Verb Network Strengthening Treatment (VNeST) for Connected Speech in Aphasia
Lisa A. Edmonds* and Swathi Kiran+
*Department of Communication Sciences and Disorders, The University of Florida, Gainesville, FL
+
Department of Communication Sciences and Disorders, The University of Texas, Austin, TX
Test
VERB THEMATIC NETWORKS
Butcher
Post-tx
Pre-tx
Post-tx
78.5
86.4
73.8
81.2
70.6
82.3
Boston Naming Test
71.7
81.7
86.7
91.7
40.7
58.3
44.0
68.0
TASK PREDICTED
TO IMPROVE
56.5
80.9
86.9
76.2
95.2
90.5
52.0
30.6
MEASUREMENT OF IMPROVEMENT
53.3
56.6
Generalization in all
participants
SW naming NOUNS
Boston Naming Test
SW naming VERBS
NVPB
3/4 participants improved >
10%
Sentence production
NVPB without provision of verbs
Patient
Message Level
Lexical selection
Functional Level
Function assignment:
(among competitors)
Lexical Selection
Function Assignment
Carpenter
Plumber
(Agent: carpenter) (V: measure) (Patient: stairs)
Measure
Grammatical Component
Weigh
Stairs
Wall
Positional Level
Lexical Retrieval
Constituent Assembly
Lexical retrieval Constituent assembly:
:
S
det/N/
VP
aux /V/
NP
Output
Kertesz, A. (1982). Western Aphasia Battery. Austin, TX: Pro-ed.
Abbreviated Treatment Steps
• Make 3-4 agent/patient pairs (cues, as
needed)
• Choose one pair, answer wh-questions
• Listen to sentences containing verb and
decide if semantically correct (e.g., The
chef measures a shoe.)
• Attempt to make 3 agent/patient pairs (no
cues)
Who
Surveyor
Measure
Example
Utterance
What
Subject and
verb?
Relevant?
The tree is open.
+
_
No
Her name
Cinderella.
_
+
No
Land
Carpenter
Lumber
Me/Mechanic
Car bumper
When
Chef
Goodglass, H., & Kaplan, E. (1983). Boston Diagnostic Aphasia
Examination. 2nd edition. Media, PA: Williams and Wilkins.
Determination of Complete
Utterances
Treatment protocol
Sugar
Why
Where
He’s the top of the
cookie (car car) jar
(xxx).
_
The kids are
raiding the cookie
jar.
+
_
+
They were trying to find some cookies.
(But) he’s standing up.
The girl was standing on the floor.
5
It’s tilting.
She was reaching with one hand to reach a cookie.
6
He’s almost starting to fall.
Her brother was handing her a cookie.
7
He’s the top of the cookie (car car) jar
(xxx).
The boy was standing on a stool.
8
He has a cookie xxx.
It was beginning to fall.
9
Looking for a cookie while his sister is
reaching (xxx).
(As) he hit with two hands.
10
His last cookie.
One hand was leaning over.
11
While they’re doing that the mother is
drying a plate.
He was beginning to fall.
12
He’s not paying attention to the water
that’s coming.
With his other hand he was reaching for the cookie jar.
13
The sink and pouring over the sink.
He had the cupboard.
14
And he has a (xx xx) for get that.
He had it opened.
P3: (X2(1) = 11.68, p < .001
15
The mother is standing with curtains
folded on each side.
(So) the top part was beside it.
P4: (X2(1) = .16, p < 1
16
(So) she can look through the window.
He was picking up a cookie with the other hand.
17
To walk through the step.
He had one door that he had opened of the cabinet.
18
There’s some plants near there.
While he was on that, mother was standing on the kitchen
where the sink was.
19
Back in the kitchen again he’s standing
with two cups and a plate over there.
Evident she was not looking.
20
n/a
Water was pouring from the sink and pouring over all the
way to the floor.
21
n/a
The mother was drying a (a) plate.
22
n/a
And he had one pool in front.
23
n/a
He was wearing an apron.
24
n/a
25
n/a
It looked like the bottom window was open.
26
n/a
The other side you could see the window and part of a
house and some plants beside that.
27
n/a
He had curtains on the side of the window.
28
n/a
Beside the kitchen was two cups.
29
n/a
There was one glass.
Post-tx
P2
P3
P4
(X2(1)
= 6.59, p < .025
Pre-tx
Post-tx
P1
Phonological Level
Adapted from Bock & Levelt, 1994
The boy is standing on the top (of a
xxx).
4
Pre-tx
160
140
120
100
80
60
40
20
0
det /N/
“The carpenter is measuring the stairs.”
3
*
Number of Utterances Pre- and Post-Tx
MLU
“stairs”
NP
The children were not looking at mother.
Post-hoc analyses revealed that P4 had difficulty constructing a sentence
frame, a problem not observed in the other participants.
“carpenter”
“measure”
Mother and two of her children were in the kitchen.
While she has her back to them her
two children (xxx).
P2: (X2(1) = 4.48, p < .05
Connected speech samples for Western Aphasia Battery picture, Cookie
Theft picture, and Cinderella retell were elicited before and after VNeST
treatment.
Room
“Complete
utterance?”
No
Yes
Reliability on utterance coding was conducted by a trained speech-language
pathologist familiar with aphasia speech patterns. Agreement was 93%.
P2
P3
MLU Pre- and Post-tx
The effects of VNeST treatment appear to extend to improvements in
connected speech for persons with nonfluent and fluent aphasia.
Pre-tx
Post-tx
P1
P2
P3
He possibly was looking toward the window.
Conclusions
P4
Participant
10
9
8
7
6
5
4
3
2
1
0
Post-treatment
A mother is working in the kitchen.
2
P1:
All participants improved >
15%
Pre-treatment
1
Participant
Speech Samples
The carpenter is measuring the stairs.
Utt
*
*
P1
# Utterances
Nurse
100
90
80
70
60
50
40
30
20
10
0
OUTCOME
The carpenter is measuring the stairs. (Trained)
The nurse is weighing the baby. (Untrained)
SENTENCE PRODUCTION MODEL
Produce
Sugar
Designer
91.3
72.7
Sentences in picture description with
trained and untrained verbs
Chef
Measure
59.1
Percent "Complete Utterances" Pre- and Post-Tx
Weigh
Gold
Land
54.2
86.4
Cashier
Lumber
Surveyor
Pre-tx
82.5
72.7
Pre-tx Post-tx
P4
76.4
NVPB sentence
production without verbs
given
Meat
Jeweler
Carpenter
Pre-tx Post-tx
P3
Western Aphasia
Battery
Northwestern Verb
Production Battery
(NVPB) Single Verb
naming
Theoretical Rationale for Treatment
P2
Percent correct
P1
Pre- and Post-tx Cookie Theft
Description for P3
Pre-Post Tx Results
Summary of Treatment Results
Abstract
Some persons with aphasia exhibit a selective semantic verb deficit as characterized by
reduced/impaired verb production across tasks, including sentence production in
connected speech.
Previous verb treatment studies have resulted in limited generalization to connected
speech samples (e.g., Edwards, Tucker, & McCann, 2004; Schneider & Thompson,
2003).
Four persons with moderate aphasia participated in Verb Network Strengthening
Treatment (VNeST), a semantic treatment focusing on strengthening the connections
between verbs (e.g., measure) and their typical thematic roles (e.g., chef, sugar).
Participants engaged in three pre-post treatment speech elicitation tasks (two picture
description tasks and a narrative) analyzed as one sample.
Assuming generalization thresholds were achieved on single sentences, improvement
in connected speech was predicted.
Significant post-treatment increases for utterances containing complete S-V-(O)
constructions with relevance to the topic were observed in three of the four participants.
Post-hoc analyses showed that P4, who did not show improvements in connected
speech, appeared to have deficits in constructing a sentence frame, a problem not
observed in the other participants.
These findings are more consistent than previously reported (e.g.,
Edwards, et al., 2004; Schneider & Thompson, 2003).
In persons with difficulty constructing a sentence frame, increased
word retrieval abilities in single word naming and within individual
sentences is evident. However, these abilities do not appear to
generalize to connected speech. Thus, direct treatment on sentence
frame construction may be warranted.
These findings are promising, but preliminary. Replication and future
research is needed to examine the effects of VNeST on a variety of
connected speech topics and tasks.
P4
Participant
Participants
Pt
M/F
Age
Educ
Occupation
Type of Aphasia
Site of
Lesion
MPO
1
M
52
10
Body mechanic
Transcortical Motor
Left MCA
10
2
F
63
16
Computer
programmer
Transcortical Motor
Left MCA
96
3
F
75
16
School teacher
Conduction
Left MCA
22
4
F
56
14
Musician
Conduction
Large Left 21
MCA
References
1. Bock, J. K., & Levelt, W. J. (1994). Language production. Grammatical encoding. In
M. A. Gernsbacher (Ed.), Handbook of Psycholinguistics. San Diego, CA: Academic
Press.
2. Edwards, S., Tucker, K., & McCann, C. (2004). The contribution of verb retrieval to
sentence construction: A clinical study. Brain and Language, 91, 78-79.
3. Schneider, S. L., & Thompson, C. K. (2003). Verb production in agrammatic aphasia:
The influence of semantic class and argument structure properties on generalisation.
Aphasiology, 17(3), 213-241.