Training Cognitive Flexibility in Aphasia

1
Training Cognitive Flexibility in Aphasia

• Mary Purdy, Ph.D.
• Keri-Jo Cocchiola, B.A.
• Southern Connecticut State University

2
Introduction

• There are some data to suggest that the use of
  communication strategies relies on executive
  function ability, and that executive functioning
  may be impaired in individuals with aphasia.11-12
• The purpose of this pilot study was to determine
  the benefit of cognitive flexibility training on
  the use of trained symbols on a functional
  communication task.

3
Participants

• B.W.
• 56 year old man
• 3 years post Left CVA
• WAB AQ 34.5
• Moderate-severe verbal apraxia
• Right hemiparesis- wheel chair bound
• High school graduate
• Worked as a transfer operator at the time of his
  stroke
• Resides in a skilled nursing facility- goes home
  with his wife on weekends.

• L.K.
• 73 year old man
• 8 years post Left CVA
• WAB AQ 25.8
• Moderate limb apraxia
• Ambulatory
• Mild right hand weakness
• High school education
• Retired electrician
• Lives at home with wife

4
Assessment

• Communicative Activities in Daily Living-2
• Overall Score
• Cognitive Flexibility Score
• ( successful modality switches /
  opportunities to switch.
• This score significantly correlates with the
  WCST14)
• Referential Communication Task
• Cognitive Flexibility Score
• ( successful modality switches /
  opportunities to switch).

5

• Referential Communication
• This task consisted of describing15 action
  pictures to a naive partner.
• Each picture contained two to three of the
  previously trained symbols, for a total of 34.
• Participants were instructed to use whatever
  means necessary to describe the picture.

6
Treatment

• Interchanging Modalities
• Three sets of the same 20 concepts, represented
  by different pictures, were used for training.
• Participants were initially instructed that the
  concept could be conveyed in verbal, gestural,
  pointing, and writing modalities.
• Direct input and feedback to elicit a correct
  production was provided for each modality.
• Feedback was faded and participants were probed
  by asking How else can you communicate that?

7

• Categorical Sorting
• Participants were required to sort picture cards
  by specific attributes.
• Initially, sorts were based on concrete semantic
  features (e.g. function), then gradually became
  more abstract (e.g. size, weight, cost).
• Additionally, the number of items to be sorted
  gradually increased.

8

• Sequence Generation15
• Participants were asked to generate three-shape
  and three-number sequences by manipulating a
  series of cards each containing either a single
  shape or a single number.
• Participants were first be given three cards to
  rearrange in as many sequences as possible.
• When they reached the maximum number of
  arrangements, they were given 4 cards to arrange
  in sequences of three, then five cards.

9
Treatment Schedule

• Number of 60 minutes treatment sessions provided
  for each participant.

10
Results B.W.

• Results L.K.

11
Results
12
Results
13
Discussion

• Modest changes were seen on functional
  communication tasks following a brief period of
  cognitive flexibility.
• Although both participants showed some
  improvement, changes were more dramatic for B.W.
• This is likely due to L.K.s coexisting limb
  apraxia and more significant aphasic and
  cognitive flexibility impairments.

14
Clinical Implications

• Cognitive flexibility should be addressed in
  individuals with aphasia in conjunction with
  training of augmentative communication
  strategies.
• A more consistent, interactive training approach
  that focuses on conscious switching among
  communication options may be more appropriate for
  individuals with cognitive flexibility deficits.

15

• These findings are consistent with suggestions by
  Garrett and Kimelman16 who state that AAC users
  should be taught to use their strategies in
  integrative situations that demand strategic,
  on-the-spot implementation (p. 344).
• They also suggest that aphasic individuals may
  generalize more readily if strategies are
  incorporated in more realistic interactions at
  the beginning of treatment.

16
Limitations

• Case study format
• Cognitive flexibility treatment needs to be
  carried out on a larger group of individuals,
  using appropriate methods of control.
• Limited number of treatment sessions
• The number of sessions required to elicit the
  desired outcome should be systematically studied.
• However, the number of sessions provided in this
  study may actually reflect typical service
  delivery systems.

17
AcknowledgmentsThis project was supported in
part though a grant from the Connecticut State
University System and a graduate student
fellowship from the SCSU Graduate
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