Referential Skills of Adults with Aphasia vs. Peers in a Photo-Reminiscing Task - PowerPoint PPT Presentation

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Referential Skills of Adults with Aphasia vs. Peers in a Photo-Reminiscing Task

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Referential Skills of Adults with Aphasia vs. Peers in a Photo-Reminiscing Task Kathryn L. Garrett, Ph.D. CCC-SLP Alison L. Wilber, MS, SLP Marissa J. Krisak, MS, SLP – PowerPoint PPT presentation

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Title: Referential Skills of Adults with Aphasia vs. Peers in a Photo-Reminiscing Task


1
Referential Skills of Adults with Aphasia vs.
Peers in a Photo-Reminiscing Task
Kathryn Garrett DONT PRINT SLIDE 1 - TITLE --
HAVE SEPARATE BANNER
  • Kathryn L. Garrett, Ph.D. CCC-SLP
  • Alison L. Wilber, MS, SLP
  • Marissa J. Krisak, MS, SLP
  • Duquesne University Pittsburgh, PA
  • ASHA 2003, Chicago

2
I. Introduction
  • Referential communication is a fundamental
    component of socio-communicative interactions for
    both children and adults.
  • Referential communication skills emerge before
    the age of 1 year, and before the onset of verbal
    communication in young children

3
What is referential communication?
  • Abbeduto, Short-Meyerson, Benson, Dolish,
    Weissman (1998) described physical referencing
    as
  • ...an understanding that an item that is present
    in an individuals proximal life space may be
    the topic of conversation or concept under
    discussion.
  • Their research indicated that referential skills
    (particularly physical referencing) are present
    in young children as well as older children with
    developmental language delays.

4
Examples of Early Referential Skills
  • Visually attending to others (especially
    speakers)
  • Pointing deictically/gesturing to request
  • Pointing deictically to an object, picture or
    written word to clarify the referent when
    answering/commenting
  • Pointing deictically to request info
  • or indicate anothers turn
  • Searching for items or symbols that represent
    answers to questions (What do you want to play
    with?)

I want you to pick me up
Whats dat?
5
The relationship of referential skills to
attention..
  • Bruner (1983) stated that verbal referential
    communication skills develop as a result of
    learning how to manage ones own and direct
    others attention
  • Early, object-level, deictic referencing that
    occurs in conjunction with joint attention...
  • to referential communication that is complex,
    intentional, verbal-symbolic, and
    displaced over time and space.

EVOLVES
6
So what does this have to do with severe aphasia?
  • Do people with severe aphasia engage in joint
    attention and referential communication at the
    same level as peers with no aphasia? Is
    referential communication a prerequisite for
    intentional linguistic communication in aphasia?

7
II. Statement of the Problem
  • Some communicators with severe-to-profound
    aphasia appear to have an elemental challenge in
    referential as well as verbal/linguistic
    communication skills
  • In group therapy, communicators with severe
    aphasia often need explicit instruction to
  • establish coordinated joint attention between the
    communicator, partners, and physical referents
    (Show that to Liz -- she wants to know too)
  • signal others to look, take a turn, refer to an
    item, or share info (Show me where you went
  • Point to John - ask him!)

8
So...according to child language learning
principles
  • Is it appropriate to begin working on speech,
    symbolic gestures, or symbolic AAC strategies
    before communicators demonstrate some evidence of
    ATTENTION and REFERENTIAL skills?

9
III. Hypotheses
KG
CC
Limb
  • A) Individuals with moderate, severe, or
    profound aphasia may not engage in referential
    communication as much as speaking peers
  • B) Individuals with severe aphasia may not be
    able to produce propositional, verbal-symbolic
    communication (speech or nonspeech
    modalities) until basic referential skills
    emerge (either naturally or with facilitation)
  • pointing to others
  • shifting gaze to a speaker
  • physically manipulating externally-stored symbols
    (pictures, words, etc.) to answer a question.

10
  • C) Perceptions of communication competence in
    communicators with severe aphasia may
    correlate with referential ability as well as
    linguistic ability
  • D) Perhaps explicitly teaching communicators
    with severe aphasia to engage in referential
    communication can improve their overall
    communication and/or linguistic skills
  • Who did you come with? Show me!
  • Ask Robert - where did you go for Thanksgiving
    point?

11
IV. Research Study -- Phase 1
  • Research Question for Hypothesis 1
  • Is there a difference between the referential
    communication skills of adults with acquired
    aphasia and those of adult peers?
  • Participants
  • 2 adults with chronic aphasia (1 mild-mod, 1
    severe) with minimal experience in referential
    communication training during interactive
    communication therapy
  • PWA 1 age 61, WAB AQ 9.2
  • PWA 2 age 74, WAB AQ 76.4
  • 2 adult peers with no brain injury
  • Peer 1 age 54
  • Peer 2 age 55

12
Procedures
  • Participants constructed a different personalized
    photo album for each (n4) data collection
    session
  • 1 photo per page, 11 photos per album
  • 2 albums of recent events, 2 of past events
  • Instructions Talk about your pictures as much
    as you want
  • Partner was instructed to refrain from asking
    more than 5 yes/no questions
  • First 2 minutes of each videotaped interaction
    was extracted for analysis and coding
  • 2 sessions X 2 topics 4 sessions per 4
    participants (16 sessions total)

13
Dependent Variables
  • Verbal and nonverbal referential behaviors were
    coded for the communicators with aphasia and
    peers, including(adapted from Mundy, Hogan,
    Doehring, 1996)
  • Role of Referential Communicator (Initiate vs.
    Respond)
  • Number of Referential Communication Acts and
    Subacts
  • Function of Referential Communication Act
  • Establishing Joint Attention
  • Providing Specific Semantic Information
  • Commenting/Confirming
  • Level of Intentionality of Referential
    Communication Act
  • Eye gaze (Preintentional) ex. look at partner
  • Deictic-referential (Intentional/nonsymbolic) ex.
    point to self
  • Locutionary (Intentional, verbal-symbolic
    referential communication) Ex. Twenty years
    ago we went to...

14
Results 1
15
Summary of Results 1
  • Participants with aphasia and peer controls had
    no difference in proportion of eye gaze acts (.08
    and .09)
  • Participants with aphasia actually used
    proportionately more intentional deictic pointing
    than peers
  • The person with the most severe aphasia (AQ
    10) used as many deictic points (n29) in 2
    minutes as a speaking peer
  • Descriptive results contradicted the experimental
    hypothesis

PWA 1 PWA 2 Peer 1 Peer 2
of Deictic Points 29 18 14 29
of Deictic Points/ Total Subacts .50 .52 .28 .37
16
Results 2
17
Summary of Results 2
  • Participants with aphasia utilized pointing and
    eye gaze to establish joint attention during this
    task more than peer controls
  • Participants with Aphasia .52
  • Peer Controls .40
  • Conversely, peers conveyed more specific semantic
    info than participants with aphasia
  • Participants with Aphasia .31
  • Peer Controls .58
  • Thus, an inverse relationship existed between
    joint attention and semantic-level communication.

18
Other Results
  • Both PWAs and Peers used an equal proportion of
    eye gaze to establish joint attention
  • Participants with Aphasia .08
  • Peer Controls .09
  • Both PWAs and Peers showed an equal ratio of
    communication subacts to acts this meant that
    both groups contributed a similar amount of
    gestures, pointing, and verbal messages to convey
    one idea
  • Participants with Aphasia 2.26 subacts per act
  • Peer Controls 1.95 subacts per act
  • Successfulness
  • Participants with Aphasia 41 of acts --
    completely succ.
  • Peer Controls 100 of acts -- completely succ.

19
Consistency of Results
  • All participants demonstrated good
    within-subject consistency across sessions
  • However, between-subject differences were
    observed within participant categories
  • In fact, PWA 1 and Peer 1 were more similar to
    one another than to the other member of their
    participant category in
  • Proportion of joint attention subacts
  • Proportion of intentional deictic pointing
  • Proportion of unintentional eye gaze
  • Due to this variability, groups did not
    demonstrate a statistically significant
    difference in deictic communication when
    randomization tests were conducted

20
V. Interpretation of Results
  • In this photo-album reminiscing task, people with
    aphasia appeared to demonstrate the elemental
    cognitive ability to establish joint attention
  • Despite limitations in verbal output, the
    participants with aphasia made frequent attempts
    to establish joint attention and communicate
    specific referential information.
  • One of the subjects with aphasia (PWA 1)
    demonstrated an equal or greater amount of
    deictic pointing than adult peers, perhaps to
    compensate for an inability to verbally establish
    reference.

21
  • The reduced number of specific semantic acts and
    decreased proportion of message successfulness
    experienced by PWAs may have triggered their
    increased use of deictic referential gestures
  • In contrast, the linguistically competent peers
    could use language alone to establish reference.

22
Limitations of the Study
  • However, anecdotal observations indicate that
    people with aphasia may not always think to
    establish joint attention when communicating
  • Example 1 Both PWAs needed repetition of
    instructions to open the book and point to
    pictures at the beginning of data collection.
    PWA 1 also required an initial model.
  • Example 2 Both PWAs have enrolled in
    interactive group communication therapy since
    data collection was completed. In this context,
    they have required moderate-to-maximal cueing to
    point or reference for their partners in
    contextual conversations.
  • The photo album reminiscing task may have
    compelled communicators to use deictic pointing
    therefore a true picture of referential ability
    in interactive conversation may not have been
    obtained.

23
  • Therefore, we may need to investigate referential
    skills in a more demanding communication
    situation
  • Topical materials should be available, but placed
    at a distance from the communicators with aphasia
  • Situations that involve a communication
    predicament could be constructed (e.g., Partner
    says something incorrect)
  • Finally, inter-subject variability was present
    for the most important dependent variables
    (function and type of referential act)
    therefore, a larger pool of participants may
    yield different results.

24
Directions for Future Research
  • Compare referential behavior with same-age peers
    (particularly elder peers) to people with aphasia
    in a larger group study.
  • Increase complexity of referential task
  • Determine if referential ability correlates with
    other communication skills (e.g., language
    ability amount of expressive output, cognition)
  • Correlate quantitative measures of referential
    ability with perceptions of communication
    competence in communicators with aphasia

25
Clinical Implications
  • Clinicians may want consider
  • Observing the referential skills of clients with
    moderate-to-severe/profound aphasia
  • Explicitly instructing individuals to reference
    external representations of meanings (e.g.,
    objects, symbols, written words, people) AND
    establish joint attention with other
    conversational participants
  • perhaps before or while working on
    verbal-symbolic communication
  • teaching attentional, referential, pragmatic, and
    symbolic communication skills within interactive
    contexts

26
J.V. telling Sara he wants to watch a movie by
pointing to a photo choice after she asked Well,
what do you feel like doing right now? Show
me.
27
Final Thoughts
  • Perhaps some of the information on referential
    communication, intentionality, and symbolic
    communication from the child language and severe
    disability literature can contribute to our
    therapy approaches for people with severe aphasia
  • Further investigation is warranted

28
For handouts..choose an option!
  • Access the MS Word handout on the ASHA conference
    website (wait 1 week)
  • Email kg at garrettk_at_duq.edu -- she will send you
    this Powerpoint presentation as an attachment
  • Visit the University of Nebraska-Lincoln AAC
    website for the Powerpoint presentation
    http//aac.unl.edu
  • But give me and the folks at UN-L a week or 2 to
    post this.
  • Thanks for your interest!!


29
Acknowledgements
  • Thanks to graduate students Abby James and Kelly
    Hanna for their assistance in compiling data for
    this project.
  • Thanks to the clients with aphasia and the peers
    for their participation.
  • Partial funding for this project was obtained
    from a Duquesne University Faculty Development
    Award (2002).
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