Repetition Priming and Anomia: An Investigation of Stimulus DosageRepetition Priming and Anomia: An Investigation of Stimulus DosageCatherine A. Off, Ph.C.,Catherine A. Off, Ph.C., CCC-SLP CCC-SLP 11; Holly Kavalier, B.A. ; Holly Kavalier, B.A. 11; Margaret A. Rogers, Ph.D.; Margaret A. Rogers, Ph.D.1, 21, 2; CCC-SLP; Kristie Spencer, Ph.D., CCC-SLP ; CCC-SLP; Kristie Spencer, Ph.D., CCC-SLP 11

ParticipantsParticipants

1Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington; 2American Speech-Language-Hearing Association, Rockville, MD

DesignDesignSingle Subject ABA Design with Replication across 4 Individuals with Aphasia and 1 Non-Brain-Injured, Age- and Gender-Matched Control

Probe Sessions: 40 Trained Items; 20 Untrained Items; Balanced for Syllable Length and Word Frequency

Training Sessions: 40 Trained Items; 20 1-Trials/Session; 20 4-Trials/Session; Balanced for Syllable Length and Word Frequency

Dependent Variables: Response Accuracy (Live and Audio-Recorded Samples) and Response Time (Measured by E-Prime - milliseconds)

Reliability: All Probe Sessions Transcribed and Coded for both Accuracy and Error Type by Independent Judges Blinded to Training Variables

Delivery Schedule

SESSION # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Baseline Probes              

Training Sessions                                    

Training Probes                          

Stimulus Generalization                    

Maintenance                                          

Training Sessions

Characteristics of Repetition Priming (Healthy Adults)

•Increases Reaction Time and Improves Accuracy on Subsequent Trials

•Persistent Across Time (Cave, 1997)

•Sensitive to # of Repetitions (Brown, Jones, & Mitchell, 1988; Reber, Gitelman, Parrish, & Mesulam, 2004 )

•Item Specific (Brown, Jones, & Mitchell, 1996)

•Generalizes to Alternate Exemplars (Koutstaal, Wagner, Rotte et al., 2001)

Repetition MattersRepetition Matters

A102 A103 A104 A106 CONTROL

# Training Sessions 15 6 12 15 9

# Exposures 600 240 480 600 160

Naming Attempts w/o support

300; 1200 120; 480 240; 960 300; 1200 180; 720

Naming attempts w/ support

300; 1200 120; 480 240; 960 300; 1200 180; 720

Total Naming Attempts 600; 2400 240; 960 480; 1920 600; 2400 360; 1440

Integrating Principles of Neuroplasticity into clinical practice is necessary to optimize rehabilitative outcomes.• Repetition is fundamental to skill learning and re-learning• Motor learning, at both behavioral and neural levels, requires hundreds of trials

The current investigation examines the application of repetition to improve naming performance in individuals with chronic aphasia. Though repetition is a ubiquitous component of anomia treatment protocols, and may be one of the most potent sources of change, systematic investigation of the influence of stimulus dosage on naming performance has yet to be reported, particularly with respect to the acquisition and maintenance of trained items, generalization to untrained items and generalization to alternate exemplars of trained items.

Is Repetition Priming: Independent Variables

Persistent across Time?Immediate vs. Delayed probes; Baseline vs. Maintenance Probes (6 weeks after final training session)

Sensitive to # of Exposures/Session? 1 vs. 4 Trials per Training Session

Item Specific? Trained vs. Untrained Stimuli

Generalize to Alternate Exemplars? Stimulus Generalization Probes

Stimulus Dosage by Participant

Experimental Questions and Independent Variables

X* X *

coffee

Response Time Results (ms)Response Time Results (ms)

Accuracy ResultsAccuracy Results

A102 A103 A104 A106 Control

Baseline Probes Overall 1851 1897 1151 733 691

Last Two TrainingProbes

Trained 1549 1409 1041 755 568

Untrained 2103 1092 1118 1002 711

1 Trial 1533 1360 1029 758 571

4 Trials 1556 1462 1054 749 564

Maintenance Probes

Trained 1092 1800 pending pending pending

Untrained 1585 1887 pending pending pending

1 Trial 1106 1765 pending pending pending

4 Trials 1086 1806 pending pending pending

DiscussionDiscussionIs Repetition Priming: Individuals with Aphasia Age- & Gender-Matched Control (Matched A103)

Persistent across Time?

Response Accuracy: Yes – A102 & A103 maintained improved response accuracy for trained items 6 weeks after last training session; awaiting results from A104 & A106; stronger priming effects for immediate post-training probes vs. delayed probes

Response Time: Yes for A102; A103 demonstrated a RT for accuracy trade-off

Reaction Time: Pending Maintenance Probes

Sensitive to # of Exposures/Session?

Response Accuracy: Inconclusive – may depend on underlying impairment or time post onset

Response Time: Inconclusive

Reaction Time: Yes – 7 ms difference between 4 trials per session and 1 trial per sessions

Item Specific?

Response Accuracy: No evidence of generalization to untrained items presented during experiment; however, note positive changes of BNT and PALPA scores pre/post

Response Time: Yes for A102, A104 & A106: trained items were responded to faster than untrained items; A103 demonstrated a RT for accuracy trade-off

Reaction Time: Yes – No evidence of generalization from trained to untrained items (143 ms difference between trained and untrained items)

Generalize to Alternate Exemplars?

Response Accuracy: Inconclusive, but no obvious trends towards stimulus generalization

Response Time: Yes for A102, A106; No for A103, A104

Reaction Time: Yes – 165 ms difference between first stimulus generalization probe to the last stimulus generalization probe

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d=7.30

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* d=Busk & Serlin’s d

  A102 A102 A104 A106

Age 90 47 76 78

Gender Female Female Female Female

Time post CVA 6 months 3.5 yrs 1.5 yrs 8 months

Type of CVA Embolic Hemorrhagic Hemorrhagic Embolic/Thrombolic

Location of CVA L MCAL Temporal

lobeL Basal Ganglia

L MCA; L frontal lobe, ant. insula region

L frontal operculum

Cognitive-Linguistic Battery

Pre Post Pre Post Pre Post Pre Post

WAB 73.9 61.4 60.2 70.8 82.8 81 54.1 pending

BNT 10/60 14/60 5/60 10/60 27/60 24/60 12/60 pending

PALPA 25/60 43/60 26/60 38/60 50/60 52/60 35/60 pending

Cognitive-Linguistic Battery

Administered only once at study onset. Data used for inclusionary & descriptive purposes.

Pyramids & Palms

38/52 48/52 48/52 49/52

ABA No apraxia No apraxia No apraxiaDNT - Complicated

by conduction aphasia

RCBA 29/30 30/30 30/30 30/30

Visual Agnosia 10/10 10/10 10/10 10/10

Raven’s 18/36 36/36 20/36 18/36

BDI-II 3/63 10/63 18/63 7/63