By Ron Cole & Leora Cherney
Leora Cherney, Anita Halper, Audrey Holland, Ron Cole, Sarel van Vuuren, Nattawut Ngampatipatpong, Edna Babbitt; Jaime Lee, Rosalind Hurwitz
Script training is a functional approach to aphasia therapy, developed by Audrey Holland and colleagues, that can facilitate participation in personally relevant conversational activities. At the Center for Aphasia Research, Rehabilitation Institute of Chicago procedures for script training have been standardized and, with the Center for Spoken Language Research, developed into a software tool, AphasiaScriptsTM (also known as C-CoSTA, (Computerized Conversational Script Training for Aphasia). The software tool enables individuals with aphasia to first create and then practice scripts that they can use in everyday life. The program allows the individual to practice the script by reading the sentences in the conversation at the same time as the words are produced by a virtual therapist, and then to practice the conversation with the virtual therapist.
Scripts guide and facilitate identification of participants and actions involved in social situations. Script knowledge includes understanding, remembering and recalling the temporal organization of events in routine activities. Research indicates that script knowledge is not seriously compromised by aphasia, at least when the language deficit is mild to moderate thus making aphasic individuals candidates for script training. (Armus et al, 1989; Lojeck-Osiejuk, 1996)
Script training methodology arises from instance theory of automatization (Logan, 1988). Instance theory suggests that automaticity of skills is achieved by retrieving memories of complete, context-bound, skilled performances. Thus, many highly routinized tasks are more appropriately practiced as a whole, rather than being broken down into component sub-skills. To promote automatization of script production, cue-based massed drilling of the entire script is required. This whole task, mass practice and drill can be accomplished by using repeated oral reading. Cost effectiveness can be achieved with use of computers.
First, the speech-language pathologist works with the person with aphasia to create individualized conversational scripts. Considerations for the development of an individualized script include: the person’s communication needs and interests; type of script (dialogue or monologue, e.g., telling a joke); number of conversational turns; length of each turn; grammatical complexity; and vocabulary selection.
After individualized scripts are developed, they are transcribed into the computer program and recorded, using an easy to use interface developed for the project. Initially the patient sees the written script and the animated agent. Practice begins with maximum cues including visual cues of the highlighted words, the sound of the words, and the sight of the articulators. Cues are gradually removed as follows: the sound is turned down and practice proceeds with only the two visual cues; the view of the articulators is removed; finally, all cues are removed so that the patient practices a conversation only with the animated agent, thereby simulating a real-life conversation. The figure below illustrates the authoring tools, examples of scripts used by the patients, and a summary of the client’s progress following a session.
Figure 1: Authoring Tools (Main Screen)
Figure 2: Authoring Tools (Add new script)
Figure 3: User Screen (1)
Figure 4: User Screen (3)
Figure 5: User Screen (2)
Figure 6: Authoring Tools (Report)
A research study assessing the efficacy of AphasiaScriptsTM is underway. In this study, three scripts are developed for each subject with each script being practiced for three weeks. Scripts are practiced daily at home for at least 30-minutes on a loaned laptop. In addition, once-weekly sessions with a speech-language pathologist occur to check status and ensure compliance. The first and last script productions with the speech-language pathologist are transcribed and coded. Objective measures include percent script related words, rate of production of script related words, numbers of nouns, verbs and modifiers, and the mean length of morphemes per utterance.
Patient 1 is a 65 year old female with a severe Broca’s aphasia following an ischemic stroke 4 years previously. The following is an example of improvement on one of the scripts for patient 1:
From pre-training to post training, number of words improved from 26 to 98; percent script related words improved from 23% to 86%; script related words per minute increased from 7.54 to 39.52; nouns increased from 20 to 28; verbs increased from 2 to 15; modifiers increased from one to 22; and sentence and phrase complexity level increased from 0 to 6.38 and 6.0 respectively.
Patient 2 is a 78 year old male with a moderate Wernicke’s aphasic following an ischemic stroke 19 months previously.
The following is an example of improvement on one of the scripts for patient 2: From pre-training to post training, number of words improved from 16 to 62; percent script related words improved from 19% to 76%; script related words per minute increased from 11.29 to 32.06; nouns increased from 5 to 15; verbs increased from 3 to 13; modifiers increased from 0 to 6; sentence complexity level increased from 4.0 to 9.0; and phrase complexity level increased from 0 to 5.0
PowerPoint slides created by Dr. Cherney provide further details of the project, and additional pictures of the program.
This study is supported by Grant H133B031127 from the National Institute on Disability and Rehabilitation Research, Department of Education.
Armus, S.R., Brookshire, R. H., & Nicholas, L.E. (1989). Aphasic and non-brain-damaged adults’ knowledge of scripts for common situations. Brain and Language. 36, 518-528.
Logan, G.D. (1988). Toward an instance theory of automatization. Psychological Review, 95, 492-527.
Lojek-Osiejuk, E. (1996). Knowledge of scripts reflected in discourse of aphasics and right-brain-damaged patient. Brain and Language, 53, 58-80.