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Hildred Stimulation Treatment Over the Internet

www.Hildred.com Stimulation Treatment Over the Internet. Richard C. Katz, Ph.D. CCC-SLP, BC-NCD Chair, Audiology and Speech Pathology Carl T. Hayden VA Medical Center Phoenix, Arizona 85012 USA richard.katz@va.gov Adjunct Professor Department of Speech & Hearing Science

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Hildred Stimulation Treatment Over the Internet

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  1. www.Hildred.comStimulation Treatment Over the Internet Richard C. Katz, Ph.D. CCC-SLP, BC-NCD Chair, Audiology and Speech Pathology Carl T. Hayden VA Medical Center Phoenix, Arizona 85012 USA richard.katz@va.gov Adjunct Professor Department of Speech & Hearing Science Arizona State University Tempe, Arizona 85287 USA

  2. Technology and Treatment • Assistive & Augmentative Communication Devices (AACD) • Computer-Assisted Treatment (CAT) • Computer-Only Treatment (COT)

  3. Computer-Only Treatment • Automated, rapid presentation • Hierarchically arranged cues • Randomized stimuli • Corrective feedback specific to response • Teach correct response • Limited number of stimuli

  4. Katz, R. C., & Nagy, V. T. (1984). An intelligent computer-based task for chronic aphasic patients. In R. H. Brookshire (Ed.), Clinical aphasiology:1984 conference proceedings (pp. 159-165). Minneapolis, MN: BRK. http://aphasiology.pitt.edu/http://aphasiology.pitt.edu/archive/00000806/

  5. Task • Written confrontation naming • Stimuli: 7 pictures • Response: Typing name of object • Criteria: 6 names on 1st attempt and 7th name on 2nd attempt for 3 consecutive sessions, or 15 sessions

  6. Intervention • Drill & practice (specific responses) • 6 levels of cues • Repeat attempt • Anagram without feedback • Response after model • Anagram with feedback • Multiple choice • Copy from model

  7. Phase II Study • 8 subjects • chronic aphasia • Occlusive CVA • Different types of aphasia • All had reading & writing problems • Performance measures • Pre/post writing confrontation naming task • Treatment task performance

  8. Scores and Corresponding Cues

  9. WHAT IS THIS? _

  10. Results • Sessions Range: 4-15 Average: 10.4 • Confrontation writing measures (Avg.) Pre: 34% Post: 85% (Diff: +51%) • Task performance measures (Max = 7) Baseline: 2.7 Last 3 sessions: 6

  11. Katz, R. C., & Wertz, R. T. (1997). The efficacy of computer-provided reading treatment for chronic aphasic adults. Journal of Speech, Language and Hearing Research, 40(3), 493-507.

  12. Phase III Study • 55 subjects • Compared 3 groups of aphasic subjects • 21 computerized language (reading) treatment • 19 computer nonlanguage (games) stimulation • 15 no treatment • Computer conditions • 78 hours of treatment or stimulation • 3 hours per week for 26 consecutive weeks

  13. Subject Criteria • 85 years of age or less • at least one year postonset of aphasia • performed between the 15th-90th PICA OA %-ile • premorbidly right-handed • completed at least the eighth grade • premorbidly literate in English • visual acuity >20/100 corrected in the better eye • auditory acuity >40 dB SRT, unaided, in better ear • no language treatment 3-month prior to entry • living in a non-institutionalized environment

  14. Measurements • At entry, 3-months, and 6-months • Porch Index of Communicative Ability (PICA) • Western Aphasia Battery (WAB) • 95% (258 out of 330) of tests scored by a second clinician without knowledge of subject or condition for >99% agreement (i.e., single blind condition)

  15. Treatment Software • Visual (nonlinguistic) matching and reading comprehension tasks (match-to-sample) • Single key (1-6) response • 232 different tasks • 29 activities (e.g., spelling, naming, sentence completion, grammar, etc.) • each containing 8 levels of assumed difficulty (i.e., increase linguistic complexity and/or number of foils)

  16. FUNCTIONS Find the word below that goes best with the word in the box. Restaurant 1. Sit 2. Buy 3. Eat 4. Drive 5. Sleep 6. Put Select the key (1-6) that goes best with the word:

  17. Mean percentile change in PICA OA

  18. Mean percentile change in PICA VRB

  19. Mean change in WAB AQ

  20. Conclusion • Computerized reading treatment administered with minimal assistance • Improvement on reading tasks generalized to non-computerized tasks • Improvement resulted from language content and not stimulation of computer • Computerized reading treatment provided was efficacious to adult outpatients with chronic aphasia

  21. Early Telecommunicology • Vaughn (late ‘70s through the ‘80s) • small, microprocessor-driven devices • PDP-11 “minicomputers” • via telephone lines (similar to modem) • Reading, writing, listening, speaking

  22. Internet-Provided Auditory Stimulation Treatment for Aphasic Adults Richard C. Katz, Ph.D. VA Medical Center, Phoenix Colleen Karow, Ph.D.University of Tennessee, Knoxville

  23. Stimulation-Facilitation Treatment • Controlled and intensive auditory stimulation of the impaired system to facilitate and maximize language reorganization and recovery. • Controlled refers to manipulation of stimulus dimensions to aid the patient in making maximal responses.

  24. Frequency of occurrence Semantic confusion/distance Parts of speech Word length Phonemic/Spelling complexity Visual similarity (confusion) Auditory confusion (discrimination) Grammatical complexity Concrete/Abstract Redundant information Vocal stress/emphasis Stimulus Dimensions

  25. Number of multiple choices Number of critical elements Delay of response (retention) Delay of presentation (anticipation) Speed of presentation Competing signal/noise Alerting signal Repeat item Auditory fidelity Simultaneous visual cue Presentation Dimensions

  26. Phase I Study • Is treatment active? • Small subject sample (N = 10) • No control subjects • Develop hypothesis for further refinement in Phase II

  27. Task • Standard, match-to-sample format • Stimuli: spoken (digital) speech • 2-6 multiple choices • Pictures displayed on monitor • Respond using mouse to point and click

  28. Treatment Program • 90 hierarchically arranged tasks • Performance determines direction • Presents stimuli and response array • Presents appropriate feedback • Correct/Incorrect • Treatment for error items when task performance is below criterion • Stores performance

  29. Treatment Hierarchy • If criteria is <80% correct for 3 consecutive attempts at a task -- • Repeat item • Alerting signal • Slow down rate of presentation • Simultaneous visual (printed) cue • Back down parameter dimension • Flag clinician for monitoring and clinician-provided intervention

  30. PARAMETER HIERARCHY Task parameters, stimulus parameters, and their dimensions PARAMETER TYPE DIMENSIONS Multiple Choice Task 2-6 choices Critical elements Task 1-3 elements Frequency of Occurrence Stimulus Common, Occasional Delay of Response Task 0, 5 seconds Semantic Confusion Stimulus Different, Related

  31. Task Hierarchy • 5 parameters • 14 dimensions • 90 stimulus sets (10 stimulus per set) • 900 stimulus item presentations

  32. Example of item from Task #1  (The first item in the hierarchy) Digitized speech: “Chair” Monitor: Picture of a car and a chair PARAMETER TYPE DIMENSIONS Multiple Choice Task 2 Critical elements Task 1 Frequency of Occurrence Stimulus Common Delay of Response Task 0 Semantic Confusion Stimulus Different

  33. Computer says: “Chair”

  34. Example of item from Task (About 1/3 through the hierarchy) Digitized speech: “Fork and cup” Monitor: 1) Blank screen for 5 seconds, then 2) display pictures of a fork, spoon, cup and bowl PARAMETER TYPE DIMENSIONS Multiple Choice Task 4 Critical elements Task 2 Frequency of Occurrence Stimulus Common Delay of Response Task 5 seconds Semantic Confusion Stimulus Related

  35. Computer says: “Fork, Cup”

  36. Please Wait . . .

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