Aphasia Rehabilitation: An Auditory and Verbal Task Hierarchy. ISBN 0398040249, 978-0398040246

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Aphasia Rehabilitation: An Auditory and Verbal Task

Hierarchy

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APHASIA REHABILITATION
An Auditory and Verbal
Task Hierarchy

By

DEBORAH ROSS, M.A., C.C.C. and SARA SPENCER, M.S., C.C.C.


Speech Pathologists
Department of Physical Medicine and Rehabilitation
Sacramento Medical Center
University of California, Davis
Sacramento, California

CHARLES C THOMAS • PUBLISHER


Springfield • Illinois • U.S.A.
Published and Distributed Throughout the World by
CHARLES C THOMAS • PUBLISHER
Bannerstone House
301-327 East Lawrence Avenue, Springfield, Illinois, U.S.A.

This book is protected by copyright. No part of it


may be reproduced in any manner without written
permission from the publisher.

© 1980, by CHARLES C THOMAS • PUBLISHER

ISBN 0-398-04031-1 (cloth)


ISBN 0-398-04024-9 (paper)
Library of Congress Catalog Card Number: 79-24617

With THOMAS BOOKS careful attention is given to all details of manufacturing and design.
It is the Publisher's desire to present books that are satisfactory as to their physical qualities
and artistic possibilities and appropriate for their particular use. THOMAS BOOKS will be
true to those laws of quality that assure a good name and good will.

Liobrary of Congress Cataloging in Publication Data


Ross, deborah, 1950-
Aphasia rehabiliation.
Bibliography: p.
l. Aphasia-Rehabilitation. I. Spencer, Sara,
1950- joint author. II. Title.
RC425.R67 616.8 '552' 06 79-24617
ISBN 0-398-04031-1
ISBN 0-398-04024-9 pbk.

Printed in the United States of America


Wm-11
INTRODUCTION
This clinician's manual for the treatment of the aphasic adult
contains a selection of treatment tasks for the two primary
communicative modalities-auditory processing and verbal expres-
sion. The manual is divided into two major sections (auditory and
verbal) with each section containing activities presented in a task
hierarchy.
The manual was developed primarily for clinicians' use. It is both
extensive and comprehensive in that stimulus material for all levels
of aphasic involvement (from marked to mild) is contained within
each task hierarchy. It is portable and efficient; a score sheet and all
necessary materials are contained within the manual.
Although this manual is written with the aphasic adult in mind,
selected tasks are also appropriate for apractic and dysarthric
patients and those who are cognitively impaired. Suggestions for
specific application are included in each section.
ACKNOWLEDGMENTS
We are greatly indebted to three special persons who contributed
to the completion of this project. We are grateful to Susan Slakey
and Wendy Walker for their excellent and clear illustrations. We
wish to thank Julia Halladay Robinson for her many hours of
typing and editing for the completion of this manual.
CONTENTS
Page
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments ........................................... viii
SECTION ONE
AUDITORY PROCESSING
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Single Unit Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
TwoUnitProcessing .......................................... 13
Three Unit Processing ......................................... 37
Multiple Unit Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Paragraph Comprehension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
SECTION TWO
VERBAL EXPRESSION
Introduction ................................................ 103
Single Word Responses ........................................ 107
Two and Three Word Responses ................................ 155
Sentence Formulation ........................................ 185
Complex Sentence Formulation ................................ 209
Paragraph Formulation ....................................... 227
Suggested Reading and Materials ............................... 237
Appendix . .................................................. 239
APHASIA REHABILITATION
SECTION ONE
AUDITORY PROCESSING
INTRODUCTION
SINGLE UNIT PROCESSING
Identification of Single Objects Named
Answering Single Unit Yes-No Questions
TWO UNIT PROCESSING
Answering Personal Two Unit Yes-No Questions
Following Two Unit Body Part Commands
Following Two Unit Commands with Visual Stimuli
Identification of Objects Described by Function
Identification of Objects Described by Other Characteristics
Identification of Two Objects Named Serially
Answering Two Unit Yes-No Questions
THREE UNIT PROCESSING
Following Three Unit Body Part Commands
Following Three Unit Commands with Visual Stimuli
Identification of Three Objects Named Serially
Answering Three Unit Yes-No Questions
MULTIPLE UNIT PROCESSING
Following Multiunit Body Part Commands
Following Multiunit Commands with Visual Stimuli
Answering Multiunit Yes-No Questions
Following Multiunit Commands- Temporal Relations
Following Multiunit Commands-Spatial Relations
Following If- Then Commands with Visual Stimuli
Following If- Then Body Part Commands
Answering Multiunit Yes-No Questions-Comparatives
Answering Multiunit Yes-No Questions- Temporal Relations
Answering Multiunit Yes-No Questions-Spatial Relations
PARAGRAPH COMPREHENSIO~
My Grandmother
The Oldest Man
3
4 Aphasia Rehabilitation

Cauliflower
McDonald's Hamburgers
Horseradish
Howard Hughes
Monaco
Nantucket
The Dinner
Michael Malloy
INTRODUCTION
This section of the manual is focused on drills designed to
strengthen the auditory processing modality. The treatment tasks
developed and selected for this section include:
l. Tasks requiring single unit processing.
a. Identification of objects named
b. Answering yes-no questions
2. Tasks requiring two unit processing.
a. Identification of objects named
b. Identification of objects described
c. Following two unit commands
d. Answering yes-no questions
3. Tasks requiring three unit processing.
a. Identification of objects named
b. Following three unit commands
c. Answering yes-no questions
4. Tasks requiring multiple unit processing.
a. Answering yes-no questions containing comparatives, temporal
relations, spatial relations, and if-then situations
b. Following multiple unit commands
5. Paragraph comprehension.
These treatment tasks were selected to strengthen auditory
processing deficits of retention, sequencing, slow rise time,
intermittent auditory imperception, reduced information capacity,
noise buildup, and shifting ability. The treatment tasks are
presented in a task hierarchy, first introducing single units of
information and progressing to multiple units of information, thus
strengthening the aphasic adults' potential capacity for processing
auditory information.
The following variables were considered when establishing this
task hierarchy:
1. Length of Stimuli. The number of words in the stimuli, including
small functor words as well as the number of substantive units
contained in the stimuli, were considered in the stimuli development
and placement in the hierarchy.
2. Semantic complexity of stimuli. A stimuli's use in the English
language was considered an important factor. High frequency words
are known to be easier to process than low frequency words.
3. Syntactic complexity of stimuli. Treatment tasks were developed and
selected with syntactic structures in mind. Such structures include

5
6 Aphasia Rehabilitation
grammatic contrasts e.g. prepositions "on" vs. "under"; morphemic
contrasts, e.g. plurality; word order and properties of words in
sentences, e.g. subject vs. object. Additional syntactic structures
included in higher level tasks are those which require high level
auditory sequencing and retention abilities, e.g. comparatives, before
and after constru!=!ts, if-then commands, and questions.
4. Presence or absence of visual cues. Auditory stimuli accompanied by
visual cues are easier to process than auditory stimuli presented
without visual cues.
5. Redundancy of material. The type and amount of additional auditory
cues necessary for eliciting a response.
6. Relationships between substantive words used in the stimulus. When
the substantive words within a stimulus are related, the stimuli will be
more easily processed than when they are unrelated, e.g. "Do you get
milk from a cow?" will be an easier task than "Point to cow and
spoon" because the two substantive units in the first example are
related and therefore more easily processed.
7. Rise time. The patient whose processing system is characterized by
slow rise time tends to miss the initial portions of incoming auditory
messages because his/her processing system takes a greater amount of
time to shift from a passive nonprocessing state to an active processing
state. Therefore, development and selection of treatment tasks were
selected with this factor in mind.
It is suggested that the clinician also consider what he/she can do
to control the task hierarchy. The variables that are clinician
controlled include the following:
1. Speed of delivery. This variable affects the rise time, shifting abilities,
retention, and noise buildup.
2. Stress produced on substantive words. This provides for cueing for a
response through intonation and stress.
3. Repetition of stimulus.
4. Clinician introduction of additional auditory and/or visual cues.
The auditory task hierarchy is theoretical and should not be
implemented as an absolute sequence of progression for all patients.
It is suggested that the clinician proceed in a task hierarchy,
however, selecting those treatment tasks which are most
appropriate for each individual patient. For example, some
patients who experience more difficulty with auditory processing
than with verbal expression may find that pointing to two objects
named will be an easier task than answering a two unit yes-no
question and vice versa. Another patient may respond better to
tasks with visual cues, though the stimulus contains two unrelated
words while another may respond best to the yes-no questions
because of contextual cues.
Introduction 7
It should be noted that some tasks in this section are particularily
applicable to the cognitively impaired patient. All of the higher
level auditory tasks are beneficial due to the frequent problems in
auditory sequencing and retention abilities in this population. The
temporal relations and spatial relation ta$ks, however, we have
found to be particularily useful therapy material.
SINGLE UNIT PROCESSING
Single Unit Processing 11
IDENTIFICATION OF SINGLE OBJECTS NAMED

MATERIALS: A Pictures, B Pictures, and C


Pictures.
TASK INSTRUCTIONS: Arrange the stimulus items in two
rows of five (A Pictures).
CLINICIAN INSTRUCTIONS: 'Til say the name of each picture,
and you point to it."
If ten stimulus items are too
many initially, reduce the
number of stimulus items
according to the patient's ability
and proceed with the activity as
directed.
SUGGESTED CRITERIA 100 percent accuracy without the
FOR ADVANCING TO B need of repetition of the task
AND C PICTURES: instructions or significant delays
in responding.

POINT TO THE-
A PICTURES B PICTURES C PICTURES
1. cup 1. bell 1. calendar
2. phone 2. saw 2. parachute
3. spoon 3. pipe 3. battery
4. car 4. tent 4. lawnmower
5. chair 5. radio 5. envelope
6. brush 6. umbrella 6. helicopter
7. watch 7. saddle 7. camera
8. money 8. kite 8. stapler
9. bed 9. flashlight 9. fire hydrant
10. book 10. refrigerator 10. scale
12 Aphasia Rehabilitation
ANSWERING SINGLE UNIT YES-NO QUESTIONS

MATERIALS: None.
TASK INSTRUCTIONS: Ask the patient questions without
the presence of the visual stimuli.
CLINICIAN INSTRUCTIONS: 'Tm going to ask you some
questions, and I want you to
answer/indicate yes or no."
SUGGESTED CRITERIA: 90 percent accuracy without the
need of repetition of the task
instructions or significant delays
in responding.

1. Are you a man?


2. Are you asleep?
3. Are you married?
4. Are you hungry?
5. Do you have a cold?
6. Are you thin?
7. Are you tired?
8. Are you tall?
9. Are you in a hospital?
10. Do you wear makeup?
11. Do you have a beard?
12. Do you have hands?
13. Do you have a wife?
14. Do you shave?
15. Are you angry?
16. Do you have a nose?
17. Are you bald?
18. Are you dressed?
19. Are you awake?
20. Do you have legs?
TWO UNIT PROCESSING

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