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DATE DUE DATE DUE DATE DUE I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSU Is An Affirmative Action/Equal Opportunity Institution

 

A VISUAL HIEIDHIC VERSUS DIRECT IISTRUCTIOH
APPROACH TO FACILITATE RECALL II
CLOSED HEAD IIJURY PATIEITS

BY

Angela R. lbssenberg

A DISSERTATION
Submitted to
Hichigan State University
in partial fulfillnent of the require-ants
for the degree of

DOCTOR OF PHILOSOPHY

Department of Audiology and Speech Sciences

1988

ABSTRACT
A VISUAL HNEMONIC VERSUS DIRECT INSTRUCTION

APPROACH TO FACILITATE RECALL IN
CLOSED HEAD INJURY PATIENTS

BY
Angela R. Massenberg

Two experiments were conducted to determine the effects
of mnemonic based instruction versus direct instruction on
the recall of personal names by individuals with a Closed
Head Injury. Experiment I utilized an alternating
treatment, single-subject multiple baseline across subjects
design in which four adults served as subjects. Each
subject was taught a total of 20 personal names, ten with a
mnemonic based instruction and ten with a direct instruction
approach, to determine which type of instruction would yield
better recall of the stimulus names.

Each treatment session consisted of the following
procedure: Initially, each subject was shown photographs of
individual people whose name was to be recalled. Those
names receiving the mnemonic based instruction were paired
with a second photograph which depicted the individual
holding an object that was representative of the person’s
name (i.e., a mnemonic). Those photographs receiving the
direct instruction approach depicted the individual without
the mnemonic. The results revealed that two out of the

four subjects demonstrated improved name recall with

mnemonic instruction, while the remaining two subjects
demonstrated no marked improvement in name recall under
either instructional mode.

Experiment II employed an alternating treatment single-
subject multiple baseline across behaviors design with two
subjects. The treatment procedure was the same as in
Experiment I, except that in Experiment II each subject
served as his own control. Results from Experiment II
revealed that both subjects demonstrated a trend for better
recall of personal names receiving the mnemonic instruction
as compared to those receiving the direct instruction

approach.

To my beloved mother, Hallie Hassenberg

ii

ACKNOWLEDGEMENTS

Many fine people have assisted me and provided support
throughout my doctoral program. I would like to thank the
following people:

Dr. Michael W. Casby, my academic advisor and major
professor, for his abiding support, interest, encouragement,
and knowledge that he so willingly shared. He has taught me
more than I could ever express, and for that I am so
grateful.

Drs. Richard Johnson, Peter LaPine, and John
Tonkovich, for their willingness to serve on my committee and
the guidance provided during the preparation of the study.

Ms. Charlene McNeal and Ms. LaVerne Moore,
Administrators, of the Irvine Group Home, for the
expeditious manner in which they secured three of the
subjects for participation in my study.

Dr. Jeffrey Ditty and Ms. Terri King, Administrators,
of J.A. Ditty and Associates, Inc., for their willingness to
allow me to utilize two of their clients for participation
in my study and the expeditious manner in which the subjects'

participation was secured.

iii

Dr. Timothy Broe, Administrator, of Broe Rehabilitation
Services, for his willingness to secure one of his client’s
for participation in my research.

Ms. Juanita McKinnie, who served as a research
assistant, and provided constant encouragement.

All the people who agreed to participate in the study.

Finally, I want to thank my family who has been my
anchor throughout my educational pursuits. I especially
want to thank my father, Mr. Millard F. Massenberg, Jr., who
has constantly been there for me, for all the love he has
always given, and for his pride in me that he has always
openly expressed. He taught me the meaning of perseverance,
and having his continuous support and encouragement has
meant so much to me. I also want to thank my sister, Ms.
Dianne Frazier, and my grandmother, Ms. Rebecca Massenberg
(bereaved), for their love, continuous support, and

encouragement.

iv

TABLE OF CONTENTS

LIST OF TABLES ..................................
LIST OF FIGURES .................................

LIST OF APPENDICES ..............................

INTRODUCTION AND REVIEW OF THE LITERATURE...

METHOD: Experiment I ........................
Subjects ...............................
Experimental Design and Procedures .....
Treatment ..............................

Reliability ............................

RESULTS: Experiment I .......................
Subject 1 ..............................
Subject 2 ..............................
Subject 3 ..............................

Subject 4 ..............................

METHOD: Experiment II .......................
Subjects ...............................
Experimental Design and Procedures .....
Treatment ..............................

Reliability ............................

Page
vii
viii

ix

24
24
32
38

42

43

46
47

49

50
51
56
57

61

Page

RESULTS: Experiment II ....................... 62
Subject 5 ............................... 62
Subject 6 ............................... 66

DISCUSSION .................................... 71

REFERENCES .................................... 78

APPENDICES .................................... 88

vi

LIST OF TABLES

Table Page
1 Rancho Los Amigos Scale of Cognitive

Levels and Expected Behavior ........... 29
2 Functional Communication Measure:

Cognitive Communication ................ 31
3 Description of Subjects for

Experiment I ........ . ................. 32

4 Pretest Recall Results for CHI

Subjects ............................... 36
5 Recall Results for Non-brain Damaged

Subjects ............................... 37
6 Description of Subjects for

Experiment II .......................... 55
7 Pretest Recall Results for Subject 5

and Subject 6 .......................... 58

vii

LIST

Figure

1 Baseline and treatment
for Subjects 1 and

2 Baseline and treatment
for Subjects 3 and

3 Baseline and treatment
for Subject 5 .....

4 Baseline and treatment

for Subject 6...... ...............

OF FIGURES

data

data

viii

Page

44

45

63

67

Appendix

A Stimulus
B

C

D Subtest
E Subtest
F Subtest
G Subtest
H Subtest
I Subtest
J

LIST OF APPENDICES

Names .............................

Boston Diagnostic Aphasia Examination
Results for Subjects 1 - 4 ...............

Boston Diagnostic Aphasia Examination
Results for Subjects 5 and 6 .............

Summary
Summary
Summary
Summary
Summary

Summary

Profile

Profile

Profile

Profile

Profile

Profile

for

for

for

for

for

for

Subject
Subject
Subject
Subject
Subject

Subject

1

2

5

6

000000

Informed Consent Form ......................

ix

Page

88

89

93
97
98
99
100
101
102

103

Introduction

Every year hundreds of thousands of people are involved
in accidents. Often times, the result of these accidents,
is a Closed Head Injury (CH1). CH1 can be defined as a non-
penetrating traumatic injury to the head that results in
cerebral dysfunction (Adamovich, et al, 1985). According to
the National Head Injury Foundation, Inc.,the estimated
prevalence of head injuries in the U.S. is 1,000,000-
1,800,000 (Williams, 1986), with 350,000 resulting from
automobile accidents. It has been further estimated that
140,000 Americans die annually from a head injury, and that
20,000 remain comatose (Williams, 1986). Additionally, head
injuries are responsible for up to 60% of auto-related
deaths (Pederson, 1986).

Due to medical advances (e.g., improved emergency room
procedures, medical technology) many more of these victims,
especially with severe head injuries, are surviving (Dikmen
et a1, 1983; Kirn, 1987). Approximately 50,000 - 70,000 CHI
victums are left with permanent physical and intellectual
disabilities however (Williams, 1986). These residual
deficits include physical handicaps, memory impairments,
attentional problems, impaired cognition, visual and
auditory difficulties, as well as difficulties with

communication (Levin, 1986; Adamovich et a1, 1985).

Neuroanatomical and Neuropsychological Changes

The individual sustaining a closed head injury
suffers from many neuroanatomical and neuropsychological
changes; this is particularly true with severe cases.

A severe blow to the head results in cortical
neuroanatomical alterations caused by the brain’s
accelerating, rotating, compressing, and expanding within
the skull (Hagen, 1981; Hooper, 1969; North, 1984; Russell,
1971). When the brain accelerates, and ultimately
decelerates, as a result of a blow to the head, there is
only a limited extent in which it may move within the skull
and dural envelope. When this movement is suddenly ceased
(due to the frontal and temporal poles impacting against the
walls of the anterior and middle cranial fossae), damage is
done to the tips (poles) of the temporal and frontal lobes,
as well as to the orbital surface of the frontal lobe
(Auerbach, 1983, 1986; Miller, 1983; North, 1984). The
rotating movement of the brain results in widely shattered
shearing of axons within the myelin sheaths leading itself
to diffuse brain damage. The jarring movement of the brain
itself also results in cortical contusions and/or

lacerations.

Cortical Damage

As a result of the cortical damage resulting from a CHI
there are various physical manifestations (e.g., cognitive,
behavioral, and emotional changes; memory problems, agnosia,
apraxia, aphasia and related speech/language problems;
visual field disturbances; visual spatial disturbances;
hemiplegia, hemipareses; cortical blindness, seizures,
perseveration) (Baggerly, 1986). Some manifestations of a
CHI may be the result of emotional and behavioral
alterations that occur with damage to the medial cortical
regions that are deemed part of the limbic system. For
example, arousal and attentional deficits may be the result
of diffuse white matter injury which is associated with
altered consciousness.

Frontal Lobe. The frontal lobe area of the brain
contains the precentral cortex which controls all motor
functions. A localized lesion in the posterior inferior
region results in difficulty in programming and direcing the
speech musculature in the intergrated coordinated sequences
necessary for speech (i.e., apraxia of speech) (Brookshire,
1978). Lesions in the same area may result in a Broca's
aphasia. Characteristics of Broca's aphasia include
nonfluent speech, consisting of a few words and short
sentences (Kertesz, 1979; Damasio, 1981). Speech production

is laborious and telegraphic. However, auditory

comprehension is relatively intact.

There are a host of other behaviors that are
particularly observed with those individuals who have
sustained frontal lobe injuries secondary to a CHI. Among
these are personality changes, either being more subdued or
aggressive than was the case premorbidly (Baggerly, 1986;
Habermann, 1982; Oddy & Humphrey, 1980). Also, signs of
euphoria or apathy, lack of insight, lack of social graces
or disinhibition and inability to self-monitor, emotional
responses that are inappropriate for a particular situation
are observed. It has also been observed that some CHI
individuals demonstrate a lack of initiative and goal-
directed behavior. These individuals in general,
demonstrate poor problemrso1ving/reasoning skills, with
responses being concrete and literal. They also often
exhibit difficulty with cognitive flexibility, that is,
"shifting from one concept to another" (Baggerly, 1986), as
well as perseveration.

Parietal Lobe. Resultant parietal lobe damage from a
CHI involves many of the cortical sensory and sensory
intergration systems which are altered as a result of a CHI.
Specifically, deficits in the ability to identify familiar
objects based on tactile information, that is, asterognosis,
may be observed. In the most general sense, damage to the
left hemisphere many result in aphasic and problems such as

alexia (i.e., difficulty with reading information) and

agraphia (i.e., relative to the impaired spelling). The
portion of the angular gyrus that is within the parietal
region has sustained damage to note the alexia and agraphia
(Baggerly, 1986; Smith, 1979). Skilled movement deficits
and/or reduced analytical and logical reasoning abilities
may also be impaired as a result of parietal lobe damage.
Constrastly, right hemisphere parietal lobe damage will
typically result in visual-perceptual and spatial
impairments, agnosia and loss of prosody (Baggerly, 1986).
Temporal Lobe. Damage to the dominant temporal lobe in
general, results in reduced language abilities. The second
most common language disorder after a CHI is Wernicke’s
aphasia (Levin, 1981), which is located in the posterior
aspect ofthe temporal region. The characteristics observed
with this language disorder consist of fluent, well
articulated paraphasic speech, poor comprehension for oral
and written language, and impaired repetition (Brookshire,
1978; Kertesz, 1979).

Furthermore, a CHI with damage to the temporal area
produces behavior manifestations such as anxiety, calmness,
rage, aggression, and depression. These behaviors are
triggered by internal mechanisms and are not asssociated
with circumstances in the external environment. The
structures involved include the amygdala which is
responsible to a large part for these various emotional

responses (e.g., rage, aggression) (Heimer, 1983).

 

When considering the neuropsychological problems which
occur as a result of a CHI, the temporal lobe is also an
important region for memory/new learning (Arnold, 1982;
Khan, 1986). The hippocampi, a structure connected with
recent memory is located medially to the temporal lobe, is
frequently damaged (Muramoto et al., 1979; Pang, 1985). The
hippocampus although important for recent memory (i.e.,
facts that are presented or events that occur after the
onset of damage-anterograde, Nissen, 1986), has connections/
circuits with other types of memory, as well.
ggmory Functioning in Non-Brain Injured Individuals

Multiple Stores Theory

When considering normal memory functioning the multiple
store theories would be appropriate. These theories
postulate that there are two or more functionally different
types of memory systems (Howard, 1983; Reynolds & Flagg,
1977). The two different types of memory storage, consists
of one that is transitory, and the other, permanent. The
two major types of memory are short term memory, also known
as working memory, and long term memory, or reference memory
(Howard, 1983; Reynolds & Flagg, 1977; Somjen, 1983). The
function of STM is thought to be where information is
ititially held, however, remaining there anywhere from a few
seconds to 1-2 minutes. This memory has a small capacity,
being able to accommodate a maximum of seven items, plus or

minus two, at any given time (SomUen, 1983). To retain

information at this level it must be actively rehearsed.
Long term memory possesses an extremely large capacity
of memory traces. Somjen (1983) decribes memory traces as
the elementary form of information storage in the brain.
These memory traces are more difficult to acquire than those
of STM, however once obtained, are sustained for a
indefinite amount of time, perhaps the lifespan of the
individual. When information in LTM can not be readily
retrieved, it is not a result of the memory trace fading,
but rather access to it may be hindered. LTM acts as an
enormous warehouse that stores all that one knows, ranging
from vocabulary to the content of various life experiences.
When the information from the sensory store is matched, the
meaning or ”name" associated with the LTM represents a
transfer to STM; however information may go directly to LTM.
Howard (1983) discusses a memory system that consists
of three stores, in which STM as described aboved is broken
into two parts, sensory registers and working (i.e., STM)
memory, and LTM. At any one time many stimuli impinge on
one’s sensory organs, with these representations residing
briefly in the sensory registers. It is assumed that each
of these representations automatically contacts a place in
long term memory where information about the stimulus is
housed. It is thought that part of the LTM representation
of an item is automatically contacted whenever that item is

placed in the sensory register, but we do not assume that a

permanent record of that occurrence is stored in LTM. New
information is only stored permanently in LTM, if further
attention is given to the item.
Neurophysiological Bases of Memory

There are many theories that attempt to explain the
storage of memory traces. It has been suggested that there
are neurophysiological differences between STM and LTM.
With STM, a form of electrical activity among neurons occur
(Reynolds & Flagg, 1977). However, LTM due to its longevity,
seems to involve either structural changes among neurons
(e.g., new interconnections are developing) or the formation
of new chemical molecules, or both. Somjen (1983) discusses
various theories of memory trace formation, with the two
most recent ones being discussed.
Theories of eeuipotentiality‘and of mass action

Somjen (1983) addresses Lashley's search for the engram
(i.e., memory trace) in experiments in which various parts
of the cerebral cortex of animals were surgically removed.
The animals were tested for three behaviors: 1) retention
of habits learned before the animal’s operation; 2) their
ability to re-learn what they appeared to have forgotten;
and 3) their ability to learn new tasks. It was concluded
that memory function is disturbed in proportion to the
amount of cortx destroyed, irrespective of which part of the
cortex had been removed. As far as learning was concerned,

it was thought that all parts of the cortex were equipotent,

with the exception of the visual cortex.

Instead of localized storage of memory traces, Lashley
proposed a new concept. He agreed that recall entails
reactivating a previous pattern of neuronal excitation.
However, he argued that the pattern representing any one
memory could be evoked not in just one specific set of
neurons. Lashley believed that many sets in many places
could be evoked, and perhaps anywhere in the areas of the
brain that have to do with memory function.

Theories of chemical coding

It has been proposed that the experiences acquired by
an individual could be stored in the brain in ways similar
to that by which the experiences of the species are laid
down in genetic information in cell nuclei, out of which
grew the theory of encoding memories in the structure of
macromolecules (Somjen, 1983). The nucleic acids or
proteins were the only molecules that could serve as
chemical encoders due to their size and structure.

Somjen (1983) notes that if this theory were true many
secondary problems would arise. For instance, how would the
sensory information which is originally encoded in neuronal
signals be translated into the chemical code and how would
memory traces stored in chemical form be re-translated into
neuronal signals when they were recalled? Moreover, would
all the information one has learned be stored in all the

neurons of the brain, or is learning domain of specialized

10

cell groups? Are certain kinds of memories stored in
specific types of neurons? Many experiments have been
conducted to attempt to answer these questions. However,
this issue has remained unresolved.

In summary, for what is known today, it is not possible
to determine whether all forms of learning depend on
variants of a single kind of elementary biophysical or
biochemical change, or whether there exists several

basically different mechanisms of memory trace formation.

Memory and CH1

One major neuropsychological impairment demonstrated by
CHI individuals, which has been well documented is that of
memory deficits (Adamovich et al., 1985; Arnett & Corrigan,
1986; Auerbach, 1983, 1986; Baggerly, 1986; Brooks, 1972,
1974, 1976, 1983; Brooks et al., 1980; Evans, 1981;
Fodor, 1972; Glasgow et al., 1977; Gloag, 1985; Hagen, 1981;
Mandleberg & Brooks, 1975); McMillan & Glucksman, 1987;
Pederson, 1986; Richardson, 1979; 1984; Schacter & Crovitz,
1977; Thomas & Trexler, 1982; Violon & DeMol, 1987).
Closed head injury patients demonstrate difficulty with
remembering new information. In fact, the most apparent
memory deficit in the severely brain-injured individual is
the extreme difficulty encountered in retaining new
information (Arnett & Corrigan, 1986; Nissen, 1986). Pang
(1985) and Somjen (1983) both noted that although new
information is correctly perceived, it can not be stored
beyond immediate use. This deficit was interpreted as an
inability to transfer information from short term to long
term memory, that is, to consolidate memory traces. It was
also reported that the most prominent memory deficits are
the loss of the ability to recall numbers, events, and names
several minutes after learning them (Somjen, 1983), although

immediate retrieval is generally possible (Pang, 1985).

11

12

Violon & DeMol (1987) investigated the memory
functioning of CHI patients, as assessed by the Rey's 15
words test. Although no description of this test was
provided to assist in determining what the task entailed,
these researchers found that the memory functioning was
altered in 64% of CHI patients during the first weeks
following the trauma. At six months post-injury, memory
remained impaired in 48% of the cases. When considering
those patients who sustained a severe CHI, Violon and
DeMol (1987) reported that none were free of memory
disturbance during the first month. Their data also showed
that five months after the injury, only 6% patients had
normal memory, with only 12% showing normal memory within
the first 2 years, and 21% after 2 years. Also, Pederson
(1986) found that of 252 CHI subjects, 82% had memory
problems. Such staggering data regarding memory
disturbances clearly emphasizes the prevalence, persistence
and magnitude of this deficit.

While Violin & DeMol (1987) and Pederson (1986)
reported that individuals with severe CHI demonstrated
memory problems, Richardson (1979, 1982, 1984) reported that
CHI patients with minor head injuries also present memory
problems. In 1979, he investigated 48 patients diagnosed as
having a minor CHI (i.e. less than 8 hours from trauma to

return of continuous, day-to-day, memory) to determine if

 

13

there was a difference in their recall of concrete and
abstract words. He investigated the use of these two types
of words because he hypothesized that CHI patients were
impaired in their ability to recall common nouns, but that
this was a result of a defect in imaginal encoding.
Therefore, the impairment of memory function should be with
concrete material but not with abstract material. In testing
his hypothesis, Richardson employed a total of 100 nouns.
Fifty of these nouns had imagery and concreteness ratings of
6.0 or above, based on Paivio and associates’ research
(1968), (e.g., alligator, baby); while the remaining 50
nouns had such ratings of less than 6.0 (e.g. answer,
anecdote).

The subjects were presented with 10 lists, each with 10
words. The words were presented at a rate of one every 3
seconds, with 30 seconds given for the immediate oral recall
of each list. Following the recall of the 10th list, each
patient was instructed to recall all 100 words within a
3 minute time limit.

It was found that the CHI the patients showed a
significant reduction in the recall of concrete words when
their responses were compared the control group of subjects.
The normal control group did not perform better than the CHI
subjects with the abstract words, however. The control
subjects showed the normal advantage in the recall of

concrete material over that of abstract material, but the

14

CHI subjects did not. Due to both groups of subjects
performing the same with the abstract words, Richardson
argued that his present investigation failed to find any
suggestion of an impairment in the recall of abstract words
for the CHI subjects. Furthermore, the CHI group showed no
significant difference between the two sorts of material.
It was concluded that the major finding in this study was
thus of a specific impairment in the recall of concrete
words with CHI patients.

Furthering his 1979 investigation, Richardson (1984)
examined the types of errors made by CHI patients when
attempting to recall lists of concrete nouns. He wanted to
determine if the subjects made intrusive errors of words
from previous lists; or if they made phonemically related
errors (e.g., tar for car) or semantically related errors
(e.g., chair for table).

Richardson (1984) found no evidence to support that a
CHI affects the occurrence of either phonemic or semantic
related confusion errors. He did report however, that the
CHI subjects did make intrusive errors. He further noted
that the basis of the intrusion errors of the CHI subjects,
unlike those of the control group, were meg related to the
image evoking feature (i.e., the level of concreteness) of
the such stimulus items.

When recalling words from the concrete lists, the

control group made 58 concrete intrusion errors (i.e., those

15

58 errors were from other concrete lists than the list that
was being assessed at that time), but only 20 of their
intrusion errors were from previous abstract lists. In other
words, the control subjects were recalling more concrete
words, although they were not recalling the correct concrete
words for the appropriate concrete list. When the CHI
subjects recalled the same concrete lists, they made 37
concrete errors, and 46 abstract intrusion errors. That is,
unlike the the normal group who relied on the image-evoking
quality to recall the concrete words (as evident by their 58
errors), the CHI subjects were not attending to the image-
evoking quality that would assist in recalling these
concrete words.

The control group demonstrated a clear relationship
between the concreteness of the list from which an intrusion
error apparently originated and the concreteness of the list
from which the subject was attempting to recall. Findings
for the control group demonstrated that the image-evoking
quality for the noun was the highly salient feature in
deciding whether or not an item was retrieved. However, the
CHI subjects did not demonstrate such an effect. The
concreteness of their intrusion errors was essentially
unrelated to the concreteness of the list from which they
were attempting to recall. Richardson suggests that the CHI
patients do not attend to the concreteness or image—evoking

aspect of the current list in evaluating which items to

It?

(f

16

retrieve.

It was therefore suggested that there may be a
disruption in the CHI patients’ employment of mental imagery
as a form of elaborate encoding in long term memory.
Richardson argued that this might be attributed to a failure
to attend to the image-evoking quality of the stimuli.

An implication of the Richardson research is that the
memory deficit resulting from a CHI might be alleviated if
the image-evoking quality of the stimulus material is
explicitly indicated or enhanced for CH1 patients with
memory problems. Hence, as suggested by Richardson (1984),
although CHI patients may not spontaneuously use imagery
they may be taught to use such a strategy, and thereby
ameliorate their memory problems.

Utilieing Mnempnic Strategies with CHIgpatieQEe

As stated earlier, memory deficits is one of the major
neuropsychological impairments present following a CHI.

What has been less researched, however, is how to treat the
memory deficits that are present in such a way to improve
the functioning of these individuals. Strategies utilized
to facilitate memory range from verbal rehearsal to visual
mnemonics. Glasgow et al. (1977) reported a verbal
rehearsal strategy called PQRST. The acronym represents the
following steps: Preview (i.e., briefly skim the material to
learn for its general content); Question (i.e., ask key

questions relative to the content); Read (i.e., read

17

actively with the goal of answering the questions); §£fl£§
(i.e., repeat or rehearse the information that has been
read); and Tee; (i.e., test oneself by answering the
questions that have been developed). By virtue of its
format, this approach utilizes a rehearsal strategy,
requiring the individual to state aloud what was recalled
about the stimulus material.

Examples of the visual mnemonic approach could be the
keyword and pegword methods. Scruggs et al. (1987) studied
the use of mnemonic facilitation of LD students’ memory for
expository prose. Two experiements were conducted. With
one, the students were seen individually and were read a
passage describing three types of dichotomous information
about eight North American minerals. Such attributes as
hardness (soft vs. hard), color (pale vs. dark), and use
(home vs. industrial) were included. The eight stimulus-
mineral words (and the keywords in the mnemonic condition)
were then presented from a list. The mnemonic pictures
exerted a strong facilitative effect on LD students’
learning of textually embedded science facts.

During Experiment 2, the students were explicitly
instructed to remember specific attributes rather than
dichotomous atttribute classifications. In the mnemonic
condition, a list of 10 rhyming "pegword" (e.g. eee_is 233,
Eye is eeee, etc) was used to represent the Hardness levels

1 through 10. THe instructions indicated that the children

18

would be using ”word clues" (keywords) and "number clues"
(pegwords) to recall speicific hardness-level, color, and
use attributes of eight minerals. Using the mineral
crocoite, the picture included an orange (color) crocodile
(keyword for crocoite) wearing shoes (pegword for Hardness

Level 2) in a display case (used for displays). Also, the

 

materials in the control condition paralleled the mnemonic
materials except that the keywords and pegwords were not
included, and nonmnemonic illustrations were used for
representing each mineral’s hardness level, color, and use.
Results revealed that for all four attribute-memory

tests given, the mnemonic subjects outperformed control
subjects.

In particular, the visual mnemonic strategy has been
applied in a number of different ways with closed head
injury patients. One approach is based on a paired
association strategy in which a patient is required to
generate a visual image of, for example, a the person’s
name. Glasgow, et al. (1977) discussed a case study in which
such a procedure was used with one head injured patient.

The patient was taught to remember names of people from a
list of names that he wanted to remember. The patient wrote
the names on a 3x5 card and three times daily, he read each
name on the list. He also was instructed to visualize the
people as he read the names to be remembered. It was

reported that the patient did note improvement. However,

 

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self-reports were the only measure used to assess the effect
of treatment.

Wilson and Moffat (1984) cite studies in which two
versions of visual imagery were reported to be used
effectively to facilitate memory for names with head injury
patients, as well as with other memory impaired individuals.
The first strategy involved having the patient form a mental
image associated with someone’s name. For example, if the
name Angela Webster was to be learned, the patient would
construct a mental image involving an angel, web, and star
(Wilson & Moffat, 1984). This system has been reported to
have been successfully applied to learning names of staff
and patients by amnestic individuals attending
rehabilitation centers (Wilson & Moffat, 1984). However,
the subject population of this report was not specific, and
the methodology portion provided insufficient information.

Another approach discussed by Wilson and Moffat
requires subjects to image a feature of the person whose
name is to be remembered to assist in the recall of the
name. It is coined face-name association. The method
involves linking a distinctive feature of a person with the
name which is to be mentally imagined (Glasgow et al., 1977;
Wilson & Moffat, 1984). For instance, if the distinctive
feature of Angela Webster was her hair, the image might be
of angel and a star caught in a web, made out of hair.

However, it appeared that certain brain damaged people were

 

11

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20

unable to cope with all the stages of this strategy (Wilson
& Moffat, 1984). Again, however, subject description was
inadequate, making it impossible to discern which brain
damaged people experienced the most difficulty.

With such strategies it must be noted that there are
elements of rehearsal and paired associate learning, as well
as visual mnemonics. These techniques differ on the
reliance of external and self-generated cues.

Wilson (1987) using a multiple baseline across
behaviors design, investigated the use of visual imagery
versus rehearsal with a CHI subject, who was being taught 16
personal names of staff personnel whom he was familiar.
Photographs were taken of the 16 people and paired with line
drawn pictures of mnemonics which represented each name
(e.g., the name Mike may be depicted as a man holding a
microphone). All 16 stimulus names were held in baseline,
and every day or two two new names were introduced, one for
the visual imagery condition, and one for the rehearsal
condition. Recall was assessed after 2 minutes, 30 minutes,
and 24 hours. During recall each of the 16 photographs were
placed before the subject, and he was asked to identify the
person’s name. Any mistakes were corrected but scored as
errors.

The results revealed that the visual imagery condition
was significantly better than rehearsal based on a Wilcoxon

analysis (p < .01). Overall, the subject’s best recall

21

performance was 6 out of 8, and by the final session (i.e.,
session 22), there was a slight decrease to a recall level
of 5 out of 8. In the rehearsal condition, the subject
recalled only 2 out of the 8 names. It should be noted that
the investigator did not indicate which recall results
(i.e., 2 minutes, 30 minutes, or 24 hours) were being
recorded. Furthermore, the multiple baseline across
behaviors design was unorthodox, in that new names were
trained every 1-2 days regardless of whether or not
improvement in the recall of previous names was noted.

Massenberg and Casby (1988) reported two single -
subject multiple baseline studies in which a visual mnemonic
strategy was employed to assist CHI patients’ ability to
remember personal names. The strategy involved presenting a
visual mnemonic of a name which was to be remembered.

The training package for the first subject consisted of
a total of 13 photographs including 5 of the professional
staff, and 8 of contemporary celebrities, while for the
second subject, 15 photographs, 8 and 7, respectively. For
each stimulus photograph a black line figure was drawn which
represented a visual mnemonic for the name of the person.
For example, the name "Claudia" was drawn as a elem and a
gee (bag), and "Therese", as two "trees". This visual
mnemonic was then paired with the respective photograph and
presented to the subject.

During the first three baseline evaluations subject 1

 

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never immediately named more than 2 of the 7 set one names
and no more than 2 of the 6 set two names. He initially
received treatment for the recall of the set one names,
while the second set of names were continued in baseline.

The subject 2 never named more than 1 out of 8 for the
set 2 names, and 1 out of 7 for the set 1 names. The
training package was introduced in a counterbalanced order
(i.e., for subject 2, set 2 first, followed by set 1).

Results showed that both of the subjects made immediate
and steady progress when the treatment was applied to the
the first set of names trained, i.e., staff or celebrity
names. Both subjects made marked gains in each of the first
three treatment sessions with continued improvement
thereafter. While improvement was being made with the
recall of the first set of names trained, the subjects
continued to perform poorly on baseline measurements of
recall of the second set of names. It was not until session
9, when the treatment was applied to the second group of
names, that the subjects showed marked improvement in their
recall. After a five week training period results
demonstrated that both of the subjects had increased their
correct recall of personal names to a level of 92%, and 93%,
respectively for the two subjects.

Memory deficits resulting from a CHI are quite
prevalent and persistent. Memory functioning is affected to

some degree for the majority of the CHI patients.

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23

Considering the magnitude of this problem in the CHI
population, it is unfortunate that there is only a paucity
of clinical research available which addresses treatment of
these memory deficits (Levin et al., 1982). With few
exceptions the treatment studies reported in the literature
demonstrate poor methodology, a lack of empirical support, a
lack of, or poor controls, and no replication data for
single case studies. The memory strategies discussed
generally included elements of rehearsal and paired
associate learning, as well as visual mnemonics, with no
attention to the individual additive contribution of each of
these. Furthermore, little controlled clinical research has
followed-up on Richardson’s suggestion that CHI patients may
be taught to attend to the image-evoking aspect of stimuli
and thus improve there memory. The purpose of this study is
to take into account the aforementioned observations. This
investigator wanted to determine the effect of visual

mnemonic instruction, on the memory of the CHI individuals.

Experiment I

Method

An alternating treatment, single subject multiple
baseline across subjects design was utilized to investigate
the efficacy of a direct instruction based intervention
approach versus a mnemonic based instruction approach when
teaching personal names to patients with CHI.

Subjects
Four adults, who had sustained a CHI, served as

subjects. The ages ranged from 23 - 41 years. The subjects
had no history of previous head injuries or other
neurologically based disorders, as well as no history of
alcoholism or substance abuse as determined by case history
interviews. The subjects were functioning minimally at
cognitive level VI, Ranchos Los Amigos Scale (Hagen, 1981),
and no higher than a cognitive level VII, as confirmed by
the investigator. As can be seen in Table 1, at this level
the patient is able to demonstrate carryover of learned
tasks, and is able to exhibit goal directed behavior,
although still dependent on external input for direction
(Adamovich et al., 1985; Baggerly,1986). Based on the
Functional Communication Measure - Cognitive Communication
(Larkins, 1987), the subjects were at least functioning at a

Level 4 but no higher than a Level 5 (see Table 2 for entire

24

25

scale). The subjects’ range for time since CHI was from 1
year to 12;7 years.

Subject 1 was a 41 year old female who was employed
for 20 years at a major insurance company. She was involved
in an automoblie accident, sustaining a CHI one year prior
to her participating in this study. At the time of the
research, she was currently taking the medication, Tranxene,
3.75 mg. daily, which is a tranquilizer.

Subject 2 was a 23 year old male who also sustained a
CHI secondary to an automobile accident. His accident
occurred 6;3 years prior to participating in this study,
while he was a senior in high school. During the first
eleven training sessions of the research the patient was
taking 800 mg. Tegratol, 300 mg. Dilantin, and 150 mg.
Buspar, all to control seizures. During the twelfth through
sixteenth session his medication regime increased to 1000
mg. Tegratol, 400 mg. Dilantin, and 150 mg. Buspar.

Subject 3 was a 29 year old male. At the time of his
accident, 1;10 years prior to his involvement in this study,
he was employed at a major automotive factory. The
subject’s CHI resulted from his being struck by an
automobile. At the time of the research he was currently on
no mediation.

Subject 4, also a 29 year old male, sustained a CHI at

the age of 17 years. He was a senior in high school, when

26

involved in an automobile accident. At the time of the
study he was taking 25 mg. of Mellaril daily, to reduce
anxiety (i.e., a tranquilizer).

The subjects were given the Boston Diagnostic Aphasia

 

Exammnation (BDAE) (Goodglass & Kaplan, 1983) to assess
language abilities. This test examines the areas of
auditory and reading comprehension, oral expression
including repetition, naming, oral reading, and automatic
speech abilities, paraphasia and fluency, writing, and
recitation, singing, and rhythm. In evaluating the subjects
performance results the BQAE cut-off scores for normal
performance and the percentile ratings based on the aphasic
population were used. Subjects 1 and 3 were found not to
fall below the cut-off for any of the subtests of the BDAE.

Subject 2 fell below the cut-off score in the following
areas (see Table 3 for the total number of subtests that
fell below the cut-off scores): Auditory Comprehension -
Word Discrimination with a raw score of 64 (cutoff score =
67), ranking at the 70th percentile, Animal Naming with a
raw score of 11 (the cutoff score = 12), ranking at the 9lst
percentile, and Comprehension of Oral Spelling, with a raw
score of 5 (the cut-off score = 6), ranking at the 75th
percentile.

Subject 4 fell below the cut-off score for normal
performance for repetition of Low Probability Sentences with

a raw score of 5 (the cut-off score = 6), ranking at the

27

85th percentile, and for Reading Sentences and Paragraphs
with a raw score of 6 (the cutoff score = 7), ranking at the
70th percentile. (See Table 3 for the total number of
subtests that fell below the cut-off scores).

Overall, none of the subjects demonstrated any specific
aphasia syndromes. (See Appendix C for the raw scores and
percentile ranks for all major areas for Subjects 1 through
4, and Appendices D, E, F, and G, for Subjects’ 1 through 4
individual Subtest Summary Profile, respectively).

The Woodcock-Johnson Psycho-Educational Battery
(Woodcock & Johnson, 1977), Memory Cluster subtest, was
given to assess the subjects’short term memory abilities.
This subtest consists of two parts. One requires that the
individual repeat sentences of varying lengths. The second
portion requires one to repeat digits in a reversed order.
Subjects 1 through 4's performance ranged from the 15th
percentile to the 24th percentile (see Table 3).

The Airplane List (Crovitz, 1979) was also used to
assess the subjects’ memory. It consists of a story passage

where throughout, the individual is told to remember a total

 

of 10 words. The Airplane List is based on mnemonic
encoding principles. Recall of the ten words was assessed
immediately, and with a 30 minute delay. As can be seen

from Table 4, Subjects 1, 2, and 3 were each able to recall
four items immediately, whereas Subject 4 recalled two

words immediately after presentation of the story. After

28

the thirty minute delay, recall performance decreased to 2,
0, 3, and 1, for Subjects 1 through 4, respectively.
Crovitz (1979) found that when the Airplane List was given
to non-brain damaged individuals they were able to recall
all ten words in order forward and in reversed order.

Radiological information was available for three of the
four subjects. Electro-encephalography information was
available for Subject 1 revealing left temporal lobe damage.
CT information for Subject 2 revealed no specific site(s) of
lesion, but rather overall cerebral atrophic changes.
Subject 3’s most recent CT scan (within a year of this
experiment) was normal. No such radiological information
was available for Subject 4.

All the subjects were screened for prosopagnosia (i.e.,
the inability to recognize familiar faces). This was done
by having the subjects match color facial photographs of
various individuals in two different poses (i.e. full-face
to profile). All subjects' passed with 100% accuracy. In
addition, each subject passed a hearing screening evaluation
at 25 dB HTL, at 250, 500, 1000, 2000, 4000, and 8000 Hz.
Inquiries were made regarding the subjects’ wearing of

eyeglasses, and if so, they were worn during treatment.

29

Table 1
Rancho Los Amigos Scale of Cognitive Levels and Expected
Behavior Associated with Closed Head Injury

 

Level I No Response Unresponsive to all
stimuli
Level II Generalized Inconsistent, nonpurposeful,
Response nonspecific reaction to

stimuli. Responds to
pain, but response may be

delayed.
Level III Localized Inconsistent reaction di—
Response rectly related to type of
stimulus presented. Re~

sponds to some commands.
May respond to discomfort.

Level IV Confused, Disoriented and unaware of
Agitated present events with
Response frequent bizarre and in-

appropriate behavior.
Attention span is short
and ability to process
information is impaired.

Level V Confused, Nonpurposeful random or
Inappropriate fragmented responses when
Nonagitated task complexity exceeds
Response abilities. Patient

appears alert and
responds to simple
commands. Performs
previously learned tasks
but is unable to learn
new ones.

Level VI Confused, Behavior is goal-directed.
Appropriate Responses are appropriate

Response to the situation with in-
correct responses due to

memory difficulties. More

awareness of not knowing
the correct answer.
Completes previously
learned tasks with
supervision.

30

Level VII Automatic,
Appropriate
Response

Level VIII Purposeful,
Appropriate
Response

Correct routine responses
which are robotlike. More
awareness of self and
others. Appears oriented
to setting, but insight,
judgement, and problem-
solving are poor.

Correct responding, carry-
over of new learning. No
required supervision, poor
tolerance for stress, and
some abstract reasoning
difficulties; more
awareness of deficits

 

Adamovich et al. 1985; Baggerly, 1986
(Scale originally developed by Hagen, C., and

Malkmus, D., 1979)

31

Table 2

FUNCTIONAL COMMUNICATION MEASURE: COGNITIVE COMMUNICATION

Level

Level

Level

Level

Level

Level

Level

0

1

Unable to test
No meaningful cognitive communication

Cognitive communication is limited to brief
episodes of appropriateness with minimal cueing;
client is unaware of deficits

Cognitive communication is functional only for
selected activities with supervision.
Client is aware of deficits with cueing.

Cognitive communication is functional only in a
structured environment; supervision and/or
cueing is necessary for activities of daily
living needs and simple ideas.

Cognitive communication is functional for
activities of daily living, but limited in
complexity; self-monitoring and use of
compensatory strategies are inconsistent.

Cognitive communication is functional in most
situations, although minimal difficulty may
occur,, e.g., complex problem solving, latency
of response.

Self-monitoring/self-correcting are present.

Cognitive communication is normal in all
situations.

(Larkins, 1987)

l>——l

32

 

 

 

 

 

 

 

 

 

 

Table 3. Description of subjecte for Experiment I.
Subjects
: 1 2 4
Age : 41 24 29 29
Sex : F M M M
Post i 1 year 6;3 1;10 12;7
injury : years years years
CT/EEG : left cerebral normal none
: temporal atrophic available
Cognitive: VII VI VII VI
level :
(RLAS) :
WJPEB : 15th 19th 24th 16th
Memory : %tile %tile %tile %tile
Airplane 1 4/2 4/0 4/3 2/1
List :
(0/30 min)
BDAEX : 0 3 0 2

 

(* Indicates the number of subtests below the cut-off scores
for normal performance)

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33

Experimental Design and Procedures

The experimental design was an alterating treatment
multiple baseline across subjects single-subject design.
With this type of design, at least two independent variables
(e.g., intervention approaches) are compared to determine
which is more effective for changing behavior. To control
for order effects, the treatments are administered in an
immediately counterbalanced, or alternating fashion (Kazden
& Hartmann, 1978; McReynolds & Kearns, 1983). The
independent variables for this study consisted of two
intervention approaches for the treatment of the
subjects’recall of personal names: a) a direct instruction
based approach, and b) a mnemonic based approach. The
multiple baserate feature of the design serves to document
that any observed changes in behavior noted are the result
of the experimental intervention; in that the behavior of
interest should change only for that subject who is
receiving intervention.

Materials

The materials consisted of a total of 40 color 35mm
photographs, two each of 20 various adults whom the subject
did not know. Contrived last names were constructed and
randomly assigned to each of the 20 individuals. The last
names were developed so that they consisted of two

syllables, and that for each of the names, the first

34

syllable or entire word was easily represented by a visual
mnemonic. For example, the name Wyner was selected because
of its possibility of being represented with a bottle of
wine. (See Appendix A for the names used). The titles of
Mr. and Ms. were used with the last names.

The first set of photographs were full-face 3/4 poses
of each individual. In the second set of photographs, each
individual was shown in the same pose, while holding an
object that was to serve to represent the last name. The
object served as a visual mnemonic to assist the subject in
associating the person’s name to the mnemonic. For
instance, the fictitious person Mr. Hatfield was
photographed holding a hat. Likewise, Ms. Glassner was
photographed holding a drinking glass, Ms. Keyston, holding
a ring of keys, and so on, for all 20 individuals.

Pre-test and Baseline

Prior to the initial baseline session, each subject was
shown the 20 plain photographs in random order, and asked,
What is this person’s name?". Since the individuals in the
photographs were unfamiliar to the subjects, it was expected
that they would not be able to provide any of the names.
After a subject’s failure to give the person’s name, the
investigator provided the name of the individual, e.g.,

"This is Mr. Hatfield". Following a five-minute break the

 

photographs were once again presented to the subject to

assess recall of the personal names. This pre-test

35

procedure was conducted on two separate occasions within one
week for each subject. On the second occasion the subjects
were once again told the names. Table 4 shows the results
of this pretesting for the subjects.

To determine how many names that non-brain-damaged
individuals would be able to recall, given identical
procedures, six normal adults were told the names of the
people in the 20 photographs. Following a five—minute
delay, they too, were asked to recall the names. Results
revealed that on the first occasion their performance ranged
from 1 to 6 names correctly recalled. On the second
occasion, these individuals were able to correctly recall at
least five names, with the range being between 5 - 10 names

(see Table 5).

36

Table 4. Pretest results for CHI subjects’ ability to
recall personal names

 

Time 1 Time 2
SI O 1
82 0 0
83 O 0

S4 0 0

 

37

Table 5. Results of name recall for non-brain-damaged adults

 

Time 1 Time 2
SI 2 5
82 4 5
83 1 7
S4 4 7
S5 3 10
86 6 10

 

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38

Baseline sessions immediately followed the second
pretesting for the CHI subjects. For the baseline,
the 20 photographs were randomly presented, and
the subject was asked, "What is his/her name?". For
Subjects 1 and 3, three baseline sessions were conducted
within five days, with the criterion for each subject being
that no more than three out of ten of the personal names
could be recalled. The multiple baseline for Subjects 2 and
4 was continued until Subjects 1 and 3, respectively, had
demonstrated appreciable gains in the recall of the names
under either treatment approach, (i.e., minimum recall of
five out of ten items). The multiple baseline sessions for
the Subject 2 and 4 were conducted three times per week.

A plus/minus scoring system was used throughout the
entire experiment. To receive a plus score the subject had
to produce the name exactly correct. For example, if the
subject said, Ms. Glasser for Ms. Glassner or £2;

Lockens for Mr. Lockett, no credit was given.

 

Treatment

 

Treatment sessions were conducted 4 to 5 times a week,
in a private room with the experimenter sitting across from
the individual subject. Half of the names (ten) were
randomly assigned to a direct instruction approach, while
the other half (ten) were assigned to a mnemonic based

instruction approach. There were equal numbers of males and

39

females in each stimulus set. Each training session was
divided into two phases: a) intervention and b) recall. In
the first phase, the subjects received the two intervention
methods (e.g., mnemonic based instruction, or direct

instruction) in an immediately counterbalanced order

 

throughout the experiment. Prior to each training session
the subjects were told that they were going to be seeing
pictures of the investigator’s friends and that they were to
try to remember their names. During the second phase each
subject’s recall of the training items was assessed.

Direct instruction. During direct instruction, each
actual photograph was shown to the subject. The subject was
told that, ”This is (name of person)"., while the photograph
remained for approximately 3 seconds. This instructional
sentence was stated only once. To avoid the effects of
rehearsal, the subject was told not to repeat the person’s
name. The experimenter then proceeded to the next
photograph. As with the first photograph, the subject was
informed that, " This is --". This type of direct
instruction occurred for each of the ten photographs in this
set. During direct instruction, providing the personal name
for each individual in the photograph was the only
information given to the subject. Once direct instruction
was provided for each of the ten photographs, the
photographs were randomized and the procedure was repeated a

second time. Hence, for each session each subject was

40

presented with the stimuli twice, for a total of 20 direct
instruction trials.

Mnemonic Instruction. During mnemonic instruction, the
subject was presented with both the plain photograph of the
individual, and the photograph depicting of the visual
mnemonic. For example, with the personal name Mr. Hatfield,
the visual mnemonic for this individual was a "hat". The
investigator stated, "This is Mr. Hatfield. Each time you
see this (with the examiner pointing to the actual picture)
picture (actual) of him, I want you to think of him holding
the hat". This teaching instruction was stated once, and
the subject was not allowed to respond or repeat (i.e.,
rehearse). Each of the ten personal names assigned to this
type of instruction were taught in the same manner. This
same procedure was immediately repeated after instruction of
the tenth stimulus word. Consequently, each subject was
presented with the stimulus items twice during mnemonic
instruction, for a total of 20 mnemonic instruction trials
per session. As with direct instruction, training stimuli
were presented in random order.

After the first phase of each intervention session, the
subject was engaged in a mental manipulation task, such as
counting backward from 100 aloud. In addition, the subjects
were engaged in conversation relative to the day’s events,
for 5 minutes. This was done to ruleout the possibility of

rehearsal.

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41

Recall Procedure. The recall phase of each session
immediately follwed the five minutes of unrelated activities
mentioned in the preceding. In the recall phase of each
session the investigator presented each of the 20 plain
photographs of the stimulus items in random order (i.e., ten
from direct instruction and ten from mnemonic-based
treatment), and the subject was asked, "What is his/her
name?". The investigator noted the correctness of the
subject's responses, keeping a separate record of those
items trained under direct instruction versus those trained
via mnemonic instruction. No positive reinforcement was
used throughout treatment.

Subject 2 remained in baseline until Subject 1
responded correctly to a minimum of five out of ten of the
stimuli in either the direct instruction or mnemonic-based
instruction. The training sets and order of intervention
were counterbalanced with Subject 2. That is, the set of
personal names trained first via direct instruction for
Subject 1 was now trained with the mnemonic approach,
followed by training of the first set of personal names.
Except for the necessary counterbalancing, the procedure and
training conditions remained the same as they were with
Subject 1. Additionally, Subject 3’s training replicated

Subject 1, and Subject 4’s training, that of Subject 2.

42

Reliability

One unbiased judge recorded the subjects responses
while reviewing an audiotape or a videotape of sessions,
once weekly, throughout treatment, and compared her responses
with those of the experimenter. The judge scored the
accuracy of the subjects’ abilities to remember the personal
names, during the recall phase of each treatment session.
Reliability agreement was 99.5%, which was calculated as
agreements divided by disagreements plus agreements,

multiplied by 100.

Results

Figures 1 and 2 depict the number of names recalled
during baseline sessions, and the recall phase of each
training session for the four subjects. Pretest data are
contained in Table 4. Results of pretesting and baseline
measures clearly demonstrate that the subjects had
difficulty in recalling the personal names employed. As can
be seen in Table 4, only one subject was able to provide
one of the names during pretesting in which the names were
introduced. As also can be seen, in Figures 1 and 2, when
baseline sessions were initiated none of the subjects
recalled more than one name from either stimulus set.

After the third baseline session, treatment for Subject
1 was initiated for the stimulus names, while Subject 2
remained in baseline. The initial effects of treatment can
be compared to Subject 1’s baseline sessions, and to Subject
2’s continued responding in baseline. With the institution
of treatment, Subject 1’s recall increased to five out of
ten items during the first training session for the mnemonic
based instruction; this compares to an increase of one item
under direct instruction. Subject 1 continued to
demonstrate better performance with mnemonic instruction,
although with each treatment session the difference between

the two treatment approaches became less apparent, and by

43

Figure 1

(Subjects 1 and 2)

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44

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46

the tenth training session she was recalling items in both
mnemonic instruction and direct instruction with 100%
accuracy.

Following her successful treatment, Subject 1 was
followed-up once a week for three weeks with only the recall
phase (i.e., no treatment) to determine if she could
maintain a similar level of recall performance following
training. It was found that her recall of personal names
receiving the mnemonic based instruction ranged from nine
out of ten during the first follow-up session, but increased
to 100% for both the second- and third- week follow~up
sessions. She also demonstrated continued high levels of
recall of those names for which she received direct
instruction (see Figure 1).

Subject 2 was held in multiple baseline until Subject 1
had attained at least 50% recall in one of the instructional
modes. As shown in Figure 1, Subject 2 demonstrated
consistently low recall throughout the multiple baseline.
However, his performance during treatment was sporadic, and
he never recalled more than three names in any one
condition. Initially, Subject 2 was making slow but
continuous gains with mnemonic instruction as opposed to
direct instruction (see sessions five through seven in

Figure 1). However, during the eighth training session his

47

recall for those items receiving direct instruction was
slightly better than his recall of mnemonic based
instruction items. During the ninth session he performed
equally poor with both the mnemonic instruction and direct
instruction approach, having only one correct recall from
each. During the tenth through the thirteenth session,
Subject 2’s recall was only slightly better as a result of
direct instruction. During the twelfth through the
sixteenth session Subject 2 could consistently only recall a
total of three personal names for both conditions. It
should be noted that Subject 2’s overall consistent decrease
in performance from sessions twelve through sixteen were
consistent with his having had an increase in his medication
at that time. No follow-up data were collected for Subject
2.

In a manner similar to Subjects 1 and 2, Subjects 3 and
4 were treated in a multiple baseline across subjects (see
Figure 2). During the pretests and baseline evaluations
Subject 3 could not recall any of the names assigned to
either instructional mode. However, when treatment
commenced, his performance increased to three out of ten
correct recall in mnemonic instruction and one out of ten
correct recall of those names receiving direct instruction.
By the fifth session he was recalling five out of ten names
under the mnemonic instruction approach, compared to two

names receiving direct instruction intervention. By the

48

tenth session, Subject 3 was recalling nine out ten names
correct with mnemonic instruction. Although there was a
drastic drop-off in recall across eleven and twelve. He
continued to make steady gains with the mnemonic based
intervention, and during two out of the last three training
sessions (i.e., sessions thirteen through fifteen) continued
to recall nine out of ten names correctly with this
approach. Subject 3’s decline in recall across sessions
eleven and twelve may be attributed to some personal
problems he was encountering at that time.

Subject 3’s best recall with direct instruction was six
out of ten names correctly, which was achieved during
session ten. From the eleventh through fifteenth training
session his performance decreased, ranging from three to
five items correct. During the last three out of four
training sessions (i.e., sessions twelve through fifteen) he
consistently recalled four out of the ten personal names
receiving this type of instruction (See Figure 2). As with
Subject 1, one week after treatment (i.e., session sixteen)
ceased his recall of the names without the training phase
was assessed. Although his performance had decreased, he
continued to perform better with those names which received
the mnemonic intervention approach, recalling six out of ten
names. His follow-up recall of items receiving the direct
instruction intervention was two out of ten correctly

recalled (see Figure 2).

49

Subject 4 was held in baseline until Subject 3 had
demonstrated at least 50% recall under at least one of the
intervention approaches (like Subject 1, that condition was
the mnemonic based intervention). As shown in Figure 2,
Subject 4 demonstrated continued low recall during the
multiple baseline sessions. During the first six training
sessions (i.e., sessions six through eleven) Subject 4 never
correctly recalled more than two items receiving either the
mnemonic based instruction or direct instruction
intervention. It was not until the twelfth session that
Subject 4 demonstrated an increase in performance. From the
thirteenth through the seventeenth session there was a
noticeable difference in Subject 4’s recall of the the
mnemonic based intervention versus the direct instruction
training items, with him demonstrating better recall of
those names receiving the direct instruction treatment. In
summary, Subject 4 did not demonstrate improved recall until
after several training sessions. He also was better able to

recall those names trained via direct instruction.

Experiment II

Given the results of Experiment I, particularly the
unclear performance of Subjects 2 and 4, it was decided to
conduct a second experiment. As with Experiment I, the
second experiment sought to investigate the differential
benefits of a direct instruction or mnemonic based
instruction approach for the recall of personal names. It
differed from the first experiment in that it was a single-
subject multiple baseline design across behaviors, wherein
each individual subject specifically serves as his or her
own control. This is in contrast with Experiment I, wherein
a multiple baseline across subjects design was employed. It
was believed that a multiple baseline across behaviors
design as in Experiment II provided for more control over
subject variables observed in Experiment I (e.g.,
medication, assessed cognitive/linguistic level, time post
injury). For example, during Experiment I, it was found
that Subject 2’s medication regime was markedly different
from that of Subject 1 (who was currently taking 3.75 mg. of
Tranxene daily, to reduce anxiety, i.e., a tranquilizer),
and likewise for Subject 3 (who was currently on no
medication) and Subject 4 (who was taking 25 mg. of Mellaril

a day to reduce anxiety, i.e., a tranquilizer).

50

51

In addition, Experiment II was motivated to assess what
effects the number of training items might have on a
subject’s recall performance. Recall that during Experiment
I, each subject was presented with 10 direct instruction and
10 mnemonic instruction items, for a total of 20, for each
training session. This was felt to be an overwhelming
number of training items for these subjects, particularly
Subjects 2 and 4. Given this concern regarding the number
of training items, Subjects 1 and 3’s gains in treatment
were quite remarkable. Nonetheless, it was of interest to
explore the effects of the treatment protocol when a fewer
number of training items were introduced at one time.

Method
Subjects

Two adults, who sustained a CHI served as subjects in
Experiment II. They will be referred to as Subject 5 and 6.
Subject 5 was a 23 year old male who sustained a blow to the
head, resulting in a CHI, 3 months prior to his
participation in the study. At the time of his injury he
was not employed. His medication regime consisted of 200
mg. of Tegratol daily for seizures. Subject 6 was a 30 year
old female, who was employed as a waitress at the time of
her accident. She sustained a CHI eight months previous to
her participation in the research, as a result of her being

struck by a car. Her medication for the first eight

52

treatment sessions consisted of 1400 mg. of Tegratol and
1000 mg. of Depakote, both to control seizures. During the
ninth through seventeenth sessions the amount of Tegratol
precribed was reduced to 1000 mg., with the amount of
Depakote remaining unchanged.

As with the first four subjects of Experiment I, these
two had no history of previous head injuries or other
neurologically based disorders, and no history of
alcoholism, as determined by case history interviews.
Subjects 5 and 6 were both judged to be functioning at a
cognitive level VI/VII RLAS, or at a level 4/5 according to
the Functional Communication Measure - Cognitive
Communication (Larkins, 1987).

The subjects’ language abilities were assessed with the
Boston Diagnostic Aphasia Examination (BDAE)(Goodglass &
Kaplan, 1983) (see Appendix C for raw scores and percentiles
specific subtests). In evaluating the subjects’ performance
results, the cut-off scores for normal performance and the
percentile ratings based on the aphasic population were
used. Subject 5 fell below the cut-off score in the
following areas (see Table 6 for the total number of
subtests that fell below cut—off scores): For Commands, he
obtained a raw score of 9 (cut-off score = 13), ranking at
the 45th percentile; a raw score of 20, for Responsive
Naming (cut-off score = 27), ranking at the 70th percentile,

Oral Sentence Reading, a raw score of 7 (cut-off score = 8)

53

ranking at the 80th percentile, a raw score of 8 for
Repetition of Words (cut-off score = 9) and 1, for
repetition of Low Probability Sentences (cut-off score = 6),
ranking at the 50th percentile, and a raw score of 9, for
writing Sentences to Dictation (cut-off score = 10), ranking
at the 93 percentile (see Appendix H for Subject 5’s
individual Subtest Summary Profile).

Subject 6 fell below the cut-off score for normal
performance in the following areas (see Table 6 for the
total number of subtests that fell below cut-off scores):
She obtained a raw score of 7 (cut-off score = 8) for her
auditory comprehension of Complex Ideational Material,
ranking at the 65th percentile, a raw score of 6 (cut-off
score = 8) for Oral Sentence Reading, ranking at the 78th
percentile, a raw score of 5 (cut—off score = 6) for
repetition of Low Probability Sentences, a 3 for
Comprehension of Oral Spelling (cut-off score = 6), and a
raw score of 6 (cut-off score = 7) Reading Sentences and
Paragraphs, ranking at the 70th peercentile. (See Appendix C
for raw scores and percentiles for specific subtests, and
Appendix I for the subject 6’s individual Summary Profile
Sheet). Overall, no specific aphasia syndromes were
observed for either Subject 5 or Subject 6.

Also, when using the Bye§_to assess the areas of
Paraphasia and Recitation, Singing, and Rhythm, neither of

the subjects’ performance revealed any deviant behaviors.

54

The Woodcock-Johnson Psycho-Educational Battery
(Woodcock & Johnson, 1977) Memory Cluster subtest was also
given to these subjects. For both, their performance was at
the less than 1 percentile rank. (See Table 6).

When given the Airplane List (Crovitz, 1979), both

 

subjects were able to recall 6 out of the ten names in the
story immediately. After the 30 minute delay, both subjects
recalled four of the words from the passage (see Table 6).
In addition, CT scan information revealed that Subject 5 had
left parietal damage. Subject 6 reported that after she
sustained her CHI, a (frontal) lobotomy was performed, which
was confirmed by her caregivers. Although, no radiological
information was available. Table 6 presents the descriptive
information for the two subjects.

The two subjects were screened for prosopagnosia in the
same fashion as the subjects in Experiment I, and they also
passed with 100% accuracy. Furthermore, the subjects’ also
passed a hearing screening test at 25dB HTL, at 250, 500,
1000, 2000, 4000, and 8000 Hz. Inquiries were made
regarding the subjects’ wearing of eyeglasses. Both

subjects stated that they did not wear eyeglasses.

55

 

 

 

 

 

 

 

 

 

 

Table 6. Description of subjects for Experiment II.
Subjects
I 5 6
Age I 23 30
Sex I M F
Post I 3 8
injury I months months
CT/EEG I left parietal none available
Cognitive: VI/VII VI/VII
level I
(RLAS) I
WJPEB I <1 %tile (1 %tile
Memory I
Airplane I 6/4 6/4
List I
(0/30 min)
BDAEX I 6 5

 

(* Indicates the number of subtests below the cut-off score
for normal performance)

56

Experimental Design and Procedures

The experimental design for Experiment II was a single-
subject alternating treatment multiple baseline across
behaviors design. The alternating treatment aspect of the
design was the same as in Experiment I, in that two
independent variables (e.g., intervention approaches) were
compared to determine the relative effectiveness of each for
improving recall. The treatments were administered in an

immediately counterbalanced, or alternating manner to

 

control for order effects (Kazden & Hartmann, 1978;
McReynolds & Kearns, 1983).

The intervention variables were the same as in
Experiment I (i.e., a) a direct instruction approach, and
b) a mnemonic based approach).

Material

The materials consisted of the same 40 color 35 mm
photographs used in Experiment I. Recall that 20 of the
photographs depicted a full-faced 3/4 view of individual
people, while the second set of photographs consisted of the
same 20 people in similar poses, except for the presence of
an object serving as a visual mnemonic for the person’s

name.

57

Pre-test and Baseline

 

Pretesting and baseline evaluations were conducted in
the same manner as Experiment I. Pretesting results were
such that neither subject correctly recalled more than two
names (see Table 7).

When the recall of Subjects 5 and 6 were compared to
that of the non-brain-damaged individuals reported in
Experiment I (See Table 5), it was apparent that these
subjects demonstrated difficulty in the recall of personal
names.

Baseline sessions immediately followed the second
pretesting for Subjects 5 and 6. For the baseline measures,
the 20 plain photographs were randomly presented, and the
subject was asked, "What is his/her name?". For both
Subject 1 and Subject 2, three baseline sessions were
conducted within five days of one another, with the
criterion being that, for each subject, no more than 30% of
the personal names could be recalled.

As in Experiment I, a plus/minus scoring system was
used throughout the entire experiment.

Treatment

 

Treatment consisted of 5 sessions a week. It was
conducted in a private room with the examiner sitting across

from the individual subject. Of the 20 names, half of the

names were randomly assigned to a direct instruction

58

Table 7. Pretest recall results for Subjects 5 and 6.

 

Pretest Recall Results for CH1 Subjects
Time 1 Time 2

81 O 2

S2 1 1

 

59

approach, while the other half were assigned to a mnemonic
based instruction approach. For purposes of the multiple
baserate across behaviors design, those ten names randomly
assigned to the direct instruction approach were further
divided, with five of them being randomly assigned to
initial intervention and five being assigned to the multiple
baseline. In a like manner, those ten names assigned to the
mnemonic based instruction approach were further divided
into sets of five; one set for initial intervention and one
set for the multiple baseline.

Each training session was divided into two phases, a)
intervention and b) recall. Just as in Experiment 1, during
the first phase, the individual subjects received the two
intervention methods (e.g., mnemonic based instruction, or

direct instruction) in an immediately counterbalanced order

 

throughout the experiment. Prior to each training session
the subjects were told that they were going to be seeing
pictures of the investigator’s friends and that they were to
try to remember their names. During the second phase each
subject’s recall of the training items was assessed.

The randomization that occurred to determine which set
of ten names would be trained first was such that for
Subject 5, the names he correctly recalled during baseline
sessions were trained second. This was done to observe the
subject’s recall performance when starting with a 0 baseline

score (see Figure 3). To accomodate counterbalancing,

60

Subject 6 was first trained with those ten personal names
held in baseline for Subject 1, which were the Set 2 names.
Subject 6’s recall of the Set 2 names during baseline
sessions revealed a total of no more than a total of one
name being correctly recalled (See Figure 4).

Direct instruction in Experiment II remained the same
as in in Experiment I except that now fewer items were being
trained at once. That is, with this Experiment only five
items were trained initially, as compared to all ten names
being trained at once in Experiment I.

The mnemonic instruction procedure also remained
unchanged from Experiment I, except for the fact that fewer
items were trained at once, as explained in the preceding
for direct instruction.

During the recall phase of each session the
investigator presented each of the ten plain photographs of
the stimulus items in random order (i.e., five from direct
instruction and five from mnemonic-based treatment), and the
subject was asked, ”What is his/her name?”. Baseline
probes were done each session for both subjects to assess if
a change in baserate was occuring. The items held in
baseline were interspersed with the training items. The
data collecting remained the same as in Experiment I.

The Set 2 names remained in baseline until Subject 1
demonstrated recall of at least three out of the five names

in either the direct instruction or mnemonic based

61

instruction approach. The training sets and order of
intervention were counterbalanced with Subject 2. That is,
the ten names receiving the direct instruction approach were
now receiving the mnemonic based instruction intervention.
Within each instructional mode, the five names that were
assigned to Set 1 were now held in baseline for Subject 2,
and the Set 2 names were trained first, followed by training
of the Set 2 personal names. Except for the necessary
counterbalancing, the procedure and training conditions
remained the same as they were with Subject 1.
Reliability

The reliability procedure remained unchanged from

Experiment I. There was 100% agreement for Experiment II.

62

Results

Subject 5.

 

As shown in Table 8, during pretesting Subject 5 was
able to recall two names; and as can be seen in Figure 3,
Subject 5 was not able to recall any of the names in
baseline for which intervention was first introduced. His
maximum recall of those items held in the multiple baserate
was two for the names to be trained under the direct
instruction approach and one, for those names to be trained
with mnemonic instruction (see bottom graph in Figure 3).
After the third baseline session, treatment for Subject 5
was initiated for the first set of names to be trained, with
the second set of names being held in baseline.

Initially, for Subject 5 during the first training
session for Set 1 names there was no change from baseline in
the recall for the five names receiving either mnemonic
instruction or for the five receiving the direct instruction
approach. During the fifth training session he increased
his recall of names receiving mnemonic instruction to two
out of five and increased his recall of direct instruction

items to one out of five. Continued improvement was

Figure 3

(Subject 5)

63

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noted during the third treatment session, with Subject 5
correctly recalling four of the names receiving mnemonic
instruction, and three of those receiving the direct
instruction based intervention. He performed equally well
with both types of intervention during session eight,
recalling four out of the five names for both approach.

During the eleventh session, Subject 5 demonstrated a
correct recall performance of five out five for those names
receiving the mnemonic based instruction. He continued to
recall four out of the five names receiving direct
instruction. During the twelfth treatment session there was
a decrease by one in his recall for those items receiving
mnemonic instruction. By the fourteenth and fifteenth
session, he consistently demonstrated correct recall of five
out of five of those items receiving the mnemonic
instruction approach. On the other hand, his performance
for those items being trained under the direct instruction
approach reached an asymptote, with his recall performance
of four items correct remaining unchanged from the tenth
training session.

When Subject 5 correctly recalled at least three out of
five names in either training approach for the Set 1 names,
intervention was begun for the Set 2 items being held in the
multiple baseline. This occurred following session six

wherein he first attained a recall of four out of five

65

of the items receiving mnemonic instruction, and three out
of five of the items receiving direct instruction see Figure
3). It should be noted that all the while the Set 1 items
were receiving intervention, Subject 5’s recall of Set 2
items, in the multiple baseline was at a stable low level
(see Figure 3). When intervention was initiated with Set 2
items, steady improvement was seen in the recall in the
recall of those items receiving the direct instruction, as
well as the mnemonic instruction approach (see Figure 3).
During the eighth session, Subject 5 increased his
recall by one name for both the direct instruction and
mnemonic based instruction approach. Sessions eleven
through thirteen revealed an increase in correct recall to
four items for those receiving the mnemonic instruction, now
exceeding his recall for the.direct instruction approach.
By the final two training sessions (i.e., sessions thirteen
and fourteen) his recall for the those items receiving the
direct instruction approach had increase to four correct;
demonstrating equal recall performance with both type of
instructional modes for the Set 2 names.
If one observes Subject 5’s recall performance of the entire
training package, (i.e., the 20 names), by the last two
sessions he was correctly recalling nine out of ten items
trained with mnemonic instruction, as compared to eight out
ten for those receiving the direct instruction training.

Once weekly for two weeks, Subject 5 was followed-up to

66

determine if his performance would be similar when treatment
was no longer instituted. As shown in Figure 3, his recall
performance remained superior with those items receiving
mnemonic based instruction. During both follow-up sessions
he recalled all ten items receiving mnemonic instruction,
and a total of eight names receiving the direct instruction.
Overall, his improvement slightly changed with the mnemonic
instruction approach and remained unchanged with the names

receiving the direct instruction approach.

Subject 6.

During pretesting, Subject 6 was not able to recall
more than one of the 20 names. During the baseline and
multiple baselines her performance remained low. As with
the previous subjects, the effect of treatment for Subject 6
can be compared to her baseline performance, as well as to
her multiple baseline.

To account for the counter-balancing of training
stimuli, training was initiated with the Set 2 names while
the Set 1 names remained in baseline. The fourth session
revealed an increased recall by one to one for the mnemonic
instruction names and continued to do so until the seventh
session in which her performance remained the same, with
three out of five names being correctly recalled. As shown

in Figure 4, Subject 6’s recall for those names being

Figure 4

(Subject 6)

67

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trained with the mnemonic instruction approach continued to
improve, as compared to those receiving the direct
instruction intervention during the ninth through twelfth
sessions. Furthermore, during the eleventh treatment
session, she was correctly recalling all five names receiving
mnemonic instruction.

Despite a decrease with the mnemonic instruction during
the twelfth session, she continued to outperform her recall
performance demonstrated with the names receiving direct
instruction, although in a marginal way. During the last
two training sessions (i.e., sessions fourteen and fifteen),
her correct recall performance increased to a level of
four out of five names being trained with the mnemonics.
Whereas her recall of those items trained via direct
instruction remained at a level of three out of five.

Treatment for the second set of names for Subject 6
(i.e., Set 1), commenced after session six, wherein she
recalled three out of five names correct from the Set 2
names receiving the mnemonic instruction approach. Like
that of Subject 5, the initial treatment session for the Set
1 names revealed no change in performance from baseline
probes, which was 0 correct. Sessions eight and nine
revealed equal recall performance with both types of
instructional modes. Sessions ten through fifteen (except

session thirteen) revealed superior recall performance with

69

those items trained with the mnemonic instruction as
compared to the direct instruction items (See Figure 4).
Overall, Subject 6 demonstrated superior recall with those
items trained with the mnemonic instruction approach.

When examining her overall recall performance for the
entire treatment package, she was recalling nine out of ten
names receiving the mnemonic based instruction approach,
whereas, Subject 6's best recall performance for those names
under the direct instruction approach was seven out of ten
(i.e., session thirteen) and by the fifteenth treatment
session, her recall under the direct instruction was
recalling only five out of the ten names. This subject
clearly demonsrated better learning with the mnemonic based
instruction approach.

Following treatment, Subject 6 was followed-up once
weekly for two weeks to assess her recall of the personal
names when no intervention had been applied. Her recall of
those items receiving the mnemonic based instruction was
better than for those names under the direct instruction
approach. Subject 6 recalled seven out of ten names
receiving the mnemonic instruction intervention compared to
her recall of four out of ten names under the direct
instruction intervention (see Figure 4). During the second
week follow-up, she demonstrated improved recall of the
personal names. Subject 6 could recall a total of eight

names from the mnemonic based instruction approach and six

70

names from the direct instruction intervention. Although
Subject 6’s recall performance decreased overall for both
types of instruction, she continued to demonstrate better
recall for those items receiving the mnemonic based

instruction treatment.

Discussion

 

In general this research demonstrated that both a
direct instruction and a mnemonic based instruction approach
can have an impact on the personal name recall abilities of
some patients with a CHI. Two out of the four subjects of
Experiment I demonstrated improved name recall with mnemonic
instruction, while the remaining two subjects demonstrated
no marked improvement in name recall under either
instructional mode. Additionally, the two subjects of
Experiment II demonstrated relatively better recall of names
which received mnemonic instruction; albiet a marginal
relative effect.

During the initial period of intervention, Subjects 1
and 3 demonstrated better recall of those names receiving
mnemonic instruction as opposed to those receiving direct
instruction. However, at the conclusion of training,
Subject 1 was recalling items in both mnemonic and direct
instruction conditions equally well. Subject 3
demonstrated consistently better recall with the mnemonic
based instruction than the direct instruction approach
throughout the treatment.

As will be presented more specifically later, when
examining the types of errors made by Subjects 1 and 3, it

was found that the majority of their errors on those items

71

72

receiving the mnemonic instruction did contain the mnemonic
itself, although the entire name was not correct. For
example, Subject 1 was observed to initially refer to ”Ms.
Keyston" as "Ms. Keyson". Likewise, Subject 3, was noted to
refer to "Ms. Bellant" and "Ms. Bellum". Under the scoring
procedure employed, these types of responses were considered
incorrect.

Neither Subjects 2 nor 4 demonstrated marked
improvement in name recall for either instructional mode.
These subjects were judged to be functioning at a cognitive
level VI (RLAS) (level 4 (FCM)), indicating that both had
more severe cognitive deficits than Subjects 1 and 3. The
assessed cognitive performance of Subjects 1 and 3 was at
level VII (RLAS) (level 5 (FCM)). Furthermore, both
Subjects 2 and 4 were several years post onset (i.e.,
Subject 2, 6;3 years post injury, Subject 4, 12;7 years post
injury), whereas neither Subjects 1 nor 3 were more than
1:10 years post injury. Perhaps such mnemonic instruction
as a type of memory strategy yields better performance with
CHI individuals who are functioning cognitively at or above
a level VII (RLAS) (level 5 (FCM)), or even a level VI/VII
(RLAS) (level 4/5 (FCM)) such as Subjects 5 and 6. However,
Massenberg & Casby (1988) found that CHI individuals
functioning cognitively at a level VI (RLAS) did perform
well with mnemonic instruction when they were less than two

years post injury.

73

Due to the heterogeneity observed with Subjects 1 - 4
relative to years post injury, and assessed cognitive
functioning, it was decided that instead of an alternating

treatment single-subject multiple baseline across subjects

 

design, an alternating treatment single subject multiple

baseline across behaviors design would better address these

 

dissimilarities. Hence, Experiment 11 utilized the latter
design.

In addition, with Experiment II, the number of items
trained at one time was reduced, since the number of
training items presented during Experiment I (i.e., 20) was
thought to present more of a problem for Subjects 2 and 4.
It was recognized that with the smaller number of training
items introduced at one time, there would be less room for
the subjects to demonstrate learning, and as such, the
results of Experiment II should be interpreted with some
degree of caution.

Both Subjects 5 and 6 demonstrated overall gains in
recall of names when treatment was introduced, notwith-
standing the smaller number of items trained. Both subjects
demonstrated a trend for better recall of personal names
receiving the mnemonic based instruction as compared to
those receiving the direct instruction approach. By the
last two training sessions, Subject 5 was recalling nine out
of ten items receiving the mnemonic instruction (combined

results for Set 1 and Set 2). The only name incorrectly

74

recalled from those items receiving the mnemonic instruction
was Mr. Beerson, whom Subject 5 generally referred to as Mr.
Beepster. This demonstrated that in fact he did utilize the
mnemonic (i.e., a can of beer) for that personal name.
Interestingly, during the follow-up sessions for Subject 5,
this name was correctly recalled.

Subject 6 also demonstrated better recall of items
receiving the mnemonic based instruction as opposed to the
direct instruction. When considering the total recall of
items, Subject 6 was recalling nine out of ten items correct
that received the mnemonic instruction, during the last two
training sessions. She correctly recalled seven, and then
five out of ten of those items receiving direct instruction
during the last two training sessions, respectively. During
follow-up she recalled seven and then eight of the combined
sets of training names correctly that received the mnemonic
instruction, compared to four, followed by six items of the
combined direct instruction training sets correctly
recalled.

Subject 6 demonstrated similar types of errors during
recall of the mnemonic instruction items as Subjects 1, 3
and 5, in that the portion of the name represented by the
mnemonic was correctly recalled, although the entire name
was not produced correctly. For example, early in
treatment, the subject referred to Ms. Wiggins as Ms. Wiggy.

It was also noted, that this subject correctly recalled Mr.

75

Lockett from the second through the ninth training session.
However, the remaining three sessions she referred to him as
Mr. Lockens. It was interesting however, that during the
one- and two~week follow-up sessions, she correctly recalled
this name.

When examining the types of recall errors made by
Subjects 1, 3, 5 and 6, 91% of the errors made contained the
correct mnemonic when recalling those items receiving
mnemonic instruction, although the entire name was not
correct (e.g., Ms. Combreak for Ms. Combrink). As mentioned
previously, these type of responses were considered as
incorrect under the scoring system used. Had a
multidimensional scoring system been employed wherein
partial credit was given for certain responses, a higher
score would have been yielded for these subjects. Errors
made during direct instruction did not have such a mnemonic
aspect. Interestingly, only 12% of the errors which
occurred during direct instruction could be similarly
interpreted as mnemonic based. Also, the recall attempts of
the two subjects who demonstrated low gains in either
mnemonic instruction or direct instruction, very seldom, if
ever, demonstrated a mnemonic bases. This type of error
analysis, in concert with Subjects 1, 3, 5, and 6’s relative
improved recall of mnemonic based items, demonstrates that
these subjects did indeed incorporate the visual mnemonic

strategy into their attempts (correct and incorrect) at

76

recalling names receiving mnemonic based intervention.

Reviewing the data from all six of the subjects, it
appear that those subjects judged to be functioning at
cognitive level VI/VII to VII (RLAS) (Level 4/5 to a Level 5
(FCM)) demonstrated the most gains from either the mnemonic
based instruction or the direct instruction. When comparing
the relative effects of the mnemonic instruction to that of
the direct instruction approach, the data seem to
demonstrate a trend that mnemonic based intervention leads
to better recall performance.

The population of CHI is very heterogeneous with
regards to age of onset, site and extent of lesions,
following neuropsychological deficits, as well as times
since injury and initiation of a particular intervention
approach. The subjects in Experiment I and II certainly
reflect this hetergeneity with respect to these areas. As
was found in Experiments I and 11, not all subjects perform
similarly relative to treatment. However, four subjects
(i.e., Subjects 1, 3, 5, and 6) demonstrated improved name
recall relative to baseline performance and relative to
multiple baselines. Additionally, there appears to be a
relative effect of mnemonic based instruction over that of a
direct instruction approach.

This research examined the effects of mnemonic
instruction versus direct instruction on the recall of

personal names in CHI subjects. With four subjects (i.e.,

77

Subjects 1, 3, 5, and 6) there was a trend for their recall
of personal names to be better when trained with a mnemonic
based instruction. Two subjects (i.e., Subjects 2 and 4)
did not demonstrate marked gains with either instructional
mode. Subjects 2 and 4’s reduced cognitive functioning
(i.e., level VI, RLAS, (level 4, FCM)) paired with the
amount of time post injury (i.e., 6;3 years and 12;7 years,
respectively) may account for their reduced learning
ability.

The results of this research seem to suggest that
mnemonic based instruction yields better recall of personal
names with CHI individuals that are less than 2 years post
injury. Further studies need to investigate the utility of
a multidimensional scoring system. Such a system may reflect

a higher overall level of recall performance.

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APPENDICES

Appendix A

Personal Names

Females
1. Ms. Wyner
2. Ms. Lightsie
3. Ms. Keyston
4. Ms. Rosen
5. Ms. Lacy
6. Ms. Bellant
7. Ms. Glassner
8. Ms. Penrod
9. Ms. Wiggins
10 Ms. Combrink
Males
1 Mr. Hatfield
2 Mr. Booker
3. Mr. Shuman
4. Mr. Beerson
5. Mr. Appleby
6. Mr. Roper
7. Mr. Spooner
8. Mr. Lockett
9. Mr. Nutkins

10. Mr. Hartwell

88

(holding
(holding
(holding
(holding
(holding
(holding
(holding
(holding
(holding

(holding

(holding
(holding
(holding
(holding
(holding
(holding
(holding
(holding

(holding

APPENDIX A

a

a

wine bottle)

 

lightbulb)

 

ring of keys)

 

CREE)
piece of lace)
Dell)

drinkingjglass)

 

an ink pen)

a

a

a

a

wig)

 

 

can of beer)

 

an apple)

a

a

a

rope)

§P__00_9.).

combination 1995)

an walnut)

(holding a paper heart)

 

Appendix B

(percentile and raw score/maximum score)

89

APPENDIX B

Performance on the BDAE

 

SUBJECTS
SubtestsI 1 I 2 I 3 I 4
Fluency I I I I
AR I 70 (7/7) I 70 (7/7) I 70 (7/7) I 70 (7/7)
PL I 70 (7/7) I 70 (7/7) I 70 (7/7) I 70 (7/7)
ML I 60 (7/7) I 60 (7/7) I 60 (7/7) I 60 (7/7)
VA I 80 (13/14): 75 (12/14):100 (14/14): 80 (13/14)
Aud. Cp I I I I
WD I 100 (72/72): 70 (64/72): 100 (72/72): 100 (72/72)
B-PI I 100 (20/20): 100 (20/20): 100 (20/20): 100 (20/20)
Com I 90 (15/15): 90 (15/15): 90 (15/15): 90 (15/15)
CIM : 70 (8/12) I 80 (9/12) : 85 (lo/12): 90 (ll/12)

Naming

RN

CN

AN

0. Rdg

WR

OSR

Repet

RW
HP

LP

Auto. Sp

AS

Rec.

100

100

99

90

100

90

90

100

90

80

(30/30):

(114/ :

114):

(22/23):

(30/30):

(10/10):

(10/10):

(8/8) :

(8/8) :

(8/8) :

(2/2) :

100

94

91

90

100

90

80

90

70

8O

90

(30/30):
(109/ I

114):
(ll/23):

(30/30):

(10/10):

(10/10):

(7/8) I

(6/8) I

(7/8) :

(2/2) :

100

100

100

90

100

90

90

95

90

80

(30/30):

(114/ :

114):

(34/23):

(30/30):

(10/10):

(10/10):

(8/8) :

(7/8) :

(8/8) :

(2/2) :

100

100

91

90

90

70

90

85

70

80

(30/30)

(114/

114)

(13/23)

(30/30)

(9/10)

(9/10)

(8/8)

(5/8)

(7/8)

(2/2)

91

Rdg. Cp. I I I I
SD I 70 (10/10): 70 (10/10): 70 (10/10): 70 (10/10)
WR I 80 (8/8) I 80 (8/8) I 80 (8/8) I 80 (8/8)
COS : 100 (8/8) I 75 (5/8) I 100 (8/8) I 100 (8/8)
W-PM I 80 (10/10): 60 (9/10) I 80 (10/10): 80 (10/10)
RSP I 100 (10/10): 80 (7/10) I 95 (9/10) I 70 (6/10)

Writg. I I I I
Mech. I 90 (5/5) I 90 (5/5) I 90 (5/5) : 60 (4/5)
SW : 100 (47/47): 100 (47/47): 100 (47/47): 100 (47/47)
P-LD I 90 (15/15): 90 (15/15): 90 (15/15): 90 (15/15)
SP-D I 100 (10/10): 85 (6/10) I 90 (7/10) I 90 (7/10)
WCN I 100 (10/10): 100 (lo/10): 100 (10/10): 100 (10/10)
SD I 100 (12/12): 100 (12/12): 100 (12/12): 95 (10/12)
NW I 100 (5/5) I 90 (4/5) I 100 (5/5) : 90 (4/5)

 

Key: Fluency-- AR = articulation rating, PL = phase length,
ML = melodic line, VA = verbal agility; Auditory
Comprehension-- WD = word discrimination, B-PI = body-part
identification, Com. = commands, CIM = complex ideational

material; Naming-- RN = responsive naming, CN =

92

confrontation naming, AN = animal naming;

Oral Reading-- VR = word reading, OSR = oral sentence
reading; Repetition-- RV = repetition of words, HP = high
probability, LP = low probability; Automatic Speech--

AS = automatized sequences, Rec. = reciting; Reading
Comprehension—- SD = symbol discrimination, VR = word
recognition, COS = comprehension of oral spelling, V-PM =

word-picture matching, RSP = reading sentences and

paragraphs; Vriting—- Mech. = mechanics, SV serial

writing, P-LD = primer-level dictation, SP-D spelling to
dictation, WCN = written confrontation naming; SD =

sentences to dictation, NW = narrative writing.

Appendix C

APPENDIX C

Performance on the BDAE

(percentile and raw score/maximum score)

SUBJECTS

 

SubtestsI 6
Fluency I I
AR I 50 (6/7) I 70 (7/7)
PL I 50 (5/7) I 70 <7/7)
ML I 50 (6/7) I 60 <7/7)
VA I 50 (8/14) I 80 (13/14)
Aud. Cp I I
VD I 100 (72/72) I 100 {72/72)
B-PI I 100 (20/20) I 100 <20/20)
Com I 45 (9/15) I 90 (15/15)
CIM I 90 (ll/12> I 65 <7/12>

94

Naming I I
RN I 70 (20/30) I 100 <30/30)
ON I 100 (114) I 100 (114)
AH I 91 <12/23) I 92 (14/23)
ORdg I I
VR I 78 (24/30) I 83 (27/30)
OSR I 80 (7/10) I 78 (6/10)
Repet I I
RV I 50 (8/10) I 70 (9/10)
HP I 75 (6/8) I 90 (8/8)
LP I 50 (1/8) I 85 (5/8)
Auto. Sp I I
AS I 70 (7/8) I 70 <7/8)
Rec. I 80 (2/2) I 80 (2/2)

95

 

Rdg. Cp. I
SD I 70 (10/10) 70 (10/10)
VR I 80 (8/8) 80 (8/8)
COS I 100 (8/8) 60 (3/8)
W-PM I 80 (10/10) 80 (10/10)
RSP I 80 (7/10) 70 (6/10)
Vritg. I
Mech. I 90 (5/5) 90 <5/5)
SW I 100 {47/47) 100 {47/47)
P—LD I 90 (15/15) 90 (15/15)
SP-D I 85 (6/10) 85 <6/10)
WCN I 100 (10/10) 85 <8/10)
SD I 93 (9/12) 99 (ll/12)
NV I 80 <3/5) 80 (3/5)
Key: Fluency-- AR — articulation rating, PL = phase length,
ML = melodic line, VA = verbal agility; Auditory

Conprehension-- VD
identification, Com.
material;

word discrimination,
= commands,

laning-- RN = responsive naming,

B-PI = body-part

CN

complex ideational

96

confrontation naming, AN = animal naming;

Oral Reading-- WR = word reading, OSR = oral sentence
reading; Repetition-- RW = repetition of words, HP = high
probability, LP = low probability; Automatic Speech-—

AS = automatized sequences, Rec. = reciting; Reading
Comprehensione- SD = symbol discrimination, WR = word
recognition, COS = comprehension of oral spelling, W-PM =
word-picture matching, RSP = reading sentences and

paragraphs; Vriting-- Mech. = mechanics, SW = serial

writing, P-LD = primer-level dictation, SP-D spelling to
dictation, WCN = written confrontation naming; SD =

sentences to dictation, NW = narrative writing.

Appendix D

97

SUBIEST SUMMARY PROFILE

 

 

 

 

 

 

 

 

 

 

 

NAME: Subject 1 DATE OF EXAM:
PERCENTILES: 0 IO 20 30 40 SO 60 70 80 90 100
SEVERITY RAIINC o I 2 I I o
ARIICULAIION RAIING I 2 4 S 6 Q
. PHRASI them I I 4 ' o
IIUENCI ’ /‘
MEIOOIC UN! I .' I b .
VIRBAI «CIIIIY ' o 3 a o a “N I4
wow DISCRIMINAIION 0 IS 25 I7 46 5! so e4 67 70
AUDHORY com-mun IOEMIIICAIION o I 5 I0 I I :5 l6 I7 Ia
COMPREHENSION commwos o 4 o 5 I0 I I I I I4 .
COMPux ID€AIIO~AI MAYERIAL 0 2 I 4 s 6 g -/ II I2
RESPONSIVE NAMINC o I 5 I0 IS 20 2c 27 2
NAMINC CONFRONIAHON ~w~c o 9 25 4 I so 72 a4 94 I05
ANIMAI. ummc o I : I I 6 9 0/2)
wono READING o I I 7 I; n 26
ORAL READING
om SENIENCE READING o I z 4 7 9
atmmo~ 06 woaos o 2 s 7 a 9 9
REPUITIO\ MICHI’RIIBABIIIII .I I 3 I I ‘ ‘.
uMJ'IIoII \aum I) : 3 4 o \‘
\(IIIIIIJsm‘ «I In a 4 .‘ ' O '
. IIIIRAI a: I' :: 9 o. 3 I 2 I\ 0
PKRAPHANA
VERBAL 40 23 III IS I.‘ 9 7 4 I I \.
txn~o¢o 75 I2 5 I I o
AUYOMAIIHO Si (NCIS 0 I 2 I 4 6 7
AUTOMAIIC SPEECH 0”
athtmc o I
swam OIscammAnm o 2 s 7 a 9 K
NIT I ' 7
RE ADI N C woao ucoc On: 0 I I I e O\
COMPRIHUHSION 0‘ ORAL SPtluNc o I 4 o 7 O
COMPREHENSION //
WORD-POOL!!! MAICHINC 0 I 4 3 9 ..
IIIAOINC SEVIINCES mo PARAGRAPHS o I 2 I 4 s b 7 \K 9
Manama I 2 3 I 9
sum wmmc o 7 Is 25 I0 II :0 u «I
PflIMfl-ltvu OICIAIION o I 4 6 9 II II N <‘
WRIHNC SPIIIINC. IO OICIAII0~ n I : I 3 r '
WRIIIIN C(NIRUMAIION VAMINC o I 3 I h ° 9 D
Shawls m OICHIIm. o I I a a ‘
VARRAIIVI wanna u I : I 4 .
\IL‘SIC >I~(.I.~c u I

I
RHYYHM O I \C'

 

Appendix E

SEVERITY RATING

FlUE NCY

AUOIIORY
COMPREHENSION

NAMINC

ORAL READING

REPUIIION

PARAPHASIA

IUIOMIIIIC SPEECH

RE ADWC
COMPRLHLNSION

MINING

MUSIC .

98

SUBTESI SUMMARY PROFILE

 

 

 

 

 

NAME: Subject 2 DATE OF EXAM:

PERCENTILES: 0 I0 20 30 40 SO 60 70 80 90 I00
0 I 2 I 4 O

ARIICULAIION RAIINC. I 2 4 s e I

PHRASE IINGIH I I 4 I o

MELOOIC LINE I 2 4 o O<rh

VERBAL AGIuIv o 2 s 6 II 9 '7 II I4

WORD OISCRIMINAIION 0 IS 25 I7 46 SI 60 .w 72

aomwm IDENIIIICAIION o I s 10 II II lb I7 Ia / O

COMMANDS ' o I 4 6 II III II I I I4 / O

COMPLEX IDEAYIONAL MAIERIAL o 2 I 4 s 6 a 0 - II I2

RESPONSIVE NAMINC o I 5 I0 Is 20 24 27

CONERONIATION NAMINC o 9 23 4I 00 72 II4 94 105. II4

ANIMAI NAMING o I 2 I 4 6 9 ' 23

mm READING o I I 7 Is 2I 26 ,\

ORAL SENIENCE READING 0 I 2 4 " 9 0

 

 

 

 

 

 

ammo»: or wonos o 2 I 7 a 9 /'
HICH-PRIIIIAIIIIIII o I .‘ 4 S .\ 8
I()\\.PII(IIIAIIIIIII II I 2 4 0 II
NIOIIKIISIK 40 H) 9 4 .' I .\

IIIUIAI 4? I7 I: 9 o 3 I 2 I O
VLRBAL . 40 2! lo l5 I2 9 7 4 I I
(XIENDIO 75 I2 5 l I '

AUIOMAIIZED SEQUINCES o I 2 I 4 o O a
RICIIINC o I \.

swam DIscnmmAmm o 2 s r a 9 O\

WORD RICOCNIIION o I I 4 S o .' /O
((IMPIIIHENSION Of ORAL SPELIINC. o I I 4 O o ' a
WORD-PICIURI MA'K'HINC o I 4 6 EI . I0

READING SENII~CI5 two PARAGRAPHS o I 2 I 4 s 6 . I I0
MECHANICS I 2 I 4 o\
SERIAL wanmc o 7 III 25 I0 II 40 n 46/ J
PRIMUl-UVH DICIAIION I 4 6 II II II I4 '
Sflumc IO DICIAIION o I 2 I 3 0/? no
WRIIIUI COM RUNIAIION NAMINC o I 2 I 4. ‘ 9\ O
SENIINCES IO DIE'I Huh (I I I o a ‘
NARRAIIVI wmImc o I 2 I Q/ S
SINGING U I

O
IMVIHM' 0 | \..

 

Appendix F

SEVERITY RAIINC

FLUENCY

AUDIIORY
COMPREHE NSION

NAMINC

ORAL READING

REPUITIO‘.

PARAPHASIA

AUIOMAIIC SPEECH

READING
COMPREHENSION

WRIIINC

MUSIC

99

SUBTEST SUMMARY PROFILE

 

 

 

 

 

 

 

 

 

 

NAME: Subject 3 DATE OF EXAM;
PERCENTILES: 0 IO 20 30 40 50 60 70 80 90 I00
0 I 2 I 4 .
ARTICULATION ILAIINc I 2 4 s 6 '
PHRASE LENcm I I 4 s 6 / é
MELOOIC LINE I 2 4 6 O
VERBAL ACILII’Y o 2 6 o 9 N D
woao DISCRIMINAIION o Is 25 I7 46 S] 60 64 67 7o 2
soovmm IOENIIHCAIION o I I I0 II II I6 I7 Io /
COMMANDS 4 6 II Io II I] I4 .
COMPLEX IDEAIIONAL MAIERIAL o 2 4 s 6 a 9 II I2
IIESPONIIVE NAMINC o I I I0 Is 20 24 27 ’
CONFRONYAIION NAMINC o 9 26 4I 6o 22 64 94 I05 0
ANIMAL NAMINC o I 2 I 4 6 9 ‘
WORD READING o I I 7 Is 2| 26 .
ORAL SENIENCE READING o I 2 4 7 9
ILEPmIION o: woaos o 2 s 7 a 9 ’
HICHPRUBAIIIIIII I) I .‘ 4 S ‘ b
IIIw.PIquAIIILIn II I 2 4 «A. a
NIoLocIsnc 40 I6 9 4 2 I o \
LITERAL ' 47 I7 I2 9 6 s 2 I 0
VERBAL 40 2I III II I2 9 7 4 I I \Q
EXIENDED 75 I2 5 I I o
ALIIoMAIIZED SEQUENCEI o I 2 I 4 6 7 d
RECIIINC o I p /
SYMBOL DIICRIMINAIION o 2 s 7 a 9 K
woao RECOGNIIION o I I 4 s 6 7
CDMPIIENENIION 0‘ ORAL SPILUNC o I I 4 6 7 a
WORD-PICIURL MAICHINC o I 4 I, II 9 pf
READING SENIINCEs ANo PARAGRAPHS o I 2 I 4 s 6 7 \0 I0
MECHANICS I 2 I 4 .\
SERIAL wmINc o 7 III 25 I0 II 40 4I 46 /
PRIMERIEVEL OICYAI'ION 0 I 4 6 9 II I I I4 .
SPILLINC IO OICIAIION o I 2 3 \IO
WRIIIEN conoNIAIIoN NAMINc o I 3 I I, .- 9
SINIENCES I0 OICIAIION u I 6 II
NARRAIIVI \SRIIIVC 0 l 1 l I ‘

 

SINLIINL; o I U
RHY INM o I \.

 

Appendix G

SEVERITY RAIINC

FLUENO

AUDIIORY
COMPREHENSION

NAMINC

ORAL READING

REPEIIIIO\

PARAPHASIA

AUIOMAIIC SPEECH

READINC
COMPREHENSION

WRIIINC

MUSIC

100

SUBTEST SUMMARY PROFILE

 

 

 

 

 

 

 

 

 

 

 

NAME: Subject 4 DATE OF EXAM:

PERCENTILES: 0 I0 20 30 40 SO 60 70 80 90 I00
0 I 2 I 4 Q

ARIICULAIION ILAIINC I 2 4 s 6

PflRASE LENGTH I I 4 5 6

MELODIC LINE I 2 4 6 6

VERBAL ACILITY o 2 s 6 II 9 II . I4

WORD DISCRIMINAIION 0 IS 25 I7 46 SI 60 64 67 70 1

momma! IDENIIncAIIoN o I 5 I0 II II I6 I7 I6 .

COMMANDS o I 4 6 I I0 II II I4 ’/

comm IDEAIIONAL MAI’ERIAL o 2 I 4 s 6 a 9 J I2

RESPONSIVE NAMINC o I 5 I0 IS 20 24 27

CONI'RONI'ATION NAMINC o 9 26 4I 6o 72 64 I05

ANIMAL NAMINc o I 2 I 4 6 9 0/21

WORD READING 0 I I 7 IS II 26

ORAL SENTENCE READING 0 I 2 4 7 I0

ILEPEIIIION OF WORDS o 2 s 7 I I0

HICH PIILIBAIIILIII o I 2 4 3 ‘

Low PROD AIIILIIV I) I 2 4 0/ '9 LI

NEOIUCISIIC «I III 9 4 2 I Q;

LIIEIIAL 4: I.- I2 9 6 S I 2 '\ ’\

VERBAL 4o 2) I6 Is I2 9 7 4 I I

EXIENOEO 75 I2 I I I 0

AUIOMAIIZEO SEQUENCES o I 2 I 4 6 0.\ a

«cum; 0 I O

SYMBOL DISCRIMINAIION o 2 S 7 II 9

WORD RECOGNIIION o I I 4 s 6 7 I. .

COMPREHENSION or ORAL SPELLINC o I 4 6 -/7’ ‘

WORD~PICIURE MAICNINC o I 4 6 a 9

READING SENIENCES AND PARAGRAPHS o I 2 I 4 s 7 6 I0

MECHANICS I 2 I O s

SERIAL wmINc o 7 III 25 I0 ”NO

PRIMER-LEVEL DICIAIION o I 4 6 9 II II I4 0

Imun-c Io DICIAIIoN o I 2 I ‘ Lo

WRIIIEN CONE RONIAIION VAMINC o I .‘ I 6 9

SENIENCES IO OICIAIION o I 6 0 I2

NARRAIIVE WRIIINC u I 2 S

SINCINL; I ‘

RHYIHM o I \.

 

Appendix H

SWERITY RATING

flUENCY

AUDITORY
COMPREHENSION

NAMINC

ORAL READING

REPUIIION

PARAPHASIA

AUIOMAIIC SPEECH

RI «DING
COMPREHENSION

II RIIINC

MUSIC

101

NAME: Subject 5

SUBTEST SUMMARY PROFILE

DATE OF EXAM:

 

 

 

 

 

 

 

 

 

 

 

 

PERCENTILES: 0 IO 20 30 40 SO 60 70 80 90 I00

0 I 2 I . s
ARIICULAIION RAIINC I 2 4 s 7
PHRASE lENCIH I I 4 6 7
MuOOIc MN! I 2 4 Q 2
«REAL ACILIIY o 2 s 6 ‘ 9 II II I4
WORD DISCRIMINAIION IS 25 I7 46 SI 60 64 67 7o
BODY-PAR! IOENIIEICAIION I 5 I0 II II I6 I7 III
COMMANDS I 4 6 6 I II I4 IS
COMPLEII IDEAIIONAL MAIERIAL o 2 I 4 s 6 II 9 I2
RESPONSIVE NAMINC o I I I0 Is . 4 27 Io
CONFRONIAIION NAMINC o 9 26 4) 60 72 64 94 I05
ANIMAL NAMINC o I 2 I 4 6 9 Ir 2)
WORD READING o I I 7 Is 2I ‘26 Io
ORAL SENIINQ READING 0 I 2 4 O 9 I0
REPEIIIION or wows o s 7 p 9 I0
NICN.PR0IIAIIILIII I 2 \4_\O ‘ a
[(MPRUBAIIIIIIV o ./’2- 4 6 6
NIOLUCISIIC 40 II. II 4 2 I .\
LIIERAL 4.‘ I7 I2 I4 6 S I 2 I 0
VERBAL 40 2I III II I2 9 2 4 I I \ca
AUIoMAIIzto SEQUENCEI o I 2 I '-4 6 Q\ I
RICIIINC o I ¢
SYMBOI DISCRIMINAIION o 2 S 7 a 9 O\
WORD RECOGNIIION 0 I I 4 S b " O \
COMPRIHENSION or ORAI snumc o I 4 6 7 .
woaoncwRE MAIcNINC o I 4 6 II 9 0/
RI ADINC SINIINCEs AND PARAGRAPHS o I 2 I 4 6 5 6 I0
MECHANICS I 2 I 4 ’ \
SERIAL WRIIINC 7 III 25 10 II 40 4I 46 /’
PRIMER-(EVIL DICIAIION I 4 6 9 II II I4
SPILIINC IO DICIAIION I 2 I 5 ‘ I0
waIIIIN (LINIIIONIAIILIN NAMINC - \

0 I 2 I 6 . 9 /

SINHNCIS IL) oIcIAIIUN 0 I I 6 a 0 I2
NARRAIIVI \VRIIINC, u I : ' ./4 I
swam; u I §
RHYIHM o I \ a

 

Appendix I

SEVERITY RAIING

PLUENCY

AUDIIORY
COMPREHENSION

NAMING

ORAL READING

RIPUIIION

PARAPHASIA

AUIOMAIIC SPEECH

RLADINC
COMWEHEVSION

WRIIING

MUSIC

102

SUBIEST SUMMARY PROFILE

 

 

 

 

 

 

 

 

 

 

 

NAME: Subject 6 DATE or EXAM:

PERCENTILES: 0 IO 20 30 40 SO 60 70 80 90 100
0 I 2 I 4 .

ARIICULAIION RAIINC. I 2 4 S 6

PHRASE LENGTH I I 4 5 6

MLLODIC IINE I 2 4 6 D \

VERBAL ACILITY o 2 S 6 6 9 II . I4

WORD DISCRIMINAIION 0 IS IS I7 46 SI 60 64 67 70 1

600mm" IDENIIEICAIION o I S I0 II IS I6 I7 I6 /

COMMANDS 0 I 4 6 6 I0 II II

COMPLEX IDEAIIONAI. MAIERIAL o 2 I 4 S 6 9 II I2

RESPONSIV! NAMINC I S I0 IS 20 24 27 D

CONFRON‘IATION NAMINC o 26 u 60 72 64 94 Ios ‘

ANIMAL NAMINC o I 2 I 4 6 9| / 2I

WORD RLADINC o I I ' IS II 94 IO

ORAL SENIENCI RLADINC 0 I 2 4 O 7 9 I0

REPEIIIION OF woaos o 2 s 7 6 0 \ Io

HIGH PRLIII \HILIIY II I .‘ 4 S .‘ I

LIM‘I‘ROIIAIIILIII «I I 2 4 0 6 6

VEOLUCISIIC 40 I6 9 4 ,- I \

LIIERAL 47 I7 I: 9 6 I I 2 I .\

vERIIAL 40 2I I6 IS I2 9 2 4 I I .

(X‘ENOEO 75 II S ’ I . ________,————_—-/

AutoMAIIzED SIQLILNCLS o I 2 I 4 6 .\ 6

RtCIIINC o I 9

SYMBOL DISCRIMINAIION z s 7 a 9 Q

WORD RECOGNIIIQN I I 4 S ‘

COMPRLHEVSION OI ORAL SPILLINL'. o I . 4 6 7 6

- \

WORD-PICIURL MAICHINL, o I 4 6 6 9 /

READING StNYINCES AND PARALZRAPHS 0 I 2 I 4 . 7 6 I0

MtCI-IANICS I 2 I 4 k

SERIAL WRIIINC o 7 I6 25 I0 II 40 4I 46 O

PRIMERIIVEI DICIAIION o I 4 6 9 II II I4 /

SPELLINC IO OICIAIION o I 2 I S o 7 IO

wRIIIEN CONFRONIAIION \AMIVC o I 2 I 6 2 fl 9 Le

SINIINCIS IO DICIAIION o I I 6 6 I2

VARRAIIVF WRIIINC 0 I 2 4 S

SINGINLL o I Q

RHY‘IHM o I \ .

 

Appendix J

103

CONSENT FORK

I, . freely and voluntarily
consent to serve as a subject in a scientific study of the
effects of direct instruction (i.e., only being told the
name) and mnemonic instruction (i.e.. being told the name
while being paired with a visual aid) on the recall of
personal names, conducted by Angela R. Massenberg.

 

I understand that the procedures for this study are
experimental. that the duration of the study is for no more
than 16 sessions, and that the results of this study may not
be of direct personal benefit to me.

I understand that I will not be exposed to any experimental
conditions which constitute a threat to my hearing. physical.
or psychological well-being.

I understand that the data gathered from the participation in
this experiment are confidential. that no information
uniquely identified with myself will be made available to
other persons or agencies. and that any presentation of the
results of this research will maintain my anonymity.

I agree to participation in this study freely. without
payment to me or from me. and without implication of personal
benefit. I understand that I may cease participation in the
study at any time.

I agree to allow the experimenter to review my medical
records to obtain information concerning my medical history.

I understand that I may be audio/videotaped and that these
tapes will be used only for research purposes.
Confidentiality will be respected in all situations.

I have had an opportunity to ask questions about the nature
and purpose of the study. and have been provided with a copy
of this written consent form. I understand that upon
completion of the study, and at my request. I can obtain
additional information about the study.

Signature/Date:

 

Guardian/Date:

 

(Relationship)