MossTalk Training for Word Retrieval Across Semantic Categories
Tiffany Johnson, Erin Todd, & Anastasia Raymer*
Old Dominion University, Norfolk VA; *Brain Rehabilitation Research Center, Gainesville, FL
ABSTRACT
Few studies have examined the ability of patients to work independently with computer training programs to improve word retrieval in aphasia. In a single-participant design, we investigated effects of independent computerized training with MossTalk multi-mode matching exercises in two
individuals with severe word retrieval impairments. We examined effects of treatment for trained words and
untrained words from the trained semantic categories and untrained categories. Both participants improved in picture naming for trained words. One showed limited
generalization to untrained words and gains in standardized testing. Improvements were smaller than those reported for patients in a prior clinician-assisted MossTalk study.
INTRODUCTION
•Large word retrieval treatment literature reports largely
training specific effects with little generalization to untrained words (Nickels, 2002)
•Some generalization observed when training within
semantic categories; i.e. training of some category members generalizes to improvement in naming other members of the same semantic category (Spencer et al., 2000; Kiran &
Thompson, 2004)
•Training techniques are needed that patients can implement independently to increase opportunity to practice functional vocabulary
•One means of supporting independent practice is through the use of computers
•Much training software available for purchase; only limited data on usefulness
•MossTalk Words (Fink et al., 2001)
•experimental computer program for word retrieval training •Fink et al (2002) showed effectiveness of MossTalk Cueing Hierarchy Training module with partial clinician assistance •Raymer et al (2006) showed effectiveness of MossTalk
Multimodality Matching Exercises with clinician assistance - patterned after studies of comprehension training for word retrieval in aphasia (Pring et al., 1990; Nickels & Best, 1996) -Effects were greatest when training took place 3-4 times per week as compared to 1-2 times per week
METHODS
PURPOSE
•To explore usefulness of MossTalk Words Multimode Matching exercises administered independent of a
clinician
•To examine generalization of treatment effects within and across semantic categories
DISCUSSION
Why no generalization to untrained items in same semantic category?
-Methodologic differences in our study versus others
-Although Spencer et al (2000) reported generalization of naming training within a semantic category, they trained only one category at a time for many, many sessions
-Kiran & Thompson (2002) reported generalization to untrained category members when training atypical category items, but not when training typical category members
-Within constraints of MossTalk Words, we trained items that were fairly typical of the given categories, and we trained 4 categories at one time
-In order to promote generalized training effects, suggests need to train one category at a time for many sessions;
possibly need to train atypical items References
Fink, Brecher, & Schwartz. (2002). Aphasiology, 16, 1061- 1086.
Fink, Brecher, Montgomery, & Schwartz (2001). Moss Talk Words. Philadelphia: Albert Einstein Healthcare Network.
Kiran, S., & Thompson, C.K. (2002). Journal of Speech-Language-Hearing Research, 46, 608-622.
Nickels & Best (1996).Aphasiology, 10, 109-136.
Nickels, L. (2002). Therapy for naming disorders: Revisiting, revising, and reviewing. Aphasiology, 16, 935-979.
Pring, White-Thomson, Pound, Marshall, & Davis (1990). Aphasiology, 4, 479-483. Raymer, A.M., Kohen, F., & Saffell, D. (2006). Aphasiology, 20, 257-268.
Spencer, K.A., Doyle, P.J., McNeil, M.R., Wambaugh, J.L., Park, G., & Carroll, B. (2000). Aphasiology, 14, 567-584.
Zingeser, L.B., & Berndt, R.S. (1990). Brain and Language, 39, 14-32.
Participants: 2 right handed individuals with stroke leading to right hemiparesis, aphasia, apraxia
P1 P2
Age: 62 yrs 52 yrs
Gender: M F
Education: 9 yrs 17 yrs
Time post CVA: 3 yrs 4 1/2 yrs Aphasia Classification Broca Broca
Lexical Testing (Zingeser & Berndt, 1990)
Pic Naming Nouns 13/60 39/60 Wd/Pic Verif Nouns 36/60 50/60
Breakdown: semantic mild semantic
Single Subject Treatment Design:
Daily Probe Task/Stimuli:
Name to picture confrontation
Stimuli: 50 nouns 4 x 6 colored pictures
from 4 semantic categories: clothing, vegetables, toiletries, kitchen items
Tx Set 1: n=16 - 4 items from 4 categories Tx Set 2: n=16 - 4 items from 4 categories
Generalization set: n=8 – 2 items from 4 categories
Control set: 10 items from unrelated semantic categories (tools, furniture) matched for frequency
Correct responses: recognizable spoken word allowing for articulatory distortions.
Dependent variable: # correct
Procedure: Single participant treatment design 3-4 Baseline Sessions
Training: 5 days per week for 2 weeks Probe sessions: 1-2 times per week
Treatment competed after 2 weeks or 2 sessions at 90% accuracy
Treatment Protocol: MossTalk Words
Multimode Matching Exercises (Fink et al., 2001)
Independent practice daily
1) Spoken + Written word/picture matching
- computer says word and presents written word; - pt. touches correct picture of 4 related choices
2) Spoken word/picture matching - computer says word
- pt. touches correct picture of 4 related choices 3) Written word/picture matching
- computer presents written word
- pt. touches correct picture of 4 related choices
Participant then attempted to say name of target picture.
Naming Training (Figures 1 & 2):
• Both participants demonstrated modest, but
significant naming improvements, greater for P2 than for P1; P2 replicated the effect in a second set of training items
• Very little generalized improvements in untrained items from same semantic categories and from
different semantic categories (control set)
• Improvements in this independent study not as
strong as earlier study (Raymer et al., 2006) using MossTalk Words with clinician assistance
Standardized Testing Results
• Both participants improved slightly on BNT, and P2 improved also on WAB – primarily in
comprehension tasks
• Improvement in comprehension compatible with training protocol in which auditory
comprehension critical component
Alternative Explanations for Results
• Spontaneous Recovery or Repeated Exposure? • Both subjects many years post onset of aphasia • Effects for training words surpassed effects for
untrained words, suggesting repeated exposure may have contributed to small generalized
improvements, but training effects far surpassed simple practice.
RESULTS
Picture Naming Effect Sizes
Phase 1 P1 P2
Trained 1 4.0 3.0*
Trained 2 (untrained) -.57 1.19 Generalization .14 1.29 Control .25 .86 Phase 2
Trained 1 (maint) 1.07 .46 Trained 2 1.01 2.97
Generalization .65 1.36 Control .48 2.16
Acknowledgments:
Appreciation to Ruth Fink, of the Albert Einstein
Healthcare Network, who generously provided a copy of MossTalk Words. This study was supported in part by the Department of Veterns Affairs Office of Rehabilitation
Research and Development.
Western Aphasia Battery: P1 Pre Post P2 Pre Post
Fluency (max 10) 2 3 3 0 Comprehension (max 10) 4.5 5.2 5.7 7.4
Repetition (max 10) 2.2 1.2 3.4 1.2 Naming (max 10) 2.3 2.2 5.1 4.8 Total AQ (max 100) 35.9 33.2 36.4 48.8
