Use of speech-generating
devices and their effect on
mental processing
Filip Loncke
University of Virginia
Linda Meyer (Woodrow Wilson Rehabilitation Center. Fishersville, VA)
Sarah Schaller (University of Virginia)
Alyssa Weltman (University of Virginia)
Walter Huber (University of Aachen, Germany)
Ruth Nobis-Bosch (University of Aachen, Germany)
Joanna Beck (University of Virginia)
Andy Schultz (University of Aachen, Germany)
Our research:
How different are processes in AAC-users?
•
•
Will a person who uses a speech-generating communication device still
develop (and use) internal speech?
How fast will a person who uses a speech-generating communication
device integrate its use in his or her repertoire?
What do we learn about speech and language processes by altering the
output device?
What are the implications and applications for a wide range of users?
•
What exactly is a SGD user learning?
•
•
What about speech-generating devices?
intention
Message formulation
Lexical selection
Phonological
preparation
(inner speech)
Syntactic selection
Operating
device
Generated
speech
Interesting characteristics:
Portability: users can easily carry the device and use it as a
prosthetic extension of the body. Naming (or forms of messaging)
will be associated with forms of pointing (to the barcode) and
emanates from the user.
“Bar-coding” the environment: by attaching barcodes to
real objects, persons, symbols, printed words in the client’s daily
environment, s/he will be able to generate speech that is
associated with specific locations of the person (bedroom, kitchen,
etc.). The number of attached barcodes is infinite.
Self-training: the users literally can take their therapeutic tools in
their own hands. This makes the device a good candidate as a tool
for homework and self-training.
Frequency: by using the speech-generating barcode reader
frequently and repeatedly, the person will strengthen the link
between a stimulus and the word/message making it more likely
that s/he will be able to spontaneously generate the speech.
A memory task with non-disabled
college students
Results learning spread over one
week
Mean number of words learned
number of words
50
40
bc non operating
30
bc operating
20
speech alone
10
0
probe1
probe2
probe3
probes
probe4
probe5
Study 2: Learning pseudowords
pseudowords
Phonologically
simple
B.A.Bar
Phonologically
complex
Overall comparison
90.00
80.00
percentage correct
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
Series1
Phonologically non-complex (overall)
Phonologically Complex (overall)
85.39
60.20
Phonologically non-complex Words
90.00
Percentage correct
88.00
86.00
84.00
Phonologically Easy
82.00
80.00
78.00
76.00
Phonologically Easy
B.A.Bar
non-B.A.Bar
89.08
81.69
Phonologically Complex Words
63.00
62.00
Percentage correct
61.00
60.00
Phonologically Complex
59.00
58.00
57.00
56.00
55.00
Phonologically
Complex
B.A.Bar
non-B.A.Bar
62.50
57.89
Conclusions and discussion about
phonological study
• Indication that the auditory feedback of
the speech-generating device could be a
support in establishing an internal
phonological representation of the word
• Differences between individuals
Study 3:
Effects of AAC on Natural Speech
Development
Importance of the problem
• Questions about (in-)compatibility have
been around for two centuries!
• Parents and caregivers (and clients!) are
concerned (and often have an opinion).
Speech
Parent
Speechgenerating
barcode
reader
Other
behavior
What is the little
boy doing? Do
you see him?
points
Child
Child
Gesture
Wa.. [Waving]
Moves barcode
reader closer
Activates the
barcode reader
with parent’s help
Waving hello
Child
Parent
Waving hello
Child
Waving hello
Speech of child
elicited by parent
60
Speech of child
elicited by barcode
Number of Times
50
40
30
20
10
0
1
2
3
4
Session Number
5
6
7
Parent speaking turns
Child speaking turns
Number of Turns
80
70
60
50
1
2
3
4
Session Number
5
6
7
35
Number of Times
30
25
Total barcode uses
20
Speech of child elicited
by barcode
15
10
5
0
1
2
3
4
5
Session Number
6
7
Study 4:
Word finding in individuals with
aphasia
Anomic problems associated with
aphasia
• One of the most characteristic problems for
individuals with aphasia is the difficulty to
access the internal lexicon.
• Anomia (naming difficulty) is one of the
major indicators of severity of language
dysfunction. The ability to name is crucial
for expressive language use.
• Also, naming problems can be a reflection
of the ease of lexical understanding.
Participants
The participants in this study were:
A 64-year-old male who presented with aphasia
secondary to left hemisphere CVA in November 2004
A 65-year-old male who presented with aphasia
secondary to left hemisphere CVA in August 2002
A 88-year-old female who presented with aphasia
secondary to left hemisphere CVA that had occurred
several years before the study.
Scoring
5
The participant was able to name the picture
spontaneously, without using the barcode reader.
4
The participant was able to name the picture using the
barcode reader to provide a phonemic cue.
3
The participant was able to name the picture using the
barcode reader to provide one repetition of the target word.
2
The participant was able to name the picture using the
barcode reader to provide a second repetition of the target
word.
1
The participant attempted to name the picture using any
or all modalities but was unable to produce the target
word.
d
dizzy
6
5
4
3
2
1
0
frequent nouns traditional cueing
frequent nouns barcode cueing
infrequent nouns traditional cueing
se
ss
io
se n 1
ss
io
n
2
se
ss
io
se n3
ss
io
se n 4
ss
io
se n 5
ss
io
se n 6
ss
io
se n 7
ss
io
n
8
average score
Progress over sessions
sessions
infrequent nouns barcode cueing
percentage improvement frequent nouns
percentage improvement infrequent nouns
20
20
15
15
10
10
5
5
0
-5
percentage
improvement
frequent nouns - traditional
cueing
frequent nouns - barcode
cueing
-0.59
15.86
0
percentage
improvement
infrequent nouns - traditional
cueing
infrequent nouns - barcode
cueing
7.88
14.56
Study 5:
Self-instructed use of a
speech-generating device
in treatment of aphasia
Conducted by Vanessa Seidler, Andy Schultz, Ruth Nobis-Bosch,
Walter Huber
Materials
• therapy-pictures are labelled
with 4-8 barcodes (Ø 6 items),
depending on the utterances of
the normal speakers
• barcodes are covered with
nouns, verbs and object-verbcollocations, presenting the
most important propositions of
the scene
• barcode at the right bottom
margin gives the implication
items in %
kind of usage of B.A.Bar
90
80
70
60
50
40
30
20
10
0
S1
S2
S3
S4
S5
sessions
S6
naming by B.A.Bar
repetition by B.A.Bar
substituting by B.A.Bar
S7
S8
This figure shows that
B.A.Bar was predominantly
used as repetition aid.
During each session HS
used B.A.Bar significantly
more often for repetition than
for naming and substitution.
Furthermore the usage as
repetition device increased
significantly from session 2
to session 3.
correct responses in %
pre- posttest: correct responses
80
70
60
50
40
30
20
10
0
72
56
52
pretest
trained items
63
posttest
untrained items
At pretest there was no
significant difference between
trained and untrained items.
In posttest the performance
was improved for both types
of items. However, the
difference
reached
only
significance for trained items.
2nd participant (Summer 2006)
66- year old male
participant with
global aphasia
60
50
40
trained items
30
untrained items
20
10
0
pre-test
post-test
trained items
48
50
untrained items
43
37
Conclusions
• Communication devices can be helpful for
individuals with aphasia if they allow to (1)
compensate for weakened skills, or to (2)
reinforce weakened skills.