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A Picture is Worth A Thousand Words

Posted by Emily Dubas, MS, CCC-SLP
Emily Dubas, MS, CCC-SLP
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If you ever struggle to say a word that’s just at the tip of your tongue, you have a slight idea of what people with aphasia deal with. With communication a fundamental part of everyday experiences, it’s very frustrating to lose words when you want to get your message across.

Naming impairments are one of the most common deficits in people with this communication disorder, and it impacts virtually all types of aphasia including anomic aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, and global aphasia. Additionally, people with other types of brain injuries and dementia also experience naming problems.

In speech therapy, confrontation picture naming for nouns and verbs is a common therapy exercise. Traditional approaches involve using paper-based picture cards. One limitation is that the cards quickly become outdated. Finding relevant and up-to-date stimuli can be an incredibly time-consuming endeavor for clinicians.

Technology Advancements in Naming Therapy

Thankfully, advancements in technology have allowed for easier access to naming therapy. In 2005, researchers found that computer-assisted treatments for word retrieval are an effective supplement to one-on-one speech and language therapy and can provide more intensive and consistent practice. In another study from 2006, researchers at the University of Geneva looked at the effects of providing more intensive therapy by increasing the number of items people with aphasia practiced on a technology-based written naming treatment. When individuals practiced naming the larger set of items they showed significantly greater improvement, even though these items received less exposure in the treatment compared to smaller item sets.

Gone are the days of relying on old picture cards or using valuable time to scour the internet for images. Constant Therapy provides clinicians and patients with hundreds of noun and verb pictures. Not only does this help efficiency, but also you can help patients work on more items both in therapy sessions and at home.

Activate Words Through Cueing

An important aspect of confrontation naming is cueing, as they are thought to activate semantic, phonological, or orthographic processes to aid in word retrieval.

Cues (or prompts) have several benefits in therapy. For example, cues are used to understand the patient’s current word knowledge. Also, cues can improve naming performance by providing repetition priming—meaning the retrieval of the target word improves in subsequent presentations. Another theory is from the Hebbian learning principle that says, “neurons that fire together, wire together.” Each response that is produced fires connections and each time a response is produced the connection is strengthened. Cues have been found to be effective in not just naming nouns but also verbs. For example, Sonia Routhier of Laval University found in 2015 that providing a cue in verb naming (also called action naming) resulted in significant improvement.

A Different Kind of Name Game

Constant Therapy’s naming tasks are not only beneficial for people with word finding difficulties. Task features include a sound level meter, audio replay, and immediate feedback on accuracy, which make it a perfect exercise for people with dysarthria working on speech intelligibility strategies at the word level.

Featured Task: Name Pictures

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What is Name Pictures?

In this confrontation naming exercise, the patient will view an image of a noun. When the user is ready to name the picture, they can tap the start button to record a response. A sound level meter is displayed to give feedback about the appropriate loudness of the response. The program’s real-time speech recognition engine will analyze the answer and mark it as correct/incorrect. In this voice-enabled exercise, the patient can replay their response to compare their response to the target, and they can try again as many times as needed.

Four cues can be accessed in Name Pictures. If a patient needs help with word retrieval, they can tap on the Question Mark next to the picture to uncover the cues. They can select a semantic (auditory description of a feature), phonemic (first sound of the word), graphemic (first letter of the word), or whole word repetition cue. Patients can take as many cues as needed to help them get the correct answer. All cues and cue types are recorded for the clinicians in the reports section.

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How is Name Pictures leveled?

There are three levels in Name Pictures. Levels are based on a formula which takes into account frequency (how often the word is used in daily life), familiarity (how commonly known a word is), imageability (how easily a word can be pictured), word length, and number of synonyms as acceptable answers.

How is Name Pictures scored?

Scores are derived from a formula based on the number of correct responses and the number of attempts to correct an error.

Featured Task: Name Verbs

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What is Name Verbs?

In this confrontation verb naming task, the patient will view an image of an action. When ready, the user will tap the start button to record their response. Feedback on their loudness level is displayed with the sound level meter. The program uses a real-time speech recognition engine to analyze the user’s response and mark it as correct/incorrect. The patient can replay their response and compare it to the target, and they can try again as many times as needed.

Patients who need help with word retrieval can choose from three cues. They can tap on the Question Mark next to the picture to uncover these cues. They select a phonemic (first sound of the word), graphemic (first letter of the word), or whole word repetition. Patients can take as many cues as needed to help them say the correct word. Clinicians can view all cues and cue types in the reports section.

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How is Name Verbs leveled?

There are three levels in Name Verbs. Levels are based on a formula which takes into account frequency (how often the verb is used in daily life), imageability (how easily a verb can be pictured), number of arguments, and synonyms as acceptable answers.

How is Name Verbs scored?

Scores are derived from a formula which based on the number of correct responses and the number of attempts to correct an error.

Encourage Naming Practice

These voice-enabled tasks provide the opportunity for patients to increase the frequency of their practice with naming exercises. You can identify your patients’ performance and detailed info. about their use of cues through the in-app reports.

View our tutorial videos on Name Pictures and Name Verbs as well as other Constant Therapy Tasks.

References:

  1. Conroy, P., Snell, C., Sage, K., & Ralph, A. (2012). Using phonemic cueing of spontaneous naming to predict item responsiveness to therapy for anomia in aphasia. Physical Medicine and Rehabilitation, S53-60.
  2. Des Roches, C., Mitko, A., & Kiran, S. (2017). Relationship between Self-Administered Cues and Rehabilitation Outcomes in Individuals with Aphasia: Understanding Individual Responsiveness to a Technology-Based Rehabilitation Program. Frontiers in Human Neuroscience, 10.3389/fnhum.2017.00007.
  3. Fink, R., Brecher, A., & Schwartz, M. (2005). Computer-assisted treatment of word retrieval deficits in aphasia. Aphasiology, 943-54.
  4. Heath, S., McMahon, K., Nickels, L., Angwin, A., MacDonald, A., van Hees, S., . . . Copland, D. (2012). Neural mechanisms underlying the facilitation of naming in aphasia using a semantic task: An fMRI study. BMC Neuroscience, 1-19.
  5. Laganaro, M., Di Pietro, M., & Schnider, A. (2006). Computerised treatment of anomia in acute aphasia: Treatment intensity and training size. Neuropsychological Rehabilitation, 630-40.
  6. Meteyard, L., & Bose, A. (2018). What does a cue do? Comparing phonological and semantic cues for picture naming in aphasia. Journal of Speech, Language, and Hearing Research, 658-74.
  7. Patterson, J. (2001). The effectiveness of cueing hierarchies as a treatment for word retrieval impairment. Neurophysiology and Neurogenic Speech and Language Disorders, 11-18.
  8. Routhier, S., Bier, N., & Macoir, J. (2015). The contrast between cueing and/or observation in therapy for verb retrieval in post-stroke aphasia. Journal of Communication Disorders, 43-55.

Topics: Featured Tasks

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Constant Therapy is an award-winning cognitive and speech therapy app, created for survivors of stroke, brain injury, and other neurogenic disorders.

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