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Treating attention to improve auditory comprehension in aphasia
... Thus, researchers have recommended that clinicians consider their clients' alertness and attention during both the assessment of aphasia and the aphasia treatment process. Given the relationship between language and attention in aphasia and the potential of attention skills to influence the outcomes of aphasia treatment, targeting attention deficits in people with aphasia has been suggested by some researchers to increase linguistic performance (Crosson & Cohen, 2012;Murray, 1999), and indeed, there has been a growing aphasia literature examining attention interventions (e.g., Helm-Estabrooks et al., 2000;Peach et al., 2017Peach et al., , 2019Sinotte & Coelho, 2007). For example, Murray et al. (2006) analyzed the effects of attention training on aphasia by using the Attention Process Training-II program (APT-II; Sohlberg et al., 2001) with a participant with chronic conduction aphasia. ...
... Results showed that the participant made improvements on attention and memory tests, albeit his auditory comprehension abilities improved nominally without any noticeable generalization to daily communication situations (Murray et al., 2006). In a study conducted with the aim of evaluating the effect of attention training on auditory comprehension in two participants with mixed non-fluent aphasia, Helm-Estabrooks et al. (2000) showed that their Attention Training Program was a promising method for enhancing auditory comprehension and nonverbal reasoning in chronic aphasia. However, they also stated that their findings "seem to raise as many questions as they answer" (p. ...
... By documenting improvements in naming following the combined treatment within a cross-over single-subject design, our findings extend those from prior aphasia investigations with less robust study designs that have reported positive effects of an attention training program by itself (e.g., APT-II [Sohlberg et al., 2001]) on language modalities such as reading comprehension and rate (e.g., Coelho, 2005;Sinotte & Coelho, 2007) or listening comprehension (e.g., Helm-Estabrooks et al., 2000). The results of our study are similar to those of Zhang et al. (2019), who, within the context of a randomized controlled trial design, also reported improved naming ability after a five-week attention training plus language intervention program, albeit their language intervention targeted language functioning as a whole. ...
a tehran university of Medical sciences, school of rehabilitation, speech therapy department, tehran, iran; b school of communication sciences and disorders, Western university, ontario, canada; c Faculty of psychology and educational sciences, shahid Beheshti university, tehran, iran ABSTRACT Aim: Given the ever-increasing evidence for the co-occurrence of attention impairments and language disorders in chronic aphasia, this study aimed to compare the effects of two naming treatment programs, one with and one without attention training components, on the naming performance of participants with aphasia. Materials and methods: This was a single-subject crossover study in which six people with chronic aphasia and different degrees of naming and attention impairments participated. Two treatment programs were implemented for each participant, with the sequence of the treatments with crossover design. Each program consisted of 12 treatment sessions plus pre-and post-treatment assessment sessions (15 weeks for each participant). The visual analysis and WEighted STatistics methods were employed for data analysis. Results: Based on visual analysis, both treatments improved in comparison to the baseline phase. Statistical analysis revealed that the number of participants with significant naming improvement following combined program (5 participants) was larger than the number of participants showing improvement following completion of the single, program. Conclusion: Although integrating attention training into a conventional treatment for anomia can increase the effect of treatment on naming ability, more studies are required to clarify the role of attention in remediating naming impairments in aphasia.
... In this view, it is well-recognized that the assessment and treatment of IWA is focused on the language deficits (Hula and McNeil, 2008). Further, there is robust evidence about non-linguistic cognitive impairments such as memory, attention and executive functions in IWA (Glosser and Goodglass, 1990;Helm-Estabrooks, 2002;Helm-Estabrooks et al., 2000;Keil and Kaszniak, 2002;McNeil et al., 1991;Murray, 2012;Purdy, 2002). ...
... While others have recently found positive effects on auditory comprehension using less direct approaches of training, applying nonverbal visual attention skills (Helm-Estabrooks, 2011;Helm-Estabrooks et al., 2004;Murray et al., 2006). Helm-Estabrooks et al. (2000) used the Attention Training Program (ATP) for treating auditory comprehension deficits in two chronic mixed nonfluent aphasics with varying results. Their first participant, who showed poor cognitive skills at baseline, showed improvement in both cognition and auditory comprehension. ...
... HGH who initially demonstrated better auditory and attentional performance compared to MZ, due to his milder form of aphasia, also experienced improvement in auditory measures but to a lesser extent as was hypothesized (d-score = 4.1). These findings confirm with that of Helm-Estabrooks et al. (2000) who also identified improvement in patients in response to their proposed attention training program. Albiet, the third participant (AN), against our expectations, did not respond to the treatment at all with a d-score of 0.5 which needs explanation. ...
Attention as a non-linguistic cognitive component appears to play a role in language performance. Few research have identified evidence of contribution of attention training in improvement of auditory comprehension with Individuals with Aphasia (IWA). Based on the previous studies, it was hypothesized that visual attention training improves auditory comprehension in IWA with moderate severity. Three adults (two male and one female) with chronic aphasia participated in the study, all with attention and auditory comprehension deficits included in the study using the auditory comprehension subset of Persian version of the Western Aphasia Battery (P-WAB) and Farsi Aphasia Test (FAT). Adopted attention cognitive tests of Stroop and Continuous Performance Test (CPT) were used to measure cognitive capabilities pre-treatment. NEurocognitive Joyful Attentive Training Intervention (NEJATI) was used as an attention cognitive intervention in a 6-weeks training program through single subject non-concurrent multiple baseline design across participants to evaluate treatment effects. Cohen’s d-static was used to quantify treatment effect size. Two of the three participants showed significant improvements in their auditory comprehension skills with corresponding effect sizes that were large and medium in magnitude (d = 5.7 and d = 4.1 respectively). The third participant did not show any sign of improvement (d = 0.5). The hypothesis that attention training leads to improvement in auditory comprehension in moderate aphasia has been confirmed in this study. Cognitive factors can also play a role in the effectiveness of the treatment. This finding needs to be more investigated in larger population of aphasia patients with control for cognitive abilities variabilities.
... Executive functions (EF) have been recognised as playing an important role in aphasia symptomatology, severity, recovery and treatment. A body of recent research suggests, for example, that deficits in cognitive effort or intention may be implicated as potential contributors to the communication problems in aphasia (McNeil et al., 2006;Murray, Holland, & Beeson, 1997;Murray, 2000;Purdy, 2002), may also play a role in recovery from aphasia (Helm-Estabrooks, Connor, & Albert, 2000;Ramsberger, 2005) and may determine response to therapy (Green et al., 2010;Helm-Estabrooks et al., 2000;Ramsberger, 2005). The majority of studies investigating the relationship between EFs and language deficits in aphasia have been conducted on monolingual persons and there are relatively few studies on the executive functioning of bilingual persons with aphasia. ...
... Executive functions (EF) have been recognised as playing an important role in aphasia symptomatology, severity, recovery and treatment. A body of recent research suggests, for example, that deficits in cognitive effort or intention may be implicated as potential contributors to the communication problems in aphasia (McNeil et al., 2006;Murray, Holland, & Beeson, 1997;Murray, 2000;Purdy, 2002), may also play a role in recovery from aphasia (Helm-Estabrooks, Connor, & Albert, 2000;Ramsberger, 2005) and may determine response to therapy (Green et al., 2010;Helm-Estabrooks et al., 2000;Ramsberger, 2005). The majority of studies investigating the relationship between EFs and language deficits in aphasia have been conducted on monolingual persons and there are relatively few studies on the executive functioning of bilingual persons with aphasia. ...
... The findings of this study suggest that there are clear interactions between language and EF skills early in the recovery phase. In monolingual patients, treatment targeting cognitive skills has been found to have a positive impact on functional communication (Ramsberger, 2005) and it has been suggested that new treatment approaches incorporating cognitive skills in the context of language tasks may be necessary to improve language skills (Helm-Estabrooks et al., 2000;McNeil, Matthews, Hula, Doyle, & Fossett, 2006;Murray & Ramage, 2000). Kohnert (2004) supported this notion in the context of bilinguals, based on the results that intervention targeting basic information processing skills positively impacted on the language deficits in a bilingual person with severe nonfluent aphasia. ...
Background: The nature, rate and pattern of recovery in bilingual persons with aphasia has been investigated over many years but several controversies remain. Recent evidence suggests that the relationship between executive function (EF) processes and language recovery may be distinct in bilinguals. An improved understanding of such underlying linguistic and cognitive processes may enhance assessment and treatment particularly in the acute phase. There is limited knowledge regarding how these processes interact and there remains little guidance as to the choice of an appropriate assessment battery. There is a need to develop a simple, effective battery which is sensitive to recovery processes, and in a multicultural and multilingual context, is able to distinguish normal from pathological profiles.
Aims: The research study aimed to identify an assessment battery for language and EF that is sensitive to the recovery process for South African bilingual persons with aphasia at two time periods within the first 12 weeks post stroke.
Methods and Procedures: A longitudinal comparison study was conducted at two acute rehabilitation centres. A sample of 10, second language English-speaking participants with aphasia (PWA) were assessed at two time periods within the first 12 weeks post stroke using the Comprehensive Aphasia Test (CAT) and a non-verbal EF battery. A matched control group of 19 neurologically intact bilingual, second language English speakers was assessed on the same battery on two occasions.
Outcomes and Results: A between-group analysis identified statistically significant differences between the bilingual aphasic and control groups for language assessment as well as on the EF assessment (measuring updating, inhibition and shifting). The battery of tests also distinguished testing period and was appropriate for a variety of cultural groups. Distinctive profiles emerged across time for both language and EF subtests for the PWA.
Conclusion: The combined battery appeared appropriate for the context and the results confirmed prior research suggesting that executive functioning may offer some explanations for differential recovery profiles. Exploring this distinct clinical profile may strengthen the decision-making process with regard to the type and language medium of therapy. Persistent EF deficits suggest the need for a cautionary interpretation of a bilingual advantage in the acute stage. Effective management in the acute phase of aphasia should be based on an understanding of recovery patterns, what is driving that pattern, and which cognitive deficits are contributing to the language behaviour. Delineating separate EFs and their linguistic correlates in bilinguals may aid management choices.
... Executive function also plays a role in recovery from aphasia (Bailey, Powell, & Clark, 1981;Coelho, 2005;Helm-Estabrooks, Tabor Connor, & Albert, 2000;Ramsberger, 2005;Sturm, Willmes, Orgass, & Hartje, 1997). Differential profiles of recovery have been identified and evidence suggests a link between better communication skills and better retained or recovered EF (Miyake, Emerson, & Friedman, 2000;Purdy, 1992). ...
... Differential profiles of recovery have been identified and evidence suggests a link between better communication skills and better retained or recovered EF (Miyake, Emerson, & Friedman, 2000;Purdy, 1992). Similarly, improvements in aspects of language performance are associated with attention and executive training programmes (Coelho, 2005;Helm-Estabrooks et al., 2000;Ramsberger, 2005). ...
... In addition, where EFs are well preserved, we would aim to develop patient-centred compensatory strategies. These strategies could be conversational or could directly address one or more of the executive skills such as direct attention training (Coelho, 2005;Helm-Estabrooks et al., 2000;Ramsberger, 2005;Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001;Sturm et al., 1997). In other cases, our focus may be better placed on providing a supportive context that will compensate for conversational and executive deficits. ...
Background: Deficits of executive function (EF) have been proposed as all or part of the underlying mechanisms of language impairment in at least some types of aphasia. Executive functions also play a role in the recovery process. There is evidence that bilingual persons have some executive functioning advantages compared to monolingual persons. In this paper we combine two lines of recent investigation in order to explore the relationship between executive function and conversational strategies in bilingual aphasia.Aims: The aim of this preliminary research was to compare the executive functioning profiles of bilingual individuals to those of monolingual participants with aphasia. A further aim was to examine evidence in the conversational samples of the participants in relation to the application of a range of executive skills and to link cognitive and conversational profiles using Barkley's (1997) model of executive functions.Methods & Procedures: The performance of two bilingual individuals with aphasia on a test battery of executive function tests was compared with that of eight monolingual persons (seven with aphasia and one with right hemisphere damage). The test battery included measures of behavioural inhibition, working memory, problem solving, and reconstitution. The presence or absence of executive features in the conversational samples of the participants was judged by four raters using conversational analysis methods.Outcomes & Results: Significant differences were found between the scores of the bilingual participants and those of the monolingual participants on measures of behavioural inhibition, working memory, planning and problem solving, and reconstitution. The bilingual participants' scores were mostly within normal limits and suggested well‐retained executive functions. Conversation analysis showed evidence of differential application of these executive functions to conversational management. Regardless of severity or type of aphasia, the bilingual participants showed evidence of good topic management, repair, and flexibility compared to the monolingual participants.Conclusions: The results are interpreted in relation to current issues in bilingualism. Our preliminary findings shed light on differential approaches to assessment, therapy, and choice of language for bilingual aphasia.
... In line with these results, some studies have investigated the influence of cognitive therapy, particularly EF training, on language improvement (Hardin & Ramsberger, 2004, cited by Helm-Estabrooks & Albert, 1991Helm-Estabrooks, Connor, & Albert, 2000;Ramsberger, 2005). After delivering attention-training programme, Helm-Estabrooks et al. (2000) revealed improved performance on tasks measuring auditory comprehension and visual analytic reasoning. ...
... In line with these results, some studies have investigated the influence of cognitive therapy, particularly EF training, on language improvement (Hardin & Ramsberger, 2004, cited by Helm-Estabrooks & Albert, 1991Helm-Estabrooks, Connor, & Albert, 2000;Ramsberger, 2005). After delivering attention-training programme, Helm-Estabrooks et al. (2000) revealed improved performance on tasks measuring auditory comprehension and visual analytic reasoning. Similarly, Hardin and Ramsberger (2004) noted that attention/executive training can lead to improvement of transactional success in conversation. ...
Background: Recent studies imply that executive functions (EF) are closely related to our ability to comprehend and produce language. A number of findings suggest that functional communication and language recovery in aphasia depend not only on intact language abilities but on EF as well. Some patients with transcortical motor aphasia (TMA) show language deficits only in tasks in which conflicting representations must be resolved by executive processes. In line with these results, others have proposed that TMA should be referred to as “dysexecutive aphasia”. EF in aphasia have mostly been studied using neuropsychological tests, therefore there is a need for systematic experimental investigations of these skills.
Aims: 1. To investigate EF in TMA, and to test whether executive dysfunctions are specific to TMA. 2. To experimentally measure different components of EF: updating working memory representations and inhibition of prepotent responses.
Methods & Procedures: Five individuals with TMA, five patients with conduction aphasia and ten healthy controls participated. We designed four nonverbal tasks: to measure updating of working memory representations, we used a visual and an auditory n-back task. To assess inhibition of prepotent responses, we designed a Stop-signal and a nonverbal Stroop task. All tasks involved within-subject baseline conditions.
Outcomes & Results: We found certain EF deficits in both groups of individuals with aphasia as compared to healthy controls. Individuals with TMA showed impaired inhibition as indexed by the Stop-signal and the nonverbal Stroop tasks, as well as a deficit of updating of working memory representations as indexed by the auditory n-back task. Participants with conduction aphasia had difficulties in only one of the tasks measuring inhibition, but no clear evidence for impairment of updating of working memory representations was found.
Conclusions: Although the results show different patterns of EF deficits in the groups with aphasia, the findings clearly demonstrate that EF deficits are not specific to participants with TMA. Based on these results, and on earlier data highlighting the role of executive processes in functional communication and language recovery, we suggest that tests of EF should be an inherent part of clinical aphasia assessment.
... As concerns auditory comprehension, our assumption is supported by the results of two case studies of Helm-Estabrooks, Tabor Connor & Albert [65], who report on "attention training" as a promising strategy regarding auditory comprehension deficits in aphasia. The authors emphasize the importance of additional training of cognitive capabilities in aphasia instead of interpreting aphasia as an exclusively linguistic deficit. ...
The main objective of this study was to investigate the efficacy of a directed rhythmic-melodic voice training (SIPARI) compared to language therapy with the focus on improvement in expressive linguistic performance. 20 patients suffering from chronic non-fluent aphasia, allocated by coin tossing to either of the groups, participated in 32 single therapy sessions over a period of 4 months. Before and after therapy, independent testers performed a standardized language test (Aachener Aphasie Test). Behavioral assessments revealed that improvements of patients of the experimental group were clinically significant compared to those of the control group. These improvements concerned the description level articulation and prosody for spontaneous speech and the subtests repetition, naming, and comprehension. Based on these improvements, a significant increase in profile level (effect size (ES) = 2.028, p < 0.001) was assessed, an overall and clinically relevant measure of the severity of aphasia. Additional fMRI examinations yielded activation in the left superior frontal gyrus for the post-minus pre- therapy assessments only for participants of the experimental group. Since this brain region is reported to be particularly involved in executive processing, we assume that the directed procedure of the SIPARI treatment with regard to musical, linguistic, and cognitive function potentially holds the key for successful language rehabilitation. While our imaging results hint at a possible explanation for its efficacy, our behavioral results corroborate the efficacy of this therapy in the treatment of chronic non-fluent aphasia patients. DRKS00026730, 19.10.21, retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026730
... Ces traitements consistaient en une augmentation soit de la conscience des réponses persé- (Kohnert, 2004). Quelques études ont montré un impact de l'APT-II sur les performances en compréhension orale (Helm-Estabrooks, Connor, & Albert, 2000) et en lecture (Coelho, 2005). Aucune n'a toutefois à priori mis en évidence d'amélioration des capacités d'expression orale après un tel entraînement. ...
Personen mit Aphasie erleben den Verlust ihrer Sprache und ihrer Gesprächsfähigkeit meist als grosse Einschränkung. Deshalb ist ein häufiges Ziel der Sprachtherapie, die Teilhabe an Gesprächen zu verbessern.
Studien zeigen, dass für erfolgreiche Gespräche neben sprachlichen Fähigkeiten auch Exekutivfunktionen relevant sind, insbesondere die Umstellungsfähigkeit. Diese wird in Gesprächen bei einem Themenwechsel, der Klärung von Missverständnissen oder dem Wechsel auf andere kommunikative Kanäle zur Verständigung benötigt. Studien weisen darauf hin, dass die Umstellungsfähigkeit bei Personen mit Aphasie beeinträchtigt sein kann, in der herkömmlichen Diagnostik und Therapie findet sie jedoch wenig Berücksichtigung.
Im vorliegenden Artikel werden deshalb bestehende Diagnostikverfahren und Therapiemethoden zu den Exekutivfunktionen im Bereich der Neuropsychologie vorgestellt, deren Übertragbarkeit auf die Sprachtherapie diskutiert und aktuelle Forschungslücken aufgezeigt. Anschliessend werden das neu entwickelte Screening zur kognitiven Flexibilität bei Aphasie (engl. Cognitive Flexibility in Aphasia-Screening/CFA-Screening) und der neu konzipierte Therapieansatz zur kognitiven Flexibilität in der Aphasietherapie (engl. Cognitive Flexibility in Aphasia Therapy/ CFAT) vorgestellt, die erstmals die Erfassung bzw. Behandlung von Störungen der Umstellungsfähigkeit bei Aphasie innerhalb von Alltagsgesprächen ermöglichen. Zur Veranschaulichung der CFAT und des CFA-Screening wird ein Einzelfall dargestellt.
... Because attentional shifting plays an important role in language learning and includes learning of new meanings, inferencing, and sentence structure (Deák & Narasimham, 2014;Jones et al., 1991;Magimairaj & Montgomery, 2013;Smith et al., 1996), designing an intervention approach that focuses on improving attentional shifting while also targeting their poor linguistic functioning may be more beneficial to accelerating language growth than focusing on language alone. Intervention studies incorporating other types of attention, including divided attention, have found that working on attention, in addition to language, in individuals with language disorders has been beneficial compared to working on language skills in isolation (e.g., Helm-Estabrooks, Connor, & Albert, 2000;Ebert & Kohnert, 2009;Khan, 2013). Whether or not the same holds true for targeting attention, including attentional shifting in preschool-age children with SLI, is unknown but potentially a worthy avenue of exploration. ...
Purpose
This study investigated attentional shifting in preschool children with specific language impairment (SLI) compared to their typically developing peers. Children's attentional shifting capacity was assessed by varying attentional demands.
Method
Twenty-five preschool children with SLI and 25 age-matched, typically developing controls participated. A behavioral task measuring attentional shifting within and across multiple dimensions (auditory, linguistic, and visual) was employed. Demands on attentional shifting were increased based on input dimension (low load: staying within dimension; medium load: shifting between 2 dimensions; and high load: shifting among 3 dimensions).
Results
Compared to controls, the group with SLI made more erroneous responses and exhibited longer response times. Although both groups' error rates were similarly affected by shifting compared to nonshifting trials, their response speed was not. The group with SLI exhibited a larger comparative decrement to their response speed in the high–attentional load condition.
Discussion
When demands on attentional shifting increase, children with SLI struggle to shift their attention as efficiently to changing stimuli as their unimpaired peers. Potential implications for the assessment and treatment of this population are discussed.
... A correct assessment of cognitive abilities and comprehension of lost and preserved functions might be useful in programming individualized rehabilitation training. Several studies [53][54][55] found a reduction of linguistic deficits after rehabilitative training for attention, memory, visual perception, or executive function-problem solving in aphasic patients who did not benefit from speech and language treatment. This suggests the greater advantage of combined rehabilitation for both language impairment and cognitive deficits in aphasic patients. ...
Cognitive dysfunction frequently occurs in aphasic patients and primarily compromises linguistic skills. However, patients suffering from severe aphasia show heterogeneous performance in basic cognition. Our aim was to characterize the cognitive profiles of patients with severe aphasia and to determine whether they also differ as to residual linguistic abilities. We examined 189 patients with severe aphasia with standard language tests and with the CoBaGA (Cognitive Test Battery for Global Aphasia), a battery of nonverbal tests that assesses a wide range of cognitive domains such as attention, executive functions, intelligence, memory, visual-auditory recognition, and visual-spatial abilities. Twenty patients were also followed longitudinally in order to assess their improvement in cognitive skills after speech therapy. Three different subgroups of patients with different types and severity of cognitive impairment were evidenced. Subgroups differed as to residual linguistic skills, in particular comprehension and reading-writing abilities. Attention, reasoning, and executive functions improved after language rehabilitation. This study highlights the importance of an extensive evaluation of cognitive functions in patients with severe aphasia.
... Many studies have established strong relationships between decreased WM capacity and language comprehension (Ivanova, Dragoy, Kuptsova, Ulicheva, & Laurinavichyute, 2015;Sung et al., 2009;Wright, Downey, Gravier, Love, & Shapiro, 2007). Further, an emerging body of research suggests that, in individuals with aphasia, treatment of specific cognitive deficits, including WM, could lead to improvements not only in these cognitive non-linguistic domains, but also in various language comprehension and production abilities (Berthier et al., 2014;Francis, Clark, & Humphreys, 2003;Helm-Estabrooks, Connor, & Albert, 2000;Mayer & Murray, 2002;Salis, 2012; for a review see Salis et al., 2015). ...
Background: Overall, there is growing consensus that working memory (WM) should be routinely assessed in individuals with aphasia as it can contribute significantly to their level of language impairment and be an important factor in treatment planning. However, there is still no consensus in the field as to which tasks should be used to assess WM in aphasia. The two main alternatives are adapted complex span tasks and N-back tasks. Both have been used interchangeably in previous studies of WM in aphasia, even though the correspondence between the two tasks has not been properly established. Aims: The current study investigates the relationship between two WM tasks—complex span and N-back tasks—in a large sample of individuals with aphasia. The relationships of these tasks to measures of language comprehension are also explored, as well as differences in performance patterns between individuals with non-fluent and fluent aphasia. Methods & Resources: Forty-four participants with aphasia (non-fluent: n = 27; fluent: n = 13; mixed: n = 4) were examined with a modified listening span task (Ivanova & Hallowell, 2014), an auditory verbal 2-back task, and a standardised Russian language comprehension test. Outcomes & Results: Results revealed a moderate relationship between the two WM measures, but demonstrated a divergence in terms of their relationship to language comprehension. Performance on the modified listening span task was related to language comprehension abilities, but performance on the 2-back task was not, suggesting that the two tasks primarily index different underlying cognitive mechanisms. Furthermore, the relationship between the modified listening span task and language comprehension was significant for individuals with non-fluent aphasia, but not for those with fluent aphasia. Conclusions: Overall, the data demonstrate that while performance of individuals with aphasia was related on the two tasks, the two tasks cannot be substituted for one another without further inquiries into their underlying differences.
... In fact, success of computer usage was tied to executive functioning skills more so than the severity of aphasia or semantic knowledge (Nicholas, Sinotte, & Helms-Estabrook, 2005). Although there is sufficient evidence to demonstrate the relation between executive functioning (and related cognitive skills) and communicative competency, relatively few studies have addressed the underlying cognitive deficits observed in aphasia and the impact of treatment on AAC (e.g., Hardin & Ramsberger, 2004; Helm-Estabrooks, Connor, & Albert, 2000; Ramsberger, 2005). In response to this burgeoning need, the Multimodality Communication Training Program (MCTP) was developed to address the cognitive flexibility impairments commonly observed in people with aphasia (Purdy & Cocchiola, 2006; Purdy & VanDyke, 2009). ...
Instructing individuals with aphasia in the usage of AAC strategies and devices is a challenging endeavor. Not only does this population present with a wide range of linguistic impairments, but many individuals also demonstrate cognitive deficits, which may adversely affect communication. This paper will summarize the wide variety of cognitive deficits demonstrated by individuals with aphasia, specifically attention, memory and executive functioning problems. In addition, we will review the impact of these cognitive impairments on communicative competence. Finally, we will discuss an intervention, the Multimodality Communication Training Program (MCTP), designed to address the cognitive impairments that influence AAC intervention.
... In fact, success of computer usage was tied to executive functioning skills more so than the severity of aphasia or semantic knowledge (Nicholas, Sinotte, & Helms-Estabrook, 2005). Although there is sufficient evidence to demonstrate the relation between executive functioning (and related cognitive skills) and communicative competency, relatively few studies have addressed the underlying cognitive deficits observed in aphasia and the impact of treatment on AAC (e.g., Hardin & Ramsberger, 2004; Helm-Estabrooks, Connor, & Albert, 2000; Ramsberger, 2005). In response to this burgeoning need, the Multimodality Communication Training Program (MCTP) was developed to address the cognitive flexibility impairments commonly observed in people with aphasia (Purdy & Cocchiola, 2006; Purdy & VanDyke, 2009). ...
... As much time as has been devoted to understanding the properties and underlying mechanisms of each, one might expect there to be substantial literature examining the effect each has on the other. Instead, attention researchers are mostly silent on language and language researchers are mostly silent on attention with these exceptions: supporters of a theory of limited resources and/or allocation of resources as a possible source of deficits in aphasia (Hula & McNeil, 2008;LaPointe & Erickson, 1991;McNeil, Odell, & Tseng, 1991;Murray, Holland, & Beeson, 1997); and a handful of others who have suggested that attention ought to be assessed (Glosser & Goodglass, 1990) and might be a valid indirect target for improving auditory comprehension (Helm-Estabrooks, Connor, & Albert, 2000) or transactional success in conversation in aphasia (Ramsberger, 2005),. ...
Although the mechanism of attention is not entirely understood, there is widespread agreement that attention is a limited capacity processing system that can flexibly allocate resources to modulate signal detection and response for controlled action. With respect to language processing, a complex combination of automatic and controlled processing mechanisms, attention plays an important role in mediating the selection of competing candidates so that, for example, the correct word can be activated. The present review summarizes current views on attention mechanisms, types of attention, the neuroscience of attention, and its presumed role in language processing.
... An emerging body of research suggests that treatment of specific cognitive nonlinguistic deficits, such as attention, perceptual processing, and memory, could lead to improvement not only in these cognitive nonlinguistic domains, but also in language abilities. Helm-Estabrooks, Connor, and Albert (2000) showed that two persons with chronic aphasia, who had reached plateaus in traditional language treatment, were able to make observable gains in linguistic auditory comprehension following a brief intervention specifically targeting sustained, selective, and divided attention. D. R. Francis, Clark, and Humphrey (2003) suggested that repetition training of sentences affected WM in participants with aphasia by increasing processing efficiency. ...
... Previous research has identified deficits in sustained attention in individuals with aphasia resulting from left-hemisphere lesions. Furthermore, problems with sustained attention have been hypothesised to account for auditory comprehension deficits (Helm-Estabrooks, Tabor-Connor, & Albert, 2000). As is evident from her scores, MS did not suffer from simple attention difficulties. ...
Background: Lack of communicative success for people with aphasia is no longer seen as purely a linguistic deficit. Instead, the integrity of the executive functions (EF) is thought to be at least partly responsible for successful communication, particularly during conversation. In order to inform clinicians regarding both conversation and EF, a merging of two paradigms—conversational and neuropsychological approaches—is proposed.This paper was presented at the Clinical Aphasiology Conference, Ghent, Belgium, May 2006.Aims: First, we explore the relevance of both neuropsychological and conversational approaches to the assessment of aphasia. Second, we present the executive battery that was designed and administered to a single participant (MS) to assess various aspects of EF. The results of a Conversation Analysis (CA) undertaken on an excerpt of MS's conversation are given. Results of the EF analysis are presented with the CA in order to highlight proposed relationships that may impact on conversational strengths and difficulties.Methods and Procedures: The executive battery was designed to assess the following constructs: attention, verbal and nonverbal working memory, memory, planning, generation, and concept formation. The participant was video‐recorded in conversation with a familiar interlocutor. Transcriptions were derived and subjected to Conversation Analysis. A discussion of conversational features is presented in conjunction with results from the executive battery.Outcomes and Results: Several areas including simple sustained attention, interference control, memory, and planning appeared to be preserved. This profile occurred together with the ability to maintain concentration and track meaning during interactions with one interlocutor. Memory for previously stated information was preserved as well as the ability to think and plan ahead. These strengths also co‐occurred with intact turn taking and topic management. However MS's performance also indicated difficulty with shifting attention, verbal and nonverbal working memory, generation, and concept formation. The latter two especially appeared to be mediated by the effects of perseveration, which resulted from a reduced ability to shift focus. In terms of conversation, MS reported difficulty in multi‐party settings. In addition, conversational repair was affected by poor generation and selection of strategies as well as an inability to shift away from current ineffectual forms of expression to more effective, flexible, and potentially successful forms of communication.Conclusions: The notion of merging two distinct and historically separate paradigms presents unique and valuable opportunities for creative and effective treatment of individuals with aphasia who have reached plateaus or who, as in this case, present with relatively intact linguistic skills on formal testing but experience daily frustration during conversation.
... The two patients with comprehension difficulties showed more improvement in the comprehension task during the first phase of training, regardless of the intensity of training. We propose that increased attentional capacities may have influenced these changes, as others have reported that auditory comprehension can be influenced by improved attention (Helm-Estabrooks, Connor, & Albert, 2000). ...
Background: Semantic comprehension training paired with verbal production leads to improved word retrieval in individuals with aphasia. Few studies have also examined effects of such training for word comprehension. MossTalk Words includes a training module to provide semantic comprehension training via computerised exercises. Variations in the treatment schedule may influence the impact of word retrieval and comprehension treatment gains.We extend our appreciation to our five participants and to Ruth Fink of the Albert Einstein Healthcare Network, who generously provided a copy of MossTalk Words for this study. This project was supported by NIH (NIDCD) grant P50 DC03888‐01A1 to the University of Florida (subcontract to Old Dominion University), and by the Dept. of Veterans Affairs Rehabilitation Research & Development Center of Excellence Grant F2182C to the Brain Rehabilitation Research Center, Gainesville, Florida.Aims: The purpose of this study was to investigate the effects of the Multi‐Mode Matching Exercises module of MossTalk Words for improving word comprehension and retrieval in individuals with aphasia. Effects of training were contrasted for two treatment schedules.Methods & Procedures: Five individuals with word retrieval impairments associated with aphasia participated. Two had word comprehension difficulties suggesting semantic anomia, and three others with intact comprehension had impairments suggesting phonologic anomia. In a single‐participant design, we investigated effects of training provided via computer with MossTalk multi‐mode matching exercises (spoken and written word/picture matching) paired with spoken rehearsal. All participated in two phases of training administered 1–2 times/week and 3–4 times/week, with order of phases counterbalanced across participants.Outcomes & Results: Improvements in word/picture yes/no verification for trained and some untrained words associated with large effect sizes (d>2.5) were evident in one of two participants when trained 1–2 times/week. Increases in picture naming associated with large effect sizes for trained words were noted in 5/5 participants when trained 4–5 times/week, and in 2/5 participants when trained 1–2 times/week. Increases in picture naming for untrained words were evident in 2/5 participants in the more frequent training schedule. At 1 month post training, picture naming performance remained above baseline levels, with little difference evident between sets trained with the two different training schedules.Conclusions: Computerised lexical training exercises may lead to increases in word comprehension and production, particularly for the target words trained. More frequent training leads to greater improvements during acquisition than less frequent training, but that advantage diminishes at 1 month post treatment, suggesting that a less frequent training schedule may be just as useful as more frequent training for promoting long‐term effects of lexical training.
... Further investigations of language in relation to STM and executive processes are needed to fully understand the role of non-linguistic cognitive processes in aphasia. Nonetheless there have been some promising recent efforts to develop diagnostic and treatment approaches that incorporate STM and executive processes in the context of language tasks with the goal of improving language (e.g., Helm-Estabrooks, Connor, & Albert 2000;Martin et al., 2010;McNeil, Matthews, Hula, Doyle, & Fossett, 2006;Murray & Ramage, 2000). Also, in the last few years the idea of a common process underlying STM and language processes has served as a foundation for treatment programmes aiming to improve language function by treatment of the ability to maintain activation of verbal representations in STM (Kalinyak-Fliszar, Koenig-Bruhin & Studer-Eichenberger, 2007;Majerus, Van der Kaa, Renard, Van der Linden, & Poncelet, 2005;Stark, 2005; for review see also Murray, this issue). ...
BACKGROUND: Language performance in aphasia can vary depending on several variables such as stimulus characteristics and task demands. This study focuses on the degree of verbal working memory (WM) load inherent in the language task and how this variable affects language performance by individuals with aphasia. AIMS: The first aim was to identify the effects of increased verbal WM load on the performance of judgments of semantic similarity (synonymy) and phonological similarity (rhyming). The second aim was to determine if any of the following abilities could modulate the verbal WM load effect: semantic or phonological access, semantic or phonological short-term memory (STM) and any of the following executive processing abilities: inhibition, verbal WM updating, and set shifting. METHOD AND PROCEDURES: Thirty-one individuals with aphasia and 11 controls participated in this study. They were administered a synonymy judgment task and a rhyming judgment task under high and low verbal WM load conditions that were compared to each other. In a second set of analyses, multiple regression was used to identify which factors (as noted above) modulated the verbal WM load effect. OUTCOME AND RESULTS: For participants with aphasia, increased verbal WM load significantly reduced accuracy of performance on synonymy and rhyming judgments. Better performance in the low verbal WM load conditions was evident even after correcting for chance. The synonymy task included concrete and abstract word triplets. When these were examined separately, the verbal WM load effect was significant for the abstract words, but not the concrete words. The same pattern was observed in the performance of the control participants. Additionally, the second set of analyses revealed that semantic STM and one executive function, inhibition ability, emerged as the strongest predictors of the verbal WM load effect in these judgment tasks for individuals with aphasia. CONCLUSIONS: The results of this study have important implications for diagnosis and treatment of aphasia. As the roles of verbal STM capacity, executive functions and verbal WM load in language processing are better understood, measurements of these variables can be incorporated into our diagnostic protocols. Moreover, if cognitive abilities such as STM and executive functions support language processing and their impairment adversely affects language function, treating them directly in the context of language tasks should translate into improved language function.
Translational neuroscience is a multidisciplinary field that aims to bridge the gap between basic science and clinical practice. Regarding aphasia rehabilitation, there are still several unresolved issues related to the neural mechanisms that optimize language treatment. Although there are studies providing indications toward a translational approach to the remediation of acquired language disorders, the incorporation of fundamental neuroplasticity principles into this field is still in progress. From that aspect, in this narrative review, we discuss some key neuroplasticity principles, which have been elucidated through animal studies and which could eventually be applied in the context of aphasia treatment. This translational approach could be further strengthened by the implementation of intervention strategies that incorporate the idea that language is supported by domain-general mechanisms, which highlights the impact of non-linguistic factors in post-stroke language recovery. Here, we highlight that translational research in aphasia has the potential to advance our knowledge of brain–language relationships. We further argue that advances in this field could lead to improvement in the remediation of acquired language disturbances by remodeling the rationale of aphasia–therapy approaches. Arguably, the complex anatomy and phenomenology of aphasia dictate the need for a multidisciplinary approach with one of its main pillars being translational research.
Purpose
This study was conducted to examine the comparative effectiveness of 2 different approaches, 1 domain-specific and the other domain-general, to language and attention rehabilitation in participants with stroke-induced aphasia. The domain-specific treatment consisted of language-specific attention treatment (L-SAT), and the domain-general treatment consisted of direct attention training (DAT) using the computerized exercises included in Attention Process Training-3 ( Sohlberg & Mateer, 2010 ).
Method
Four individuals with mild–moderate aphasia participated in this study. A randomized controlled cross-over single-subject design was used to assess the effectiveness of the 2 treatments administered in this study. Treatment outcomes were evaluated in terms of participants' task performance for each program, standardized language and attention measures, tests of functional abilities, and patient-reported outcomes.
Results
Visual comparisons demonstrated linear improvements following L-SAT and variable patterns following DAT. Omnibus effect sizes were statistically significant for 9 of the 13 L-SAT tasks. The weighted standardized effect sizes for posttreatment changes following L-SAT ranged from small to large, with the exception of 1 task. The average group gain following DAT was 5%. The Western Aphasia Battery–Revised Aphasia Quotients ( Kertesz, 2007 ) demonstrated reliable improvements for 3 of the 4 participants following L-SAT, whereas only 1 of the participants improved reliably following DAT. The margins of improvements in functional language were substantially larger following L-SAT than DAT. Performance on the Test of Everyday Attention improved significantly for 2 participants following L-SAT and for 1 participant following DAT on selected Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) subtests. Patient-reported outcomes for communication and attention following treatment favored L-SAT compared to DAT.
Conclusions
The results support the view that attention is allocated in ways that are particular to specific tasks rather than as a general resource that is allocated equivalently to all processing tasks. Domain-specific treatment for language deficits due to attentional impairment appears to be a suitable, if not preferable, approach for aphasia rehabilitation.
Supplemental Material
https://doi.org/10.23641/asha.8986427
People with aphasia frequently present with nonlinguistic deficits, in addition to their compromised language abilities, which may contribute to their problems with reading comprehension. Treatment of attention, working memory and executive control may improve reading comprehension in individuals with aphasia, particularly those with mild reading problems. This single-case experimental design study evaluated the efficacy of Attention Process Training-3, an intervention combining direct attention training and metacognitive facilitation, for improving reading comprehension in individuals with mild aphasia. A multiple baseline design across six participants was used to evaluate treatment effects. The primary outcome measure was a maze reading task. Cognitive measures were administered pre- and post-treatment. Visual inspection of graphed maze reading performance data indicated a basic effect between APT-3 and improved maze reading for three of the six participants. Quantitative analyses, using Tau-U, corroborated findings identified through visual analysis. The overall effect size was significant (Tau = .48, p = .01). Results suggest that APT-3 has the potential to improve reading in individuals with aphasia, but that it may be more efficacious under certain conditions. Treatment and participant variables, including intensity of treatment and metacognitive strategy usage, are discussed as potential influences on participants’ responsiveness to APT-3.
Background: Multiple language problems have been attributed to attentional impairments in people with aphasia. As a result, a number of investigations have examined the effectiveness of attentional treatments for improving impaired language processing. With few exceptions, all of the studies have used domain-general (nonspecific) attention training with nonlinguistic tasks as the therapeutic modality. Unfortunately, despite the well-documented associations between language and attention, these treatments have not yielded substantial improvements in language outcomes. It may be that the lack of specificity in these approaches for recruiting language-related attentional processes is a contributing factor. To address this issue, a Language-Specific Attention Treatment (L-SAT) (Peach, 2012) was proposed using language tasks that are purported to recruit attention for language processing. Further investigation into the attentional requirements of these tasks is needed.
Aims: To establish the construct validity and reliability of the baseline and probe tasks (hereafter, probe tasks) used in L-SAT in a group of healthy participants as well as to determine the external validity of these tasks in participants with aphasia.
Methods & Procedures: Twenty healthy participants and six participants with aphasia were assessed using standardized language and attention tests and an experimental battery of eight language-specific attention tasks that serve as the probe measures for this program. Correlational analyses were performed to examine the construct and external validity of the experimental tasks as well as their reliability.
Outcomes & Results: All of these language tasks were found to be independent of one another in healthy participants and to correlate strongly with at least one attention measure, with the exception of one task, which showed moderate correlations with several attention measures. Examination of the correlations among the probe tasks and the attention measures revealed a highly interpretable pattern that is consistent with the processing requirements of each task. i.e., the attentional demands suggested by these findings are reasonable and consistent with the language tasks themselves. Excellent inter- and intra-rater reliability were found for these tasks in both healthy participants and the PWA. Acceptable test-retest reliability was found in both groups for all but three of the tasks.
Conclusions: The results suggest that these probe tasks provide a valid method for recruiting language-directed attentional abilities, and therefore, may be effective for indexing attentional processing in participants with aphasia. L-SAT, which incorporates these tasks into a hierarchically organized treatment program, may offer a promising approach to treating aphasic impairments associated with attentional deficits.
Background: Findings from a number of researchers have suggested that many individuals with aphasia demonstrate concomitant, non-linguistic cognitive deficits, particularly affecting executive function, and that such deficits are not directly related to nor predictable from the primary linguistic deficit. These impairments are an important component of aphasia management, given that they not only may underlie or exacerbate aphasia symptoms, but also hamper language reacquisition and learning and use of communication support strategies.
Aims: This paper provides a review of procedures in the recent aphasia literature designed to address executive function deficits. Additionally, a case study is presented in which a self-management treatment protocol was provided to an individual with aphasia. The protocol was based on existing metacognitive strategies successfully utilised with non-aphasic patient populations presenting with executive dysfunction.
Main Contribution: Three general intervention approaches addressing executive dysfunction were identified across the aphasia literature, with negligible examination of strategy training approaches. To address this research gap, the Brain Budget protocol presented in our case study offers collaborative, dynamic metacognitive strategy training in the context of traditional aphasia therapy, is consistent with best practices for cognitive rehabilitation, and reflects the realities of current medical reimbursement policies.
Conclusions: Despite the prevalent co-occurrence of non-linguistic cognitive deficits and aphasia, relatively few aphasia studies describe evidence-based, executive function treatment approaches. Future research should explore the application of such paradigms under controlled conditions and with a variety of aphasia profiles.
Auditory comprehension is rarely unaffected by aphasia, although the extent of these deficits ranges greatly. Regardless of the severity of the deficit, however, problems understanding spoken language have a notable impact on individuals' lives. Speech-language pathologists, therefore, are obligated to employ effective approaches to remediating these problems. This paper addresses ways to treat auditory comprehension starting with a careful examination that identifies preserved and disturbed areas of function and that leads clinicians to think about underlying mechanisms that might be responsible for success and failures. Several lines of evidence support the idea that attentional problems may account for at least some of what appear to be problems with comprehension of spoken language in people with aphasia (PWA). Despite the growing body of evidence that a strong relationship exists between attention and auditory comprehension performance, the prevailing approach to treating auditory comprehension deficits continues to be the linguistic stimulation approach. This paper, therefore, reviews linguistic approaches to remediating auditory comprehension before discussing studies of attention training as a “cognitive” approach to improving these skills. Also discussed is the compelling evidence that the overall cognitive status of PWA significantly influences their response to any form of aphasia treatment.
Assessing nonverbal cognitive constructs, such as attention, in persons with aphasia is particularly challenging. The most difficult aspect of this task is determining whether language deficits are independent of attention deficits or whether the pattern of preserved and impaired performance reflects a combination of deficits of language and attention. As difficult as the task of assessing attention in people with aphasia may be, teasing apart contributions of language and attention to communication is crucial for appropriate treatment planning and goal-setting for people with communication deficits. Assessment tools, both standardized and non-standardized, are reviewed to help in determining the extent to which types of attention are affected in people with aphasia.
Background: Theoretical studies have shown that some deficits in verbal short-term/working memory can impact comprehension abilities. Clinicians often suspect that their clients are failing to understand speech because they cannot remember what has been said. Yet there are no reports of how to treat such a problem. Aims: To see if improving the short-term/working memory abilities of a person with aphasia would improve her comprehension at the sentence level. In addition, we sought to explore the issues involved in carrying out research-based therapy in a clinical environment. Methods & Procedures: The memory and language impairments of a person with aphasia were assessed. The memory impairments were then targeted in therapy by requiring the repetition of gradually more demanding sentences. Comprehension itself was not practised at all during therapy. Outcome and Results: Certain aspects of short-term and working memory improved post-therapy, notably an increase in digit span and an ability to repeat more words in sentences. There was a limited generalisation of improvement to comprehension tasks, meaning that the client could understand longer sentences and required fewer repetitions. The existence of possible additional impairments was revealed post-therapy. Conclusions: If memory limitations are causing comprehension difficulty, therapy may need to take the focus away from language and on to short-term/working memory. However, improvement may be limited. In addition, we suggest that within the context of a clinical setting, a reasonable balance between research and therapy can be struck (albeit with some difficulty) if compromises are made.
This pilot study investigated the impact of direct attention training combined with metacognitive facilitation on reading comprehension in individuals with aphasia.
A single-subject, multiple baseline design was employed across 4 participants to evaluate potential changes in reading comprehension resulting from an 8-week intervention using Attention Process Training-3 (APT-3). The primary outcome measure was a maze reading task. Pre- and posttesting included attention and reading comprehension measures. Visual inspection of graphed performance data across conditions was used as the primary method of analysis. Treatment effect sizes were calculated for changes in reading comprehension probes from baseline to maintenance phases.
Two of the study's 4 participants demonstrated improvements in maze reading, with corresponding effect sizes that were small in magnitude according to benchmarks for aphasia treatment research. All 4 participants made improvements on select standardized measures of attention.
Interventions that include a metacognitive component with direct attention training may elicit improvements in participants' attention and allocation of resources. Maze passage reading is a repeated measure that appears sensitive to treatment-related changes in reading comprehension. Issues for future research related to measurement, candidacy, and clinical delivery are discussed.
Background: Primary progressive aphasia (PPA) is a neurodegenerative disease
characterised by isolated and gradual language decline that can negatively affect
discourse. Behavioural treatments for PPA have typically targeted linguistic processes at
the micro-structure (word or sentence) level rather than the macro-structure (discourse)
level, with minimal generalisation to discourse. There is a growing consensus that nonlinguistic
mechanisms such as attention are imperative for complex language execution
such as discourse. Intentional language use (Nadeau, Rothi, & Rosenbek, 2008) is
another mechanism thought to promote language generalisation by encouraging verbal
language to the exclusion of other modalities. Attentive Reading and Constrained
Summarisation (ARCS) is a novel discourse-level treatment derived from cognitive
principles and operating on macro-structure and micro-structure linguistic levels.
Aims: In this case report of one participant with PPA we anticipated post-treatment
discourse-level improvements in coherence, cohesion, and informativeness/efficiency
with unlikely maintenance due to the neurodegenerative nature of PPA.
Methods & Procedures: ‘‘Stanley’’, a 76-year-old gentleman with PPA and concomitant
attention impairments, received the ARCS treatment. ARCS focuses attention during
reading and promotes intentional language use by summarisation with constraints.
Outcomes & Results: Pre- to post-treatment and maintenance improvements on
coherence, cohesion, and percent correct information units were observed.
Conclusions: The current findings are intriguing but must be interpreted with prudence
given that this is a case study with limitations related to lack of experimental control.
However, ARCS is a novel behavioural treatment for PPA and the post-treatment and
2-months maintenance results warrant consideration.
Background : Recent reports from a variety of labs have demonstrated that some patients with aphasia have concomitant non‐linguistic cognitive compromises, especially in the area of attention/executive functions. Recent findings also suggest that attention/executive functions may play an important role in the conversational success of persons with aphasia. Aims : This paper provides a review of recent work being carried out in a number of centres having to do with treatment of attention/executive function problems in persons with aphasia. Main Contribution : Although results of the studies reviewed herein must be interpreted with caution, there is growing support for the notion that attention/executive function skills in persons with aphasia are remediable, and that there is an important relationship between attention/executive function and functional communication in people with aphasia. The results suggest that treatment of attention/executive function in aphasia—even in people many years post‐onset—may result in measurable changes in attention/executive function skills and in the transactional success of conversational communication. Conclusions : Of course further research must be completed in order to provide clinicians with adequate evidence for clinical decision making. However, this line of research represents a promising new direction in aphasia rehabilitation.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, better known as CADASIL, is a rare, genetic form of early-onset vascular dementia. The purpose of this study was to use a modified version of Attention Process Training--II (APT-II; Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) with an individual with early-stage CADASIL.
APT-II, modified to include strategy training, was applied in an A-B, multiple-probe design for an individual who had been diagnosed with early-stage CADASIL. Outcome measures included pre-post neuropsychological testing of attention, memory, and executive function; within-treatment probes of visual and auditory attention; and a measure of subjective experience of cognitive functioning in daily living.
The participant demonstrated nominal gains on visual and auditory attention probes but improved performance on several posttreatment measures of processing speed and executive function. The participant also reported substantially improved functional outcomes following the intervention protocol.
This case illustrates the potential utility of behavioral intervention for individuals with CADASIL and highlights issues for speech-language pathologists to consider when using structured cognitive training protocols in the setting of progressive cognitive decline. These data suggest that further controlled studies for treating this population are warranted.
Unlabelled:
The relation between other aspects of cognition and language status of individuals with aphasia is not well-established, although there is some evidence that integrity of non-linguistic skills of attention, memory, executive function and visuospatial skills can not be predicted on the basis of aphasia severity. At the same time, there is a growing realization among rehabilitation specialists, based on clinical experience and preliminary studies, that all domains of cognition are important to aphasia therapy outcomes. This paper describes a new study of the relation between linguistic and nonlinguistic skill in a group of individuals with aphasia. No significant relationship was found between linguistic and nonlinguistic skills, and between nonlinguistic skills and age, education or time post onset. Instead, individual profiles of strengths and weaknesses were found. The implications of these findings for management of aphasia patients is discussed.
Learning outcomes:
Readers of this papers will be able to: list five primary domains of cognition and relate each to an aspect of aphasia therapy; describe at least three studies that examined the relation between cognition and aphasia; describe four nonlinguistic tasks of cognition that can be used with a wide range of aphasia patients.
Two consecutive treatments were conducted to investigate skill learning and generalization within and across cognitive-linguistic domains in a 62-year-old Spanish-English bilingual man with severe non-fluent aphasia. Treatment 1 was a cognitive-based treatment that emphasized non-linguistic skills, such as visual scanning, categorization, and simple arithmetic. Treatment 2 was a lexically based treatment that trained cognates (cross-linguistic word pairs that are similar in meaning and form, such as rosa/rose) and non-cognates (cross-linguistic word pairs with shared meaning but different forms, such as mesa/table). Treatment 1 resulted in modest gains in both Spanish and English. Treatment 2 resulted in improved naming for non-cognates as well as cognates within each language. However, the generalization of gains from Spanish to English was apparent only for cognate stimuli.
We report improved ability to name pictures at 2 and 8 months after repetitive transcranial magnetic stimulation (rTMS) treatments to the pars triangularis portion of right Broca's homologue in a 57 year-old woman with severe nonfluent/global aphasia (6.5 years post left basal ganglia bleed, subcortical lesion). TMS was applied at 1 Hz, 20 minutes a day, 10 days, over a two-week period. She received no speech therapy during the study. One year after her TMS treatments, she entered speech therapy with continued improvement. TMS may have modulated activity in the remaining left and right hemisphere neural network for naming.
Unlabelled:
This study examined whether attention processing training-II [Sohlberg, M. M., Johnson, L., Paule, L., Raskin, S. A., & Mateer, C. A. (2001). Attention Process Training-II: A program to address attentional deficits for persons with mild cognitive dysfunction (2nd ed.). Wake Forest, NC: Lash & Associates.; APT-II], when applied in the context of a multiple baseline ABA design, would improve the attention abilities of RW, a patient with mild conduction aphasia and concomitant attention and working memory deficits. We also explored whether APT-II training would enhance RW's auditory comprehension, other cognitive abilities such as memory, and his and his spouse's perceptions of his daily attention and communication difficulties. With treatment, RW improved on trained attention tasks and made modest gains on standardized tests and probes that evaluated cognitive skills related to treatment activities. Nominal change in auditory comprehension and untrained attention and memory functions was observed, and neither RW nor his spouse reported noticeable improvements in his daily attention or communication abilities. These and previous findings indicate that structured attention retraining may enhance specific attention skills, but that positive changes in broader attention and untrained functions are less likely.
Learning outcomes:
As a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding attention impairments and treatment approaches for patients with aphasia. (2) describe how Attention Processing Training-II affected the attention, auditory comprehension, and other cognitive abilities of the patient in this study.
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