Title: Referential Skills of Adults with Aphasia vs. Peers in a Photo-Reminiscing Task
1Referential 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
2I. 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
3What 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.
4Examples 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?
5The 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
6So 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?
7II. 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!)
8So...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?
9III. 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
12Procedures
- 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)
13Dependent 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...
14Results 1
15Summary 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
16Results 2
17Summary 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.
18Other 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.
19Consistency 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
20V. 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.
22Limitations 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.
24Directions 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
25Clinical 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
26J.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.
27Final 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
28For 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!!
29Acknowledgements
- 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).