Wendy Best

• BSc, PG dip, MSc, PhD
• Professor at University College London

Introduction: The majority of adults with acquired aphasia have anomia which can respond to rehabilitation with cues. However, the literature and clinical consensus suggest change is usually limited to treated items. We investigated the effect of an experimentally controlled intervention using progressive cues in the rehabilitation of noun retriev...

Background: In Howard, Best, and Nickels (2015, Optimising the design of intervention studies: Critiques and ways forward. Aphasiology, 2015.), we presented a set of ideas relevant to the design of single-case studies for evaluation of the effects of intervention. These were based on our experience with intervention research and methodology, and a...

Conversation therapies employing video for feedback and to facilitate outcome measurement are increasingly used with people with post-stroke aphasia and their conversation partners; however the evidence base for change in everyday interaction remains limited. We investigated the effect of Better Conversations with Aphasia (BCA), an intervention tha...

Background: There are many validated and widely used assessments within aphasiology. Few, however, describe language and life with aphasia from the perspective of the person with aphasia. Across healthcare, patient experience and user involvement are increasingly acknowledged as fundamental to person-centred care. As part of this movement, Patient...

Purpose: The study investigated the outcome of a word-web intervention for children diagnosed with word-finding difficulties (WFDs). Method: Twenty children age 6–8 years with WFDs confirmed by a discrepancy between comprehension and production on the Test of Word Finding-2, were randomly assigned to intervention (n = 11) and waiting control (n = 9...

Background Current clinical approaches to the treatment of spoken word‐finding difficulties in acquired aphasia encourage multimodal cueing, especially the joint application of written and spoken forms. Research that exclusively examines the effects and mechanisms of written cues is limited, with most studies engaging written forms only as part of...

Background Oral comprehension difficulties are prevalent in preschool children with language difficulties and are frequently the target of speech and language therapy (SLT) intervention. To support the implementation of research to practice, there is a need to identify effective interventions for this population and to describe their components. To...

Psychology embraces a diverse range of methodologies. However, most rely on averaging group data to draw conclusions. In this Perspective, we argue that single case methodology is a valuable tool for developing and extending psychological theories. We stress the importance of single case and case series research, drawing on classic and contemporary...

In this article, the importance of valuing different designs (from single-case experimental designs to randomised controlled trials) in intervention research is explored.

Background: Parent–child conversations form the primary context for language acquisition. This article investigates the role of test questions (TQs) in shaping turn construction opportunities for children with language disorder during conversational remembering with their mothers. Method: Video-recorded data from two mother–child dyads were evaluat...

Background Spoken word retrieval therapy forms an integral part of aphasia therapy. Due to the range of therapy options and variations, drawing clear-cut conclusions from the evidence base can be challenging. Aims This paper consolidates recent findings (2008–2018), pertinent to spoken word-finding interventions. Specifically, we are interested in...

Background: Recent reviews conclude that aphasia intervention is effective. However, replication and implementation require detailed reporting of intervention is and a specification of participant profiles. To date, reviews concentrate more on efficacy than on intervention reporting quality. Aims : The aim of this project is to review the descripti...

Developmental Language Disorder occurs in up to 10% of children and many of these children have difficulty retrieving words in their receptive vocabulary. Such word-finding difficulties (WFD) can impact social development and educational outcomes. This research aims to develop the evidence-base for supporting children with WFD and inform the design...

Purpose: A taxonomy of behaviour change techniques has been developed to help specify the active ingredients of behaviour change interventions. Its potential for rehabilitation research is significant, however, reliable use among allied health professionals has not yet been explored. This article describes the content of a conversation therapy for...

Right hemisphere damage impairs lexical processing, prosodic processing, and discourse and pragmatics. Clinicians and researchers have observed that conversation is a challenging communicative activity for people with right hemisphere communication disorder, but previous studies have yielded inconsistent, equivocal, and marginal results, with few c...

Research into intervention with people with speech and language needs often takes the form of single-case/case series experimental studies (SCEDs) or randomized controlled trials (RCTs). This paper explores the nature of these designs, including their strengths/weaknesses and highlights the value of understanding the intervention outcomes for indiv...

We evaluate the potential of connectionist models of developmental disorders to offer insights into the efficacy of interventions. Based on a range of computational simulation results, we assess factors that influence the effectiveness of interventions for reading, language, and other cognitive developmental disorders. The analysis provides a level...

Background Children's vocabulary knowledge is closely related to other measures of language development and to literacy skills and educational attainment. Aim To use a regression discontinuity design (RDD) to evaluate the effectiveness of a small‐group vocabulary intervention programme for children with poor vocabulary knowledge. Methods & Proced...

Previous research has suggested that learning to read irregular words depends upon knowledge of a word’s meaning and the ability to correct imperfect decoding attempts by reference to the known pronunciations of a word. In an experimental training study, 84 children ages 5–7 years were randomly assigned to an intervention or control group. Children...

Background Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, includin...

Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices...

This paper informs our understanding of the representation and processing of mass and count nouns through an investigation of the underlying causes of mass/count specific impairments in in two people with aphasia, DEH and GEC. The factors influencing the production of mass and count nouns and noun phrases was comprehensi assessed. The results showe...

Background: A recent review of interaction (or conversation)-focused therapy highlighted the potential of programmes targeting the person with aphasia (PWA) directly. However, it noted the key limitations of current work in this field to be a reliance on single case analyses and qualitative evidence of change, a situation that is not unusual when a...

We evaluated a simple computational model of productive vocabulary acquisition, applied to simulating two case studies of 7-year-old children with developmental word-finding difficulties across four core behavioural tasks. Developmental models were created, which captured the deficits of each child. In order to predict the effects of intervention,...

Background: There is a growing body of research that evaluates interventions for neuropsychological impairments using single-case experimental designs and diversity of designs and analyses employed. Aims: This paper has two goals: first, to increase awareness and understanding of the limitations of therapy study designs and statistical techniques a...

Aims: This study evaluated two forms of discrimination therapy for auditory processing impairment in aphasia. It aimed to determine whether therapy can improve speech perception and/or help participants use semantic information to compensate for their impairment. Changes in listening were also explored by recording the level of facilitation needed...

Theories of spoken word production agree that semantic and phonological representations are activated in spoken word production. There is less agreement concerning the role of syntax. In this study we investigated noun syntax activation in English bare noun naming, using mass and count nouns. Fourteen healthy controls and thirteen speakers with aph...

This article reports an intervention in the conversations between a man with chronic aphasia, Barry, and his wife, Louise (both names are pseudonyms). Preintervention analysis revealed the potential of writing as a resource for turn construction. Intervention consisted of enabling Barry to use writing to produce more complete turns at talk, thereby...

This paper investigates the representation of mass and count nouns at the lexical-syntactic level, an issue that has not been addressed to date in psycholinguistic theories. A single case study is reported of a man with aphasia, R.A.P., who showed a countability specific deficit that affected processing of mass noun grammar. R.A.P. frequently subst...

When conducting a speech and language therapy intervention study, one essential focus is the evaluation of outcomes. The therapy itself and its actual delivery, often discussed in the context of treatment fidelity (TF), are aspects which are mostly carried out in the background. According to Cherney et al. (2013), however, TF is an important compon...

Previous studies of therapy for acquired anomia have treated nouns in isolation. The effect on nouns in connected speech remains unclear. In a recent study in 2012, we used a novel noun syntax therapy and found an increase in the number of determiner plus noun constructions in narrative after therapy. Two aims arose from the previous study: to iden...

Abstract The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers wit...

Background: PREVIOUS RESEARCH HAS HIGHLIGHTED PSYCHOLINGUISTIC VARIABLES INFLUENCING NAMING ABILITY FOR INDIVIDUALS WITH APHASIA, INCLUDING: familiarity, frequency, age of acquisition, imageability, operativity, and length (Nickels & Howard, 1995) and a potential link between typicality and generalisation to untreated items in intervention (Kiran,...

Background & aims: A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment whi...

Purpose In this study, the authors investigated whether gesture, naming, and strategic treatment improved the communication skills of 14 people with severe aphasia. Method All participants received 15 hr of gesture and naming treatment (reported in a companion article [Marshall et al., 2012]). Half the group received a further 15 hr of strategic t...

Purpose In this study, the authors (a) investigated whether a group of people with severe aphasia could learn a vocabulary of pantomime gestures through therapy and (b) compared their learning of gestures with their learning of words. The authors also examined whether gesture therapy cued word production and whether naming therapy cued gestures. M...

Cognitive neuropsychology has championed the use of single-case research design. Recently, however, case series designs that employ multiple single cases have been increasingly utilized to address theoretical issues using data from neuropsychological populations. In this paper, we examine these methodologies, focusing on a number of points in parti...

ABSTRACTS This project, run by a speech and language therapist and a clinical psychologist, took place in three inner city day nurseries. A group of children over whose communication there was concern were assessed on both formal (verbal and non‐verbal) and informal (observational) measures. At each nursery these children were divided into two matc...

ABSTRACTS This paper investigates the extent to which operativity and animacy affect naming accuracy in 18 aphasic patients. Both operativity and animacy have significant effects on naming accuracy when confounding variables are not properly controlled. However, with sets of items matched for length, frequency, familiarity, imageability, concretene...

Therapy for agrammatism, once only targeted at surface grammar, has begun to demonstrate the benefits of rigorous theoretically motivated therapy aimed at underlying syntax. Whilst there is evidence that grammatical ability in the clinical setting can be improved by such therapies, it has proved hard to detect carryover to everyday conversation in...

This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [ 1 ] and Best et al. [ 2 ]). In each study, therapy involved cueing with the aim of i...

Background: Phonological and orthographic cues can both be effective in the treatment of anomia, and are often used clinically. However, studies using phonological and orthographical cues in aphasia therapy have tended to be equivocal about their benefits, and most demonstrate improvements limited to treated items. Few previous studies investigate...

We describe MH who presents with agrammatic aphasia and anomia, and who produces semantic errors in the absence of a central semantic impairment. This pattern of performance implies damage to syntactic processes operating between semantics and phonological output. Damage here may lead to lexical selection errors and a deficit in combining words to...

Studies of therapy with people with aphasia tend to use impairment-based and functional measures of outcome. The views of participants are not formally evaluated. Current health and socialcare practice requires intervention to be explicitly client-centred and evidence-based. It is therefore important to investigate the broader effects of speech and...

Semantic TreatmentsLexical TreatmentsOrthographic TreatmentsModels of Single word ProcessingSubject InformationInvestigationsTherapyGeneral DiscussionAcknowledgments

Background: Word‐finding problems commonly occur in aphasia and can significantly affect communication. Assessment of this deficit typically involves naming pictures. However, this method has been criticised as lacking ecological validity. Alternative methods include the measurement of lexical retrieval in narration or conversation, although few pu...

Previous research has shown that word-to-picture matching for targets that cannot be named at pre-test results in improved naming relative to untreated control items for people with aphasia. This paper replicates and extends this finding and investigates its source. Is the effect a result of priming of semantic representations, or of post-semantic...

This paper presents a study of PH, a woman with aphasia, who shows a robust impairment in naming pictures of non-living relative to living things. Un-timed investigations of feature knowledge show similar performance across categories suggesting that, as in previous studies, the category effect may be arising at a post-semantic level. However, her...

When normal participants are presented with written verbal short-term memory tasks (e.g., remembering a set of letters for immediate spoken recall) there is evidence to suggest that the information is re-coded into phonological form. This paper presents a single case study of MJK whose reading follows the pattern of phonological dyslexia. In short-...

Around one-quarter of children attending language support services have difficulty in retrieving words. Therapy studies with such children have shown that both semantic and phonological techniques can improve word finding. A new approach to intervention is described using a computerized aid that converts letters into sound cues. (1) To assess the w...

Background: There are two distinct theoretical positions underlying approaches to aphasia therapy. The first addresses the language impairment directly through tasks designed to improve performance in that language function. This form of therapy was employed in a related study involving the participants reported here (Hickin et al., 2002a). The sec...

Background: Impairments of word retrieval and production are a common and distressing feature of aphasia, and much clinical time is devoted to attempts at their remediation. There are now many research papers devoted to case studies examining treatments for word-retrieval impairments using a wide range of tasks with individuals who have varying lev...

Background: Treatments for word-finding difficulties in aphasia using semantic techniques have been shown to be effective (e.g., Marshall, Pound, White-Thomson, & Pring, 1990). The evidence with regard to phonological treatment is more equivocal, however, with some studies reporting only short-term improvement in word retrieval (e.g., Howard, Patte...

In the literature on repetition priming of word-production in normal participants, long-lasting effects can be found from a single prime. This contrasts with the findings with adults with anomia (as part of their aphasia) where phonological cues, such as first sound or rhyme, have been shown to have very short-lasting effects on word retrieval (Pat...

We present a preliminary report on a study of the treatment of word finding difficulties in aphasia using phonological and orthographic cues. These techniques although often used to cue word finding in the immediate term have been little evaluated in terms of therapy designed to improve word retrieval in the long term. The first phase using cued wo...

The question of whether treatment gains in picture naming generalise to conversation remains relatively unexplored. Several difficulties surround data collection and analysis. A quantitative measure of word retrieval in aphasia is presented along with relevant details relating to the reliability of the measure, and the relationship between word ret...

The question of whether treatment gains in picture naming generalise to conversation remains relatively unexplored. Several difficulties surround data collection and analysis. A quantitative measure of word retrieval in aphasia is presented along with relevant details relating to the reliability of the measure, and the relationship between word ret...

We present a preliminary report on a study of the treatment of word finding difficulties in aphasia using phonological and orthographic cues. These techniques although often used to cue word finding in the immediate term have been little evaluated in terms of therapy designed to improve word retrieval in the long term. The first phase using cued wo...

Language therapy for acquired aphasia has come under much scrutiny in recent years, with debate focusing on whether or not it is effective and how best efficacy can be measured. In this paper, we argue that although the efficacy of many different therapies has been clearly documented, there remain unanswered questions. In particular, it is still di...

This paper presents some preliminary findings from research into the phonological treatment of word-finding difficulties in aphasia focusing on two areas of investigation. Firstly we report on the effects of giving a choice of phonological cues on word-finding. Secondly we describe our findings concerning the reliability of a measure of real-life i...

This paper presents a single case treatment study of a man with dysphasia following stroke. The aim of the treatment was to improve his severely impaired word-finding abilities. Three interventions are described: a pilot study, a semantic and lexical treatment study, and treatment with a cueing aid (see Bruce & Howard, 1987). The pilot study demons...

This paper uses neuropsychological data to differentiate between three models of verbal short-term memory (Baddeley, 1983, 1986; Besner, 1987; Monsell, 1987). The focus is on three tasks: homophone judgments, rhyme judgments and pseudohomophone detection. When lesioned each model predicts characteristic patterns of impairment across these tasks. Th...

This paper provides evidence for the existence of real-word errors phonologically related to targets (formal paraphasias) in the naming attempts of a person with aphasia, MF. In particular, this is the first demonstration that such errors are genuine lexical errors and not jargon homophones (phonological errors that happen to be words by chance; Bu...

This paper presents a series of therapy studies aimed at remediation of the word-retrieval deficits of three aphasic patients. All three patients are argued to have semantic deficits and are given semantic therapy in the form of word-to-picture matching tasks. Two of the patients (A.E.R. and T.R.C.) show improved naming as a result of the therapy,...

When the influence of length on picture naming in dysphasia has been investigated in the past, studies tend to show worse performance with longer items (or no influence of stimulus length). This paper describes a man with dysphasia who is better at labelling pictures with long names than with short names: he demonstrates a reverse length effect. Th...

This paper takes the form of a selective review of studies of therapy for aphasic-naming disorders. There is a bias in the literature towards studies involving the use of semantic tasks (particularly word-to-picture matching) in therapy and therefore this is reflected here. These studies provide clear evidence that aphasic naming disorders can be r...

This paper provides a detailed analysis of the reading performance of an 85-year-old subject with developmental phonological dyslexia. Although her nonword reading was severely impaired, Melanie-Jane read real words with normal latencies and accuracy. Investigation of the factors affecting reading latencies showed that M-J had normal effects of fre...

This paper investigates the extent to which operatively and animacy affect naming accuracy in 18 aphasic patients. Both operatively and animacy have significant effects on naming accuracy when confounding variables are not properly controlled. However, with sets of items matched for length, frequency, familiarity, imageability, concreteness and rat...

This paper reports a longitudinal study of a patient (B.C.R.) who was initially diagnosed as ‘pure word deaf’ (word sound deaf). Her performance, and change over time, on tests of speech perception and environmental sound discrimination are reported. The study demonstrates that recovery of word sound deafness can occur despite the presence of bilat...

This project, run by a speech and language therapist and a clinical psychologist, took place in three inner city day nurseries. A group of children over whose communication there was concern were assessed on both formal (verbal and non-verbal) and informal (observational) measures. At each nursery these children were divided into two matched groups...

Two experiments testing the preference-feedback hypothesis regarding mere exposure Previous investigations have provided evidence for positive (“mere exposure”), negative, and inverted-U functional relationships between familiarity and liking for various categories of stimuli. The preference-feedback hypothesis offers an explanation for these seemi...