Naming performance in bilinguals with Aphasia: Using various cueing Strategies

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Naming performance in bilinguals with Aphasia
Using various cueing Strategies

• ASHA Convention- 20 November, 08
• Authors
• Maria Modayil B.S, ASLP
• Baylor University
• Rincy George B.S, ASLP
• Calicut University
• Mohammad Anwar Ali B.S, ASLP
• Calicut University
• Sapna Bhat , PhD

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Distribution of languages in India

• There are 22 official languages in India and as
  many as 1,652 dialects. The Indo-Aryan languages
  are spoken by 70 of the people and the Dravidian
  language by 20.

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Introduction

• According to MacNamare, 1967, a bilingual is
  anyone who possesses minimal competence in any
  one of the 4 language skills, i.e, listening,
  speaking, reading and writing in a language other
  than his mother tongue.
• Darley in 1979, aphasia is an impairment which
  affects the capacity for interpretation and
  formulation of language symbols and is a result
  of a brain damage and specifies that the language
  impairment is disproportionate to impairment in
  other intellectual functions
• Bilingual aphasia is aphasia in someone who knew
  more than one language pre-morbidly.
• Word-finding difficulty or anomia- one of the
  main feature of Aphasia syndrome.

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• Cueing-used with patients who cannot name in a
  natural stimulus context.
• Different types of cues-initial sound, sentence
  completion context, associated word, modeling,
  deblocking, written word or gesture.
• However, phonemic, semantic and graphemic cueing
  are most frequently used in treatment of
  word-retrieval problems in aphasia. (Hegde, 1998)

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• Various cueing strategies may have differential
  effects on efficiency of word-retrieval and this
  may be related to breakdown of underlying
  processes in specific aphasia subtypes.
  Phonological and semantic cueing techniques were
  seen to be beneficial in facilitating action
  naming for some speakers with aphasia. (Wambaugh,
  Kalinyak-Fliszar, Nessler, Cameron, Wright,
  2004)
• Written cueing hierarchy was seen to improve
  verbal naming of treated items in two adults with
  conduction aphasia. (Wilson, Wright Page, 2005)

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• Bilingualism further complicates the picture.
• Lexical level mixing is more frequent in
  comparison to any other level in normal as well
  as bilinguals with aphasia. (Perecman,1984 Bhat
  Chengappa, 2005)
• As lexical retrieval deficit is the most
  prominent in bilinguals with aphasia, they tend
  to seek help from other languages to overcome
  these. Thus, to repair a communication breakdown,
  persons with bilingual aphasia use equivalent
  expressions from another language. (Bhat,
  Chengappa, 2005 Krupa, Chengappa Bhat, 2004
  Munoz, Marquardt Copeland, 1999)

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• The knowledge is not lost as the concepts were
  accessible in other languages. It suggests that
  access to lexical item in a particular language
  probably is affected and the person with aphasia
  look for the same in the other language. Thus,
  knowledge of two languages appears to prove more
  beneficial to bilinguals with aphasia. These
  results point to necessity to observe the effects
  of cueing across various subtypes and across
  various languages known to persons with bilingual
  aphasia. In case of positive findings from
  present study cross linguistic cueing could be a
  very effective strategy for treatment of this
  population.

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• AIM of the study-
• Assessment of naming using cueing hierarchies
  such as phonemic, semantic and graphemic within a
  language and across languages with and without
  constraints on language of response.

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Methodology

• SUBJECTS-
• Two groups
• The control group consisted of thirty normal
  subjects, both males and females with a mean age
  of 40 years.
• The experimental group comprised of three
  patients with Brocas aphasia and one with
  conduction aphasia. The patients with aphasia
  could comprehend and express both Kannada and
  Tulu languages (South-Indian languages of
  Dravidian origin) pre-morbidly.

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• MATERIAL-
• Thirty-five scanned line drawings of different
  lexical categories based on familiarity rating by
  the control group, fluent in both languages,
  Kannada and Tulu. The basic format was based on
  the Boston Naming Test (BNT).

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• PROCEDURE-
• The subjects were required to name the pictures
  in both Kannada and Tulu languages on different
  days.
• In case they failed to answer the picture, they
  were presented phonemic, semantic or graphemic
  cues one after the other within a time period of
  15 seconds each. If they could not produce the
  target response within 60 seconds, it was
  considered as a no response.

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• The responses recorded for the experimental group
  were
• 1. Naming in Kannada using cues in Kannada.
• 2. Naming in Tulu using cues in Tulu.
• 3. Naming in Kannada using cues in Tulu with
  constraints.
• 4. Naming in Tulu using cues in Kannada with
  constraints.
• 5. Naming in Kannada using cues in Tulu without
  constraints.
• 6. Naming in Tulu using cues in Kannada without
  constraints.

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• When naming without constraints, the subjects
  response could be in either language, whereas
  when naming with constraints, the subjects
  response had to be strictly within the language
  specified even though cues were provided in the
  other language.
• The percentages for the accuracy and latency of
  the responses in seconds were calculated.

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Discussion of result
Graph 1 shows percentage of response accuracy
within Kannada language cues
Graph 2 shows latency of response within Kannada
language cues
Response accuracy- A1 showed good responses for
graphemic cues in this condition. A2 and A3 for
phonemic cues and A4 for graphemic along with
phonemic cues. Latency of response- A1 showed
less latency for graphemic cues. A2, A3 and A4
showed less latency for phonemic cues followed by
graphemic.
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Graph 3 shows percentage of response accuracy
within Tulu language cues
Graph 4 shows latency of response within Tulu
language cues
Response accuracy- A1 showed good responses for
graphemic cues. A2 showed best responses for
phonemic cues. A3 and A4 showed good responses
for graphemic followed by phonemic cues. Latency
of response- A1 showed lower latency for
graphemic cues. A2 showed lower latency for
phonemic followed by without language cues. A3
demonstrated lower latency for without language
cues followed by graphemic and then phonemic
cues. A4 showed lower latency for phonemic cues
followed by graphemic.
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Graph 5 shows percentage of response accuracy
across Kannada language cues with constraints
Graph 6 shows latency of response across Kannada
language cues with constrints
Response accuracy- The subjects did not show
much effect on naming performance with any of the
language cues. A2 showed some responses for
across language phonemic cues. A4 had almost the
same effect on all the types of cues. All
subjects showed good response for naming without
any cues for language constraint
condition. Latency of response- All four subjects
demonstrated lower latency for naming without
cues in across language cues with constraints.
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Graph 7 shows percentage of response accuracy
across Tulu language cues with constraints
Graph 8 shows latency of response across Tulu
language cues with constraints
Response accuracy- A1 did not show any response
with and without language cues. A2 performed
better with phonemic followed by semantic and A3
for phonemic. A3 and A4 showed maximum responses
for without language cue condition. Latency of
response- All subjects showed lower latency for
without cues conditions followed by phonemic.
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Graph 9 shows percentage of response accuracy
across Kannada language cues without constraints
Graph 10 shows latency of response across Kannada
language cues without constraints
Response accuracy- All subjects demonstrated very
good responses for naming without cues when a
language constraint was not imposed. Among the
cues, phonemic cues got better responses for all
four subjects. Latency of response- Without
language cues showed better response for naming
when compared to other conditions followed by
latency for graphemic cue for A1 and phonemic cue
for A2, A3 and A4.
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Graph 11 shows percentage of response accuracy
across Tulu language cues without constraints
Graph 12 shows latency of response across Tulu
language cues without constraints
Response accuracy- A1 and A3 demonstrated good
responses for phonemic cues among the language
cues provided. However, A2 and A4 performed
better without any language cues. Latency of
response- A4 showed lower latency for without
language cue conditions. A1 performed with
phonemic cues as other conditions are not
applicable for the patient.
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Conclusion

• As there are individual differences, it is seen
  that there are no universally accepted rules for
  the response patterns with the provision of cues.
• Overall results of our study show that graphemic
  cues are better for the patient with conduction
  aphasia, and for patients with Brocas aphasia,
  phonemic cues followed by graphemic and then
  semantic cues.

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• Across the languages, without constraints
  subjects showed higher scores, irrespective of
  the provision of cues. The reason for this could
  be the pragmatic flexibility to use both the
  available languages. Cross linguistic cueing with
  language constraints does not appear to be
  helpful.
• When a language constraint was imposed, maximum
  responses were obtained without any language
  cues. But, the results varied among the subjects.
  

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• Better responses were obtained in case of across
  languages without constraints among all other
  conditions. Therefore, bilingual subjects should
  be provided with the freedom of responding in any
  language he can express in, as this will
  facilitate their communication better.
• Cross-linguistic cueing helps the subjects to
  access other languages, provided that language
  constraints are not imposed, by reducing the
  stress on language production mechanism in
  persons with aphasia.

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References

• Bhat, S. Chengappa, S. (2005). Code switching
  in normal and aphasic Kannada-English bilinguals.
  Proceedings of 4th International symposium on
  bilingualism, ed. Cohen, J., McAlister,K Rolstad,
  K and McSwan, J. 306-316. Somerville,MA
  Cascadilla Press.
• Hegde, M.N. (1998). Course book on aphasia.
  Thomson learning Texas.
• Krupa, E.D., Chengappa, S. Bhat, S. (2004).
  Language mixing in Malayalam-English bilingual
  aphasics. Asia pacific journal of disability and
  rehabilitation, 20, 120-25.
• Munoz, M.L., Marquardt, T.P., Copeland, G.
  (1999). A comparison of the code switching
  patterns of aphasic and neurologically normal
  bilingual speakers of English and Spanish. Brain
  and Language, 66 249-274.
• Perecman, E. (1984). Spontaneous translation and
  language mixing in a polyglot aphasic. Brain and
  Language, 24, 43-63.
• Wambaugh, J., Kalinyak-Fliszar, M., Nessler, C.,
  Cameron, R., Wright, S., (2004). Retrieval of
  action names in aphasia Effects of two cueing
  treatments. Aphasiology, 18, 979-1004.
• Wilson, Wright Page (2005) .Using Writing to
  Improve Verbal Output in Adults with Aphasia.
  convention.asha.org. Retrieved January 5, 2007,
  from http//convention.asha.org/2005/handouts/293_
  Wilson_Kresta_071067_111605085807.ppt

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THANK YOU!!!