BAS Conference 2011, Day 2

My main highlight of day 2 was probably the second keynote address by Faustina Hwang (Uni of Reading) on “Technology and aphasia” which proved to be very inspirational for what appeared the majority of the audience. When we struggle with technology (e.g. not being able to set up a computer or work apps, or even ‘basic’ functions on our phones), we generally have a tendency to blame ourselves for not being ‘intelligent’ enough to work it out. However, Faustina instead suggested it is OK for us to think that the technology has not been designed to effectively allow its intuitive use and it is not just down to our own deficiencies. She also pointed out that designers of technology cannot be expected to get it right if there is no collaboration and exchange of ideas from the actual users and vendors of technology – what is obvious to us, as SLTs may not be obvious to designers, so things like AAC devices will only be fit for purpose if we tell designers what the purpose is. Personally, having read hundred, if not thousands, of tweets on Twitter about the use of iphones, ipads, and various apps in speech and language therapy (as an affordable form of AAC), I am often a little concerned that technology is moving so fast that it appears to be becoming adopted in routine clinical practice, perhaps without due care and attention to evaluating the effectiveness of such things. However, I’m also aware that very often it is the PWA driving their adoption as such things are relatively easy to find if you can find your way around Google. While I still have reservations about technology (as I’m not particularly techie), I’d say that I have been inspired as the presentation gave clear examples of how technology can clearly be of benefit to PWA and other populations (e.g. the elderly, those with other impairments which may have limiting effects on activity and participation).

The first parallel session on gesture and non-linguistic cognition saw Jane Marshall (City University) present results from a therapy study comparing the effectiveness of gesture therapy and naming therapy. Following 15 hours of therapy where equal time was spent on improving gesture and naming (on different items), gesture use had improved for those items treated with gesture therapy (from approximately 35% correct to 45% correct) and naming had improved on items treated with naming therapy (from approximately 12% correct to 35% correct). There was no evidence of generalisation to untreated items within each modality (e.g. gesture did not improve for items only treated with naming therapy or with items that were completely untreated). What was very promising though was that the PWA’s ability to convey a message to a partner (who was blind to the message) from written sentences and videotaped messages improved for both treated and untreated items, where the PWA was free to employ both speech and gesture to communicate. So this got me wondering about where gesture comes from in terms of models of language production – are they generated at single word level or above this? Rather helpfully, the following presentation by Miranda Rose (La Trobe Uni, AUS) went into this when discussing gesture production across different classifications (e.g. Broca’s, Wernicke’s, etc.) and severities of aphasia. Admittedly the results were a bit too plentiful for me to record at the time so I think I’ll have to follow these up but I think the jist was that gesture in PWA is qualitatively and quantitatively different from healthy speakers and there are also differences between aphasia classifications and across severities. It was then highlighted that such knowledge of how gesture is used differently would impact on therapy techniques that attempt to facilitate gesture use.

See:McNeill, D. (2000). Language and Gesture. Cambridge: Cambridge Uni Press and a Review

Rose, M. (2006). The utility of gesture treatments in aphasia. International Journal of Speech-Language Pathology, 8, 92-109.

The final session of the day was focused on phonology and naming. Now – phonology is not my strong suit but Paul Conroy (Manchester Uni) presented a nice meta-analysis of two of his recent publications and a third also by the team at NARU at Manchester. The primary message of this was that items which could not be named spontaneously pre-therapy but which could be named following a cue (e.g. ‘it starts with a /p ə /’)were more likely to be successfully spontaneously named by PWA following therapy. While this is clinically informative in terms of identifying which items to work on in therapy I couldn’t help but think – what if all improvements in naming reported in published studies were attributable to cueability at pre-therapy but were not interpreted as such because this information wasn’t obtained as it wasn’t the focus of the study? On the plus side, it could give researchers a nice way to improve the prospects of obtaining positive results in future studies by choosing items to work on where naming just happens to be cueable.

Finally, Caroline Barwood (Uni of Queensland, AUS) presented results from a study comparing rTMS (repeated transcranial magnetic stimulation) therapy to a placebo therapy. So this was all pretty technical stuff but the results were remarkably clear. Without going into the specific details, rTMS was applied to the right hemisphere homologue to Broca’s area (or Brodmann area 45). This aimed to inhibit assumed over-activation in this area (as a result of stroke) which was further assumed to be interfering with language processing, or at least restricting effective reactivation of Broca’s area in the left hemisphere. Following ONLY rTMS therapy(i.e. without parallel naming/behavioural therapy), participants showed signficant gains in their naming performance which also continued after cessation of therapy. Comparable gains were not shown in the participants who received the placebo therapy. It kind of makes you think what kind of improvements you might see if you did rTMS in addition to behavioural therapy – lucky there’s been stuff done on that:

See: Naeser, M. A. et al (2010). Research with rTMS in the treatment of aphasia. Restorative Neurology & Neuroscience, 28(4), 511-529.


About chrissp1980
Currently a lecturer in speech pathology in North Queensland, Australia. I'm lecturing in acquired disorders of speech and language and also attempting to enthuse students in conducting clinically-relevant projects using principles of Evidence-Based Practice. Wish me luck!

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