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Decreasing and increasing cues in naming therapy for aphasia
Aphasiology
Abstract
Background: Applying a hierarchy of cues is a well-established method in therapy for aphasic naming disorders (see overview in Nickels, 2002b; and Hillis & Caramazza, 1994; Wambaugh, 2003). Usually, cues are used in the increasing direction. Giving assistance as sparsely as possible, the naming of an individual item remains effortful which enhances the chance to recall it later on. But the high opportunity to make errors may be disadvantageous. As an alternative, the method of vanishing cues (see Glisky, 1992), which was designed for treatment of memory disorders, provides as much assistance as needed, thereby helping patients to avoid errors (see Riley & Heaton, 2000). Therefore, this method complies with “errorless learning” (see Baddeley & Wilson, 1994). It is favoured when amnesic patients have to learn new information. In aphasia therapy, the errorless learning procedure may be interesting for patients with severe naming disorders because it prevents them from producing frequent errors. Aims : The purpose of this study was to compare the effectiveness of increasing and vanishing cues for aphasic patients with naming disorders in a 4-week therapy programme. As patients may differ in the underlying mechanism of impairment, we expected a different therapy effect among and within patients. Furthermore, the importance of errorless learning should increase with severity of impairment because of error opportunity. Methods & Procedures : A total of 100 line drawings were selected and split into four sets of 25 items each. The sets were assigned to four conditions: control (no training), vanishing cue, increasing cue, and both-cue condition (training with both methods). Then 20 therapy sessions were ordered according to the alternating treatments design. During treatment, the patient's attempts to name a picture were assisted by a hierarchy of oral cues given by the therapist. Treatment methods differed in order of application but not in the type of cues used. Outcomes & Results : Cueing therapy in general was effective for 8 of 10 patients. Those patients with moderate naming disorders profited less than those with severe naming disorders. Both methods differed among and within patients. However, in contrast to our prediction, we found no patient who improved only under vanishing cues but several who showed positive effects with increasing cues alone or with both, increasing and vanishing cues. Conclusions : Unlike patients with amnesia, patients with aphasia do not seem to be troubled by their errors and may not require the vanishing cue method.
... Researchers proposed that memory impairments limited the ability to filter out incorrect responses. Likewise, errorless learning has been utilized within picture naming tasks to treat anomia in acquired aphasia resulting in gains for PWA that are broadly similar or less than the gains from errorful anomia therapy (see below for an explanation on errorful learning; Abel et al., 2005Abel et al., , 2007Choe et al., 2017;Conroy et al., 2009aConroy et al., , 2009bFillingham et al., 2003;Fillingham et al., , 2006Lacey, 2010;Lacey et al., 2004;Thomas et al., 2012;Mckissock & Ward, 2007;Middleton et al., 2015Middleton et al., , 2016Middleton et al., , 2019Schuchard & Middleton, 2018a, 2018b. In an errorless picture naming task, a person with aphasia is presented with the spoken and written target name along with the stimulus picture and typically asked to immediately repeat the name, sometimes with fading cues. ...
... When comparing errorless to errorful training in anomia therapy, outcomes generally show no difference (Abel et al., 2007;Choe et al., 2017;Conroy et al., 2009a;Fillingham et al., , 2006Lacey, 2010;Lacey et al., 2004). Some studies have reported an advantage of errorful instruction in specific analyses or participants (Abel et al., 2005;Lacey et al., 2004), while other studies have found an advantage for errorless instruction in certain analyses (Conroy et al., 2009b;Mckissock & Ward, 2007). ...
... sometimes equated with learning (see Peñaloza et al., 2022). Studies are emerging that examine the impact of different methods of instruction on rehabilitation outcomes for people with aphasia (Abel et al., 2005(Abel et al., , 2007Choe et al., 2017;Conroy et al., 2009aConroy et al., , 2009bFillingham et al., , 2006Fridriksson et al., 2005;Friedman et al., 2017;Lacey, 2010;Lacey et al., 2004;Mckissock & Ward, 2007;Middleton et al., 2015Middleton et al., , 2016Middleton et al., , 2019Schuchard & Middleton, 2018a, 2018b or examine the relationship between novel learning and outcomes (Dignam et al., 2016;Laganaro et al., 2006;Schuchard et al., 2017;Tuomiranta et al., 2014). However the body of work examining these questions is limited, and systematic methods to identify specific learning deficits in people with aphasia do not exist (Helm-Estabrooks, 2002;Peñaloza et al., 2022). ...
Background: While linguistic deficits are key to diagnosing and treating aphasia, there is growing interest in the cognitive processes important for rehabilitation outcomes, particularly the role of learning. Of relevance to the current study, research has manipulated instructional methods (errorless vs. errorful) to assess their effects on outcomes. However, it is still unclear whether individualized profiles of errorless and errorful learning exist in aphasia and whether they might be meaningful for clinical practice. Aims: The current study aimed to examine learning in people with aphasia, manipulating instruction method (errorless, errorful) and linguistic demands of learning. Methods & procedures: Nine people with stroke-induced aphasia participated in this preliminary study. Participants engaged in error-less and errorful novel object pairing and word retrieval tasks. Learning outcomes were assessed on the same day, next day, and after one week. Participants also completed cognitive-linguistic assessments to investigate the contribution of memory, language, and executive functioning abilities on learning outcomes. Outcomes & results: At the group level, participants performed significantly better following errorful training for novel object pair-ing (p = 0.001) relative to errorless training. An errorful advantage was observed at the individual level in 7 participants during same day testing, with the highest overall performers on the task showing the most persistent errorful learning benefits. In the word retrieval practice task, group and individual-level differences in scores following errorless and errorful practice were minimal. Scores in errorful novel object pair learning correlated with verbal short-term memory and nonverbal long-term memory assessments, while no other correlations were found between learning scores and cognitive-linguistic variables. Conclusions: Findings are consistent with prior research that suggests that successful effortful retrieval may pose an advantage over errorless learning when acquiring novel information and the potential contributions of verbal short-term memory and nonverbal long term memory on learning. Results from the word retrieval practice task draw attention to differences between practicing lexical access
... One study (Thomas et al., 2012) was removed from the comparative effectiveness data extraction because the participant produced more errors during ELess compared to EFul training. Twelve studies compared ELess and EFul (Abel et al., 2005(Abel et al., , 2007Choe et al., 2017;Conroy et al., 2009aConroy et al., , 2009bFillingham et al., 2005aFillingham et al., , 2005bFillingham et al., , 2006Lacey, 2010;Lacey et al., 2004;McKissock & Ward, 2007;Thomas et al., 2012), six studies compared ELess and RP (Friedman et al., 2017;Middleton et al., 2019Middleton et al., , 2015Middleton et al., , 2016Schuchard & Middleton, 2018a, 2018b), and one study compared RP and EFul (Fridriksson et al., 2005; see Figure 2). ...
... Models of lexical access have been applied to explain learning under ELess naming treatment in five studies (Abel et al., 2005(Abel et al., , 2007Middleton et al., 2019;Schuchard & Middleton, 2018a, 2018b. Abel et al. (2005Abel et al. ( , 2007 applied the weight decay model of lexical access (see Dell et al., 1997) to ELess and EFul. ...
... Models of lexical access have been applied to explain learning under ELess naming treatment in five studies (Abel et al., 2005(Abel et al., , 2007Middleton et al., 2019;Schuchard & Middleton, 2018a, 2018b. Abel et al. (2005Abel et al. ( , 2007 applied the weight decay model of lexical access (see Dell et al., 1997) to ELess and EFul. However, they found that a semantic-phonological model of lexical access better aligned with treatment response. ...
Purpose
Increasingly, mechanisms of learning are being considered during aphasia rehabilitation. Well-characterized learning mechanisms can inform “how” interventions should be administered to maximize the acquisition and retention of treatment gains. This systematic scoping review mapped hypothesized mechanisms of action (MoAs) and treatment ingredients in three learning-based approaches targeting naming in aphasia: errorless learning (ELess), errorful learning (EFul), and retrieval practice (RP). The rehabilitation treatment specification system was leveraged to describe available literature and identify knowledge gaps within a unified framework.
Method
PubMed and CINHAL were searched for studies that compared ELess, EFul, and/or RP for naming in aphasia. Independent reviewers extracted data on proposed MoAs, treatment ingredients, and outcomes.
Results
Twelve studies compared ELess and EFul, six studies compared ELess and RP, and one study compared RP and EFul. Hebbian learning, gated Hebbian learning, effortful retrieval, and models of incremental learning via lexical access were proposed as MoAs. To maximize treatment outcomes within theorized MoAs, researchers manipulated study ingredients including cues, scheduling, and feedback. Outcomes in comparative effectiveness studies were examined to identify ingredients that may influence learning. Individual-level variables, such as cognitive and linguistic abilities, may affect treatment response; however, findings were inconsistent across studies.
Conclusions
Significant knowledge gaps were identified and include (a) which MoAs operate during ELess, EFul, and RP; (b) which ingredients are active and engage specific MoAs; and (c) how individual-level variables may drive treatment administration. Theory-driven research can support or refute MoAs and active ingredients enabling clinicians to modify treatments within theoretical frameworks.
... Cueing and feedback encourage a point of interaction between the person with aphasia and the therapist and are crucial to the therapeutic process (Byng, 1995). Cues are used by the therapist to promote accuracy and participation by assisting word retrieval and/or accurate speech production (Abel et al., 2005). Feedback serves to increase the monitoring of production and possibly alter language and/or motor neural representations to encourage self-correction and improved accuracy (Byng & Black, 1995). ...
... Whilst the tasks were varied, the therapeutic inputs in the sessions appeared to be consistent and well-established techniques in relation to cueing and feedback (Abel et al., 2005;Linebaugh et al., 2005). Cueing was the main therapeutic technique observed in this study with an average of 87 cues used by therapists per session. ...
... Phonological cueing followed by semantic cueing were the next most frequently used. However, semantic cueing ranked last in effectiveness in contrast to other evidence about the importance of semantic information for word retrieval (Abel et al., 2005). Phonological cues were as effective as orthographic, visual, and gestural cues. ...
Background: Usual care is the term used to describe everyday practice in the management of a client within a profession. The knowledge of the tasks used in therapy and key therapeutic processes used within these treatments, provides critical information about if and how the therapy works. The Very Early Rehabilitation in SpEech Randomised Controlled Trial (VERSE RCT) had three arms with therapists within the intensive Usual Care-Plus arm (UC-Plus) providing daily direct aphasia therapy at their discretion for 20 sessions.
Aims: To describe usual care aphasia treatment provided in the Usual Care-Plus arm of VERSE RCT.
Methods and Procedures: One in four intensive Usual Care-Plus treatment sessions were video-recorded (N = 187) within the main trial. Twenty-five of these (13%) were transcribed, coded, and analysed for therapeutic inputs to describe usual care aphasia therapy using the Template for Intervention Description and Replication (TIDieR) checklist as an overriding framework.
Outcomes and Results: Therapy predominantly took place in an inpatient setting (52%) with an average session duration of 51 minutes (SD 7.8). Across the sessions, 96 different tasks were used and 57% of these focused on verbal expression at the single word level. Visual materials were most frequently used compared to the use of technology during sessions. Therapists (n = 16) did the majority of the talking during sessions and most frequently provided models as cues or problem-solving accuracy feedback. Models (55%), sentence completion (51%), and orthographic cues (44%) were the most successful at eliciting the target response.
Conclusions: Considerable variability in task selection was seen in the sample which may be a hallmark of usual care. Therapists may have a preference for single word tasks and appear to produce the majority of verbal utterances during sessions, potentially creating an unequal communication environment. This study provided a comprehensive description from the Usual Care-Plus data of the VERSE RCT and may establish a baseline of therapy type for future research.
... and to treat anomia or word-finding difficulties for therapeutic purposes (see Horton & Byng, 2000;Howard et al., 1985;Marshall et al., 1990). Traditionally conceived and explored in neuropsychology (Abel et al., 2005;Morton, 1979), they have more recently been investigated in an interactional and conversation analytic perspective (cfr. Horton, 2008;Merlino, 2017;Wilkinson, 2013). ...
... Other types of cueing 6 (such as syntactic-which is providing a sentence context for the target word) are also considered when the effectiveness of the "hierarchy of cueing" is debatedthat is, which type of cueing should be given first and which last (Nickels, 2002;Wambaugh, 2003). Increasing (from weakest to strongest) cueing is generally preferred to decreasing/vanishing cueing, this latest being generally used to assist patients with severe memory disorders 7 (but see Abel et al., 2005, for a discussion of these alternative hierarchies for treating aphasic naming disorders). The choice of a cueing method or hierarchy is connected with the type of disorder as well as the necessity of avoiding the production of errors, also with reference to the task's difficulty, and with "implicit assumptions of stability in naming performance" (Horton, 2008, p. 988). ...
... In total, 13 patients and 9 speech therapists are included in the data collection. Our study focuses on the organisation of a specific activity -the 6 Abel et al., 2005, list the following increasing cues methods: naming, definition, closure sentence, first sound, first syllable, repetition. 7 The effectiveness of the cueing method might be related to the nature of the underlying psycholinguistic deficit (but assessments about the type of disorder can be problematic, see Rapp & Caramazza, 1993) and the severity of the disorder. ...
This paper investigates aphasia speech therapy as a particular form of institutional interaction dedicated to the recovery of language and communicative abilities in adult speakers. This specific form of social interaction involves both health and pedagogical issues, by presenting features generally observed in instructional settings. The paper investigates these features by focusing on the interactional and sequential organisation of naming activity – that is, the activity of naming a card. Through detailed analyses of participants’ multimodal conduct, it is shown that this task (e.g. producing a specific linguistic item) is collaboratively accomplished. This defends a conception of the therapy as a socially situated and collaborative process, whose dynamics must be investigated taking into consideration participants’ multimodal resources. By focusing in particular on the cueing practices used by the therapist in order to assist the client’s word retrieval and production of the target item, the paper shows that these practices are strictly dependent on the micro-details of interaction, on the client’s audible and visible conduct, and as such are incrementally and locally occasioned. It therefore highlights the active role played by the client in negotiating the assistance needed by the therapist and, more broadly, in co-constructing the therapeutic process.
... Yet, understanding mechanisms and organisation of the healthy brain might help to improve methods that assist language recovery after brain damage (Kleim & Jones, 2008). Therefore, we designed a computer-assisted learning paradigm derived from behavioural treatments for aphasia patients (Abel, Schultz, Radermacher, Willmes, & Huber, 2005;Abel, Weiller, Huber, Willmes, & Specht, 2015). This paradigm was designed to explore training-related changes of brain activation during word production in healthy participants and to be compared with therapy-induced changes of brain activations in patients with aphasia in the future. ...
... Using pseudowords assures avoidance of prior exposure to the material to be learned. Second, it was important for us to implement a standardised training that matches the learning process of healthy participants to (re)learning in aphasic patients as far as possible (Abel et al., 2005(Abel et al., , 2015. Thus, the to-be-learned pseudoword/concept association was new to each participant, mimicking re-learning in aphasia under highly controlled conditions, while at the same time, some phonemic/ semantic similarity to existing words induced confusion in the mental lexicon, mimicking the preservation of some knowledge about the lexical entry in failed word access. ...
... During training sessions, learning was supported by presenting phonological and semantic information about the target item, which served as cues (see Figure 1(a)). Materials and procedures were adapted from speech therapy for aphasic patients (Abel, Schultz, Radermacher, Willmes, & Huber, 2003;Abel et al., 2005Abel et al., , 2015. Both cueing techniques offer stepwise decreasing assistance, and thereby ease immediate word retrieval from the mental lexicon and improve lexical access in the longer term. ...
Background: Re-learning of lexical entries is fundamental to rehabilitation of the common word finding deficits in language disorders after brain damage. Previous studies examined and compared neural correlates of speech production and word learning in aphasic and healthy speakers, but longitudinal control studies were rarely set out to mimic the lexical confusion and therapeutic remediation in aphasia.
Aims: Thus, we aimed to examine functional brain organisation before (familiar word naming), during (learning phase) and after (consolidation phase) standardised training of speech production modulated by aphasia therapy.
Methods & Procedures: During the first functional magnetic resonance imaging (fMRI) measurement, participants were asked to name pictures using familiar words; during learning and in the consolidation phase, they were asked to name pictures using newly acquired pseudowords. To examine differential involvement of brain areas dependent on learning and consolidation success, we followed up activations for finally correctly learned (CoL) items between fMRI measurements, and compared activation during naming of CoL versus finally not learned (NoL) items at each measurement.
Outcomes & Results: Naming accuracy of participants improved significantly. Although performance increase until the second fMRI measurement was minor, brain activation was present for CoL in comparison to NoL items in right hemisphere homologues of fronto-temporal language-related areas in this phase. Comparing learning with consolidation phases for pseudowords, naming CoL items was accompanied by activation in areas related to monitoring and selection between multiple lexical competitors, and in the right posterior middle temporal gyrus. Conversely, activation specific to the consolidation phase, and also to CoL items in that phase, consisted of a widely distributed network involving areas associated with motor, language and consolidation processes. Activation in right supramarginal and left superior temporal gyrus was related to individual learning success.
Conclusions: We were able to demonstrate phase- and performance-dependent activation differences in various areas of the speech production network, which were in part correlated with learning success. The observed similarities to therapy-induced activation changes in aphasia reveal that the novel paradigm is useful in mimicking therapy and may uncover compensatory mechanisms specific to aphasia.
... The cue training was commonly used in standard speech and language therapy (Nickels 2002;Abel et al. 2005;Pohl et al. 2017). Participants saw a picture of an item with a choice of four cues, or the option to name the item with no cues. ...
... The neural bases of successful speech and language therapy have been rarely explored, and those studies that have done so have yielded varying results (Abel et al. 2015;Nardo et al. 2017;Woodhead et al. 2017). The methods adopted in this study were deliberately designed to mimic those used to treat wordfinding difficulties, where patients aim to re-establish meaningful, native vocabulary through multiple learning sessions and vanishing phonemic cues (Abel et al. 2005), over several weeks (Dignam et al. 2016). By using the same paradigm, future studies can explore whether the neural correlates of word learning/relearning in aphasia follows the same framework. ...
The Complementary Learning Systems (CLS) theory provides a powerful framework for considering the acquisition, consolidation, and generalization of new knowledge. We tested this proposed neural division of labor in adults through an investigation of the consolidation and long-term retention of newly learned native vocabulary with post-learning functional neuroimaging. Newly learned items were compared with two conditions: 1) previously known items to highlight the similarities and differences with established vocabulary and 2) unknown/untrained items to provide a control for non-specific perceptual and motor speech output. Consistent with the CLS, retrieval of newly learned items was supported by a combination of regions associated with episodic memory (including left hippocampus) and the language-semantic areas that support established vocabulary (left inferior frontal gyrus and left anterior temporal lobe). Furthermore, there was a shifting division of labor across these two networks in line with the items’ consolidation status; faster naming was associated with more activation of language-semantic areas and lesser activation of episodic memory regions. Hippocampal activity during naming predicted more than half the variation in naming retention 6 months later.
... Die Ergebnisse der bisherigen Studien zum Vergleich fehlerbehafteter und fehlerfreier 1 Methoden in der Aphasietherapie (z. B. Abel et al., 2005;Conroy et al., 2009;Fillingham et al., 2005aFillingham et al., , 2005bFillingham et al., , 2006Machleb, 2019;McKissock & Ward, 2007;Middleton et al., 2015) lassen keinen klaren Schluss darüber zu, ob Patient*innen mit Aphasie von der Vermeidung von Fehlern profitieren. In allen Studien liegt eine Konfundierung der Ergebnisse mit einem Aufgabenwechsel und somit möglicherweise auch mit dem für das Lösen der Aufgabe erforderlichen kognitiven Aufwand vor (vgl. ...
... Die bisherigen Studien zum Vergleich fehlerbehafteter und fehlerfreier Ansätze (z. B. Abel et al., 2005;Conroy et al., 2009;Fillingham et al., 2005aFillingham et al., , 2005bFillingham et al., , 2006Machleb, 2019;McKissock & Ward, 2007;Middleton et al., 2015) können hierzu aufgrund der mit beiden Methoden verbundenen unterschiedlichen Aufgabenstellungen nur begrenzt Aus kunft geben. Die vorliegende Untersuchung stellte daher die Analy se von Fehlern innerhalb einer Aufgabenstellung (Bildbenennen) in den Fokus. ...
... Die Ergebnisse der bisherigen Studien zum Vergleich fehlerbehafteter und fehlerfreier 1 Methoden in der Aphasietherapie (z. B. Abel et al., 2005;Conroy et al., 2009;Fillingham et al., 2005aFillingham et al., , 2005bFillingham et al., , 2006Machleb, 2019;McKissock & Ward, 2007;Middleton et al., 2015) lassen keinen klaren Schluss darüber zu, ob Patient*innen mit Aphasie von der Vermeidung von Fehlern profitieren. In allen Studien liegt eine Konfundierung der Ergebnisse mit einem Aufgabenwechsel und somit möglicherweise auch mit dem für das Lösen der Aufgabe erforderlichen kognitiven Aufwand vor (vgl. ...
... Die bisherigen Studien zum Vergleich fehlerbehafteter und fehlerfreier Ansätze (z. B. Abel et al., 2005;Conroy et al., 2009;Fillingham et al., 2005aFillingham et al., , 2005bFillingham et al., , 2006Machleb, 2019;McKissock & Ward, 2007;Middleton et al., 2015) können hierzu aufgrund der mit beiden Methoden verbundenen unterschiedlichen Aufgabenstellungen nur begrenzt Aus kunft geben. Die vorliegende Untersuchung stellte daher die Analy se von Fehlern innerhalb einer Aufgabenstellung (Bildbenennen) in den Fokus. ...
... In the past 15 years there has been some research work on errorless learning as a treatment method for word finding difficulties in aphasia (e.g. Abel, Schultz, Radermacher, Willmes, & Huber, 2005;Conroy, Sage, & Lambon Ralph, 2009;Fillingham, Sage, & Lambon Ralph, 2005a, 2005b, 2006McKissock & Ward, 2007;Middleton, Schwartz, Rawson, & Garvey, 2015). All studies presumed that both errorless learning as well as the conventional errorful treatment conditions affected the same underlying functional deficits. ...
... The results show that the errorless as well as the errorful treatment approach can both lead to improvements in word finding difficulties irrespective of the underlying functional deficit. On the whole the data replicates the findings that errorful learning methods lead to an at least slightly higher effectiveness in improving naming (Abel et al., 2005;Conroy et al., 2009;Fillingham et al., 2005aFillingham et al., , 2005bFillingham et al., , 2006. But unlike other studies this one has a closer look at the impact of errorless and errorful learning methods. ...
In the past 15 years there has been some research work on errorless learning as a treatment method for
word finding difficulties in aphasia (e.g. Abel, Schultz, Radermacher, Willmes, & Huber, 2005; Conroy,
Sage, & Lambon Ralph, 2009; Fillingham, Sage, & Lambon Ralph, 2005a, 2005b, 2006; McKissock &
Ward, 2007; Middleton, Schwartz, Rawson, & Garvey, 2015). All studies presumed that both errorless
learning as well as the conventional errorful treatment conditions affected the same underlying
functional deficits. Therefore both were expected to improve naming. But whereas some results clearly
count for an advantage of errorless over errorful learning methods in the naming improvement of
aphasics (e.g. McKissock & Ward, 2007), in some studies similar outcomes for both conditions were
found (e.g. Conroy et al., 2009; Fillingham et al., 2005a, 2005b, 2006). The detailed impact of the
treatment approaches remains unclear.
This study deals with the following novel questions: How does errorless and errorful learning methods
affect naming? And when there is no naming improvement, is there no therapy impact at all? On the
basis of a single case series design with a detailed background assessment of every participant it can be
shown that the improvements in naming after errorless learning depend on the individual underlying
functional deficits in each participant. It seems to be important to look close on other linguistic levels as
well as neuropsychological competence to assume effectiveness of either therapy method.
In this study a multiple baseline cross over design with multiple reassessments is used to show how
individually effective both errorless and errorful learning methods can be.
... The second important concern is that repeated probing may itself influence performance. For example, Nickels (2002a) found that for JAW production of items that were simply exposed for naming improved (see also, Abel, Schultz, Radermacher, Willmes, & Huber, 2005;D Howard, Patterson, Franklin, Orchard-Lisle, & Morton, 1985;N. Martin, Fink, Renvall, & Laine, 2006). ...
... A number of researchers adopt the approach of a by-items statistical analysis(e.g. Abel et al, 2005;Best et al, 1997;N Martin, Fink, Laine, & Ayala, 2004), as is conventional and uncontroversial in the field of cognitive neuropsychological case studies not involving therapy. The tests used take advantage of the fact that the same items are usually repeated in each probe. ...
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 and, second, to suggest some designs and statistical techniques likely to produce intervention studies that can inform both theories of therapy and service provision. Main Contribution & Conclusions: We recommend a single-case experimental design that incorporates the following features. First, there should be random allocation of stimuli to treated and control conditions with matching for baseline performance, using relatively large stimulus sets to increase confidence in the data. Second, prior to intervention, baseline testing should occur on at least two occasions. Simulations show that termination of the baseline phase should not be contingent on "stability." For intervention, a predetermined number of sessions are required (rather than performance-determined duration). Finally, treatment effects must be significantly better than expected by chance to be confident that the results reflect change greater than random variation. Appropriate statistical analysis is important: by-item statistical analysis methods are strongly recommended and a methodology is presented using WEighted STatistics (WEST).
... In regard of patient-related factors, which can be described as factors regarding personal characteristics, attitudes and behaviours, dimensions such as the perceived level of confrontation in therapy settings, as well as the experience of exhaustion, lack of interest and lack of time due to the amount of daily activities are factors prohibiting guideline-based therapy. While the effect of increasing or decreasing cueing on word retrieval, semantic, phonological or word type-specific cueing is not understood but well discussed, [40][41][42] the effect on the person performing the task has not yet been discussed beyond the linguistic level: the present results make it clear that the methodological tools of speech therapy and sufficient intervention planning must also include the assessment of possible effects on the patient. Even the contrast between a drill-based and a conversationbased therapy application was conducted at the level of the linguistic, not the motivational outcome, 43 the effects of task difficulty were researched at the level of cortical activation, 44 not hollistically. ...
Objectives
Clinical guidelines recommend high-frequency speech therapy for people with aphasia. Little is known about the experiences of people with aphasia with high-frequency speech therapy, why they do not receive it, what they expect from it and their general wishes and requirements for therapy. The aim of this qualitative study was to investigate the reasons for refusing high-frequency speech therapy and therapy preferences of patients with aphasia.
Design
An interview study with people with aphasia.
Setting
Interviewees were recruited via snowball sampling in different settings of healthcare system (eg, speech and language practices, self-help groups, clinics of neurorehabilitation).
Participants
Twenty-one people with aphasia and one relative participated in semi-structured interviews.
Results
We identified five categories of not using high-frequency speech therapy: patient-related factors, health system-related factors, disease-related factors, social-economic factors and organisational factors. Most reasons for non-utilisation are within the domain of the healthcare system and are partly attributable to personnel shortages in care provision and knowledge deficits among healthcare practitioners. Patient therapy preferences notably pertain to the enhancement of speech therapy services, encompassing sessions both inclusive and exclusive of family members as well as the facilitation of information dissemination.
Conclusions
As expected, there were indications of a lack of staff, poor care in rural areas and the influence of being affected by aphasia for a longer period on utilisation behaviour. These factors in the healthcare system and organisational factors are not unknown to those with practical experience, and some of them must and could be changed quickly. This would require a change from the established face-to-face setting in presence to sufficient digital therapy adjuvants. The results of patient-related factors could be a further reason to reflect on speech therapy and its settings and to view and treat people with aphasia in a more holistic, less language-focused way.
... In terms of the order of presentation, most studies (76%, 28/37) used a hierarchy of increasing cues where later cues are presumed to provide greater specificity of information regarding the target word than earlier cues. A smaller number of studies (25%, 9/37) used a hierarchy of decreasing cues (where cues become less informative), but all of these were studies that systematically examined differences between increasing and decreasing cues (e.g., Abel et al., 2005;Conroy, Sage, Lambon Ralph 2009;). Finally, one study compared the random order of cue presentation with a blocked cueing pattern (Diedrichs et al., 2023). ...
... According to the lexical models of word production, anomia arises from impairment in the semantic or phonological level of word processing or at the connection between these two levels (Dell et al., 2007;Foygel & Dell, 2000;Schwartz, 2014Schwartz, , 2006. Semantic-based and phonological-based treatments of anomia are two standard methods of anomia therapy that focus on semantic and phonological aspects of word retrieval processing, respectively (Abel et al., 2005;Best et al., 2002;Boyle & Coelho, 1995;Conroy et al., 2009;Hickin et al., 2002;Kiran et al., 2013;Leonard et al., 2008;Lorenz & Ziegler, 2009;Lowell et al., 1995;Madden et al., 2017;Nettleton & Lesser, 1991). However, studies have shown that semantic-based treatments affect word form activation and phonological-based treatments influence semantic processing; therefore, both treatments activate all levels of word retrieval processing (Leonard et al., 2015(Leonard et al., , 2008Marcotte et al., 2018;Neumann, 2018;van Hees et al., 2013). ...
The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.
... Effortful retrieval practice (i.e., confrontation naming without cues or other supports) has been shown to produce robust improvements in naming ability for trained words (Middleton et al., 2016). Retrieval practice has also been studied in the context of cueing hierarchies (e.g., Abel et al., 2005) and priming studies (e.g., Tabrizi et al., 2021), where treatment paradigms facilitate successful naming by reducing retrieval effort. These studies of facilitated retrieval practice also found improvements in naming, with the added advantage that facilitated retrieval practice may be more suitable for individuals with more severe anomia who perform poorly on effortful naming tasks. ...
Purpose
Specifying the active ingredients in aphasia interventions can inform treatment theory and improve clinical implementation. This secondary analysis examined three practice-related predictors of treatment response in semantic feature verification (SFV) treatment. We hypothesized that (a) successful feature verification practice would be associated with naming outcomes if SFV operates similarly to standard feature generation semantic feature analysis and (b) successful retrieval practice would be associated with naming outcomes for treated, but not semantically related, untreated words if SFV operates via a retrieval practice–oriented lexical activation mechanism.
Method
Item-level data from nine participants with poststroke aphasia who received SFV treatment reported in the work of Evans, Cavanaugh, Quique, et al. (2021) were analyzed using Bayesian generalized linear mixed-effects models. Models evaluated whether performance on three treatment components (facilitated retrieval, feature verification, and effortful retrieval) moderated treatment response for treated and semantically related, untreated words.
Results
There was no evidence for or against a relationship between successful feature verification practice and treatment response. In contrast, there was a robust relationship between the two retrieval practice components and treatment response for treated words only.
Discussion
Findings were consistent with the second hypothesis: Retrieval practice, but not feature verification practice, appears to be a practice-related predictor of treatment response in SFV. However, treatment components are likely interdependent, and feature verification may still be an active ingredient in SFV. Further research is needed to evaluate the causal role of treatment components on treatment outcomes in aphasia.
... For this study, the treatment ingredients were composed of both the tDCS (active or sham) and the naming treatment, which focused on cueing. 22 So far, there have been no published studies that suggest tDCS by itself improves recovery from aphasia. Accordingly, and similar to the study by Thiel et al, the treatment approach taken by Meinzer includes both an organ function (tDCS) and skills and habits (naming therapy) approach. ...
The Rehabilitation Treatment Specification System (RTSS; Van Stan et al., 2019)
was developed as a systematic way to describe rehabilitation treatments for the purpose of both research and practice. The RTSS groups treatments by type and describes them by three elements - the treatment (i) ingredients and (ii) the mechanisms of action that yield changes in the (iii) target behavior. Adopting the RTSS has the potential to improve consistency in research, allowing for better cross-study comparisons to strengthen the body of research supporting various treatments. As it is still early in its development, the RTSS has not yet been widely implemented across different rehabilitation disciplines. In particular, aphasia recovery is one area of rehabilitation that could benefit from a unifying framework. Accordingly, this paper is part of a series where we illustrate how the RTSS can be applied to aphasia treatment and research. This paper more specifically focuses on examining the neurobiological mechanisms of action associated with experimental aphasia therapies – including brain stimulation and pharmacological intervention – as well as more traditional behavioral therapy. Key elements of the RTSS are described, and four example studies are used to illustrate how the RTSS can be implemented. The benefits of a unifying framework for the future of aphasia treatment research and practice are discussed.
... In terms of external timing, clinicians make various decisions during drill-based treatment about aspects such as overall trial duration (e.g., when to move on), trial rate (e.g., spacing between trials), and when to provide specific cues when using cue-based treatment protocols. [17][18][19] These decisions could affect treatment-related processes such as memory decay, 20-22 retrieval interference, 23 and overall treatment dosage. 24 For example, PWA can demonstrate slowed decay of active lexical information, which may increase retrieval interference in subsequent trials if spaced too closely together. ...
People with aphasia demonstrate language impairments evident in both performance accuracy and processing speed, but the direct relationship between accuracy and speed requires further consideration. This article describes two recent attempts to make quantitative progress in this domain using response time modeling: the diffusion model (Ratcliff, 1978) applied to two-choice tasks and a multinomial ex-Gaussian model applied to picture naming. The diffusion model may be used to characterize core linguistic processing efficiency and speed–accuracy tradeoffs independently, and research suggests that maladaptive speed–accuracy tradeoffs lead to performance impairments in at least some people with aphasia. The multinomial ex-Gaussian response time model of picture naming provides a simple and straightforward way to estimate the optimal response time cutoffs for individual people with aphasia (i.e., the cutoff where additional time is unlikely to lead to a correct response). While response time modeling applied to aphasia research is at an early stage of development, both the diffusion model and multinomial ex-Gaussian response time model of picture naming show promise and should be further developed in future work. This article also provides preliminary recommendations for clinicians regarding how to conceptualize, identify, and potentially address maladaptive speed–accuracy tradeoffs for people with aphasia.
... 1.1) im Therapiesetting als sinnvoll erwiesen hatte (Abel, 2007) [33], setzten wir sie zum ersten Mal bei einem Einzelfall mit neurodegenerativer Erkrankung ein. Darüber hinaus nutzten wir unsere Lexikontherapie mit semantisch-phonologischen Cueing-Hierarchien, die sich bei insgesamt 17 von 20 aphasischen Patienten als wirksam gezeigt hatte [33,112], um in Einzelfallanalysen [113,114] erstmals die Effektivität beider Behandlungsmethoden bei SD vergleichen zu können. ...
Die vorliegende Habilitationsschrift präsentiert neun englischsprachige und drei deutschsprachige Publikationen, in denen die normale und gestörte Wortverarbeitung aus psycholinguistischer, neurolinguistischer und/ oder sprachtherapeutischer Sicht beleuchtet wird. Zunächst wird eine Erweiterung des psycholinguistischen Modells von Dell, das zur computergestützten Diagnosestellung einer Lexikonstörung eingesetzt wird, vorgeschlagen und durch drei Patientenstudien zum Nachsprechen und zur Leistung des verbalen Arbeitsspeichers begründet und ergänzt. Ein kognitiv-funktionelles Modell wird somit für Aphasieforschung und -therapie genutzt und die gewonnenen Erkenntnisse geben Hinweise zur Modifizierung der Modellarchitektur. Anschließend werden Probandenstudien mit funktioneller Magnetresonanztomographie (fMRT) zu neuralen Entsprechungen von Komponenten und Routen des Wortverarbeitungsmodells, von sprachassoziierten Prozessen und von Versprechern dargestellt. Die Vorstellung von Probandenstudien zur anatomischen Konnektivität mit Diffusions-Tensor-Imaging (DTI) und zur effektiven Konnektivität mit Dynamic Causal Modeling (DCM) rundet den neurolinguistischen Teil ab. Es werden neue Einsichten in die Beziehung zwischen kognitiv-funktionellen Verarbeitungskomponenten und -routen einerseits und Daten über an der Verarbeitung beteiligte neuro-funktionelle Hirnregionen
und Faserverbindungen andererseits gewonnen. Die resultierenden Erkenntnisse bieten auch die Grundlage für den Vergleich mit abweichenden Aktivierungsmustern bei Patienten mit
zentralen Sprachstörungen (Aphasie). In den anschließenden Patientenstudien werden neurale Korrelate von gestörter Wortverarbeitung und von Therapieeffekten untersucht, die
durch modellgeleitete und störungsspezifische Lexikontherapie induziert werden. Neben der Aufhellung von Mechanismen der Hirnreorganisation werden Erkenntnisse zur Wirksamkeit
von Therapie bei den zwei untersuchten Patientengruppen gewonnen, bei Personen mit progredienter Aphasie und bei Personen mit Aphasie nach Schlaganfall.
... The cue training was commonly used in standard speech and language therapy (54,56). Participants saw a picture of an item with a choice of four cues, or the option to name the item with no cues. ...
The Complementary Learning Systems (CLS) theory provides a powerful framework for considering the acquisition, consolidation and generalisation of new knowledge. We tested this proposed neural division of labour in adult humans through an investigation of the consolidation and long-term retention of newly learned native vocabulary. Over three weeks, participants (n=20) learned the names and corresponding semantic descriptions of previously-unknown, uncommon objects and animals. Training was successful with a mean 88% gain. Functional neuroimaging data were acquired post-learning. Newly learned items were compared to two conditions: (i) previously known items to highlight the similarities and differences with established vocabulary; and (ii) unknown/untrained items to provide a control for non-specific perceptual and motor-speech output. Consistent with the CLS, retrieval of newly-learned items was supported by a combination of regions associated with episodic memory (including left hippocampus) and the language-semantic areas that support established vocabulary (left inferior frontal gyrus and left anterior temporal lobe). Furthermore, there was a shifting division of labour across these two networks in line with the consolidation status of the item; faster naming was associated with more activation of language-semantic areas and lesser activation of episodic memory regions. Neuroimaging measures of hippocampal activity during naming predicted more than half the variation in naming retention six months later.
... By letting the patient get access to more or less assistive information during training, a task can become easier or harder without breaking the general progress of the patient. Examples are found in word mobilization, where the display of pictures of objects or written words may cue verbal pronunciation (Abel, Schultz, Radermacher, Willmes, & Huber, 2005;Breitenstein et al., 2007;Fink, Brecher, Sobel, & Schwartz, 2005;Katz & Nagy, 1984Kim, et al., 2004;Ramsberger & Marie, 2007) or attention training where attention may be directed towards a particular item or spot using sound or light after a period of time (e.g. Myers & Bierig, 2000;Robertson, Mattingley, Rorden, & Driver, 1998). ...
How visual feedback impacts the visuo-motor adaptation to prism diverted visual input
... Consequently, PWA could correct their answer when the maximum phonemic prompts were shown. Although PWA participants may answer incorrectly in the five-second gap between the cueing hierarchies and maximum phonemic prompts, it was reported that unlike the population of people with amnesia, most PWAs do not get into trouble due to error naming [29]. As a result, PWA participants could learn new words with the cueing hierarchies and maximum phonemic prompts. ...
... Für eine größtmögliche Vergleichbarkeit der Therapie lag der Fokus auf dem Wortabruf. In der Therapie wurde eine aufsteigende Hil- fenhierarchie eingesetzt, um explizit Lernpro- zesse anzuregen ( Abel et al. 2005). Zur An- wendung kamen, je nach dem Bedürfnis der Patienten, störungsspezifische Übungen, wie etwa zum Sprachverständnis und zur Schrift- sprachverarbeitung, da besonders Lesen und Schreiben nachgewiesenermaßen eine links- hemisphärische Aktivierung erfordern (Purcell et al. 2011). ...
... Wambaugh et al., 2001). Additionally, studies that have combined phonological and semantic information into cueing hierarchies have resulted in improved word finding (Abel, Schultz, Radermacher, Willmes, & Huber, 2005;Abel, Willmes, & Huber, 2007;Cameron, Wambaugh, Wright, & Nessler, 2006;Conroy, Sage, & Lambon Ralph, 2009;Doesborgh et al., 2004;Fink, Brecher, Schwartz, & Robey, 2002;Herbert, Best, Hickin, Howard, & Osborne, 2003). Interestingly, some studies have shown better recovery of naming in persons with phonologically-based anomia after semantically focused training (A. ...
... Previous research has also examined the effect of systematically decreasing vs. increasing cues throughout treatment. Results have shown similar findings for both decreasing and increasing cues (Conroy et al., 2009), although one study showed an effect only for increasing cues and also found that patients who were more severe showed a greater overall gain in treatment than patients who were less severe (Abel et al., 2005). Therefore, additional research is required to understand whether or not tailoring the cues available according to individual's performance could be an effective treatment approach. ...
An advantage of rehabilitation administered on computers or tablets is that the tasks can be self-administered and the cueing required to complete the tasks can be monitored. Though there are many types of cueing, few studies have examined how participants’ response to rehabilitation is influenced by self-administered cueing, which is cueing that is always available but the individual decides when and which cue to administer. In this study, participants received a tablet-based rehabilitation where the tasks were selfpaced and remotely monitored by a clinician. The results of the effectiveness of this study were published previously (Des Roches et al., 2015). The current study looks at the effect of cues on accuracy and rehabilitation outcomes. Fifty-one individuals with aphasia completed a 10-week program using Constant Therapy on an iPad targeted at improving language and cognitive deficits. Three questions were examined. The first examined the effect of cues on accuracy collapsed across time. Results showed a trend where the greater the cue use, the lower the accuracy, although some participants showed the opposite effect. This analysis divided participants into profiles based on cue use and accuracy. The second question examined how each profile differed in percent cue use and on standardized measures at baseline. Results showed that the four profiles were significantly different in frequency of cues and scores on WAB-R, CLQT, BNT, and ASHA-FACS, indicating that participants with lower scores on the standardized tests used a higher percentage of cues, which were not beneficial, while participants with higher scores on the standardized tests used a lower frequency of cues, which were beneficial. The third question examined how the relationship between cues and accuracy was affected by the course of treatment. Results showed that both more and less severe participants showed a decrease in cue use and an increase in accuracy over time, though more severe participants continued to used a greater number of cues. It is possible that self-administered cues help some individuals to access information that is otherwise inaccessible, even if there is not an immediate effect. Ultimately, the results demonstrate the need for individually modifying the levels of assistance during rehabilitation. time, though more severe participants continued to used a greater number of cues. It is possible that self-administered cues help some individuals to access information that is otherwise inaccessible, even if there is not an immediate effect. Ultimately, the results demonstrate the need for individually modifying the levels of assistance during rehabilitation.
... Bei einer Fehlbenennung werden den Patienten dabei sukzessive semantische bzw. phonologische Hilfen dargeboten(Howard 2000;Abel et al. 2005;Raymer et al. 2007). Die tDCS-bzw. ...
... Bei einer Fehlbenennung werden den Patienten dabei sukzessive semantische bzw. phonologische Hilfen dargeboten(Howard 2000;Abel et al. 2005;Raymer et al. 2007). Die tDCS-bzw. ...
Thieke, J. Schröder, A., & Stadie, N. (2010). Semantische Komplexität in der Behandlung von Wortabrufstörungen: Eine Einzelfallstudie. In: Wahl M, Stahn C, Hanne S, Fritzsche T. (Hrsg.), Spektrum Patholinguistik (Band 3), Schwerpunktthema: Von der Programmierung zur Artikulation: Sprechapraxie bei Kindern und Erwachsenen. Potsdam: Universitätsverlag.
http://www.uni-potsdam.de/de/treatmentlab/publ.html
... Previous research has also examined the effect of systematically decreasing vs. increasing cues throughout treatment. Results have shown similar findings for both decreasing and increasing cues (Conroy et al., 2009), although one study showed an effect only for increasing cues and also found that patients who were more severe showed a greater overall gain in treatment than patients who were less severe (Abel et al., 2005). Therefore, additional research is required to understand whether or not tailoring the cues available according to individual's performance could be an effective treatment approach. ...
How do individuals with aphasia relearn to use strategies during therapy and how does that translate to improvement in treatment? This study investigates this relationship while using Constant Therapy, which is an iPad-based therapy program with over 30 tasks. Fifty-one individuals with aphasia due to a stroke or traumatic brain injury were recruited for a 10 week treatment program. The software tracked both accuracy and hint counts (i.e., what level of assistance is needed), such as repetition of audio stimuli. Total hint counts were examined by session with a simple regression analysis both by participant (including hint counts of zero) and by task (excluding hint counts of zero) which found that, for both participants and tasks, half showed a significant relationship between accuracy and hint use. Total hint counts were also examined by cluster analysis, which resulted in a general trend where the greater the hint use, the lower the participant’s accuracy, though interestingly, a couple of patients did show trends of higher accuracy with increased hint use. Additional analyses examining the relationship between accuracy and hint use over time specific to each task that each patient completed is ongoing. These results reveal that using cues can help overall accuracy but only to a certain extent and that overuse of cues can hinder accuracy. Ultimately, the results demonstrate the need for individualizing and moderating levels of assistance employed during rehabilitation.
... AAT Aachen Aphasia Test ANELT Amsterdam-Nijmegen Everyday Language Test ANOVA analysis of variance MRI magnetic resonance imaging SLT speech and language therapy rTMS repetitive transcranial magnetic stimulation focused on reactivation of word retrieval as required in tasks such as oral and written picture naming, picture description, and writing from memory. To ensure as much consistency of SLT and treatment fidelity between subjects and across therapists as possible, the treatment was conducted according to the following principles: (1) main focus on oral naming; (2) preactivation of word finding by receptive tasks (oral and written word-picture matching); (3) application of increasing cues to support deliberate lexical retrieval as validated by Abel et al 38 for the German language; (4) consolidation of successful verbal naming by additional written naming (providing increasing written cues: initial grapheme, initial syllable, word anagram, complete word); (5) variation of training stimuli progressing from single object to related action pictures as provided by the Everyday Life Activities set 39 ; and (6) exclusion of holistic or nonverbal facilitation methods, or both, that might primarily involve right hemisphere functions. 40,41 All therapy plans were developed by the same experienced speech and language therapist, who was blinded to group allocation and not involved in conducting the treatment. ...
Few studies have dealt with the effect of repetitive transcranial magnetic stimulation (rTMS) on functional communication. Thus, the current study aims to determine to which extent rTMS combined with speech and language therapy improves functional communication and basic linguistic skills of individuals with subacute aphasia.
Randomized, blinded and sham-controlled study.
Neurological rehabilitation hospital.
Thirty participants with subacute aphasia after stroke.
During a two-week treatment period, half of the participants received 10 sessions of 20 min inhibitory 1Hz-rTMS over the right inferior frontal gyrus (BA 45) and the other half was subjected to sham stimulation. Directly thereafter all the participants underwent 45 min of speech and language therapy.
Aachen Aphasia Test, Amsterdam-Nijmegen Everyday Language Test, a naming screening and subscales of the Functional Independence Measure, all assessed the day before and the day after treatment period.
The participants who received real rTMS significantly improved with respect to all 10 measures of basic linguistic skills and functional communication whereas sham treated participants significantly improved only regarding 6/10 measures (P<0.05, paired t-tests). There was a significant difference in the gains made by the two groups on 5/10 measures including functional communication (ANELT) (P<0.05, repeated measures ANOVA).
For the first time, this study has demonstrated that basic linguistic skills as well as functional communication are bolstered by combining rTMS and behavioral language therapy in patients with subacute aphasia.
Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. http://authors.elsevier.com/a/1RxNfwCfm12S
... Errorless learning paradigms aim to prevent the production of errors in training and thus reduce the reinforcement of negative learning patterns [84]. Preliminary research indicates that errorless and errorful therapy techniques result in comparable therapeutic outcomes for adults with aphasia [85][86][87][88]. However, this is an emerging field of research, and further consideration into the effect of error production on therapeutic outcomes in persons with cognitive and language impairments is required. ...
Treatment intensity is a critical component to the delivery of speech-language pathology and rehabilitation services. Within aphasia rehabilitation, however, there is currently insufficient evidence to guide clinical decision making with respect to the optimal treatment intensity. This review considers perspectives from two key bodies of research; the neuroscience and cognitive psychology literature, with respect to the scheduling of aphasia rehabilitation services. Neuroscience research suggests that intensive training is a key element of rehabilitation and is necessary in order to achieve functional and neurological changes post-stroke. In contrast, the cognitive psychology literature suggests that optimal long-term learning is achieved when training is provided in a distributed or non-intensive schedule. These perspectives are evaluated and discussed with respect to the current evidence for treatment intensity in aphasia rehabilitation. In addition, directions for future research are identified including study design, methods of defining and measuring treatment intensity and selection of outcome measures in aphasia rehabilitation.
Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
... Repeated probing may influence performance Goldstein (2015, this issue) asserts that any effects of repeated probing are 'small at best'. That may be true, but they are present (e.g., Abel, Schultz, Radermacher, Willmes, & Huber, 2005;Howard, Patterson, Franklin, Orchard-Lisle, & Morton, 1985;Martin, Fink, Renvall, & Laine, 2006Nickels, 2002a, and to unpredictable extents across individuals. Hence, given that treatment effects are also not guaranteed, and may be small, there is a very real risk of repeated probing effects being interpreted as treatment effects. ...
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 set of simulations. Our discussion and conclusions were not intended as guidelines (of which there are several in the field) but rather had the aim of stimulating debate and optimising designs in the future. Our paper achieved the first aim—it received a set of varied commentaries, not all of which felt we were optimising designs, and which raised further points for debate.
Aphasia, a neurological condition primarily resulting from stroke, significantly impairs communication and quality of life. This review focuses on aphasia recovery and emphasizes the interplay of clinical impairment, neural adaptation, and therapeutic intervention. Natural recovery varies with factors such as lesion characteristics, white matter integrity, and demographics, and neuroplasticity and cognitive compensation play crucial roles. Treatment-induced recovery encompasses traditional language therapies and innovative strategies, including the integration of advanced neurological techniques like neuromodulation and neurofeedback. Emerging trends, such as self-managed digital therapeutics and precision medicine approaches, offer promising avenues for enhancing language recovery. By bridging the gap between neurological understanding and clinical application, this review highlights the multifaceted nature of aphasia recovery and the latest advancements in treatment strategies, paving the way for more targeted and effective rehabilitation approaches.
The subject of aphasia rehabilitation is frequently explored in recent literature since it is one of the most common forms of brain damage and presents an
assortment of variations depending on the specific case, making it so that professionals who are in charge of patients with this condition find themselves in
need of effective treatment methods. This article aims to present the design for the single case study rehabilitation of a patient with conduction aphasia and
pure anomia. The patient in question is a 62-year-old male with a P.h.D. level education, diagnosed with conduction aphasia and anomia caused by an ischemic
event with an 18-month evolution, he received neuropsychological treatment following the historic-cultural and neurocognitive models, spanning two different
treatment periods, one hour a week. A neuropsychological evaluation was made before and after the rehabilitation program, as well as using a baseline for both
periods and taking into account the perspective of both the patient and his wife. Patient performance in the first and second evaluations shows improvement
in some language areas, while the baselines, as well as the patient and his wife’s assessment speak of important changes, concluding that the program had
favorable effects on the patient’s communication at home.
There is a growing body of literature demonstrating that language rehabilitation can improve naming impairments for individuals with aphasia. However, there are challenges applying evidence-based research to clinical practice. Well-controlled clinical studies often consist of homogenous samples and exclude individuals who may confound group-level results. Consequently, the findings may not generalize to the diverse clients serviced by speech-language therapists. Within evidence-based guidelines, clinicians can leverage their experiences and theoretical rationale to adapt interventions to meet the needs of individual clients. However, modifications to evidence-based interventions should not alter aspects of treatment that are necessary to produce change within the treatment target. The current discussion paper uses errorless learning, errorful learning, and retrieval practice for naming in aphasia to model how treatment theories can guide clinicians in making theory-informed modifications to interventions. First, we briefly describe the learning mechanisms hypothesized to underlie errorless learning, errorful learning, and retrieval practice. Next, we identify ways clinicians can provide targeted supports to optimize learning for individual clients. The paper ends with a reflection on how well-defined treatment theories can facilitate the generation of practice-based evidence and clinically relevant decision making.
Speech and language therapy can be an effective tool in improving language in post-stroke aphasia. Despite an increasing literature on the efficacy of language therapies, there is a dearth of evidence about the neurocognitive mechanisms that underpin language re-learning, including the mechanisms implicated in neurotypical learning. Neurotypical word acquisition fits within the idea of Complementary Learning Systems, whereby an episodic hippocampal system supports initial rapid and sparse learning, whilst longer-term consolidation and extraction of statistical regularities across items is underpinned by neocortical systems. Therapy may drive these neurotypical learning mechanisms, and efficacy outcome may depend on whether there is available spared tissue across these dual systems to support learning.
Here, for the first time, we utilised a reverse translation approach to explore these learning mechanisms in post-stroke aphasia, spanning a continuum of consolidation success. After three weeks of daily anomia treatment, 16 patients completed a functional magnetic resonance imaging protocol; a picture naming task which probed (i) premorbid vocabulary retained despite aphasia, (ii) newly re-learned treated items and (iii) untreated/unknown and therefore unconsolidated items. The treatment was successful, significantly improving patients’ naming accuracy and reaction time post-treatment. Consistent with the Complementary Learning Systems hypothesis, patients’ overall naming of treated items, like that of controls when learning new vocabulary, was associated with increased activation of both episodic and language regions. Patients with relatively preserved left hemisphere language regions, aligned with the control data in that hippocampal activity during naming of treated items was associated with lower accuracy and slower responses – demonstrating the shifting division of labour from hippocampally-dependent new learning towards cortical support for the efficiently-named consolidated items. In contrast, patients with greater damage to the left inferior frontal gyrus displayed the opposite pattern (greater hippocampal activity when naming treated items was associated with quicker responses), implying that their therapy-driven learning was still wholly hippocampally reliant.
Open access
For the purpose of open access, the UKRI-funded authors have applied a Creative Commons Attribution (CC-BY) licence to any Author Accepted Manuscript version arising from this submission.
Background
A variety of therapies for aphasia can be found in the current literature. However, the questions of which changes in the brain are most linked with improvement of language abilities, and how alterations in neural activation are affected by different approaches to therapy, require further exploration. This systematic review therefore aimed to investigate the effects of different therapies on both language deficits and brain function and structure.
Methods & Procedures
Studies utilising neuroimaging and language testing before and after neuroscience-based treatment were identified using a 2-stage analysis. From an initial 506 citations, 483 were excluded, leaving 23 studies to be included in the review.
Outcomes & Results
The resulting studies covered therapies ranging in approach from targeting specific stages of language processing, to employing alternative modalities of communication, to facilitating activation of specific regions of the brain. Many studies found changes in both hemispheres following treatment, particularly those with datasets including mild deficits.
Conclusions
Overall, this review shows that manifold changes in the brain may occur, stemming from therapy and improvement in language abilities, although which changes are most important in facilitating improvement for participants with different specific profiles of damage and language deficit remains unclear.
Dieses Kapitel beschäftigt sich mit der Planung und den Rahmenbedingungen einer Aphasie-Therapie. Fragen der Wirksamkeit und ICF-orientierten Zielsetzung der Therapie werden ebenso behandelt wie die unterschiedliche Ausrichtung der Therapie im Verlauf einer Aphasie. Zahlreiche Faktoren, die bei der Therapieplanung zu berücksichtigen sind, werden erläutert. Hierzu gehören z. B. Beginn und Intensität einer Therapie oder Auswahlkriterien für Übungen und Material.
Attention is improved through cognitive rehabilitation. The purpose of the present study was the evaluation of the effect of a paper and pencil program for attention rehabilitation and strengthening (PARS) in children with ADHD. Thirty children with ADHD were randomly divided into two equal intervention and control groups. The intervention group received 12–15 sessions of intervention through PARS. Sustained, selective, and shifting attention, inhibitory control, and working memory were assessed by Persian attention registration, Stroop, color trail making, Go/No-Go, and 1- back tests. Analyses indicated that the experimental group, in comparison with the control group, showed improved selective and sustained attention and the training effects transfers to executive functions, inhibitory control and working memory. The result is discussed in the light of transferability of training effects from attention to executive functions.
In older adults with subjective memory complaints (SMCs), featuring a decline in memory but not exhibiting problems during medical examinations and objective memory tests, the weak links between nodes evident in the word retrieval process can be a primary factor for predicting mild cognitive impairment and dementia. This study examined the frequency of the “Tip-of-the-Tongue” (ToT) phenomenon according to age and subjective memory complaints of older adults, and identified differences in the resolution method using sequential cues. A celebrity naming task was performed on older adults (aged 50 to 79) with SMCs (n = 30) and without SMCs (n = 30), comparing the frequency of the ToT phenomenon and in resolution methods. We found that, even if our subjects with SMCs obtained normal results in the objective neuropsychology test, they experienced a significantly higher frequency of the ToT phenomenon than those without SMCs. In addition, subjects with SMCs showed a significantly lower rate of resolution, both spontaneous and following a syllabic cue, compared to those without SMCs. SMCs can be a very early marker of degenerative diseases causing cognitive dysfunction, and thus the selection of appropriate tools for early detection of SMCs is important. The proper naming task may sensitively detect subclinical symptoms of SMCs in subjects who are not classified as patients with cognitive impairments on general neuropsychological test. In addition, this task can identify weak connections between semantic and phonological nodes due to changes in the neural region of older adults with SMCs.
Background
People with aphasia may improve their communication with speech and language therapy many months/years after stroke. However, NHS speech and language therapy reduces in availability over time post stroke.
Objective
This trial evaluated the clinical effectiveness and cost-effectiveness of self-managed computerised speech and language therapy to provide additional therapy.
Design
A pragmatic, superiority, single-blind, parallel-group, individually randomised (stratified block randomisation, stratified by word-finding severity and site) adjunct trial.
Setting
Twenty-one UK NHS speech and language therapy departments.
Participants
People with post-stroke aphasia (diagnosed by a speech and language therapist) with long-standing (> 4 months) word-finding difficulties.
Interventions
The groups were (1) usual care; (2) daily self-managed computerised word-finding therapy tailored by speech and language therapists and supported by volunteers/speech and language therapy assistants for 6 months plus usual care (computerised speech and language therapy); and (3) activity/attention control (completion of puzzles and receipt of telephone calls from a researcher for 6 months) plus usual care.
Main outcome measures
Co-primary outcomes – change in ability to find treated words of personal relevance in a bespoke naming test (impairment) and change in functional communication in conversation rated on the activity scale of the Therapy Outcome Measures (activity) 6 months after randomisation. A key secondary outcome was participant-rated perception of communication and quality of life using the Communication Outcomes After Stroke questionnaire at 6 months. Outcomes were assessed by speech and language therapists using standardised procedures. Cost-effectiveness was estimated using treatment costs and an accessible EuroQol-5 Dimensions, five-level version, measuring quality-adjusted life-years.
Results
A total of 818 patients were assessed for eligibility and 278 participants were randomised between October 2014 and August 2016. A total of 240 participants (86 usual care, 83 computerised speech and language therapy, 71 attention control) contributed to modified intention-to-treat analysis at 6 months. The mean improvements in word-finding were 1.1% (standard deviation 11.2%) for usual care, 16.4% (standard deviation 15.3%) for computerised speech and language therapy and 2.4% (standard deviation 8.8%) for attention control. Computerised speech and language therapy improved word-finding 16.2% more than did usual care (95% confidence interval 12.7% to 19.6%; p < 0.0001) and 14.4% more than did attention control (95% confidence interval 10.8% to 18.1%). Most of this effect was maintained at 12 months ( n = 219); the mean differences in change in word-finding score increased by 12.7% (95% confidence interval 8.7% to 16.7%) more words in the computerised speech and language therapy group ( n = 74) than in the usual-care group ( n = 84) and increased by 9.3% (95% confidence interval 4.8% to 13.7%) in the computerised speech and language therapy group than in the attention control group ( n = 61). Computerised speech and language therapy did not show significant improvements on Therapy Outcome Measures or Communication Outcomes After Stroke compared with usual care or attention control. Primary cost-effectiveness analysis estimated an incremental cost per participant of £732.73 (95% credible interval £674.23 to £798.05). The incremental quality-adjusted life-year gain was 0.017 for computerised speech and language therapy compared with usual care, but its direction was uncertain (95% credible interval –0.05 to 0.10), resulting in an incremental cost-effectiveness ratio of £42,686 per quality-adjusted life-year gained. For mild and moderate word-finding difficulty subgroups, incremental cost-effectiveness ratios were £22,371 and £28,898 per quality-adjusted life-year gained, respectively, for computerised speech and language therapy compared with usual care.
Limitations
This trial excluded non-English-language speakers, the accessible EuroQol-5 Dimensions, five-level version, was not validated and the measurement of attention control fidelity was limited.
Conclusions
Computerised speech and language therapy enabled additional self-managed speech and language therapy, contributing to significant improvement in finding personally relevant words (as specifically targeted by computerised speech and language therapy) long term post stroke. Gains did not lead to improvements in conversation or quality of life. Cost-effectiveness is uncertain owing to uncertainty around the quality-adjusted life-year gain, but computerised speech and language therapy may be more cost-effective for participants with mild and moderate word-finding difficulties. Exploring ways of helping people with aphasia to use new words in functional communication contexts is a priority.
Trial registration
Current Controlled Trials ISRCTN68798818.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 19. See the NIHR Journals Library website for further project information. The Tavistock Trust for Aphasia provided additional support to enable people in the control groups to experience the intervention after the trial had ended.
Background: In the context of therapy for word retrieval in aphasia, the person with aphasia is often required to attempt to name treated items on multiple occasions. However, there is limited information about the impact of these repeated attempts at naming in and of themselves.
Aim: The aim of this study was to examine if repeated attempts at naming, with no treatment or feedback, improve naming accuracy in people with aphasia.
Methods & Procedures: 23 participants with stroke aphasia named 50 pictures on seven occasions, approximately six weeks apart. No support, cues (written or spoken) or feedback on accuracy was provided at the time or between naming attempts. This was part of a larger study investigating two different types of therapy on different items.
Outcomes & Results: After excluding any potential influence from treatment of other items, four participants showed significant improvements in accuracy and two participants showed a worsening of accuracy for the stimuli that received repeated naming attempts (but were untreated). We found evidence that significant change in accuracy was predicted by the variability of naming accuracy between sessions, executive functioning skills (as measured by the Wisconsin Card Sorting Task), and picture naming ability (Nickels’ Naming Test).
Conclusions: We hypothesised that in the context of variability in naming accuracy, intact executive functioning may help monitor responses, such that only correctly named items are reinforced. Critically, without the ability to monitor responses without feedback, incorrect responses may be reinforced, leading to a worsening of performance. The fact that four individuals with aphasia showed improved naming accuracy by naming items once every six weeks is striking and suggests that further investigation of effects of repeated naming at closer intervals is warranted, as for some participants any advantage from a naming attempt may have decayed by the time of repetition.
It has been suggested that neuroimaging can be used to inform therapeutic intervention. The current study aimed to determine whether an individual would benefit more from training engaging their intact or their damaged neural pathway. Two males with chronic stroke aphasia participated, with DM showing milder disruption of connectivity along the dorsal language pathway relative to JS, according to distortion corrected diffusion-weighted magnetic resonance imaging. Each patient received two blocks of six repetition training sessions over two weeks, one of which was "phonological" and the other "semantic" in nature. Both phonological and semantic training produced significant gains for both patients for trained items. For the untrained control items, significant gains were specific to training type for each patient. Only phonological training elicited significant generalisation for DM, which was greater than that seen for JS. Conversely, only semantic training elicited significant generalisation for JS, which was greater than that seen for DM. This double dissociation in generalisation effects suggests that a restitutive approach is more effective for patients with milder damage while a compensatory approach may be more effective for those with more severe damage. These results indicate the utility of neuroimaging to optimise relearning strategies and promote generalisation to untrained items.
Aphasiologists developing treatments for anomia should closely align therapy methods with the typological and morphological characteristics of the language in question. The lead author initiated this study to develop more defensible interventions for speakers of Sesotho, a South African language. Prefix-based cueing (our alternative name for initial phoneme cueing that describes these cues in Sesotho-oriented terms) was compared to a novel technique, root-based cueing (RBC). While prefix-based cues are described in the literature, we hypothesized root-based cues would be more appropriate in this context since they were thought to be more consonant with the linguistic parameters of Sesotho. Two speakers with aphasia, who demonstrated significant anomic symptoms, served as participants. We used a multiple-baseline, single case study design. Two 144-item word lists were developed with every item represented by a photograph. Each of the two word lists was associated with one of the two cueing techniques investigated. After baseline measurements were obtained, each participant attended eight facilitation sessions for each cueing condition, resulting in eight data points per condition and participant. For both participants, RBC resulted in greater naming performance than cueing by means of initial phonemes. Our explanation of these results is based on the Interactive Lexical Network model of lexical access; root-based cues may be more effective because they more efficiently constrain the number of lemmas activated after a cue is provided. We argue that a confluence of factors (word-retrieval processes and the character of Sesotho morphosyntax) gave rise to the noted differences in naming facilitation.
Our ability to make great progress in delivering, optimizing, and predicting rehabilitation outcomes for individuals with aphasia is challenged by factors that influence rehabilitation outcomes. These include patient demographic factors such as age, education, and neurologic factors such as time poststroke, the site and size of the lesion, and the resulting severity of language impairment. Also variable across individuals is the type of treatment and its duration and intensity. This article examines the utility of big data analysis for understanding one of these factors, severity of impairment, and how individual responsiveness to rehabilitation is influenced by a patient's severity of language and cognitive impairment(s). Using examples from two studies and a larger data set, we show that when rehabilitation is tailored to an individual's specific level of impairment, severe and mild patients both show improvements in accuracy and latency. Furthermore, more severe patients tend to show substantial gains on targeted rehabilitation tasks as well as on standardized tests. These results provide support for recent reviews of aphasia rehabilitation studies in concluding that systematic aphasia rehabilitation is indeed effective, and importantly, severity is not a negative prognostic indicator for successful outcomes.
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See Fink et al . (doi: 10.1093/aww034 ) for a scientific commentary on this article.
Transcranial direct-current stimulation (tDCS) has shown beneficial effects in post-stroke aphasia, but selecting stimulation sites is challenging. In a randomised controlled trial, Meinzer et al . demonstrate that motor cortex tDCS induces long-lasting improvement of language and everyday communication in patients, and may be a clinically feasible way to enhance recovery.
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See Fink et al . (doi: 10.1093/aww034 ) for a scientific commentary on this article.
Transcranial direct-current stimulation (tDCS) has shown beneficial effects in post-stroke aphasia, but selecting stimulation sites is challenging. In a randomised controlled trial, Meinzer et al . demonstrate that motor cortex tDCS induces long-lasting improvement of language and everyday communication in patients, and may be a clinically feasible way to enhance recovery.
Background: Mobile Technologies are pervading many areas of speech language therapy. A large number of apps have been developed for use by and for people with aphasia. Despite their availability, it’s unclear which design principles were followed to create these apps and which users were targeted for these apps. Aims: The aim of this paper is to introduce the use of claims analysis as an approach for user-centred design for clients with aphasia and for the speech-language pathologists (SLPs) who treat them. We aim, through the use of a single worked-example, to show how claims can influence the design of a treatment app. Methods & Procedures: The paper is divided into two parts. Part 1 describes the claims analysis method we used to research SLP and client needs. Part 2 shows how claims were considered and integrated into the design of an app for speech-language therapy. This app, BangaSpeak, is offered as one example of how designers can simultaneously consider the needs of two different types of users: clients with aphasia and SLPs. Conclusions: This paper shows how development teams can capture the needs of users separate from requirements. Finally, it outlines the design of one app for use in aphasia treatments. We believe that this approach can serve as a model for other development teams to follow.
Background: The study of generalisation is integral to both demonstrating and maximising therapy effectiveness. With aphasia therapy aiming to promote change in everyday communication, there is a temptation to “fish” for any evidence of improvement; multiple tasks, elicitation methods, and measures may be used to identify any change that might then be attributed to therapy. Examining the evidence about generalisation will allow us to develop our theoretical understanding of change following aphasia intervention and strengthen our ability to form robust predictions for generalisation that can be tested. Aims: We explore what is meant by generalisation, considering it within the broader context of impact of intervention. We propose a framework focusing on linguistic generalisation at the levels of word, sentence, and connected speech. The discussion draws on the therapy literature for spoken production, exploring single-word therapies for nouns and verbs, sentence production therapies, and discourse therapies. Main Contribution: This article introduces a framework to conceptualise and describe generalisation within level, i.e., change to untreated stimuli within the same linguistic level as the focus of treatment, and across level, i.e., change at a different linguistic level to the focus of treatment. The existing evidence base for spoken production is reviewed using the framework, considering our current knowledge, the predictions we are able to make, and areas for future focus. Conclusions: There is an urgent need for further research in this area. While within-level generalisation has often been addressed systematically, there have been more limited attempts to systematically define, predict, and measure generalisation across linguistic levels. This has resulted in a limited evidence base from which to make decisions regarding when and how to best facilitate generalisation and where and how to best measure generalisation. We propose it is time to stop fishing for change in an opportunistic way and to develop a greater understanding of the relationship between change at the different linguistic levels of words, sentences, and connected speech. We need to use theory and evidence to predict change (selecting the right “pond” within which to fish) and identify valid and reliable ways to measure both targeted and generalised therapy effects (selecting the right “bait”).
Virtual reality (VR)-based technologies are one of the emerging tools that appear to have great potential for use in cognitive rehabilitation. However, it still is unclear how brain capacities are involved and what is the best approach to such training. Quantitative aspects are encouraging because some improvements have been shown after few training sessions. By contrast, qualitative design of VR tools is more questionable. Choice of errorless or error-full designs may depend on the severity of disturbances. Most VR tools emphasize the explicit component of tasks; even procedural aspects comprise the main strength of VR retraining programs. VR and augmented reality tools give various stimuli and indicators, but their best modalities stay unclear, given that most data are coming from learning studies in normal subjects more than rehabilitation studies in brain-injured patients. Specific studies to explore the impact of sensorial transmodal effects and emotional involvement in VR tasks are required. Rehabilitation protocols utilizing virtual environments are moving from single applications to cognitive impairment (i.e., alertness, memory, neglect, language, executive functions) to comprehensive rehabilitation programs, with the aim of achieving efficient improvement in autonomy and transfer of benefits in real life conditions. A core issue that presents challenges to rehabilitation is decreased ability of persons with brain injury to transfer learning from one situation or context to another. The multi-context approach to cognitive rehabilitation proposes treatment methods for teaching the use of strategies across a wide range of meaningful activities, which can promote generalization and enhance functional performance.
Presents a standardized set of 260 pictures for use in experiments investigating differences and similarities in the processing of pictures and words. The pictures are black-and-white line drawings executed according to a set of rules that provide consistency of pictorial representation. They have been standardized on 4 variables of central relevance to memory and cognitive processing: name agreement, image agreement, familiarity, and visual complexity. The intercorrelations among the 4 measures were low, suggesting that they are indices of different attributes of the pictures. The concepts were selected to provide exemplars from several widely studied semantic categories. Sources of naming variance, and mean familiarity and complexity of the exemplars, differed significantly across the set of categories investigated. The potential significance of each of the normative variables to a number of semantic and episodic memory tasks is discussed. (34 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
The notion that difficult initial retrieval facilitates subsequent recall was tested in a situation similar to Brown and McNeill's (1966) tip-of-the-tongue (TOT) paradigm. After 50 trials, Ss were unexpectedly asked to recall all the target words. It was found that words retrieved with difficulty in the definition session were relatively well recalled in the final test. Further analyses revealed that the critical factor for good recall was the presence of a TOT state, or a strong feeling of knowing the word, during initial retrieval. An explanation in terms of activation of the word's attributes was suggested.
There are various ways in which cues can be faded. The method of vanishing cues
is just one option. It is argued that, when selecting a method, we should choose
one that will encourage effortful recall on the training trials, but at the same time
avoid too many errors and omissions. To achieve this end, we must take into
account the circumstances of application, including the difficulty of the item to
be learnt and the memory abilities of the learner. More difficult items and poorer
memoriesmay require more gradual fading to avoid an excess of errors and omissions;
easier items and better memories may require more rapid fading to
encourage effortful recall. To test this prediction, two methods of fading were
compared in teaching general knowledge items to 12 individualswith a history of
head injury. Consistent with the prediction, Increasing Assistance (that permits
more rapid fading) was more effective for those with better memories and for
easier items, and Decreasing Assistance (in which fading is more gradual) was
more effective for those with poorer memories and more difficult items.
A series of four experiments are described investigating the effects of a number of treatments on the ability of aphasic patients to retrieve picture names, at some time after the treatment is applied. Auditory word-to-picture matching, visual word-to-picture matching and semantic judgements are found to have effects lasting for up to 24 hours. It is argued that durable facilitation of aphasic word retrieval is a consequence of treatment techniques that require the patients to access the semantic representation corresponding to the picture name, and this is contrasted with the short-term effects of techniques that provide patients with information about the phonological shape of the name. The theoretical and therapeutic implications of these results are discussed.
This paper discusses guidelines for devising a hierarchy when fading response prompts in training individuals with developmental disabilities. Existing guidelines are seen as poorly defined, inconsistent, and lacking both theoretical and experimental support. An alternative theoretical account is proposed which suggests that prompts in a hierarchy should progressively reduce the amount of information provided. (Author/DB)
A phonologically based treatment was implemented to train oral picture naming in four aphasic subjects with severe word-retrieval deficits. An initial assessment based on current cognitive neuropsychological models of naming indicated different levels of phonological and/or semantic deficits underlying naming failure across the subjects. Using a single-subject multiple baseline design across behaviours and subjects, the effects of treatment were evaluated by daily probing of both trained and untrained items across lexical tasks: oral naming, oral reading, and written naming. Results indicated successful acquisition of trained naming targets for the four subjects, and varied patterns of response generalization to naming of untrained phonologically and semantically related pictures, and to oral reading and written naming for the same words. Baseline levels of oral reading performance were noted to predict success in oral naming treatment. Differences in generalization patterns across tasks are discussed with regard to the varying functional levels of breakdown noted across subjects. This investigation demonstrates the utility of cognitive models in guiding the development of appropriate treatment strategies and generalization measures, and the importance of incorporating single-subject experimental designs in documenting changes associated with treatment.
An interactive 2-step theory of lexical retrieval was applied to the picture-naming error patterns of aphasic and nonaphasic speakers. The theory uses spreading activation in a lexical network to accomplish the mapping between the conceptual representation of an object and the phonological form of the word naming the object. A model developed from the theory was parameterized to fit normal error patterns. It was then "lesioned" by globally altering its connection weight, decay rates, or both to provide fits to the error patterns of 21 fluent aphasic patients. These fits were then used to derive predictions about the influence of syntactic categories on patient errors, the effect of phonology on semantic errors, error patterns after recovery, and patient performance on a single-word repetition task. The predictions were confirmed. It is argued that simple quantitative alterations to a normal processing model can explain much of the variety among patient patterns in naming. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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 levels of impairment. Aims: This paper aims to continue the selective review of this literature carried out by Nickels and Best (1996a). It summarises in table form those published papers since 1980 which present single case studies of treatment for word-retrieval impairments and which satisfy minimal methodological criteria. Main Contribution: Several main themes are derived from the literature and discussed in more detail, these include strategic approaches and facilitative or repair approaches to remediation, the contrast between semantic and phonological tasks in therapy, generalisation in therapy tasks and the relationship between impairment, therapy task, and outcome. Further discussion relates to the relationship between impairment level treatments, and measures of disability and handicap, and between therapy research and therapy practice. Conclusions: There are now many research papers devoted to impairments of word retrieval, and there can be no doubt that therapy for word-retrieval impairments can be highly successful, resulting in long-term improvements which can be of great communicative significance for the individual with aphasia. However, predicting the precise result of a specific treatment task with a specific individual with certainty is still not possible. For clinicians the recommendation is to use analyses of functional impairments to guide the choice of task, but to ensure that efficacy is tested and not assumed. Furthermore, structured multi-modal and multicomponent tasks (e.g., ''semantic'' or ''phonological'' cueing hierarchies) may hold the most promise for many individuals. For researchers, there remains a need to further dissect tasks, impairments, and their interactions across series of single cases..a u Thanks to all the contributing authors who have worked so hard to comply with my demands, and also to the reviewers of their papers. Thanks to Chris Code for inviting me to compile and edit the volume, and to Deborah Maloney and the production team at Psychology Press for their patience.
Background: One application of a task, such as word-picture matching or repetition, has been demonstrated to affect subsequent picture naming ('facilitation' or 'priming') in both aphasic and non-aphasic subjects. As aphasia assessment frequently involves repeated use of the same stimuli in different tasks, it is suggested that some aphasic individuals may have improved performance in picture naming as a result of assessment. Aims: The aim of this paper is to demonstrate that there can be improvements in picture naming as a result of repeated presentation of stimuli and promote discussion regarding the mechanisms that may have caused such effects and their corresponding implications for treatment. Methods & Procedures: This paper describes a single case study of JAW, a man with aphasia. JAW's picture naming had been observed to improve over time while other tasks remained stable. An investigation was performed to identify the source of this improvement. Three treatment tasks were used, attempting to name the picture, reading aloud and delayed copying of the picture names. Outcomes and Results: All three tasks significantly improved subsequent picture naming of the treated items despite the fact that no feedback or error correction was provided. It is argued that the source of this improvement is from priming of retrieval of the phonological form. In the 'attempted naming' condition, this priming occurred every time a picture name was successfully produced. As JAW was not perfectly consistent, on each attempt at naming some additional items were primed. Thus, over time an increasing proportion of stimulus items were primed and were hence more likely to be successfully produced. Conclusions: This study demonstrated that for at least one aphasic man, JAW, practice makes (closer to) perfect, even without correction. Not only was there significant improvement from tasks that provided the word form (reading aloud and delayed copying) as has been shown in the past, but also there was the novel finding that simply attempting to name a picture can improve subsequent word retrieval. It is argued that this novel finding could be applicable to other aphasic individuals and has functional significance. In recent years there has been a relatively large body of research into rehabilitation of the word-finding difficulties that are so prevalent in aphasia (e.g.
Recently, there has been great interest in errorless learning as a new intervention technique. This may be because there are data from both basic neuroscience and clinical application that suggest it is superior to more traditional trial and error methods. In the contemporary literature the most prominent investigations of errorless learning are those designed for rehabilitation of memory impairments. These studies include numerous demonstrations of effective amelioration of word finding difficulties using errorless intervention. The aphasic literature contains no examples of purely errorless learning methods, however, some studies have successfully treated anomia using error reducing techniques. This suggests that errorless learning could be advantageous for treating aphasic disorders, in particular anomia. To explore this idea, we discuss previous research and review two current theories of errorless learning. We provide our own framework for thinking about errorless and errorful learning. In addition, a review of the anomia treatment literature (from 1985 to the present) is presented and conclusions drawn on the methods of treating the word finding difficulties of patients with aphasia.
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, Patterson, Franklin, Orchard-Lisle, & Morton, 1985a) and other studies reporting lasting effects (e.g., Miceli, Amitrano, Capasso, & Caramazza, 1996). There is also little in the literature on the use of orthographic cues in treatment (Howard & Harding, 1998). Additionally, whereas several studies have reported the results of using cues in facilitation of word-finding difficulties (e.g., Patterson, Purrell, & Morton, 1983), none so far has attempted to relate response to facilitation and response to treatment using similar techniques in the same individuals.
Aims: This study set out to investigate whether the use of phonological and orthographic cues in the treatment of word-finding difficulties could produce lasting improvements in word retrieval. The response of the participants to phonological and orthographic cues in a facilitation study was also related to their response to treatment using similar cues.
Methods & procedures: The study used a case series design. The participants were eight people with acquired aphasia who were all at least 1 year post-onset, had a single left CVA, and had word-finding difficulties as a significant aspect of their aphasia. Detailed assessment of each participant was carried out to identify the nature of their word-finding difficulties and this was related to response to treatment.
Outcomes & results: Results are given for the eight participants, seven of whom benefited overall from treatment. Both phonological and orthographic cues were effective in improving word retrieval. For the group as a whole there was a significant correlation between the overall outcome of facilitation and response to treatment.
Several investigators have suggested that microcomputers might serve as useful external aids for memory-impaired patients. However, knowledge of basic computer vocabulary may be necessary for patients to use and benefit from a microcomputer. The present paper describes a procedure, the method of vanishing cues, which facilitated the acquisition of computer-related vocabulary in four memory-impaired patients. The method involves the systematic reduction of letter fragments of to-be-learned words across trials. Although learning was slow and strongly dependent on first-letter cues, all patients acquired a substantial amount of the vocabulary and eventually were able to produce the target words in the absence of fragment cues. Further, they retained the vocabulary over a 6-week interval and showed some transfer of the knowledge they had acquired. These findings suggest that memory-impaired patients may eventually be able to use a microcomputer as a prosthetic device.
The effects of two therapy methods in the treatment of picture naming problems are compared, using a within-patient design with 12 adult patients with chronic acquired aphasia. We contrast techniques that require the patient to process the meaning corresponding to the picture name (semantic treatment) with those that provide the patients with information about the phonological form of the name (phonological treatment). With each method, patients either had 4 sessions of treatment over one week, or 8 sessions over two weeks. Both methods caused day-by-day improvement that was specific to the actual items treated. Both methods resulted in significant improvement in naming when this was measured one week after the end of treatment, with a small, but significant advantage for the semantic treatment; this is mainly due to improvement that generalizes to untreated items. We conclude that specific and theoretically motivated treatment methods can cause significant improvement in the word retrieval ability of patients with chronic aphasia.
An interactive activation model for picture naming was used to guide treatment of a semantic-level deficit in 4 individuals with aphasia and severe picture-naming problems. Participants exhibited a profile consistent with Broca's aphasia with severe naming deficits, part of which was attributable to a semantic impairment based on testing of the lexical system. A semantic-based treatment was used to train naming of nouns in two semantic categories using a single-participant multiple baseline across behaviors and participants. Additional treatment, which included orthographic and phonological information about target words, then was applied. Treatment responses and error patterns demonstrated that semantic treatment resulted in improved naming of both trained and untrained items for 2 of 4 participants. Two participants did not show improved naming until treatment emphasizing the phonological form of the word was provided. This study demonstrates the utility of using an interactive activation model to plan treatment based on levels of disruption in the lexical processing system.
In Speaking, Willem "Pim" Levelt, Director of the Max-Planck-Institut für Psycholinguistik, accomplishes the formidable task of covering the entire process of speech production, from constraints on conversational appropriateness to articulation and self-monitoring of speech. Speaking is unique in its balanced coverage of all major aspects of the production of speech, in the completeness of its treatment of the entire speech process, and in its strategy of exemplifying rather than formalizing theoretical issues.
Bradford Books imprint
Aphasia therapy is an ambiguous term, meaning either “therapy of aphasia” or “therapy of the aphasic patient”. Of course, the two aspects cannot and should not be separated in clinical practice. First of all, there is always the individual person with her or his specific history of illness and handicap. Patients differ greatly in how they deal with their being aphasic, which, in most cases, has changed their lives drastically. The degree to which a new personal perspective can be built up and social integration be achieved depends on numerous factors, such as etiology and prognosis of the basic illness, premorbid personality, family support, friends and self-help groups, social status and profession, financial resources, etc.
Our experience with aphasia therapy has developed in the Neurology Department of the Technical University in Aachen under the direction of Klaus Poeck. Aphasia therapy is provided for both in- and outpatients. Inpatients stay either on acute wards, including intensive care, or on a special aphasia ward. Outpatients are seen either for extensive neurolinguistic and neuropsychological diagnosis at the neurological clinic or for aphasia therapy administered at the school of logopedics. The aphasia therapists cooperate with an interdisciplinary group of researchers including linguists, psychologists, and neurologists. Research on therapy has developed from clinical, diagnostic, and theoretical interests. In the past, we have made several attempts to combine different approaches to a comprehensive treatment regimen (cf. Huber, 1988; Huber, 1991, 1992; Huber, Poeck, & Springer, 1991; Huber & Springer, 1989; Poeck, 1982; Poeck, Huber, Stachowiak, & Weniger, 1977; Springer, 1986; Springer & Weniger, 1980; Weniger,Huber, Stachowiak, & Poeck, 1980; Weniger & Springer, 1989). Furthermore, we have been concerned with methodological issues of therapy research using either single case or group designs (Willmes, 1985, 1990).
The effects of two cueing treatments for lexical retrieval were examined with three aphasic speakers who demonstrated different levels of lexical processing impairment (i.e., predominately semantic, predominately phonologic, and mixed semantic-phonologic). Each speaker received both treatments, with treatments being applied sequentially to different word lists in a multiple baseline design. Both treatments consisted of a prestimulation phase followed by the application of a response-contingent cueing hierarchy. One treatment employed semantic-level cueing, whereas the other treatment utilised phonologic-level cueing. All participants evidenced a positive response to both of the treatments and one participant (predominately phonologic-level deficit) showed a superior response to lexicalsemantic treatment.
In this paper we discuss some aspects of the role of theory in cognitive neuropsychological research. We will consider, in particular, the nature of performance criteria used in classifying patients with acquired cognitive disorders, and we will argue that all such criteria are necessarily theory-laden. This issue will be discussed in the specific context of the putative distinction between patients with access vs. storage deficits (Warrington & Shallice, 1979). We will conclude that although the theoretical distinction between access and storage is potentially an exciting and useful one, the phononema that have been reported are far from compelling. Furthermore, and more importantly, we will argue that the proposal is not supra-theoretical in scope as has been claimed, but rather that its evaluation and verification rely crucially in the theoretical framework within which it is presented.
The word-finding difficulties of dysphasic patients are assisted by providing semantic or phonological cues about objects and their names. Experiments that have evaluated a single application of such cues suggest that semantic assistance is more beneficial. However, both approaches seem helpful in repeated therapy sessions. An experiment to identify the source of this assistance was performed. The results replicated previous reports that therapy effects persist for long periods but the experiment failed to find a difference in the effects of word/pictures-matching tasks where semantic information must be accessed and a task where the picture was seen while its name was repeated. An unexpected finding was that generalisation to non-target items in the therapy task occurred, but only for those unrelated to the targets. Some thoughts are offered on the appropriateness of this approach to therapy.
Background: Lexical retrieval problems are pervasive in aphasia and are often an important focus of treatment. Although many treatments have been demonstrated to positively impact lexical retrieval in aphasia, comparisons of such treatments have been relatively rare. Aims: The purpose of this investigation was to compare the relative effects of two lexical retrieval cueing treatments when administered concurrently with a participant with chronic anomic aphasia. The cueing treatments, phonological cueing treatment (PCT) and semantic cueing treatment (SCT) were designed to target the lexical phonologic and lexical semantic levels of processing, respectively. Methods & Procedures: The participant received both treatments concomitantly in the context of an alternating treatments design and multiple baseline design across behaviours. Separate lists of words were assigned to each treatment and additional word lists were designated for generalisation assessment. Following achievement of criterion levels of performance, each treatment was then applied to the additional lists in order to attempt to replicate treatment effects. Outcomes & Results: The participant showed a positive response to both treatments. However, he achieved higher levels of accuracy of naming for items treated with SCT. This effect was observed in both phases of treatment application. Conclusions: For this participant, SCT appeared to be the preferred treatment, at least in the context of concurrent administration of the treatments. This preferential response may be related to a pretreatment pattern of responding in which the participant routinely used descriptions and semantically related sentence cues to attempt to retrieve words.
The case of a globally aphasic patient (JCU) is reported. Four experiments are described. In the first, she was able to make correct non-verbal semantic judgements about pictures. In naming, correct phonemic cues elicited correct names for 49% of the pictures. Incorrect cues elicited a variety of errors; semantic errors were the most frequent, and they were not often rejected by JCU saying “no” immediately afterwards. Unrelated word paraphasias were usually rejected. Cued word reading was no worse than naming but there were many fewer semantic errors. In a comprehension task, JCU was able to judge that correct names were correct, and that unrelated names were inappropriate, but she judged more than 50% of semantic co-ordinates of the correct names to be correct. The nature of the processes responsible for her semantic errors is discussed, and it is argued that JCU is using incomplete semantic information in name retrieval and word comprehension, but that she does not have a deficit specific to any particular lexical items.
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 remediated but it remains difficult to ascertain the precise mechanism by which this improvement in naming is achieved. Several issues are discussed which pertain to this problem: the effectiveness of ‘semantic’ and ‘phonological’ tasks; the relevance of each component of the therapy task to the outcome of the therapy; the relationship between the type of deficit and the effectiveness of a task; when generalization can be expected as opposed to (treated) item-specific improvement; and the importance of patient success on the task to the success of the therapy. Finally, the paper concludes with suggestions for the possible direction of further research into this important area.
Neuropsychological results are increasingly cited in cognitive theories although their methodology has been severely criticised. The book argues for an eclectic approach but particularly stresses the use of single-case studies. A range of potential artifacts exists when inferences are made from such studies to the organisation of normal function – for example, resource differences among tasks, premorbid individual differences, and reorganisation of function. The use of “strong” and “classical” dissociations minimises potential artifacts. The theoretical convergence between findings from fields where cognitive neuropsychology is well developed and those from the normal literature strongly suggests that the potential artifacts are not critical. The fields examined in detail in this respect are short-term memory, reading, writing, the organisation of input and output speech systems, and visual perception. Functional dissociation data suggest that not only are input systems organised modularly, but so are central systems. This conclusion is supported by findings on impairment of knowledge, visual attention, supervisory functions, memory, and consciousness.
This study investigated the efficacy of two types of cues (phonemic and semantic) in aphasic patients with naming deficits. Subjects consisted of ten Broca's, ten Wernicke's, eight conduction, and eight anomic aphasic subjects. Cues were administered following failure to name on confrontation. Responsiveness to cueing was dependent on type of cue and type of aphasia. Subjects performed better on phonemic as compared to semantic cues. In addition, aphasic subgroups responded differentially, with conduction subjects responding significantly better to cueing than Wernicke's subjects. These findings are discussed with respect to the neuropsychological mechanisms involved in cueing.
Little is known about the treatment of object naming impairments in patients with multiple loci of deficit in the cognitive processes underlying picture naming. We evaluated the outcome of naming treatment in two such patients. We developed two treatments on the basis of a cognitive neuropsychological assessment of naming and contrasted their effectiveness with that of simple verbal rehearsal. In Treatment Programme 1, we targeted presumed impairment at the level of lexical retrieval by attempting to train subjects to use a phonological cueing hierarchy during a name to auditory definition task. In Treatment Programme 2, we targeted presumed impairment of visual-semantic processing by attempting to train subjects to use a visual-semantic cueing hierarchy during an oral picture naming task. Treatment Programme 3 was designed to determine if improvement in oral naming could result from simple rehearsal. All three treatment programmes improved naming abilities of the two subjects to some degree, particularly Treatment Programmes 1 and 2. We discuss various factors that may have contributed to these results. Although this report does not conclusively demonstrate efficacy of naming treatment in subjects with inordinate picture naming impairment due to multiple loci of disruption within the naming process, it suggests that cognitive processes implicated in this disorder are sensitive to these interventions.
In a repeated case study design, six aphasic patients with naming difficulties were selected according to criteria generated from the application of a cognitive neuropsychological model of naming. Two subjects were thought to have problems within the semantic system, and were given semantic (model-appropriate) therapy. Two subjects were thought to have problems relating to the phonological lexicon; they were given phonological (model-appropriate) therapy. Two subjects were thought to have problems at the level of phoneme assembly; they were given semantic (model-inappropriate) therapy. This was in order to test whether a treatment programme designed for one type of naming disorder could be effective if used indiscriminately (as might happen in current clinical practice).Three of the subjects receiving model-appropriate therapy showed improved naming after eight weeks of therapy; the two subjects receiving model-inappropriate therapy did not improve. The results suggest that applying a processing model in selecting patients for therapy for naming difficulties is a promising development which merits further testing.
Picture descriptions of aphasic patients and nonaphasic controls were analyzed with respect to type and amount of linguistic repairs and searching phenomena (“prepairs”). Repairs occurred far less frequently than prepairs, which indicates impaired postarticulatory as opposed to intact prearticulatory monitoring. Prepairs were found to be most frequent in patients with relatively good comprehension, in patients with poor production, and in those who had both good comprehension and poor production. Contrary to expectation, there was no reliable difference in the distribution of prepairs and repairs between patients with Wernicke's and Broca's aphasia, although these two groups differed in performance. Possible mechanisms of linguistic monitoring are discussed.
This paper presents a simple and widely ap- plicable multiple test procedure of the sequentially rejective type, i.e. hypotheses are rejected one at a tine until no further rejections can be done. It is shown that the test has a prescribed level of significance protection against error of the first kind for any combination of true hypotheses. The power properties of the test and a number of possible applications are also discussed.
This study compared the facilitative values of six types of cue for eliciting picture naming responses from Brocas, Wernickes, and anomic aphasics. Degree of responsivity to cues was inversely related to severity of naming disorder. Type of cue, severity of naming disorder, and diagnostic category contributed significantly to the results obtained, though the diagnostic groups did not show differential patterns of response to the cues. First Sounds and Completion sentences were the most effective cues. The finding of diagnostic group differences in degree of responsivity to cues, without differential sensitivity to type of cue, was interpreted as indicating that a single factor might account for group differences in ability to benefit from cuing.
Previous research demonstrated that a single amnesic patient could acquire complex knowledge and processes required for the performance of a computer data-entry task. The present study extends the earlier work to a larger group of brain-damaged patients with memory disorders of varying severity and of various etiologies and with other accompanying cognitive deficits. All patients were able to learn both the data-entry procedures and the factual information associated with the task. Declarative knowledge was acquired by patients at a much slower rate than normal whereas procedural learning proceeded at approximately the same rate in patients and control subjects. Patients also showed evidence of transfer of declarative knowledge to the procedural task, as well as transfer of the data-entry procedures across changes in materials.
In this study of auditory prestimulation cues, picture naming performances under phonemic and semantic conditions were compared to picture naming performance under a neutral condition. Twenty aphasic subjects named 324 pictures (108 pictures x 3 conditions) each. Responses were scored using a coding system adapted by the investigator from classification systems used by Williams and Canter (1982) and Kohn and Goodglass (1985). Results indicated that naming accuracy was facilitated by phonemic and semantic cues. An examination of the distribution of errors under the three conditions revealed systematic effects of phonemic and semantic cues on the frequency of occurrence of specific error types. Increases in semantic paraphasia proportion scores and decreases in unrelated word error proportion scores were associated with the semantic condition, while increases in phonemic paraphasia proportion scores were associated with the phonemic condition. The finding that naming performance of aphasic adults varies as a function of the type of information provided by the cue is discussed in relation to cascade visual confrontation naming models.
Transmission ratio distortion (TRD) is a property of complete t haplotypes which results in the preferential transmission of the t haplotype chromosome from heterozygous t/+ males to the majority of the offspring. A candidate gene for one of the primary genetic elements in TRD, the t complex responder locus has recently been suggested to be Tcp-10b
t. There are multiple, functional Tcp-10
t genes, but genetic data suggest the presence of the Tcp-10a
t gene alone is compatible with normal transmission ratios. Here we present the complete sequence and genomic structure of the Tcp-10a
t gene which is compared with sequence data from a number of cDNAs and genomic subclones representing all active Tcp-10
t family genes. A detailed table of all sequence variants discovered in the course of our investigation is presented, and we have clarified the extent of 5′ untranslated alternative splicing patterns exhibited by this gene family. A 60 base pair (bp) in-frame deletion from the 5′ end of exon 3 of the Tcp-10a
t gene is also presented and compared with the equivalent region of Tcp-10b
t and Tcp-10c
t. A search of the University of Edinburgh database has revealed a significant homology between the Tcp-10b
t open reading frame and several cytosolic filament proteins. Interestingly, the region of homology is involved in the deletion from the Tcp-10a
t gene.
This study investigated Luria's hypothesis that aphasic subgroups would respond differentially to phonemic prompts. Responsiveness to initial-sound cues was examined in 40 aphasics--10 Broca's, conduction, Wernicke's, and anomic aphasics who had naming difficulties. Results, with the exception of the anomic aphasic group, supported Luria's predictions. Broca's aphasics were responsive to phonemic cueing, while Wernicke's aphasics were not. Conduction aphasics tended to respond in a fashion similar to the Wernicke's group. The relationship of cueing responsiveness to underlying naming mechanisms is discussed.
This study describes a treatment project, carried out with two anomic subjects, RBO and GMA failed to name pictures correctly as a consequence of damage to phonological lexical forms; their ability to process word meaning was unimpaired. Words that were consistently comprehended correctly, but produced incorrectly by each subject, were identified. Some words were treated, whereas some served as the control set. A significant improvement was observed in both subjects. As predicted by the model of lexical-semantic processing used as the theoretical background for the study, improvement was restricted to treated items and did not generalize to untreated words, not even to words that were semantically related to those administered during treatment. Improvement was long-lasting, as shown by the fact that 17 months post-therapy GMA's performance on treated words was still significantly better than before treatment. These results are discussed in relation to the claim that cognitive models can be profitably used in the treatment of language disorders.
We propose that one of the major functions of explicit memory is the elimination of learning errors. The hypothesis is explored by means of a stem completion task in which subjects are presented with stems having many potential completions, and in the initial phase are either encouraged to guess, the "errorful" procedure, or are provided with the correct completion, the "errorless" condition. Learning is then tested over a sequence of nine trials. The performance of amnesic subjects who are assumed to have good implicit but bad explicit learning is compared with that of normal elderly subjects, who are assumed to have an intermediate level of explicit learning skill, and young controls who are expected to be high in both implicit and explicit learning capacity. As predicted, errorless learning is beneficial, with the effect being particularly marked for the amnesic group. A detailed analysis of the intrusion errors supports an interpretation of the results in terms of the relative contribution to the three groups of implicit learning, which is assumed to be particularly vulnerable to interference. Implications for the analysis of normal learning, and for the rehabilitation of brain damaged patients are discussed.