SPH 378: Lexical- Semanatic BOX Therapy.
Completed by: Bilqees Achmat Maseeha Tikly
INTRODUCTION
Purpose: Resource Package
Target: Patients with acquired Neurogenic
communication disorders
Topic: Lexical-Semantic (BOX) therapy
Population: Mild-Moderate Aphasia with naming
difficulties (Kiran, Bassetto, 2008)
Theoretical Basis
The LEXICAL-SEMANTIC system is a central part of language processing, thus it is a point of reference for Aphasia Therapy.
The efficacy of lexical-semantic therapy has been proved many times.
A study conducted, compared semantic therapy and phonological cueing Results showed that the effects of semantic therapy lasted 24 hours as opposed to the mere minutes of phonological cueing.
Lexical-Semantic therapy is guided by a model-based hypothesis, which means that only patients with a lexical –semantic deficit will benefit from this therapy and not someone , with say a phonological problem.
Lexical-semantic therapy aims at targeting two things:
• Language production &
• Comprehension
When assessing the effectiveness of lexical-semantic therapy, one looks at the patient’s performance on naming and their auditory and written comprehension.
However, some patients find it easier to produce a word, within object naming tasks, the context of a sentence or real life situations whereas others have difficulty in doing so.
Making it extremely difficult to assess the impact of lexical- semantic therapy on a person’s functioning in real-life situations.
Developing BOX
In order to produce a lexical item, the semantic features must be activated so you are able to retrieve the target item. If the system has been impaired, the representation of a different lexical item, which shares semantic features with the target, may become activated instead (semantic paraphasia).
When treating semantic system disorders, the therapist aims to stimulate the patient so that the semantic features which go with a certain lexical item can be re-established and reinforced.
BOX
One of the main defining features of BOX is that unlike other
lexical-semantic therapy where the point of reference was
pictures. Box provides therapy which is centered on the patient
interpreting written words, sentences and texts without a
reference to pictures.
The use of written words as a stimuli has
many advantages:
• The therapy material is easy and cheap to make
• Avoid choosing images which need to be carefully selected to avoid visual-
perceptual difficulties.
• They can be made of abstract words, which are not easy to represent visually.
• BOX includes single words, phrases and whole texts which are graded according
to difficulty.
By using written words rather than auditory input – it gives the patient more
opportunity to process the words over time.
Process.
Lexical-semantic deficit:
- Two-way deficit
- Production and comprehension
Main issue:
Features of a word indicating meaning not completely available when language
production or comprehension is required (Visch-Brink, Bajema, Sandt-Koenderman, 1997)
• Semantic features of word partly available = word substitution semantically related to the target
• Phonemic distortions = semantic paraphasias not recognizable.
Therapy enabling client to distinguish between words
and their semantic features is likely to be effective.
(Visch-Brink et al, 1997).
BOX in lexical-semantic therapy, dismisses
pictures and focuses on interpretation of
written words, sentences, and text.
Patients with moderate to mild forms of aphasia:
• Benefit from the concrete-abstract nature of written word
• Have more time to process the written words as oppose to auditory presented words.
Aims of BOX:
▪ Useful for varying degrees of lexical-semantic impairment
▪ Large number of topics for individual interests
▪ Variation in tasks to strengthen generalization
▪ Possibility to switch between tasks on word, sentence and
text level
“ The BOX consists of 1000 exercises on word, sentence and text level.
Patients are required to choose from a number of alternatives or false/correct
decisions. Making semantic decisions is the heart of lexical semantic
therapy.”
➢ Three levels of difficulty
➢ Factors: word choice, number of distractors, semantic relatedness and ambiguity.
➢ Different parts at the same level of difficulty
➢ Uniformity or a variety of exercises
➢ 6 months of therapy for 90 minutes a week
Eight Exercises
1. Semantic Categories: A number of semantically related words is given to the patient along with one word belonging to a different semantic category. The patients has to pick the odd one out.
2. Syntagmatic and Paradigmatic Relationship: A word has to be matched with another word and there are two-three possibilities. The match is either a syntagmatic (compatible combinations e.g. ducks quack not squeal) or paradigmatic (semantic set can be grouped together e.g. Monday, Tuesday, ect.).
3. Semantic Gradation: Words have to be matched with one or two antonyms
4. Adjectives and Exclamations: A sentence implies the meaning of an adjective and is given in a number of sentences. The patient has to pick out the adjective that goes with the stimulus sentence.
5. Part-Whole Relationship: A target sentence provides an example of a part-whole relationship between two content words. The alternative sentences include a number of content words, one of which has the same sort of relationship to the stimulus content word.
6. Anomalous Sentences: Sentences are presented to the patient that are either semantically correct or incorrect. The patient has to make a yes/no decision.
7. Semantic Definition: First, a word is given which can be used in compound words, there are eight possibilities and the patient must decide with a yes/no whether the combination is allowed. Next, a compound word is given followed by two definitions and the patient decides which are true/false. Lastly a list of words are given with three short definitions, some definitions apply to more than one word.
8.Semantic Context: First, short texts are presented with one or two sentence anomalies. Similar texts are also presented without anomalies and patients need to decide on the kind of text presented. Second, a text is given with two summaries. Third, a newspaper text is presented and the patient has to spot erroneous content words.
Communication Difficulty
• Lexical semantic disorders are common with Aphasia.
• BOX is suitable because therapy can ‘reteach’ semantic distinctions
through graded semantic tasks.
• It is applicable to even severe underlying semantic deficits. (Nickels, 1997)
A Study:
A pilot study conducted by Visch-Brink, et al (1997), highlights the effectiveness of using BOX therapy in patients with chronic aphasia. In this study BOX therapy was applied to two patients:
Patient A was diagnosed with severe Broca’s aphasia and slight agrammatism. After 6
months of therapy there were significant improvements in both lexical semantic
categorization and visual comprehension.
Patient B was diagnosed with transcortical sensory aphasia. After 2 months of BOX
therapy she made similar improvements to patient A
months of therapy there were significant improvements in both lexical semantic
categorization and visual comprehension.
Patient B was diagnosed with transcortical sensory aphasia. After 2 months of BOX
therapy she made similar improvements to patient A
The progress of these patients suggests that the programme is valuable to patients with severe aphasia, however there is a cut off criteria. Lexical semantic therapy is not suitable for patients
with global aphasia.
Appraisal of the approach will focus on: validity, reliability and effectiveness of the BOX programme.
Internal validity
In the pilot study by Visch-Brink et al, (1997):
1. The size of the subject population and the subject variation is very small (2 patients)
2. Two instruments collected the same type of data, but the SAT was more sensitive to
measuring progress in lexical semantic processing than the AAT
External validity
1. The study included one male with Broca’s Aphasia and one female with transcortical
sensory aphasia. The characteristics of these subjects are not varied enough to
represent all patients with different forms of aphasia.
2. Patient A received 6 months of therapy, while patient B received 2 months of therapy
before data collection. Similar improvements were found in both patients, but to ensure
valid research findings the length of time for therapy should have been the same in
both trials.
Reliability
The subject selection process shows basic requirements for undertaking semantic
therapy, namely: good physical condition, acceptable concentration level, relatively
preserved memory and executive control and good motivation.
This selection criteria is beneficial as it increases the chance that similar findings
can be found in other contexts, specifically therapy in the real world.
Effectiveness: Does it WORK?
The patients in the pilot study were both diagnosed with
chronic aphasia, this cancelled out the likelihood of a
spontaneous recovery. Therefore, it can be suggested that
any improvements made by the patients after the study was
due to BOX therapy.
Patient A : better performance on lexical semantic categorization measured by the SAT and
improved visual compression in a subpart of the AAT. The SAT also shows a generalization
effect from the graphemic to the phonological output.
Patient B: all content words in spontaneous speech was higher after therapy. The semantic
system may also influence the phonological level, leading to a reduction of neologisms.
Furthermore, patient B made improvements within only 2 months of therapy, demonstrating
how effective BOX therapy can be within a short length of time.
Researchers described lexical-semantic (BOX) therapy to be one of threemost commonly used therapy types at recruiting sites for intervention (Godecke, E., Hird, K., Lalor, E. E., Rai, T. & Phillips, M. R., 2012).
These researchers found it useful to use BOX in combination with ‘Semantic feature analysis’ to strengthen phrase-level verbal output.
BOX therapy must be an effective programme if it was still being used inthe therapeutic practice 14 years after its introduction by Visch-brink et al (1997).
References: References
Brookshire, R. H. (2015). Introduction to Neurogenic Communication Disorders. Elsevier
Godecke, E., Hird, K., Lalor, E. E., Rai, T. & Phillips, M. R. (2012). Very early poststroke aphasia therapy: a pilot study randomized control efficacy trial. International Journal of stroke, 7, 635-644
Kiran, S., & Bassetto, G. (2008, February). Evaluating the effectiveness of semantic-based treatment for naming deficits in aphasia: What works?. In Seminars in speech and language (Vol. 29, No. 1, p. 71). NIH Public Access.
Nickels, L. (1997). Evaluating lexical semantic therapy: BOXes, arrows and how to mend them. Aphasiology, 11(11), 1083-1089.
PARADIGMATIC AND SYNTAGMATIC. (n.d.) Concise Oxford Companion to the English Language. Retrieved http://www.encyclopedia.com/humanities/encyclopedias-almanacs-transcripts-and-maps/paradigmatic-and-syntagmatic
Visch-Brink, E. G., Bajema, I. M., & Sandt-Koenderman, M. V. D. (1997). Lexical semantic therapy: BOX. Aphasiology, 11(11), 1057-1078.
What is reliability. (2007) McLeod, S. A. Retrieved from https://www.simplypsychology.org /reliability.html
What is validity. (2013). McLeod, S. A. Retrieved from https://www.simplypsychology.org/validity.html
No comments:
Post a Comment