Operant conditioning and errorless learning procedures in the treatment of chronic aphasia

Abstract

I n the field of aphasia, the processes that enable improvements in fluent speech, e.g., in naming, reading, sentence structure, etc., are not well understood. At the present time the fields of cognitive psychology, clinical neuropsychology, and cognitive neuropsychology are limited with regard to explaining the causes of different symptoms of aphasia. Treatment based on operant conditioning or stimulus control procedures seems to be very promising. In the present study, four participants with chronic aphasia, aged between 52 and 62 years, received treatment based on errorless learning procedures and operant conditioning for 7 months. Treatment effects were evaluated with a multiple-baseline design across behaviours. The performances that were treated varied across participants but were two or three of the following in each case: naming people or objects, making sentences, sequencing stimuli, discriminating written words, and unassisted recall. Treatment variables were clearly defined and systematically used in standard ways across participants with flexibility for adaptation to individual outcomes using clearly defined criteria. Prompts that were used in training faded out as performances improved. The performances of all participants improved significantly in all tasks; they all reached 100% correct performance without any prompts from the experimenter in at least one task. Generalization measures across stimuli and settings demonstrated that their improved performances generalized to novel stimuli and novel settings.D ans le domaine de l'aphasie, les processus qui facilitent les améliorations du langage fluent, e.g., la nomination, la lecture, la structure de la phrase, etc., ne sont pas bien compris. En ce moment, les domaines de la psychologie cognitive, de la neuropsychologie clinique, et de la neuropsychologie cognitive sont limités en ce qui concerne l'explication des causes des différents symptô mes de l'aphasie. Le traitement basé sur le conditionnement opérant ou sur les techniques de contrô le du stimulus semble très prometteur. Dans la présente étude, quatre participants avec une aphasie chronique, âgés entre 52 et 62 ans, ont reçu un traitement basé sur les techniques d'apprentissage sans erreur et le conditionnement opérant pendant sept mois. Les effets du traitement ont été évalués avec un protocole à niveaux de base multiples à travers les comportements. Les performances qui ont été traitées ont varié à travers les participants mais elles étaient deux ou trois des suivantes dans chacun des cas: nommer les gens ou les objets, faire des phrases, faire la séquence des stimuli, discriminer les mots écrits et le rappel non assisté. Les variables du traitement étaient clairement définies et systématiquement utilisées de manière standardisée à travers les participants avec une flexibilité pour pouvoir s'adapter aux résultats individuels en utilisant des critères définis. Les indices qui ont été utilisés pendant l'entraînement ont disparu tout au long de l'amélioration des performances. Les performances ...

Behavior analysis and aphasia: A current appraisal and suggestions for the future

“…SLPs even employ many of the same practices as behavior analysts, including the frequent use of single‐subject analysis (Thompson, 2006), antecedent manipulation (i.e., prompting, modeling; Keenan, 1966; Lowell et al., 1995, Thompson et al., 2006), fading (Salvatore, 1976; Melodic Intonation Therapy [MIT]; Sparks & Holland, 1976), shaping (Holland & Harris, 1968; Silkes et al., 2019), and consequence delivery (Goldfarb, 2006; Holland & Harris, 1968; Kushner et al., 1973). This SLP work provides additional empirical support for the efficacy of operant techniques in aphasia treatment that is also demonstrated in purely behavioral work (e.g., chaining, delayed feedback, socially and self‐mediated consequences, and differential reinforcement; Doyle et al., 1989; Goodkin, 1969; Porsteinsson & Sigurðardóttir, 2007; Sigurðardóttir & Sighvatsson, 2006, 2011; Sundberg et al., 1990).…”

“…Brain injury subpopulations may also present predictably similar differential training needs. For example, Sigurðardóttir and Sighvatsson (2011) replicated Sigurðardóttir and Sighvatsson's (2006) effective treatment package targeting intraverbals and tacts and was unable to replicate results for all participants, noting differences in initial deficits. Similarly, the extension of the study found backward chaining ineffective for teaching tacts, in contrast to Porsteinsson and Sigurðardóttir (2007), who found improvement from a backward chaining intervention, likely due to participants in the former study lacking an echoic repertoire, while the latter did not.…”

“…Behavior analysis has made many sophisticated contributions to the study and treatment of aphasia (e.g., Cowley & Grenn, 1922; Doyle et al., 1989; Goodkin, 1966; Porsteinsson & Sigurðardóttir, 2007; Salvatore, 1976; Sigurðardóttir & Sighvatsson, 2006, 2011), and further behavior analytic study of aphasia could help test and refine our understanding of basic verbal operant units (which thus far have been primarily investigated in the frame of individuals with developmental disabilities; Petursdottir, 2018). Even so, aphasia remains an esoteric interest for many behavior analysts, who have little pervasive presence in traditional aphasia treatment, which is led by speech–language pathology (SLP).…”

Equivalência de estímulos e ensino por exclusão de verbos e substantivos para adultos e idosos com afasias fluentes e não fluentes

“…O uso de procedimentos de ensino com poucos erros para a população afásica também já foi descrito na literatura como benéfico na recuperação de palavras em tarefas de nomeação (Conroy et al, 2009a;2013;Middleton & Scwartz, 2013;Sigurdardottir & Sighvatsson, 2006;Sigurdardottir & Sighvatsson, 2011). O ensino sem erros promove a aprendizagem sem provocar comportamentos emocionais indesejáveis, além dos demais efeitos da ocorrência de erros discutidos anteriormente, como a persistência nos erros e a demora na aprendizagem de discriminações (Melo et al, 2014;Terrace, 1963 Os estudos sobre intervenção com pacientes afásicos descritos em outras seções dessa tese, e que relatam resultados positivos, apresentavam duração semelhante ao do presente estudo, com intervenções de cerca de um ou dois meses, com duas a três sessões por semana (e.g., Conroy et al, 2009a;Conroy et al, 2009b;Conroy et al, 2009c;Leonard, Rochon, & Laird, 2008;Park et al, 2013;Raymer et al, 2007;Wanbaugh et al, 2002).…”

“…A maioria dessas pesquisas, porém, relata sessões de duas a três horas, o que se diferencia muito da duração das sessões realizadas neste trabalho, que tinham, em média, duração de 20 minutos. Algumas outras pesquisas apresentadas aqui realizaram intervenções mais longas, com durações que variavam entre seis meses e um ano de sete meses (Kunst et al, 2013;Sigurdardottir & Sighvatsson, 2006;Sigurdardottir & Sighvatsson, 2011). Entretanto, há estudos que descrevem bons resultados com terapias intensivas, realizadas em cerca de 10 sessões, com duração de duas semanas (Bilda, 2011;Bonifazi et al, 2013;Pulvermüller et al, 2013).…”