance
How do different impairments
manifest?
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
PK (Maneta et al 2001)
•
•
•
•
Poor discrimination of minimal pairs
Unable to repeat words
Poor performance in lexical decision
Poor at word to picture matching
• Written > Spoken tests
PK (Maneta et al 2001)
Conclusion:
PK has impaired Auditory Analysis
• ‘Word sound deafness’
• ‘Auditory verbal agnosia’
• If no other language impairments: ‘Pure word
deafness’
Features of Pure Word Deafness
Environmental sounds are distinguished
With speech:
• Lip reading helps (visual support)
• Context helps
• Slowed speech helps
• Vowel > consonant discrimination
• Voices and accents are differentiated
A problem processing rapid auditory information?
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
AH (Franklin 1989)
•
•
•
•
•
•
Good discrimination of minimal pairs
Repetition of words 81%
Repetition of non words 75%
Poor auditory lexical decision 70%
Poor word to picture matching
Poor synonym judgements
• Written lexical decision 94%
AH (Franklin 1989)
• Auditory Analysis is ok (minimal pairs and
repetition)
• Access to AIL is impaired (lexical decision)
Word Form Deafness
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Bramwell (1897)
Described a woman with very impaired auditory
Comprehension
She could comprehend environmental sounds:
‘is it not strange that I can hear the clock ticking and
cannot hear you speak’
She could also:
Speak
Read
Write
Bramwell (1897)
She could often write to dictation
Example:
‘Do you like to come to Edinburgh?’
Not understood  writes ‘Edinburgh’  reads
word and understands question
Bramwell (1897): Conclusions
Can write irregular word to dictation:
AIL  POL  OOL  Writing
• Confirms that AIL is intact
• Comprehension problem is due to impaired access
from AIL to semantics
• Reading shows that semantics is intact and can be
accessed from the written word
Word Meaning Deafness
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
CJ (Franklin 1989)
•
•
•
•
•
Minimal pairs
Lexical decision
Word repetition
Word to picture match
Synonym judgement
good
good
good
impaired
impaired
Written synonyms = spoken synonyms
What about therapy?
Impairment in Auditory Analysis
PK Maneta et al (2001)
Jargon speaker with severe impairments in:
• Minimal pairs
• Auditory lexical decision
• Spoken word to picture matching
Problems in following conversation,TV, and
using the telephone
Therapy 1
Minimal pair and lip-reading training
Tasks
• graded discrimination tasks
Strategies
• lip reading
• cued articulation
• colour coding
Strategies - Lip Reading
• client given pictures of lip to sound
correspondences
• Advised to watch the speaker’s mouth
Strategies - Cued Articulation
Hand signals made next to the mouth
Show:
• voicing
• place of articulation
• manner
Strategies - Colour Coding
Used where tasks require selection of written
words
Consistent colours for different places of
articulation:
• velar
car (brown)
• alveolar
tar (blue)
• labial
bar (red)
Task Example:
Phoneme to grapheme matching
level 1
targets & distractors differ by 2 distinctive features
/t/
T
G
B
level 2
targets and distractors differ by 1 distinctive feature
/t/
P
T
K
Task Example:
Matching spoken to written words
Level 1
“man”
tan
can
man
cart
tart
part
Level 2
“cart”
Task Example:
Word to Picture Matching (Level 1)
“toy”
Task Example:
Word to picture matching (level 2)
“tart”
Did it work?
Auditory Input Tasks (PK can watch face)
Minimal pair discrimination
Repetition
Word to picture matching
Pre
Post
24/40
5/20
23/40
29/40
11/20
31/40
Small (but not significant) improvements in
discrimination
Conclusions from PK
• Improving discrimination is difficult (although
see Morris et al 1996)
• The nature of the impairment may impede
direct work
• Recent research project at UCL/City
– No change on outcome measures (e.g. minimal
pair tasks)
– Some change in the level of cueing needed during
therapy
Word Meaning Deafness
Impairment in link between AIL and Semantics
• Good minimal pairs
• Good lexical decision
• Poor auditory comprehension
Person can
• Write to dictation
• Comprehend written words
Therapy ideas for word meaning
deafness
Listen to word
Write it down
Read word and understand it
Internalise the writing strategy
Give written context (a tool for banging in nails)
Say word which is matched to picture (‘hammer’)
 Reduce context
Central Semantic Problems
Therapy aims to improve semantic processing
Possible tasks:
• Word to picture matching (semantic distractors)
• Categorisation
• Picture/word association tasks
Grayson et al 1997: semantic tasks on a jargon
aphasic. Improved performance in spoken and
written tasks.
General Therapy Issues
Practising input may recover or restore damaged
processing
But
Impaired comprehension may prevent understanding
of therapy
Input tasks are less amenable to strategies than
output tasks
So : Therapists often work through other channels
Conclusions
• Understanding of speech can fail for different
reasons
• Assessment aims to determine the level of
the impairment
• Assessment findings influence therapy
decisions, such as the selection of therapy
tasks
• ‘Direct’ therapy needs to be supplemented
with indirect approaches aiming to modify the
environment