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Within- and cross- language generalization after Verb Network Strengthening Treatment (VNeST) in a Hebrew-English bilingual with aphasia

Aviva Lerman1*, Mira Goral2 and Lisa A. Edmonds3
  • 1 The Graduate Center, City University of New York, Speech-Language-Hearing Sciences, United States
  • 2 Lehman College, The City University of New York, Speech-Language-Hearing Sciences, United States
  • 3 Teachers College, Columbia University, Communication Sciences, United States

Bilingual aphasia cases are increasing, resulting in a critical need for treatment recommendations for SLPs, but few treatment studies have shown consistent improvements to functional language in both the treated and untreated languages (e.g., Ansaldo & Saidi, 2014; Faroqi-Shah, Frymark, Mullen & Wang, 2010). Verb Network Strengthening Treatment (VNeST) (Edmonds, 2016) has found efficacy in monolinguals with varying types and severity of aphasia, including generalization to discourse and to functional communication by report. VNeST was developed to strengthen the connections between verbs and their thematic roles at the lexical-semantic level. Since different languages are thought to share semantic representations (Paradis, 1993), treatment which strengthens the semantic network has high potential for both within- and cross-language generalization in bilinguals with aphasia in the production of verbs, nouns, sentences, and discourse (Knoph, Lind, & Simonsen, 2015). Therefore, a pilot study was conducted, investigating whether VNeST provided in English for a Hebrew-English bilingual with moderate, non-fluent aphasia improves noun and verb retrieval, sentence construction and connected speech and, if so, whether this occurs in the treated language only, or in both languages - which would be considered cross-language generalization (Faroqi-Shah et al., 2010). A 71-year-old native speaker of Hebrew who acquired English in late childhood was enrolled. In 2009, he sustained a stroke resulting in an extensive left hemisphere frontal-parietal lesion. His moderate non-fluent aphasia is characterized by anomia, agrammatism and frequent language mixing. Self and family report indicated pre-morbidly better Hebrew than English, although proficient in both. Post-morbidly, impairments were more pronounced in English. Pre- and post-testing was conducted with a large bilingual testing battery, which is psycholinguistically comparable across the two languages (Goral & Borodkin, in preparation). A total of 36 hours of VNeST was provided in English over 6 weeks, following the protocol from a published tutorial (Edmonds, 2014). The results showed significant improvement in the treated language for verb and noun retrieval as single-words and in sentences, using the McNemar test of equal change (p<.05). In the non-treated language there was a trend towards significance for single-word verb retrieval. Generalization to answering WH-questions (a measure of functional communication) was observed in the treated language only. In discourse, medium NAP effects (Non-overlapping of All Pairs) were observed in some tasks, as measured by number of nouns and verbs, correct information units (CIUs), and complete utterances, though efficiency of production did not improve, as measured by CIUs/verbal units. These improvements were observed in both languages, but more consistently in Hebrew, the untreated but more pre-morbidly proficient language. These results suggest that VNeST strengthened the semantic network, resulting in an improved ability to build argument structure around verbs, and lower the threshold for the retrieval of verbs and their thematic roles. We argue that treatment that strengthens the semantic network, which is hypothesized to be shared across languages, increases the likelihood of cross-language generalization.

References

Ansaldo, A. I., & Saidi, L. G. (2014). Aphasia therapy in the age of globalization: Cross-linguistic therapy effects in bilingual aphasia. Behavioural Neurology, 2014, 1–10.

Edmonds, L. A. (2014). Tutorial for Verb Network Strengthening Treatment (VNeST): Detailed description of the treatment protocol with corresponding theoretical rationale. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 24(3), 78.

Edmonds, L. A. (2016). A review of Verb Network Strengthening Treatment: Theory, methods, results, and clinical implications. Topics in Language Disorders, 36(2), 123–135.

Faroqi-Shah, Y., Frymark, T., Mullen, R., & Wang, B. (2010). Effect of treatment for bilingual individuals with aphasia: A systematic review of the evidence. Journal of Neurolinguistics, 23(4), 319–341.

Goral, M., & Borodkin, K. (in preparation). Variables affecting impairment patterns in bilingual aphasia.

Knoph, M. I. N., Lind, M., Gram Simonsen, H. (2015). Semantic feature analysis targeting verbs in a quadrilingual speaker with aphasia. Aphasiology, 29, (12), 1473-1496.

Paradis, M. (1993). Bilingual aphasia rehabilitation. In M. Paradis (Ed.), Foundations of aphasia rehabilitation (pp. 413–419). Oxford: Pergamon Press.

Keywords: Aphasia, Bilingual, VNeST, Treatment, generalization

Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.

Presentation Type: poster presentation

Topic: Aphasia

Citation: Lerman A, Goral M and Edmonds L (2019). Within- and cross- language generalization after Verb Network Strengthening Treatment (VNeST) in a Hebrew-English bilingual with aphasia. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00086

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Received: 18 Apr 2017; Published Online: 25 Jan 2019.

* Correspondence: Mrs. Aviva Lerman, The Graduate Center, City University of New York, Speech-Language-Hearing Sciences, NY, 10016, United States, avivapolus@hotmail.com