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Following Spoken Directions

Olivia Bergman & Lauren


Lanphere

Client Information
Client initials: JH
DOB: 06/06/47
Age: 68
Medical History: Left cerebrovascular accident in June of 2015
JH Presents with mild fluent aphasia.
Verbal Expression is characterized by fluent speech with paragrammatic errors (e.g., he for
she) and literal paraphasic errors (e.g., soap for soup).
Auditory Comprehension is significantly reduced in comparison to other language abilities.
Specifically, auditory comprehension diminishes as length and complexity increases.

Goal & Objective


Goal: Will comprehend auditory information across a variety of
linguistic contexts.
Objective: Will follow auditory commands as a function of
increasing stimulus demands (length, complexity, stimulus rate,
and background noise) with 95% accuracy with minimal clinician
cues.

Following Spoken Directions Hierarchy : Overview


- Clinician gives spoken directions & client performs sequential pointing or
manipulative responses
- Length and complexity are controlled
- Client is working at a level that works but does not exceed their processing
capacity
- Successful performance requires client to quickly focus & retain attention for
duration of spoken direction
- As client improves, treatment progresses along a hierarchy.

Theory & Rationale for Use


- In line with Schuells Stimulation Approach
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Intensive auditory stimulation


Elicits direct response
Repetitive materials
Bombarding input
Reorganizing language system

- Client exhibits deficits in auditory comprehension (specifically length), working


memory, and attention.
- Wanted to increase the length and complexity of auditory information
- Client expressed background noise at home
(Chapey, 2008)

Who is it designed for?


- Individuals with mild to moderate aphasia who need improvement in:
- auditory comprehension
- verbal retention
- attention
- Would not treat apraxia, perceptual deficits, or dysarthria
- May not be appropriate for severe/global aphasia
(Chapey, 2008)

Hierarchy (Kearns & Hubbard, 1977)


1. Point to one common object by name.
2. Point to one common object by function.
3. Point in sequence to two common objects by
function.
4. Point in sequence to two common objects by
name
5. Point to one object spelled by the examiner.
6. Point to one common object described by the
examiner with three descriptors (which one is
white, plastic and has bristles?)
7. Follow one-verb instructions (pick up the
pen).
8. Point in sequence to three common objects
by name.

9. Point in sequence to three common


objects by function.
10. Carry out two-object location instructions
(put the pen in front of the knife).
11. Carry out in sequence two verb
instructions (point to the knife and turn over
the fork).
12. Carry out in sequence two verb
instructions with time constraint (before you
pick up the knife, hand me the fork).
13. Carry out thee-verb instructions (point to
the knife, turn over the fork, and hand over
the pencil).

Components of Task
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Stimuli: ten auditory commands at each level of the hierarchy


Response: following the auditory command (point or manipulate)
Type of practice: working memory/retention
Descriptive feedback: creating awareness of errors after trial
Data collection: binary
- 1 = correct, self-correct
- 0 = wrong, partially wrong

- Measureable outcomes: progress through hierarchy


- Complexity: background noise
- Reorganization of hierarchy

References
Chapey, R. (2008). Language intervention strategies in aphasia and related
neurogenic communication disorders. Lippincott Williams & Wilkins. Baltimore,
Maryland.
Kearns, K. P. & Hubbard, D. J. (1997). A Comparison of auditory comprehension
tasks in aphasia.
Brookshire, R., H. (2007). Introduction to neurogenic communication disorders. St.
Louis, MO.: Mosby Elsevier.

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