Repetition Priming and Anomia: An Investigation of Stimulus Dosage Catherine A. Off, Ph.C., CCC-SLP...
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Repetition Priming and Anomia: An Investigation of Stimulus Repetition Priming and Anomia: An Investigation of Stimulus Dosage Dosage Catherine A. Off, Ph.C., Catherine A. Off, Ph.C., CCC-SLP CCC-SLP 1 1 ; Holly Kavalier, B.A. ; Holly Kavalier, B.A. 1 1 ; Margaret A. Rogers, Ph.D. ; Margaret A. Rogers, Ph.D. 1, 2 1, 2 ; CCC-SLP; ; CCC-SLP; Kristie Spencer, Ph.D., CCC-SLP Kristie Spencer, Ph.D., CCC-SLP 1 1 Participa Participa nts nts 1 Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington; 2 American Speech-Language-Hearing Association, Rockville, MD Desig Desig n n Single 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 1 0 1 1 12 13 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 Baseline Probes Training Sessions Training Probes Stimulus Generalization Maintenance Trainin g Session s 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 Repetition Matters 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 Particip ant xperimental Questions and Independent Variables X * X * coff ee Response Time Response Time Results (ms) Results (ms) Accuracy Accuracy Results Results A102 A103 A104 A106 Control Baseline Probes Overall 1851 1897 1151 733 691 Last Two Training Probes 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 Discussio Discussio n n Is 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 Response Accuracy : Inconclusive, but no obvious trends towards stimulus generalization Reaction Time : Yes – 165 ms difference between first stimulus generalization probe to the last stimulus generalization probe 0 10 20 30 40 50 60 70 80 90 100 BP1 BP2 BP3 BP4 TP 1A TP1B TP2A TP 2B TP 3A TP3B TP4A TP 4B MP1 MP2 MP3 Probe S ession % Accuracy A102 Trained vs. Untrained 1 vs. 4 Trials Stimulus Generalization A10 3 A104 A106 0 10 20 30 40 50 60 70 80 90 100 SG1 SG2 SG3 SG4 SG5 SG6 SG7 SG8 P robe S ession % Accuracy 0 10 20 30 40 50 60 70 80 90 100 B1 B2 B3 B4 T1A T1B T2A T2B T3A T3B T4A T4B T5A M1 M2 M3 P robe S ession % Accuracy 0 10 20 30 40 50 60 70 80 90 100 B1 B2 B3 B4 T1A T1B T2A T2B T3A T3B T4A T4B T5A M1 M2 M3 Probe S ession % Accuracy 0 10 20 30 40 50 60 70 80 90 100 BP1 BP2 BP3 BP4 TP1A TP1B TP2A TP2B M P1 M P2 M P3 Probe Session % Accuracy 0 10 20 30 40 50 60 70 80 90 100 BP1 BP2 BP3 BP4 TP1A TP1B TP2A TP2B M P1 M P2 M P3 Probe Session % Accuracy 0 10 20 30 40 50 60 70 80 90 100 SGP1 SGP2 SGP3 SGP4 SGP5 Probe Session % Accuracy 0 10 20 30 40 50 60 70 80 90 100 BP1 BP2 BP3 BP4 TP 1A TP 1B TP 2A TP 2B TP 3A TP 3B TP 4A TP 4B TP5A MP1 MP2 MP3 Probe Session % Accuracy 0 10 20 30 40 50 60 70 80 90 100 BP1 BP2 BP3 BP4 TP 1A TP 1B TP 2A TP 2B TP 3A TP 3B TP 4A TP 4B MP1 MP2 MP3 P robe Session % Accuracy 0 10 20 30 40 50 60 70 80 90 100 SG1 SG2 SG3 SG4 Probe Session % Accuracy 0 10 20 30 40 50 60 70 80 90 100 BP1 BP2 BP3 BP4 TP 1A TP 1B TP 2A TP2B TP 3A TP 3B TP 4A TP 4B MP1 MP2 MP3 P robe Sessions % Accuracy 0 10 20 30 40 50 60 70 80 90 100 SG1 SG2 SG3 SG4 Probe S ession % Accuracy d=7.30 d=4.19 pendin g pendin g pendin g pendin g * 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 Hemorrhagi c Hemorrhagi c Embolic/ Thrombolic Location of CVA L MCA L Temporal lobe L 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 10/6 0 14/6 0 5/60 10/6 0 27/6 0 24/6 0 12/60 pending PALPA 25/6 0 43/6 0 26/6 0 38/6 0 50/6 0 52/6 0 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 apraxia DNT - 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
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Transcript of Repetition Priming and Anomia: An Investigation of Stimulus Dosage Catherine A. Off, Ph.C., CCC-SLP...
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
d=4.19
pending
pendingpending
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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
