Decreasing and increasing cues in...
PLEASE SCROLL DOWN FOR ARTICLE This article was downloaded by: [University of Sheffield] On: 6 July 2010 Access details: Access Details: [subscription number 731591299] Publisher Psychology Press Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37- 41 Mortimer Street, London W1T 3JH, UK Aphasiology Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t713393920 Decreasing and increasing cues in naming therapy for aphasia Stefanie Abela Andy Schultza Irmgard Radermachera Klaus Willmesa Walter Hubera a University Hospital, Aachen University of Technology (RWTH), Germany. To cite this Article Abel, Stefanie , Schultz, Andy , Radermacher, Irmgard , Willmes, Klaus and Huber, Walter(2005) 'Decreasing and increasing cues in naming therapy for aphasia', Aphasiology, 19: 9, 831 ��� 848 To link to this Article: DOI: 10.1080/02687030500268902 URL: http://dx.doi.org/10.1080/02687030500268902 Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Decreasing and increasing cues in naming therapy for aphasia Stefanie Abel, Andy Schultz, Irmgard Radermacher, Klaus Willmes, and Walter Huber University Hospital, Aachen University of Technology (RWTH), Germany Background: Applying a hierarchy of cues is a well-established method in therapy for aphasic naming disorders (see overview in Nickels, 2002b and Hillis & Caramazza, 1994 Wambaugh, 2003). Usually, cues are used in the increasing direction. Giving assistance as sparsely as possible, the naming of an individual item remains effortful which enhances the chance to recall it later on. But the high opportunity to make errors may be disadvantageous. As an alternative, the method of vanishing cues (see Glisky, 1992), which was designed for treatment of memory disorders, provides as much assistance as needed, thereby helping patients to avoid errors (see Riley & Heaton, 2000). Therefore, this method complies with ������errorless learning������ (see Baddeley & Wilson, 1994). It is favoured when amnesic patients have to learn new information. In aphasia therapy, the errorless learning procedure may be interesting for patients with severe naming disorders because it prevents them from pro- ducing frequent errors. Aims: The purpose of this study was to compare the effectiveness of increasing and vanishing cues for aphasic patients with naming disorders in a 4-week therapy programme. As patients may differ in the underlying mechanism of impairment, we expected a different therapy effect among and within patients. Furthermore, the importance of errorless learning should increase with severity of impairment because of error opportunity. Methods & Procedures: A total of 100 line drawings were selected and split into four sets of 25 items each. The sets were assigned to four conditions: control (no training), vanishing cue, increasing cue, and both-cue condition (training with both methods). Then 20 therapy sessions were ordered according to the alternating treatments design. During treatment, the patient���s attempts to name a picture were assisted by a hierarchy of oral cues given by the therapist. Treatment methods differed in order of application but not in the type of cues used. Outcomes & Results: Cueing therapy in general was effective for 8 of 10 patients. Those patients with moderate naming disorders profited less than those with severe naming dis- orders. Both methods differed among and within patients. However, in contrast to our prediction, we found no patient who improved only under vanishing cues but several who showed positive effects with increasing cues alone or with both, increasing and vanishing cues. Conclusions: Unlike patients with amnesia, patients with aphasia do not seem to be troubled by their errors and may not require the vanishing cue method. # 2005 Psychology Press Ltd http://www.tandf.co.uk/journals/pp/02687038.html DOI:10.1080/02687030500268902 Address correspondence to: Walter Huber, Section Neurolinguistics, Department of Neurology, RWTH Aachen University of Technology, Pauwelsstr. 30, D-52074 Aachen, Germany. Email: firstname.lastname@example.org We thank Wibke Hooge and Daniela Kamutzki for assisting with speech therapy, and two anonymous reviewers for their many helpful comments. The therapy study was supported by the Helmut-Bauer Prize for Rehabilitation (German Society of Neurology). APHASIOLOGY, 2005, 19 (9), 831���848
In different approaches to the treatment of word-finding problems, a variety of cueing methods have been applied to assist the aphasic patient���s immediate retrieval of a word corresponding to the picture of an object (prompting) and to improve lexical access in the long term (facilitation vs therapy see Howard, 2000). The oral or written cue delivered by the therapist contains semantic, phonological, and/or syntactic information about the target word and hence acts as a prime (e.g., Howard, 2000 Howard & Orchard-Lisle, 1984 Howard, Patterson, Franklin, Orchard-Lisle, & Morton, 1985a Nickels, 2002b Stimley & Noll, 1991). EFFECTIVENESS OF PRIMING The effectiveness of various priming techniques has been investigated in group studies and (model-driven) single-case studies (see Nickels, 2002b Nickels & Best, 1996 for reviews). Semantic priming, by providing information about the meaning of a target, facilitates the retrieval of picture names and���if repeated several times���can be very effective as a treatment method (e.g., Davis & Pring, 1991 Doesborgh, van de Sandt- Koenderman, Dippel, van Harskamp, Koudstaal, & Visch-Brink, 2004 Drew & Thompson, 1999 Howard et al., 1985a, 1985b). Phonological priming of word forms of a target is primarily a very effective prompt (e.g., Li & Canter, 1987 Li & Williams, 1989 Pease & Goodglass, 1978), but can also have long-lasting effects (e.g., Hickin, Best, Herbert, Howard, & Osborne, 2002 Miceli, Amitrano, Capasso, & Caramazza, 1996 Raymer, Thompson, Jakob, & Legrand, 1993 Wambaugh, 2003 Wambaugh, Linebaugh, Doyle, Martinez, Kalinyak-Fliszar, & Spencer, 2001). Moreover, it seems that the greater the information about the target word and the more automatic the relation between cue and target (e.g., in sentence completion tasks), the stronger is the immediate impact of a prompt (e.g., Cohen, Engel, Kelter, & List, 1979 Li & Williams, 1989). In earlier group studies, the patients were grouped together irrespective of their dif- ferent loci of impairment to assess cue effectiveness. In model-driven therapy studies (e.g., Doesborgh et al., 2004 Drew & Thompson, 1999 Hillis & Caramazza, 1994 Nettleton & Lesser, 1991 Wambaugh, 2003 Wambaugh et al., 2001), authors have tried to attribute the existing variation in effectiveness of phonological versus semantic therapy among patients to divergent loci of their functional impairment in a word-processing model (semantic and/or phonological level of processing). Phonological and semantic cues can also be combined in a cueing hierarchy to achieve improvement at both levels of processing (e.g., Hillis & Caramazza, 1994). Howard (2000) recently assumed that the difference between semantic and phonological tasks might be overstated. THE CUEING HIERARCHY: INCREASING AND DECREASING Based on group study results, cueing techniques can be ordered hierarchically according to their postulated effectiveness in assisting immediate lexical access (e.g., Danz & Lauer, 1997 Shewan & Bandur, 1994). In therapeutic applications, cueing hierarchies are frequently used in phonological word form facilitation, while semantic cueing hierarchies are rarely reported (e.g., Abel, 2001 Greenwald, Raymer, Richardson, & Rothi, 1995 Wambaugh, 2003 Wambaugh et al., 2001). The idea of using cues to improve a specific behaviour can also be found in fields other than aphasia therapy. Wolery, Ault, and Doyle (1992) have systematically outlined the architecture and application of cueing hierarchies used for teaching students with moderate to severe learning disabilities. Each hierarchy consists of a minimum of three 832 ABEL ET AL.