Transcript Acquired Writing Impairments

Language and Cognition
Colombo 2011
Psycholinguistic Assessments of Language Processing
in Aphasia - Writing
With acknowledgement to
Jane Marshall
Aims
• Familiarise students with writing routes
• Introduce patterns of writing impairment
• Familiarise students with methods for
assessing writing
• Introduce principles of therapy and
therapy approaches
3 Spelling routes
• Phoneme to Grapheme conversion
– Non-lexical route
– Lexical route
– Reliance of PGC so regular>irregular spelling
• Non-semantic/direct lexical route
– Accesses a whole word spelling in the orthographic output
lexicon from the POL
• Semantic lexical route
– Entry in the OOL is accessed from semantics
Phoneme to Grapheme Conversion (non lexical)
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Phoneme to Grapheme Conversion (lexical)
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Non-semantic/direct lexical route
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Semantic lexical route
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
An Impairment at the level of
OOL
Surface Dysgraphia
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
RG
(Beauvois and Derousne 1981)
Spelling to dictation
• Non words
100%
• Regular words
93%
• Irregular words
36%
– High frequency
44%
– Low frequency
19%
Regularisation errors
An Impairment in Phoneme to
Grapheme Conversion
Phonological Dysgraphia
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
PR (Shallice 1981)
Mild aphasia
Good naming and comprehension
Some phonological errors
Writing real words to dictation:
High frequency 100%
Low frequency 92%
No effect of regularity. Able to use POL-OOL
or semantic route.
PR: Repeating and Writing
NONSENSE words
1st
repetition
writing
2nd
repetition
CV
17/20
6/20
13/20
CVC
19/20
2/20
13/20
CVC (2)
20/20
8/20
20/20
Interim Conclusion
• Very marked lexical effect in writing to
dictation (Words > Non Words)
• Lexical routes (via OOL) are intact
• Non lexical route (via PGC) is impaired
• Good repetition suggests PGC is site of
difficulty
Writing and defining abstract words
Good
definition
Partial
definition
Poor
definition
Correctly
written
21
Incorrectly
written
3
24
9
6
8
Highlighted spelling via semantic route.
Multiple Impairments?
Deep Dysgraphia
Deep Dysgraphia
(Nolan and Caramazza 1982)
•
•
•
•
•
Poor non word spelling (PGC impairment)
Semantic errors in spelling
Content words>function words
Nouns>verbs
Imageability effect
• Writing via an impaired semantic route
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
An impairment in semantics and
Phoneme to Grapheme Conversion
i.e. Spelling via the non-semantic
lexical route
Non-semantic lexical route
• People able to spell a word without
understanding the meaning
• AIL -> POL -> OOL
GE (Patterson 1986)
Poor performance in
• Repetition
• Auditory
comprehension
(words and
sentences)
• Reading aloud
• Spoken naming
• Written naming
Good performance in:
• Minimal pairs
• Auditory lexical
decision
• Some skills in
writing to dictation
GE (Patterson 1986)
Writing to Dictation:
Non words
34%
High imag words 57%
Low imag words 54%
Regular words
Irregular words
79%
79%
Therefore not spelling via GPC
Therefore not spelling via
semantics
Therefore not spelling via GPC
GE (Patterson 1986)
GE can write words that he cannot
understand:
• Writing words to dictation >90%
• Matching same spoken words to
pictures 66%
The Story
• Central semantic impairment (poor
comprehension and naming)
• Impaired PGC (poor non word writing)
• Writing uses POL to OOL
Speech
Pictures/Objects
Auditory
Analysis
Picture
Analysis
AIL
Picture
Recognition
Writing
Visual
Analysis
VIL
GPC
Semantics
POL
Buffer
Speech
OOL
PGC
Buffer
Writing
Peripheral Dysgraphias
Grapheme Level
(Graphemic Buffer)
Allograph Level
Graphic Motor
Patterns
Writing
NB Can co-occur with central dysgraphias
Temporary Store
Assigning letter
shapes
Retrieving motor
patterns
Buffer Deficits
(eg Caramazza et al 1987)
• Letter deletions, substitutions, additions,
transpositions
• No effect of frequency, lexical status,
imageability or word class (although see Sage
and Ellis 2004)
•
•
•
•
Powerful effect of length
May be position effects
Similar performance across different tasks
Interesting errors with double letters, eg
sorella written as SORRELA (Italian for sister)
Allograph Impairments
• Oral spelling > written spelling
• Keyboard > writing
• Dissociations between upper and lower
case are seen (eg Destreri et al 2000)
Motor Impairment
• Oral > written spelling
• Key board > written spelling
• Inability to write letter shapes (although may
be able to describe them)
• Probably no effects of case
• Stroke errors, eg failure to dot i, cross t,
additional strokes in letters
• Errors are similar to those made by normal
writers when carrying out dual motor task and
deprived of visual feedback (Ellis et al 1987)
Testing Writing
•
•
•
•
Ask about writing pre stroke – literacy levels?
Ask about writing since stroke
Start with familiar items (name, address)
Screening words (eg controlled for regularity,
imageability, class, length)
• Attempt different tasks (copying, naming,
writing to dictation). Difference?
• Attempt different modes of writing (pen,
keyboard, anagram tiles)
Different Writing Approaches
Semantic problem?
• Written naming with
cues
• Correction of semantic
errors
• Word to picture
matching
• Categorisation
• ‘Semantic
brainstorming’
Different Writing Approaches
• Impaired access to
OOL?
•
•
•
•
Naming with cues
Anagram sorting
Delayed copying
Improving sound/letter
correspondences, so
person can self cue
Different Writing Approaches
• Buffer impairment?
• Copying then
delayed copying
• Segmentation of
words
• Hierarchical naming
tasks from short to
long words
• Error detection/
correction strategies
Different Writing Approaches
• Allographic/ Motor
Impairment?
• Exploit alternative
methods of writing
(keyboard, oral
spelling)
• Practice in tracing
letter shapes
• Prosthesis to assist
with motor aspects
Functional and Strategic Approaches
• Writing may be an alternative method of
communication (e.g. where speech is more
impaired than writing, see Robson et al 2001)
• Integrating impairment work with functional
strategies
• May be specific writing activities that the
person wants to resume
• Working on written messages (Robson et al
1998, 2001)
• Using computers with spell checkers! (Mortley
et al 2001)