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