J. COMMUN. DISORD. 24 (1992). 23-29
AUDITORY COMPREHENSION OF “YES-NO” QUESTIONS BY ADULT APHASICS GREER M. BACON Spokane.
Washington
ROBERT E. POTTER and J. ANTHONY Department
of Speech
and Hearing
Sciences,
Washington
SEIKEL Sratr
University
Two groups of adult aphasics were administered four different types of auditory-verbal “yes-no” questions. One group received questions including egocentric, environmental, pictorial, and relationship items in a consistent order. The second group received the same questions in random order. Support was found for the existence of a hierarchy of difficulty among the types of auditory-verbal “yes-no” questions. There was no significant difference between the two groups’ performance even though the consistent presentation group was slightly superior to the random order group on the auditory-verbal “yes-no” questions.
INTRODUCTION Two factors influencing the adult aphasic’s ability to comprehend auditory-verbal stimuli are the type of stimulus and the manner in which it is presented. Stimulus-related factors include the length of the incoming auditory signal, the relative frequency of the vocabulary used, and the syntactical composition. As the length and linguistic complexity of the verbal stimulus increases, the efficiency of the auditory comprehension process in adult aphasics decreases (Goodglass, Gleason, and Hyde, 1970; Sarno, 1974; Schuell, Jenkins, and Landis, 1961; Shewan and Canter, 1971). Factors related to the manner of stimulus presentation include extralinguistic variables such as amount and type of sensory information provided and imposed delay of response (Green and Boller, 1974; Yorkston, 1975). Clinically, it is of paramount importance to determine the effects of these factors on auditory-verbal comprehension. Some researchers have used verbal “yes-no” questions to explore the nature of the adult aphasic’s auditory comprehension, and their practical and clinical importance is well recognized (Goodglass and Kaplan, 1972; Gray, Hoyt, Mogil, and Lefkowitz, 1977; Kertesz and Poole, 1974; Schuell, 1965). For the adult aphasic with moderately to severely impaired Address correspondence ences, Washington State
to Robert E. Potter, Department of Speech University, Pullman, WA 99164-2420.
0 1992 by Elsevier Science Publishing Co., Inc. 655 Avenue of the Americas, New York. NY 10010
and Hearing
Sci-
23 002 I -9924/92/$5 .tM
24
BACON et
al.
verbal output, verbal “yes-no” questions may provide the sole avenue of communicative interaction with family, friends, and the rehabilitation staff. It is important to ascertain the type of information that patients can auditorily comprehend and to which they can accurately respond so that appropriate communication and treatment goals may be established. The present study examined the effects of several types of verbal “yesno” questions and their order of presentation on the efticiency of auditory comprehension in aphasic adults. Specifically, three questions were asked: 1. Is there a hierarchy
of difficulty in the adult aphasic’s auditory comof different types of verbal “yes-no” questions? 2. Does the order in which the verbal “yes-no” questions are presented affect the adult aphasic’s level of performance? 3. Is there an interaction between the type of verbal “yes-no” question asked of the adult aphasic and the order of presentation? prehension
METHOD Subjects Twenty aphasic adults (13 men and 7 women), ranging in age from 46 to 78 years (x = 64 years), were divided into two groups of ten. The Porch Index of Communicative Ability (PICA; Porch, 1971) was administered to all subjects, and scores ranged from the 3rd to the 75th percentile with a mean of 3 1.85. The aphasia was secondary to cerebrovascular accident in 19 cases and cerebral trauma in one. To meet selection criteria, the subjects were (1) a minimum of one month postonset at the time of their participation in the study, (2) unilaterally brain damaged, (3) assessed by the PICA within one month of their participation in the study, (4) receiving or had received language treatment, and (5) subject to a preliminary screening test to determine if they were capable of responding to the experimental task. The investigation was conducted at the Speech Pathology Service, Department of Rehabilitation Medicine, University Hospital, Seattle, Washington and its satellite locations, which include Harborview Medical Center, U.S. Public Health Service Hospital, Ballard Convalescent Center, Pinehurst Park Royal Convalescent Center, and Restorative Care Center, all of Seattle. Instrumentation Preliminary Screening Test. The screening device was composed of items 1 through 4 on the Auditory Comprehension portion (Section II, Part D) of the Boston Diagnostic Aphasia Evaluation, (BDAE; Goodglass
AUDITORY
COMPREHENSION
BY APHASICS
25
and Kaplan, 1972). Each item included one affirmative and one negative question, making a total of eight items possible on the screening test. Acceptable performance for admission into the study consisted of six correct responses. Experimental Treatments. Four auditory-verbal “yes-no” treatments were used: Egocentric, Environmental, Pictorial, and Relationship questions. In each of these treatments, subjects were asked to respond either affirmatively or negatively to auditory-verbal “yes-no” questions. In the Egocentric treatment, the questions referred to present aspects of themselves (for example, “Are you a man?“). The mean length of these questions was 4.25 words with a range of four to six words. In the Environmental treatment, the questions referred to present aspects of persons within the test environment (for example, “Is (assistant’s name) a man?“). The mean length of these questions was 4.25 words with a range of four to six words. In the Pictorial treatment, the questions referred to present aspects of persons represented by the “Cookie Theft” picture (Goodglass and Kaplan, 1972). For example, the subject was asked, “Is this a man?” The mean length of these questions was 4.41 words with a range of three to six words. To maintain 50% “yes” and 50% “no” response items in the pictorial treatment, the following adaptations were made: (1) the girl was changed from a standing position to sitting in a chair, and (2) the woman’s and boy’s hair and eyes were colored brown in the black and white line drawing. In the Relationship treatment, questions referred to general “moreless” relationships between persons and objects. For example, the subject was asked, “Are men older than boys ?” The mean length of these questions was 5.33 words with a range of five to six words. Each treatment presentation included 12 items, making a total of 48 auditory-verbal “yesno” questions. The length and linguistic complexity of the questions were controlled across the four experimental treatments in an attempt to reduce the influence of these factors over the subjects’ ability to auditorily comprehend the different types. The vocabulary used was ranked within the 500 most common words except for “brown,” “blue,” and “blonde” (Thorndike and Lorge, 1944). “Brown” and “blue” were ranked within the 1000 most common words, and “blonde” within the 5000-word category. Each experimental treatment was designed so that 50% of the items were “yes” responses.
Testing Procedures The subjects were divided into groups by 15-percentile-point intervals on the basis of their most recent PICA scores. To assure a relatively equal representation of communicative abilities in both experimental groups,
26
BACON
et al.
subjects were assigned consecutive numbers in the order of their participation in the experiment. Those with odd numbers were included in the Consistent Presentation Group (Group 1, N = 10). and those with even numbers were included in the Random Presentation Group (Group 2, N = IO). Consistent Presentation Group (Group I). Subjects received all treatments consecutively. A 30-second break was given between tasks to differentiate one from the next and to decrease subject fatigue. Random Presentation Group (Group 2). Subjects received the twelve “yes-no” items from each experimental treatment randomly distributed into four equal units of questions. Each unit contained no more than four items and no fewer than two items from each treatment, and approximately 50% of these items required “yes” responses. The experiment was conducted in a quiet, distractionfree room with the subject seated either in a chair or in bed directly across a table from the experimenter. The stimulus picture was placed on the table in a central position and was kept concealed except during administration of a pictorial task item. A “yes-no” board, composed of 2-inch block letters on a 5 x If-inch piece of tag board, was positioned directly in front of the subject. In the event that the subject elected to use an alternate means of response, the “yes-no” board was concealed to eliminate confusion and to promote a consistent means of response. An experimental assistant who was utilized as an additional scorer was seated to the subject’s left at the end of the table.
Table 1. Five-Point Multidimensional Scoring Scale Response Correct
Delayed Correction Cued Error
Description
Score
A response correctly expressing affirmation that is prompt (immediately follows the stimulus) and efficient (clearly indicates “yes” or “no”). A response correctly and efficiently expressing affirmation or negation that is not prompt. An inaccurate, inappropriate. or inefficient response that is subsequently corrected by the subject. A response that is inappropriate or inefficient, or no response that is corrected subsequent to a cue by the experimenter.” An incorrect response. a request for a repetition by the subject, or an inappropriate/inefficient response or no response subsequent to a cue by the experimenter.
4
” If a subject made no response after 15 seconds or responded inappropriately experimenter responded. “Mr. _. yes or no” accompanied by the appropriate pointing to the “yes-no” board.
3 2
I 0
or inefficiently. the head movements or
AUDITORY
COMPREHENSION
BY APHASICS
27
Scoring Procedure A five-point multidimensional scoring system was utilized by two judges for each response (see Table 1). Interscorer reliability for the two judges was evaluated using a Pearson Product-Moment Correlation, yielding coefficients of .99 (P < .Ol) for Treatments I, 3, and 4, and 0.93 (P < .Ol) for Treatment 2.
RESULTS To examine differences in the subjects’ auditory comprehension due to (1) type of verbal “yes-no” question, (2) order of presentation, and (3) the interaction between the type of verbal “yes-no” question and order of presentation, the data were analyzed by means of a two-factor analysis of variance (ANOVA) with repeated measures on the type of question. The main effect for type of question was significant (F(3.54) = 34.36, P < .OOOl), implying that there was a hierarchy of difficulty in the adult aphasic’s auditory comprehension of verbal “yes-no” questions. A NWman-Keuls’ Multiple-Range test was employed to evaluate differences among mean scores for type of question (Figure 1). Relationship questions were significantly more difficult than all other types of questions (p < .OI), and Environmental questions were significantly more difficult than 3.0
Ego. TYPO
Env. Pid. Relat. of “Yes-No” Question
Mean auditory comprehension scores for the total subject population on four different types of verbal “yes-no” questions.
Figure 1.
28
BACON et al.
Egocentric questions (p < .05). Environmental questions were not significantly different from Pictorial questions (p > .05). There was no significant difference between the Egocentric and Pictorial questions (P > .05). Neither the main effect for presentation (F(1,18) = 2.54) nor the type-by-presentation interaction (F(3,54) = .171) was significant (p > .05). DISCUSSION The findings support the existence of a hierarchy of difficulty in the aphasic’s auditory comprehension of verbal “yes-no” questions. Specifically, Egocentric questions were easier to comprehend than Environmental questions, and Environmental questions were easier than Relationship questions. The Pictorial questions, although significantly easier to comprehend than Relationship questions, did not differ from Egocentric and Environmental questions in difficulty (Figure 1). Presumably, Egocentric questions are easier for aphasics to comprehend than Pictorial or Environmental questions because of their conceptual familiarity, and thus, their higher associational value. The aphasic’s auditory comprehension of both Pictorial and Environmental questions is probably facilitated by visual stimuli, which provide additional sensory input. Since pictures are somewhat more static than the subject environment, however, their stimulus value may have contributed to the subjects’ trend toward better performance on pictorial than on Environmental questions. The relatively sharp decline in the aphasics’ performance between Environmental questions and Relationship questions suggests the presence of a type of question not examined in the present study. Specifically, further analysis of aphasics’ auditory comprehension of verbal “yes-no” questions may reveal intermediate levels of difficulty, which would further clarify this hierarchy. The findings suggest that speech and language pathologists should observe the hierarchy of difficulty both in their assessment of the aphasic’s auditory comprehension of verbal “yes-no” questions and in their attempts to establish reliable response patterns. Further, clinicians may wish to include these recommendations in working with the aphasic’s family, friends, and rehabilitation team members. Although there was a tendency for individuals in the consistent presentation group to score higher on the auditory comprehension task than those in the random order group, the difference was not significant. It was concluded that order of presentation does not significantly affect the adult aphasic’s auditory comprehension of verbal “yes-no” questions. Sample size clearly limited the findings of the investigation. It would appear to be fruitful to investigate the interaction between question type and severity of deficit. Future research analyzing the adult aphasic’s au-
AUDITORY
COMPREHENSION
29
BY APHASICS
ditory comprehension of verbal “yes-no” questions should also be directed to further assessment of the hierarchy of difficulty and the effects of cognitive and linguistic variables. In addition, the close relationship between egocentric and pictorial questions could have favorable implications for the use of communication boards and note books by aphasics, and this potential clearly warrants further study. REFERENCES Goodglass, H., Gleason, J. B., and Hyde, M. R. (1970). Some dimension of auditory language comprehension
in aphasia. J. Speech Hear. Res.,
Goodglass, H., and Kaplan, E. (1972). Boston Diagnostic Philadelphia, PA: Lea and Febiger.
Aphasia
13595-606. Examination.
Gray, L., Hoyt, P., Mogil, S., and Letkowitz, N. (1977). A comparison of clinical tests of yes/no questions in aphasia. Paper presented to the Annual Clinical Aphasiology Conference, Amelia Island Plantation, Florida. Green, E., and Boiler, F. (1974) Features of auditory comprehension impaired aphasics. Cortex 10: 133- 144.
in severely
Kertesz, A., and Poole, E. (1974) The aphasia quotient: The taxonomic approach to measurement of aphasic disability. J. Can. Sci. Neurolog. I:7-16. Porch, B. E. (1971) Porch Index of Communicative CA: Consulting Psychologists Press. Sarno, M. T. (1974) Aphasia rehabilitation. Disorders:
Remedial
Principles
Ability (Rev. Ed.). Palo Alto,
In Dickson, S. (ed.), Communication Glenview, IL: Scott, Foresman
and Practices.
and Co. Schuell, H. (1965) Minnesota Test for Differential neapolis, MN: University of Minnesota Press.
Diagnosis
of Aphasia. Min-
Schuell, H., Jenkins, J. J., and Landis, L. (1961) Relationship between auditory comprehension and word frequency in aphasia. J. Speech Hear. Res. 4:30-36. Shewan, C. M., and Canter, G. L. (1971). Effects of vocabulary, syntax and sentence length on auditory comprehension in aphasic patients. Cortex, 7:209226. Thorndike, Words.
E. L., and Lorge, I. (1944). The Teacher’s York: Harper and Row.
Word Book
of_?O,OOO
New
Yorkston, K. M. (1975). The effects of imposed delay of response on aphasics’ auditory comprehension of material presented with and without visual cues. Doctural dissertation, University of Oregon.
AUDITORY COMPREHENSION OF “YES-NO” QUESTIONS BY ADULT APHASICS GREER M. BACON Spokane.
Washington
ROBERT E. POTTER and J. ANTHONY Department
of Speech
and Hearing
Sciences,
Washington
SEIKEL Sratr
University
Two groups of adult aphasics were administered four different types of auditory-verbal “yes-no” questions. One group received questions including egocentric, environmental, pictorial, and relationship items in a consistent order. The second group received the same questions in random order. Support was found for the existence of a hierarchy of difficulty among the types of auditory-verbal “yes-no” questions. There was no significant difference between the two groups’ performance even though the consistent presentation group was slightly superior to the random order group on the auditory-verbal “yes-no” questions.
INTRODUCTION Two factors influencing the adult aphasic’s ability to comprehend auditory-verbal stimuli are the type of stimulus and the manner in which it is presented. Stimulus-related factors include the length of the incoming auditory signal, the relative frequency of the vocabulary used, and the syntactical composition. As the length and linguistic complexity of the verbal stimulus increases, the efficiency of the auditory comprehension process in adult aphasics decreases (Goodglass, Gleason, and Hyde, 1970; Sarno, 1974; Schuell, Jenkins, and Landis, 1961; Shewan and Canter, 1971). Factors related to the manner of stimulus presentation include extralinguistic variables such as amount and type of sensory information provided and imposed delay of response (Green and Boller, 1974; Yorkston, 1975). Clinically, it is of paramount importance to determine the effects of these factors on auditory-verbal comprehension. Some researchers have used verbal “yes-no” questions to explore the nature of the adult aphasic’s auditory comprehension, and their practical and clinical importance is well recognized (Goodglass and Kaplan, 1972; Gray, Hoyt, Mogil, and Lefkowitz, 1977; Kertesz and Poole, 1974; Schuell, 1965). For the adult aphasic with moderately to severely impaired Address correspondence ences, Washington State
to Robert E. Potter, Department of Speech University, Pullman, WA 99164-2420.
0 1992 by Elsevier Science Publishing Co., Inc. 655 Avenue of the Americas, New York. NY 10010
and Hearing
Sci-
23 002 I -9924/92/$5 .tM
24
BACON et
al.
verbal output, verbal “yes-no” questions may provide the sole avenue of communicative interaction with family, friends, and the rehabilitation staff. It is important to ascertain the type of information that patients can auditorily comprehend and to which they can accurately respond so that appropriate communication and treatment goals may be established. The present study examined the effects of several types of verbal “yesno” questions and their order of presentation on the efticiency of auditory comprehension in aphasic adults. Specifically, three questions were asked: 1. Is there a hierarchy
of difficulty in the adult aphasic’s auditory comof different types of verbal “yes-no” questions? 2. Does the order in which the verbal “yes-no” questions are presented affect the adult aphasic’s level of performance? 3. Is there an interaction between the type of verbal “yes-no” question asked of the adult aphasic and the order of presentation? prehension
METHOD Subjects Twenty aphasic adults (13 men and 7 women), ranging in age from 46 to 78 years (x = 64 years), were divided into two groups of ten. The Porch Index of Communicative Ability (PICA; Porch, 1971) was administered to all subjects, and scores ranged from the 3rd to the 75th percentile with a mean of 3 1.85. The aphasia was secondary to cerebrovascular accident in 19 cases and cerebral trauma in one. To meet selection criteria, the subjects were (1) a minimum of one month postonset at the time of their participation in the study, (2) unilaterally brain damaged, (3) assessed by the PICA within one month of their participation in the study, (4) receiving or had received language treatment, and (5) subject to a preliminary screening test to determine if they were capable of responding to the experimental task. The investigation was conducted at the Speech Pathology Service, Department of Rehabilitation Medicine, University Hospital, Seattle, Washington and its satellite locations, which include Harborview Medical Center, U.S. Public Health Service Hospital, Ballard Convalescent Center, Pinehurst Park Royal Convalescent Center, and Restorative Care Center, all of Seattle. Instrumentation Preliminary Screening Test. The screening device was composed of items 1 through 4 on the Auditory Comprehension portion (Section II, Part D) of the Boston Diagnostic Aphasia Evaluation, (BDAE; Goodglass
AUDITORY
COMPREHENSION
BY APHASICS
25
and Kaplan, 1972). Each item included one affirmative and one negative question, making a total of eight items possible on the screening test. Acceptable performance for admission into the study consisted of six correct responses. Experimental Treatments. Four auditory-verbal “yes-no” treatments were used: Egocentric, Environmental, Pictorial, and Relationship questions. In each of these treatments, subjects were asked to respond either affirmatively or negatively to auditory-verbal “yes-no” questions. In the Egocentric treatment, the questions referred to present aspects of themselves (for example, “Are you a man?“). The mean length of these questions was 4.25 words with a range of four to six words. In the Environmental treatment, the questions referred to present aspects of persons within the test environment (for example, “Is (assistant’s name) a man?“). The mean length of these questions was 4.25 words with a range of four to six words. In the Pictorial treatment, the questions referred to present aspects of persons represented by the “Cookie Theft” picture (Goodglass and Kaplan, 1972). For example, the subject was asked, “Is this a man?” The mean length of these questions was 4.41 words with a range of three to six words. To maintain 50% “yes” and 50% “no” response items in the pictorial treatment, the following adaptations were made: (1) the girl was changed from a standing position to sitting in a chair, and (2) the woman’s and boy’s hair and eyes were colored brown in the black and white line drawing. In the Relationship treatment, questions referred to general “moreless” relationships between persons and objects. For example, the subject was asked, “Are men older than boys ?” The mean length of these questions was 5.33 words with a range of five to six words. Each treatment presentation included 12 items, making a total of 48 auditory-verbal “yesno” questions. The length and linguistic complexity of the questions were controlled across the four experimental treatments in an attempt to reduce the influence of these factors over the subjects’ ability to auditorily comprehend the different types. The vocabulary used was ranked within the 500 most common words except for “brown,” “blue,” and “blonde” (Thorndike and Lorge, 1944). “Brown” and “blue” were ranked within the 1000 most common words, and “blonde” within the 5000-word category. Each experimental treatment was designed so that 50% of the items were “yes” responses.
Testing Procedures The subjects were divided into groups by 15-percentile-point intervals on the basis of their most recent PICA scores. To assure a relatively equal representation of communicative abilities in both experimental groups,
26
BACON
et al.
subjects were assigned consecutive numbers in the order of their participation in the experiment. Those with odd numbers were included in the Consistent Presentation Group (Group 1, N = 10). and those with even numbers were included in the Random Presentation Group (Group 2, N = IO). Consistent Presentation Group (Group I). Subjects received all treatments consecutively. A 30-second break was given between tasks to differentiate one from the next and to decrease subject fatigue. Random Presentation Group (Group 2). Subjects received the twelve “yes-no” items from each experimental treatment randomly distributed into four equal units of questions. Each unit contained no more than four items and no fewer than two items from each treatment, and approximately 50% of these items required “yes” responses. The experiment was conducted in a quiet, distractionfree room with the subject seated either in a chair or in bed directly across a table from the experimenter. The stimulus picture was placed on the table in a central position and was kept concealed except during administration of a pictorial task item. A “yes-no” board, composed of 2-inch block letters on a 5 x If-inch piece of tag board, was positioned directly in front of the subject. In the event that the subject elected to use an alternate means of response, the “yes-no” board was concealed to eliminate confusion and to promote a consistent means of response. An experimental assistant who was utilized as an additional scorer was seated to the subject’s left at the end of the table.
Table 1. Five-Point Multidimensional Scoring Scale Response Correct
Delayed Correction Cued Error
Description
Score
A response correctly expressing affirmation that is prompt (immediately follows the stimulus) and efficient (clearly indicates “yes” or “no”). A response correctly and efficiently expressing affirmation or negation that is not prompt. An inaccurate, inappropriate. or inefficient response that is subsequently corrected by the subject. A response that is inappropriate or inefficient, or no response that is corrected subsequent to a cue by the experimenter.” An incorrect response. a request for a repetition by the subject, or an inappropriate/inefficient response or no response subsequent to a cue by the experimenter.
4
” If a subject made no response after 15 seconds or responded inappropriately experimenter responded. “Mr. _. yes or no” accompanied by the appropriate pointing to the “yes-no” board.
3 2
I 0
or inefficiently. the head movements or
AUDITORY
COMPREHENSION
BY APHASICS
27
Scoring Procedure A five-point multidimensional scoring system was utilized by two judges for each response (see Table 1). Interscorer reliability for the two judges was evaluated using a Pearson Product-Moment Correlation, yielding coefficients of .99 (P < .Ol) for Treatments I, 3, and 4, and 0.93 (P < .Ol) for Treatment 2.
RESULTS To examine differences in the subjects’ auditory comprehension due to (1) type of verbal “yes-no” question, (2) order of presentation, and (3) the interaction between the type of verbal “yes-no” question and order of presentation, the data were analyzed by means of a two-factor analysis of variance (ANOVA) with repeated measures on the type of question. The main effect for type of question was significant (F(3.54) = 34.36, P < .OOOl), implying that there was a hierarchy of difficulty in the adult aphasic’s auditory comprehension of verbal “yes-no” questions. A NWman-Keuls’ Multiple-Range test was employed to evaluate differences among mean scores for type of question (Figure 1). Relationship questions were significantly more difficult than all other types of questions (p < .OI), and Environmental questions were significantly more difficult than 3.0
Ego. TYPO
Env. Pid. Relat. of “Yes-No” Question
Mean auditory comprehension scores for the total subject population on four different types of verbal “yes-no” questions.
Figure 1.
28
BACON et al.
Egocentric questions (p < .05). Environmental questions were not significantly different from Pictorial questions (p > .05). There was no significant difference between the Egocentric and Pictorial questions (P > .05). Neither the main effect for presentation (F(1,18) = 2.54) nor the type-by-presentation interaction (F(3,54) = .171) was significant (p > .05). DISCUSSION The findings support the existence of a hierarchy of difficulty in the aphasic’s auditory comprehension of verbal “yes-no” questions. Specifically, Egocentric questions were easier to comprehend than Environmental questions, and Environmental questions were easier than Relationship questions. The Pictorial questions, although significantly easier to comprehend than Relationship questions, did not differ from Egocentric and Environmental questions in difficulty (Figure 1). Presumably, Egocentric questions are easier for aphasics to comprehend than Pictorial or Environmental questions because of their conceptual familiarity, and thus, their higher associational value. The aphasic’s auditory comprehension of both Pictorial and Environmental questions is probably facilitated by visual stimuli, which provide additional sensory input. Since pictures are somewhat more static than the subject environment, however, their stimulus value may have contributed to the subjects’ trend toward better performance on pictorial than on Environmental questions. The relatively sharp decline in the aphasics’ performance between Environmental questions and Relationship questions suggests the presence of a type of question not examined in the present study. Specifically, further analysis of aphasics’ auditory comprehension of verbal “yes-no” questions may reveal intermediate levels of difficulty, which would further clarify this hierarchy. The findings suggest that speech and language pathologists should observe the hierarchy of difficulty both in their assessment of the aphasic’s auditory comprehension of verbal “yes-no” questions and in their attempts to establish reliable response patterns. Further, clinicians may wish to include these recommendations in working with the aphasic’s family, friends, and rehabilitation team members. Although there was a tendency for individuals in the consistent presentation group to score higher on the auditory comprehension task than those in the random order group, the difference was not significant. It was concluded that order of presentation does not significantly affect the adult aphasic’s auditory comprehension of verbal “yes-no” questions. Sample size clearly limited the findings of the investigation. It would appear to be fruitful to investigate the interaction between question type and severity of deficit. Future research analyzing the adult aphasic’s au-
AUDITORY
COMPREHENSION
29
BY APHASICS
ditory comprehension of verbal “yes-no” questions should also be directed to further assessment of the hierarchy of difficulty and the effects of cognitive and linguistic variables. In addition, the close relationship between egocentric and pictorial questions could have favorable implications for the use of communication boards and note books by aphasics, and this potential clearly warrants further study. REFERENCES Goodglass, H., Gleason, J. B., and Hyde, M. R. (1970). Some dimension of auditory language comprehension
in aphasia. J. Speech Hear. Res.,
Goodglass, H., and Kaplan, E. (1972). Boston Diagnostic Philadelphia, PA: Lea and Febiger.
Aphasia
13595-606. Examination.
Gray, L., Hoyt, P., Mogil, S., and Letkowitz, N. (1977). A comparison of clinical tests of yes/no questions in aphasia. Paper presented to the Annual Clinical Aphasiology Conference, Amelia Island Plantation, Florida. Green, E., and Boiler, F. (1974) Features of auditory comprehension impaired aphasics. Cortex 10: 133- 144.
in severely
Kertesz, A., and Poole, E. (1974) The aphasia quotient: The taxonomic approach to measurement of aphasic disability. J. Can. Sci. Neurolog. I:7-16. Porch, B. E. (1971) Porch Index of Communicative CA: Consulting Psychologists Press. Sarno, M. T. (1974) Aphasia rehabilitation. Disorders:
Remedial
Principles
Ability (Rev. Ed.). Palo Alto,
In Dickson, S. (ed.), Communication Glenview, IL: Scott, Foresman
and Practices.
and Co. Schuell, H. (1965) Minnesota Test for Differential neapolis, MN: University of Minnesota Press.
Diagnosis
of Aphasia. Min-
Schuell, H., Jenkins, J. J., and Landis, L. (1961) Relationship between auditory comprehension and word frequency in aphasia. J. Speech Hear. Res. 4:30-36. Shewan, C. M., and Canter, G. L. (1971). Effects of vocabulary, syntax and sentence length on auditory comprehension in aphasic patients. Cortex, 7:209226. Thorndike, Words.
E. L., and Lorge, I. (1944). The Teacher’s York: Harper and Row.
Word Book
of_?O,OOO
New
Yorkston, K. M. (1975). The effects of imposed delay of response on aphasics’ auditory comprehension of material presented with and without visual cues. Doctural dissertation, University of Oregon.
