SPPA Sentence Production Program for Aphasia 2000

1
SPPASentence Production Program for Aphasia2000

• By Laura Giannetta Dorothy Tancredi
• April 5, 2005

2
Can you identify this type of aphasia?

• Mothersahwashin dishes butfauza (faucet)
  and overflowingboyahstool(long
  pause)falland cookies and sister.. and

3
AgrammatismA Review

• Characterized by the omission of low
  information, lexical items, and grammatical
  morphemes from speech (Kearns, 2005)
• Frequently seen in Broca aphasics
• Verbal output may sound telegraphic
• Experience more difficulty with retrieval of
  verbs rather than nouns
• Typically speak in short phrases (1-3 words)
• Reduced variety of grammatical form

(LaPointe, 2005)
4
Where did SPPA originate?

• SPPA is a revised version of the Helm Elicited
  Language Program for Syntax Stimulation (HELPSS)
• HELPSS (1981) was originally developed to treat
  agrammatic and paragrammatic aphasics
• HELPSS was structured as a story completion task
• Why this structure?
• A research study in 1975 proved that a story
  completion technique was the most effective
  treatment for severe agrammatism (Gleason, et.
  al. as cited in Helm-Estabrooks Nicholas,
  2000).
• Story completion tasks involve the clinician
  beginning a brief story, followed with a simple
  question about what should happen next in the
  story.
• Nicks school bus arrives in fifteen minutes and
  Nick is still asleep. So what does his mother
  tell him to do?

(Helm-Estabrooks Nicholas, 2000)
5
Criticism of HELPSS

• Research about HELPSS proved that it was more
  suitable for agrammatic aphasics rather than
  paragrammatic aphasics
• Majority of stimuli were past tense stories
• Included gender bias
• Treated all wh questions in one category
• Did not reflect functional goals
• Extremely lengthy
• Poor stimulus pictures
• Self-correction was not scored as a correct
  response

6
The Movement towards SPPA

• HELPSS
• Paragrammatism and agrammatism
• 220 stimulus items with poor quality pictures
• 11 sentence types
• Male gender bias
• No generalization to untreated stimuli
• Focused on past tense
• Wh questions were grouped together
• Self-correction considered incorrect

• SPPA
• Agrammatism
• 120 stimulus items with new and improved pictures
• 8 sentence types
• No gender bias
• More functional approach
• Focused on present tense
• Wh questions were split into two groups
• Self-correction scored as a correct response

7
Refer to Page 9 of your Handout
8
One Important Change Was

• HELPSS
• All level A (the easier example) items were
  trained first
• Next, all level B items (the harder example) were
  trained

• SPPA
• Therapy began with level A and if patient gave a
  correct response, level B items were then trained

9
So What Exactly is SPPA all About?

• The treatment includes 8 sentence types
• Imperative Intransitive
• Imperative Transitive
• Wh- Interrogative (what and who)
• Wh- Interrogative (where and when)
• Declarative Transitive
• Declarative Intransitive
• Comparative
• Yes/No Question

Refer to Appendix A in your handout
10
Method for Administering Treatment
All stimuli are presented by the clinician
reciting a pre-scripted brief story along with a
coinciding picture.

• Begin with the first example of level A of
  sentence type 1
• If a correct response is given, advance to the
  level B of the first example of sentence type 1
• If an incorrect response is given, advance to the
  second example of level A, but remaining in
  sentence type 1
• Repeat procedure until client achieves a score of
  at least 85 for sentence type 1
• Once Level A Level B have been completed
  successfully for sentence type 1, the clinician
  will administer the 15 examples at Level B only
• Advance to sentence type 2 and repeat same
  procedure for remaining sentence types

11
Scoring

• Each correct response receives a score of 1
• A correct response includes a self-corrected
  answer, a response with extra relevant
  information, a response with the appropriate
  syntax but a synonym for the targeted word
• Each partially correct response receives a score
  of .5
• A partially correct response includes a response
  with 1 omitted word which disrupts the syntax of
  the response
• Each incorrect response receives a score of 0
• An incorrect response includes a response with 2
  or more omitted words or 2 words produced with
  error
• When Level B is not administered because the
  person incorrectly answered Level A, a score of
  Not Administered (NA) is recorded

Refer to Appendix B in your handout
12
Charting Progress

• The treatment booklet for SPPA includes a sheet
  entitled SPPA Overall Progress Score Sheet
  which is used to chart progress from
  pre-treatment to post-treatment.
• Each therapy session is dated and the sentence
  type and treatment level (A, B, or A B) is
  identified
• An X is marked for the clients score of that
  session which overtime creates a line graph
• The sheet provides a space for the clinician to
  record progress concerning agrammatism via
  standardized test scores

Refer to Appendix C in your handout
13
Research on Syntactic Treatment Strategies

• Helm-Estabrooks, Fitzpatrick, Barresi (1981)
• Single Subject Design
• Used the syntax stimulation program for ½ hour
  sessions over a period of 10 weeks
• Used the BDAE Cookie Theft Picture and the
  Northwestern Syntax Screening Test for
  pre-treatment, mid-treatment and post-treatment
  scoring
• Results indicated that the patient made
  impressive gains when tested in the middle and
  end of therapy

14
Research on Syntactic Treatment Strategies
(Contd)

• Helm-Estabrooks Ramsberger (1986)
• Six Stroke Patients
• Used HELPSS program for 24 to113 - ½ hour
  sessions (Mean 80 sessions)
• Used the BDAE Cookie Theft Picture and the
  Northwestern Syntax Screening Test for
  pre-treatment and post-treatment scoring
• Results indicated significant improvements in
  both receptive and expressive skills in all but 1
  patient

15
Research on SPPAs Effectiveness

• Helm-Estabrooks Albert (2004)
• Single Subject Design
• Used SPPA for 7 1 hour sessions for a period of
  a little more than 3 weeks
• Used the BDAE Cookie Theft Picture for
  pre-treatment and post-treatment scoring
• Results indicated that the patient improved to
  normal range of a non-aphasic speaker in some
  areas but agrammatism still existed

16
References
Kearns, K.P. (2005) Brocas aphasia. As cited
in LaPointe, L.L. Aphasia and related neurogenic
language disorders (3rd ed.). (117-141). New
York Thieme. Helm-Estabrooks, N., Albert, M.
L. (2004). Sentence production program for
aphasia. In The Manual of Aphasia and Aphasia
Therapy ( 2nd ed., pp. 235-250). Texas Pro-Ed.
Helm-Estabrooks, N., Fitzpatrick, R.,
Barresi, B. (1981). Response of an agrammatic
patient to a syntax stimulation program for
aphasia. Journal of Speech and Hearing Disorders,
46(4), 422-427. Helm-Estabrooks, N. Nicholas,
M. (2000). Sentence Production Program for
Aphasia Administration Manual. (2nd ed.).
Austin, Texas Pro-ed. Helm-Estabrooks, N.
Nicholas, M. (2000). Sentence Production Program
for Aphasia Stimulus Book. (2nd ed.). Austin,
Texas Pro-ed. Helm-Estabrooks, N.
Ramsberger, G. (1986). Treatment of agrammatism
in long-term Brocas aphasia. British Journal of
Disorders of Communication, 21(1), 39-45.
17
THE END