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Higher Level Language - Narrative Based Intervention

Joanna Benjamin and Allison Farat
by

Allison Farat

on 30 October 2012

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Transcript of Higher Level Language - Narrative Based Intervention

Higher Level Language Group Narrative Based Intervention Joanna Benjamin
Allison Farat Narrative Based Intervention Not just for kids?

Higher Level Language Impairment in adults

“Narrative structure is shown to be a useful framework for building on the developments within sentence processing impairments in aphasia and creating a bridge to more real-life language tasks” (Whitworth).

Goal is GENERALIZATION

Think about how often you use narrative skills in your everyday life Narrative-Based Intervention with Adults Advantages and Disadvantages (+) Facilitates production of complex, connected speech (Whitworth)

(+) “Taxes” the language system- language form (morphology, phonology, syntax), language content, memory, speech/intelligibility, vocabulary/word retrieval

(+) Academic, vocational

(+) Many Forms-Personal/Biographical, Fictional, Role
Playing, Scripts (Paul)
- More specific - letter writing, book reading/clubs…
- Cinderella Story

(-) Not as naturalistic as conversation, BUT narration-based intervention is a step towards conversation! Patients/Clients with Aphasia Have Difficulty With... A. Sentence Processing Impairments
Understanding event, verb retrieval, argument structure (syntax plus semantics)… (Whitworth)

B. “Real-life Situations”
Description, planning, recounting past events, explanations

Narrative-Based Therapy seeks to “bridge the gap” between structured therapy and daily life Procedures for Narrative RETELLS Written or Oral
Story Grammar- key characters, initiating event, high point, reaction to consequences (Whitworth)
Adjust according to needs/skill of clients
Higher Level Questions
Wh- for specific story grammar- who? What? When? Where?
Specific (details)
Open-ended – Example : “How do think (character) feels after….?”
Expansions/Extensions-
Narratives facilitate
Ensure that client understood all parts of narrative
Time Limit???
Depends on client’s needs/goals
Functional (academics, vocational) Areas addressed within Narrative
Retells (Whitworth) Sequencing, logical order

Memory

Semantics

Word Retrieval

Syntax - may need to teach components to increase complexity Narrative Based Intervention:
Which Procedures are Best? Consider what’s best for your clients
Syntax?
Time limit?

Remember that the key is generalization
Letter writing
Oral vs. Written How Have We Applied This? Higher Level Language Group Small group
3 Clients and 3 clinicians
Etiologies: Stroke
Similar diagnoses
Therapy 2 times weekly
Monday and Wednesday, 12-12:50 Pre-Criterion Testing Narrative Based Intervention was used in past semesters
Short passages
New approach to increase difficulty
2-2.5 minute long video clips
Quicker rate of speech
Multiple speakers
More information presented Pre-Criterion Testing (Continued) Presented 2 short video clips
Clients prompted to produce a narrative oral retell followed by a narrative written retell
Oral retell - no time limit
Written retell - 5 minute limit
Findings:
Stronger oral retell skills
Short written retells
Lacked detail
Simple vs. Complex sentences Client Objectives 1) Given auditory and visual stimuli, the client will produce a narrative oral retell with beginning, middle, and end coherence with 100% accuracy.
Rationale: To improve functional oral communication skills

2) Given auditory and visual stimuli, the client will produce a narrative written retell with beginning, middle, and end coherence with 100% accuracy.
Rationale: To improve functional writing communication skills

3) Given written stimuli, the client will identify clauses and simple, compound and complex sentences with 80% accuracy.
Rationale: To increase understanding of complex sentences for generalization to oral and written communication HLL Therapy Session 1) Introduction
2) Complete and Incomplete, Compound
Sentences
3) 5 minute written retell of 2 video clips
(sitcoms and news)
Note taking
Notebooks to monitor progress
Wh- question discussion
4) Discussion of strengths and weaknesses Midterm Progress / Outcome Sentences structure
Complete vs. Incomplete Phrases
Use of compound sentences
Longer written retells
Longer sentences
# of sentences
More attention to detail
Middle component
Better organization
Personal evaluations of progress
Improved written language
Helpful in work and school environments
Improved understanding of TV shows and movies Whitworth, A. (2010). Using Narrative as a Bridge: Linking Language Processing Models with Real-Life Communication. Seminars in Speech and Language 32(1), 64-75.

Paul, R. (2006). Introduction to Clinical Methods in Communication Disorders. Cascella, P. W. (Ed.). Baltimore: Paul H. Brookes Pub. References Questions for Review 1) What are 3 cognitive/communicative areas that narrative intervention addresses?

2) What are two short-term objectives that may be addressed in a narrative-based intervention program?

3) What are 3 advantages of a narrative-based intervention approach?
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