Matemática I Prof. Gerson Lachtermacher, Ph.D. Prof. Rodrigo Leone, D.Sc. Prof. Patrícia Carly.
Gardenia Hernandez, B.S. & Abbie Olszewski, Ph.D., CCC-SLP ...Gardenia Hernandez, B.S. & Abbie...
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Cross-linguistic Generalization: Implications for Bilingual Aphasia Therapy Gardenia Hernandez, B.S. & Abbie Olszewski, Ph.D., CCC-SLP University of Nevada, Reno Clinical Scenario Gardenia is currently a speech pathology graduate student who is interested in working with patients with aphasia, particularly those who are bilingual. She anticipates she will be working with elderly Spanish-English bilingual patients diagnosed with Broca’s aphasia during her internship placement. She anticipates she will provide services to her clients nine months post onset for an hour twice a week. Broca’s aphasia patients’ speech is generally characterized as slow and agrammatic with difficulty on repetition and naming tasks. Gardenia does not have experience providing therapeutic services to patients with aphasia. However, she does have experience evaluating patients with aphasia. Her lack of experience working with aphasia patients, specifically those that are bilingual, has led her to consider whether therapy should be conducted in bilingual patients’ primary language or in their secondary language. Precisely, she wants to know whether providing therapy in one language will result in cross-linguistic generalization in the other language. Introduction • The population of Americans aged 65 and older is expected to double during the next 25 years to about 72 million (CDC, 2013). • The elderly population is at a higher risk of suffering from medical conditions, such as strokes or traumatic brain injuries that can lead to aphasia. • In fact, in 2009, 66% of people hospitalized for strokes were those aged 65 and older (CDC, 2015). • The number of bilingual speakers in the United States is also expected to increase. (ASHA, 2015). • An increase in elderly bilingual individuals will result in an increase in bilingual individuals with aphasia. • For bilingual speakers, aphasia will result in disordered language in both languages. As a result, the bilingual speaker’s quality of life will be negatively impacted through decreased communication abilities (Spaccavento et al., 2014). • The purpose of this paper is to determine if aphasia therapy in one language will result in cross-linguistic generalization for bilingual speakers. If so, is greater generalization achieved by providing therapy in the bilingual speaker’s primary language compared to the speaker’s second language? PICO Gillam & Gillam (2008) For bilingual individuals with aphasia (P) will therapy in one language result in cross-linguistic generalization? If so, will therapy in the individual’s primary language (I) result in increased cross-linguistic generalization as measured by picture naming (O) when compared to therapy in the individual’s second language (C)? Methods Databases: ASHA, PubMed, Science Direct, EBSCO, and Google Scholar. Search terms: bilingual aphasia therapy, bilingual aphasia systematic review, and bilingual aphasia cross-linguistic generalization. Appraisal: • Ten research articles that met research criteria were located. • The articles were appraised and evaluated for validity and reliability using a CASM or CATE form. • Inter-rater reliability of 85% or greater was achieved for all articles. • The 5 articles with the best overall rating were selected for the study. Results Author & Date Participants Purpose Dependent Variable Results Ansaldo & Saidi (2014) Systematic Review N = 15 Adult Bilingual Aphasia and anomia To discuss the literature on bilingual aphasia therapy, with a focus on crosslinguistic therapy effects from the treated to the untreated language. Crosslinguistic generalization therapy effects • Some studies suggest that premorbid proficiency should be considered and that treating the premorbid weaker language appears to facilitate crosslinguistic generalization. • Other studies suggest that postmorbid proficiency should be considered. • No consensus in the reviewed studies as to which language would provide crosslinguistic transfer. Edmonds & Kiran (2006) SingleSubject N=3 Adult EnglishSpanish bilingual Aphasia To study the effect of semantic naming treatment on crosslinguistic generalization in 3 participants with EnglishSpanish bilingual aphasia. Naming Participant 1: • Crosslinguistic generalization observed in the untrained English translation items at 1050% accuracy, p = .071. • Crosslinguistic generalization was observed in untrained semantically related words with 1060% accuracy, p = .001. Participant 2: • No crosslinguistic generalization from English to Spanish on naming of semantically related words. • Crosslinguistic generalization was noted from the trained Spanish set 2 to the untrained translations from English set 2 from an accuracy of 30% to 80%. • Crosslinguistic generalization was noted on the originally trained English set 1 words from 80% to 100% accuracy upon initiation of Spanish treatment, p = .001. Participant 3: • Crosslinguistic generalization was observed on untrained English translations of set 1 from 40% to 70% accuracy, p = .200. • Crosslinguistic generalization was observed for untrained semantically related words in the untrained language (English) with accuracy increasing form 30%70%, p = .040. FaroqiShah, Frymark, Mullen & Wang (2010) Systematic Review N = 14 Adult Bilingual Aphasia To examine: outcomes when therapy is provided in second (less dominant) language, extent of cross linguistic generalization (CLT) and variables that influence CLT. Crosslinguistic outcomes of intervention (BAT, ILAT, SNB, BNT, and WhQ) conducted in either the primary (L1) or the secondary (L2) language targeting expressive skills • Five of the eleven studies found CLT to the untrained L1 after L2 treatment ( p < .05). • Four out of five studies demonstrated CLT to the untrained L2 after L1 treatment ( p < .05). • The study suggested that SLPs should consider L2 therapy for early and late bilinguals with moderate to high L2 proficiency. Kiran , Sandberg, Gray, Ascenso, & Kester (2013) Singlesubject multiple baseline across participants N = 17 Adult Bilingual Aphasia To examine if there was a principled way to understand the nature of rehabilitation in bilingual aphasia such that paeerns of acquisition and generalization are predictable and logical. Naming 3 sets per language : • Set 1: trained items • Set 2: untrained semantically related items to set 1 • Set 3: untrained translation set Naming All the following results were statistically significant with an effect size > 4.0 • 3 participants demonstrated betweenlanguage generalization from trained language set 1 to their translations in set 2 • 2 participants met the criterion for betweenlanguage generalization from trained language set 1 to untrained language set 2 • 2 participants met the criteria for control items in the untrained language Kohnert (2009) Systematic Review N = 12 84 participants Adults Monolingual and multilingual Aphasia To discuss the potential transfer or generalization of positive effects from a treated to an untreated language in bilingual or multilingual individuals with primary acquired aphasia. Crosslinguistic generalization outcomes • 10 of the 12 studies reported improvement in an untreated language. • All 5 studies that reported treating the speakers second language (L2) demonstrated improvement in the untreated language (L1). • 3 out of 5 studies that reported treating the speaker’s first language (L1) demonstrated improvement in the untreated language (L2). • 2 studies alternated treatment of L1 and L2. They demonstrated gains in the untreated language during each phase of treatment. • Some studies revealed treatment efficacy may be maximized by emphasizing structural similarities between the bilingual speaker’s two languages. References Discussion Ansaldo, A. I. & Saidi, L.G. (2014). Aphasia therapy in the age of globalization: Cross-linguistic therapy effects in bilingual aphasia. Behavioral Neurology,2014 (2), 1-10. doi: 10.1155/2014/603085 Edmonds, L. A. & Kiran, S. (2006). Effect of Semantic Naming Treatment on Crosslinguistic generalization in bilingual aphasia. Journal of Speech, Language, and Hearing Research, 49 (4), 729-748. doi: 10.1044/1092-4388(2006/053) Faroqi-Shah, Y., Frymark, T., Mullen R., & Wang, B. (2010). Effect of treatment for bilingual individuals with aphasia: A systematic review of the evidence. Journal of Neurolinguistics, 23,319–341. doi:10.1016/j.jneuroling.2010.01.002 Gillam, S. & Gillam, R. (2008). Teaching graduate students to make evidence-based intervention decisions, application of a seven-step process within an authentic learning context. Topics in Language Disorders, 28(3), 212-238. Kiran, S., Sandberg, C., Gray, T., Ascenso, E., & Kester, E. (2013). Rehabilitation in bilingual aphasia: Evidence for within- and between-language generalization. American Journal of Speech-Language Pathology, 22, s298-s309. doi: 10.1044/1058-0360(2013/12-0085) Kohnert, K. (2009). Cross-language generalization following treatment in bilingual speakers with aphasia: a review. Seminars in Speech and Language, 30, 174–186. doi: 10.1055/s-0029-1225954 The studies evidenced no consensus on whether the primary or secondary language leads to increased cross-linguistic generalization. Some studies resulted in cross-linguistic generalization when treatment was provided only in the primary language, whereas the rest of the studies indicated greater cross-linguistic success after treatment of the secondary language only. Researchers suggest that cross-linguistic generalization may be dependent on: the degree of structural overlap between languages, the type of therapy approach, the pre and postmorbid language proficiency profiles, and the status of patients cognitive control circuit (Ansaldo & Saidi, 2014). Therefore, all of these factors should be considered on an individual basis for each bilingual patient with aphasia. For my future bilingual aphasia patients, I would take these factors into account along with my clinical expertise and my patients’ preferences and perspectives regarding their treatment. In this regard, I would ensure that I am providing my patients the best service while integrating all three areas of evidence based practice.
Transcript of Gardenia Hernandez, B.S. & Abbie Olszewski, Ph.D., CCC-SLP ...Gardenia Hernandez, B.S. & Abbie...
Cross-linguistic Generalization: Implications for Bilingual Aphasia Therapy Gardenia Hernandez, B.S. & Abbie Olszewski, Ph.D., CCC-SLP
University of Nevada, Reno Clinical Scenario
Gardenia is currently a speech pathology graduate student who is interested in working with patients with aphasia, particularly those who are bilingual. She anticipates she will be working with elderly Spanish-English bilingual patients diagnosed with Broca’s aphasia during her internship placement. She anticipates she will provide services to her clients nine months post onset for an hour twice a week. Broca’s aphasia patients’ speech is generally characterized as slow and agrammatic with difficulty on repetition and naming tasks. Gardenia does not have experience providing therapeutic services to patients with aphasia. However, she does have experience evaluating patients with aphasia. Her lack of experience working with aphasia patients, specifically those that are bilingual, has led her to consider whether therapy should be conducted in bilingual patients’ primary language or in their secondary language. Precisely, she wants to know whether providing therapy in one language will result in cross-linguistic generalization in the other language.
Introduction • The population of Americans aged 65 and older is expected to double during the next 25 years
to about 72 million (CDC, 2013). • The elderly population is at a higher risk of suffering from medical conditions, such as strokes
or traumatic brain injuries that can lead to aphasia. • In fact, in 2009, 66% of people hospitalized for strokes were those aged 65 and older (CDC,
2015). • The number of bilingual speakers in the United States is also expected to increase. (ASHA,
2015). • An increase in elderly bilingual individuals will result in an increase in bilingual individuals
with aphasia. • For bilingual speakers, aphasia will result in disordered language in both languages. As a
result, the bilingual speaker’s quality of life will be negatively impacted through decreased communication abilities (Spaccavento et al., 2014).
• The purpose of this paper is to determine if aphasia therapy in one language will result in cross-linguistic generalization for bilingual speakers. If so, is greater generalization achieved by providing therapy in the bilingual speaker’s primary language compared to the speaker’s second language?
PICO Gillam & Gillam (2008) For bilingual individuals with aphasia (P) will therapy in one language result in cross-linguistic generalization? If so, will therapy in the individual’s primary language (I) result in increased cross-linguistic generalization as measured by picture naming (O) when compared to therapy in the individual’s second language (C)?
Methods Databases: ASHA, PubMed, Science Direct, EBSCO, and Google Scholar. Search terms: bilingual aphasia therapy, bilingual aphasia systematic review, and bilingual aphasia cross-linguistic generalization.
Appraisal: • Ten research articles that met research criteria were located. • The articles were appraised and evaluated for validity and reliability using a CASM or CATE
form. • Inter-rater reliability of 85% or greater was achieved for all articles. • The 5 articles with the best overall rating were selected for the study.
Results Author & Date Participants Purpose Dependent
Variable Results
Ansaldo & Saidi (2014) Systematic Review
N = 15 Adult Bilingual Aphasia and anomia
To discuss the literature on bilingual aphasia therapy, with a focus on cross-‐‑linguistic therapy effects from the treated to the untreated language.
Cross-‐‑linguistic generalization therapy effects
• Some studies suggest that premorbid proficiency should be considered and that treating the premorbid weaker language appears to facilitate cross-‐‑linguistic generalization.
• Other studies suggest that postmorbid proficiency should be considered.
• No consensus in the reviewed studies as to which language would provide cross-‐‑linguistic transfer.
Edmonds & Kiran (2006) Single-‐‑Subject
N = 3 Adult English-‐‑Spanish bilingual Aphasia
To study the effect of semantic naming treatment on cross-‐‑linguistic generalization in 3 participants with English-‐‑Spanish bilingual aphasia.
Naming
Participant 1: • Cross-‐‑linguistic generalization observed in the untrained English
translation items at 10-‐‑50% accuracy, p = .071. • Cross-‐‑linguistic generalization was observed in untrained
semantically related words with 10-‐‑60% accuracy, p = .001. Participant 2: • No cross-‐‑linguistic generalization from English to Spanish on
naming of semantically related words. • Cross-‐‑linguistic generalization was noted from the trained
Spanish set 2 to the untrained translations from English set 2 from an accuracy of 30% to 80%.
• Cross-‐‑linguistic generalization was noted on the originally trained English set 1 words from 80% to 100% accuracy upon initiation of Spanish treatment, p = .001.
Participant 3: • Cross-‐‑linguistic generalization was observed on untrained
English translations of set 1 from 40% to 70% accuracy, p = .200. • Cross-‐‑linguistic generalization was observed for untrained
semantically related words in the untrained language (English) with accuracy increasing form 30%-‐‑70%, p = .040.
Faroqi-‐‑Shah, Frymark, Mullen & Wang (2010) Systematic Review
N = 14 Adult Bilingual Aphasia
To examine: outcomes when therapy is provided in second (less dominant) language, extent of cross-‐‑linguistic generalization (CLT) and variables that influence CLT.
Cross-‐‑linguistic outcomes of intervention (BAT, ILAT, SNB, BNT, and Wh-‐‑Q) conducted in either the primary (L1) or the secondary (L2) language targeting expressive skills
• Five of the eleven studies found CLT to the untrained L1 after L2 treatment ( p < .05).
• Four out of five studies demonstrated CLT to the untrained L2 after L1 treatment ( p < .05).
• The study suggested that SLPs should consider L2 therapy for early and late bilinguals with moderate to high L2 proficiency.
Kiran , Sandberg, Gray, Ascenso, & Kester (2013) Single-‐‑subject multiple baseline across participants
N = 17 Adult Bilingual Aphasia
To examine if there was a principled way to understand the nature of rehabilitation in bilingual aphasia such that paeerns of acquisition and generalization are predictable and logical.
Naming 3 sets per language : • Set 1: trained items • Set 2: untrained
semantically related items to set 1
• Set 3: untrained translation set
Naming All the following results were statistically significant with an effect size > 4.0 • 3 participants demonstrated between-‐‑language generalization
from trained language set 1 to their translations in set 2 • 2 participants met the criterion for between-‐‑language
generalization from trained language set 1 to untrained language set 2
• 2 participants met the criteria for control items in the untrained language
Kohnert (2009) Systematic Review
N = 12 84 participants Adults Monolingual and multilingual Aphasia
To discuss the potential transfer or generalization of positive effects from a treated to an untreated language in bilingual or multilingual individuals with primary acquired aphasia.
Cross-‐‑linguistic generalization outcomes
• 10 of the 12 studies reported improvement in an untreated language.
• All 5 studies that reported treating the speakers second language (L2) demonstrated improvement in the untreated language (L1).
• 3 out of 5 studies that reported treating the speaker’s first language (L1) demonstrated improvement in the untreated language (L2).
• 2 studies alternated treatment of L1 and L2. They demonstrated gains in the untreated language during each phase of treatment.
• Some studies revealed treatment efficacy may be maximized by emphasizing structural similarities between the bilingual speaker’s two languages.
References Discussion Ansaldo, A. I. & Saidi, L.G. (2014). Aphasia therapy in the age of globalization: Cross-linguistic therapy effects in bilingual aphasia. Behavioral Neurology,2014 (2), 1-10. doi: 10.1155/2014/603085 Edmonds, L. A. & Kiran, S. (2006). Effect of Semantic Naming Treatment on Crosslinguistic generalization in bilingual aphasia. Journal of Speech, Language, and Hearing Research, 49 (4), 729-748. doi: 10.1044/1092-4388(2006/053) Faroqi-Shah, Y., Frymark, T., Mullen R., & Wang, B. (2010). Effect of treatment for bilingual individuals with aphasia: A systematic review of the evidence. Journal of Neurolinguistics, 23,319–341. doi:10.1016/j.jneuroling.2010.01.002 Gillam, S. & Gillam, R. (2008). Teaching graduate students to make evidence-based intervention decisions, application of a seven-step process within an authentic learning context. Topics in Language Disorders, 28(3), 212-238. Kiran, S., Sandberg, C., Gray, T., Ascenso, E., & Kester, E. (2013). Rehabilitation in bilingual aphasia: Evidence for within- and between-language generalization. American Journal of Speech-Language Pathology, 22, s298-s309. doi: 10.1044/1058-0360(2013/12-0085) Kohnert, K. (2009). Cross-language generalization following treatment in bilingual speakers with aphasia: a review. Seminars in Speech and Language, 30, 174–186. doi: 10.1055/s-0029-1225954
The studies evidenced no consensus on whether the primary or secondary language leads to increased cross-linguistic generalization. Some studies resulted in cross-linguistic generalization when treatment was provided only in the primary language, whereas the rest of the studies indicated greater cross-linguistic success after treatment of the secondary language only. Researchers suggest that cross-linguistic generalization may be dependent on: the degree of structural overlap between languages, the type of therapy approach, the pre and postmorbid language proficiency profiles, and the status of patients cognitive control circuit (Ansaldo & Saidi, 2014). Therefore, all of these factors should be considered on an individual basis for each bilingual patient with aphasia. For my future bilingual aphasia patients, I would take these factors into account along with my clinical expertise and my patients’ preferences and perspectives regarding their treatment. In this regard, I would ensure that I am providing my patients the best service while integrating all three areas of evidence based practice.
