Lesion characteristics related to treatment improvement in object and action naming for patients with chronic aphasia

Few studies have examined the relationship between degree of lesion in various locations and improvement during treatment in stroke patients with chronic aphasia. The main purpose of this study was to determine whether the degree of lesion in specific brain regions was related to magnitude of improvement over the course of object and action naming treatments.

PARTICIPANTS AND METHODS

Fifteen left hemisphere stroke patients with aphasia participated in treatments for object and/or action naming. Two raters assessed extent of lesion in 18 left hemisphere cortical and subcortical regions of interest (ROIs) on CT or MRI scans. Correlations were calculated between composite basal ganglia, anterior cortical, and posterior cortical lesion ratings, on the one hand, and both pretreatment scores and treatment change for both object and action naming, on the other hand.

RESULTS

Unexpectedly, greater anterior cortical lesion extent was highly correlated with better object and action naming scores prior to treatment and with greater improvement during treatment when partial correlations controlled for total basal ganglia lesion extent (r ranging from .730 to .858). Greater total basal ganglia lesion extent was highly correlated with worse object and action naming scores prior to treatment and with less improvement during treatment when partial correlations controlled for total anterior lesion extent (r ranging from -.623 to -.785). Correlations between degree of posterior cortical lesion and naming indices generally were not significant. No consistent differences were found between the correlations of ROI lesion ratings with object naming versus action naming scores.

CONCLUSION

Large anterior cortical lesions and intactness of the basal ganglia may both contribute to more efficient reorganization of language functions.

Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus

While deep brain stimulation (DBS) surgery is a well-accepted treatment for Parkinson disease (PD) that improves overall quality of life (QoL), its effects across different domains of QoL are unclear. The study reported here directly compared the effects of unilateral DBS in subthalamic nucleus (STN) or globus pallidus (GPi) on QoL in 42 non-demented patients with medication-refractory PD. Patients were enrolled in the COMPARE trial, a randomized clinical trial of cognitive and mood effects of STN versus GPi DBS conducted at the University of Florida Movement Disorders Center. Patients underwent motor, mood, verbal fluency and QoL (Parkinson disease questionnaire: PDQ-39) measures before and 6 months following surgery. Groups experienced motor and mood improvements that did not differ by target. Patients with STN DBS evidenced a slight decrement on letter fluency. On average, all patients endorsed better overall QoL after surgery. However, despite similar motor and mood improvements, GPi patients improved more than STN patients (38 vs. 14%, respectively; P = 0.03). Patients reported better QoL on subscales of mobility, activities of daily living (ADLs), emotional well-being, stigma, cognition and discomfort, but not on those of social support and communication. Improvements on the mobility, ADLs, stigma and social support subscales were greater amongst GPi patients. In regression analyses, only depression changes independently predicted changes in overall QoL as well as emotional well-being and social support changes. Within the STN group only, declining category fluency scores correlated with poorer QoL on the communication subscale. Unilateral DBS in both STN and GPi improved QoL overall and in disparate domains 6 months after surgery. Patients receiving GPi DBS reported greater improvements that cannot be explained by differential mood or motor effects; however, verbal fluency changes may have partially contributed to lesser QoL improvements amongst STN patients.

Services for aphasia, other acquired adult neurogenic communication and swallowing disorders in the United Kingdom, 2000

PURPOSE

We developed a questionnaire designed to determine the state of services provided by the National Health Service within the UK for adults with acquired neurologically caused communication disorders. A further aim was to compare our results with those from a similar survey conducted 10 years ago by Mackenzie et al.

METHOD

We sent questionnaires to 264 managers and directors of adult speech and language therapy services in the UK. We asked questions about staffing levels, regional variations, patterns of service delivery at acute and chronic stages and staff time spent working with different communication and swallowing problems.

RESULTS

Nearly 53% of average staff time was spent working with swallowing disorders accompanying neurological damage (dysphagia) compared to 24% with aphasia. As the percentage of time spent working with swallowing increased, the percentage of time spent working with aphasia reduced. Out of the time spent on aphasia treatment, 48% averages less than 3 h per week duration and just 4.8% averages more than 3 h per week, which was correlated with total number of speech and language therapists employed by a service. We found a significant difference only between London, with the highest total staff numbers, and the South West, with the lowest. We also found significant relationships between staff numbers and population size and staff numbers and the level of referrals to the service.

CONCLUSIONS

Our main conclusions are: (1) while there may have been an increase in the number of speech and language therapists working with acquired and progressive neurogenic conditions in the past 10 years, they are mainly working with swallowing disorders, and (2) findings agree with recent studies showing that the amount of treatment or therapy that aphasic clients receive is well below that recommended by the literature.

Functional and cognitive progress in aphasic patients with traumatic brain injury during post-acute phase

OBJECTIVES

To investigate the relationship between language functions and cognitive and functional outcome and to evaluate the effects of a conventional language rehabilitation programme on aphasic adult patients in the post-acute stage of traumatic brain injury (TBI).

DESIGN

Non-concurrent prospective study. Patients were assessed pre-treatment and post-treatment with standardized assessment tools.

SUBJECTS

Sixty-one aphasic patients with TBI who were admitted to a rehabilitation centre in the post-acute phase for a late inpatient rehabilitation programme.

METHODS

The motor sub-scales of the Functional Independence Measures and Disability Rating Scale were used to assess functional status and disability. Cognitive status was evaluated with the Mini-Mental Status Examination and the Functional Independence Measure cognitive sub-scale. The language function was evaluated with the Gülhane Aphasia Test.

RESULTS

All functional, cognitive and language scores increased significantly during the rehabilitation programme. Language functions at admission were correlated with the Functional Independence Measure motor change scores and the Mini-Mental Status Examination change scores. Regression analyses revealed that auditory comprehension at admission was the most important independent determinant of functional and cognitive gain during rehabilitation.

CONCLUSION

Post-acute language functions after late admission to a rehabilitation centre appear to be related to measures of cognitive and functional progress in patients with TBI. Functional and cognitive outcome is mainly affected by auditory comprehension. Results also showed the effectiveness of post-acute conventional rehabilitation in improving language functions.

Bilingual aphasia and language control: a follow-up fMRI and intrinsic connectivity study

In a world that is becoming more multilingual, bilingual aphasia is a clinical problem with a major clinical impact. However, at present we lack causal explanations of the many features of recovery patterns and there is no consensus about the language in which the patient should receive speech therapy. Further advance requires an understanding of the dynamics of recovery. In a novel longitudinal, single-case study, we combine fMRI and dynamic causal modeling to examine the effects of specific language treatment for picture naming on the representation and control of language areas during the course of recovery. Improved performance in the treated language was associated with increased activation in language areas. Consistent with theoretical expectations, causal modeling indicated increased connectedness of the control and language networks for the treated language. This functional approach holds great promise for investigating recovery patterns and the effects of specific language treatment in bilingual aphasic patients.

A linguistic communication measure for monitoring changes in Chinese aphasic narrative production

This study investigated the usefulness of the Cantonese Linguistic Communication Measure (CLCM) in monitoring changes of narrative production in five Chinese adults with aphasia in the period of spontaneous recovery (SR group) and four who underwent anomia therapies (Tx group). Language samples elicited from a picture description task were collected among SR participants at regular intervals within the first 6 months post-onset and among Tx participants before and after treatment. Results showed that the CLCM indices could reflect changes of language production in these individuals over time. The changes of index values were consistent with the expectations of performance during early stages after stroke for the SR participants and treatment outcomes of the Tx participants. While the CLCM has previously been shown to be useful in measuring aphasic narratives on a single occasion, this study has provided further evidence of its capability to monitor changes of language production over time.

The relationship between non-linguistic cognitive deficits and language recovery in patients with aphasia

BACKGROUND AND PURPOSE

Non-linguistic cognitive impairments may limit rehabilitation efficacy in patients with aphasia. The aim of this study was to determine whether post-stroke aphasia was associated with impairments of visuo-spatial working memory and abstract thinking and whether these deficits adversely affected language recovery.

METHODS

Baseline visuo-spatial memory and abstract thinking abilities were assessed in 78 patients with post-stroke aphasia and 38 healthy controls. Then, 47 of the 78 patients with aphasia completed three weeks of speech and language training. Therapy outcome was assessed by comparing pre- and post-treatment scores on the Boston Diagnostic Aphasia Examination.

RESULTS

Even though the patients' non-linguistic cognitive abilities were impaired in general, the patients were heterogeneous with regard to their deficits. Linguistic and non-linguistic deficits appeared to be distinct, although they could be concurrent. Visuo-spatial working memory was associated with the degree of improvement in two functions crucial to language communication: naming and comprehension. No relationship was found between language therapy outcome and abstract thinking ability.

Framing ideas in aphasia: the need for thinking therapy

This paper argues that some of the patterns seen in aphasia may reflect difficulties in the cognitive preparations for language. In particular, some individuals might be unable to carry out processes of 'Thinking for Speaking' (Slobin 1996), which frame thoughts for language production. Evidence to support this proposal is presented, together with signs that such thinking can be assisted with cues and therapy. It is argued that these preliminary data need to be pursued via a more comprehensive investigation of thinking therapy.

Typicality of inanimate category exemplars in aphasia treatment: further evidence for semantic complexity

PURPOSE

The typicality treatment approach on improving naming was investigated within 2 inanimate categories (furniture and clothing) using a single-subject experimental design across participants and behaviors in 5 patients with aphasia.

METHOD

Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, whereas generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants.

RESULTS

Results indicated that 2 out of 4 patients trained on naming of atypical examples demonstrated generalization to naming untrained typical examples. One patient showed trends toward generalization but did not achieve criterion. Furthermore, all 4 patients trained on typical examples demonstrated no generalized naming to untrained atypical examples within the category. Also, analysis of errors indicated an evolution of errors as a result of treatment, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias.

CONCLUSION

These results extend our previous findings (S. Kiran & C. K. Thompson, 2003a) to patients with nonfluent aphasia and to inanimate categories such as furniture and clothing. Additionally, the results provide support for the claim that training atypical examples is a more efficient method of facilitating generalization to untrained items within a category than training typical examples (S. Kiran, 2007).

Semantic complexity in treatment of naming deficits in aphasia: evidence from well-defined categories

PURPOSE

Our previous work on manipulating typicality of category exemplars during treatment of naming deficits has shown that training atypical examples generalizes to untrained typical examples but not vice versa. In contrast to natural categories that consist of fuzzy boundaries, well-defined categories (e.g., shapes) have rigid category boundaries. Whether these categories illustrate typicality effects similar to natural categories is under debate. The present study addressed this question in the context of treatment for naming deficits in aphasia.

METHODS

Using a single-subject experiment design, 3 participants with aphasia received a semantic feature treatment to improve naming of either typical or atypical items of shapes, while generalization was tested to untrained items of the category.

RESULTS

For 2 of the 3 participants, training naming of atypical examples of shapes resulted in improved naming of untrained typical examples. Training typical examples in 1 participant did not improve naming of atypical examples. All 3 participants, however, showed weak acquisition trends.

CONCLUSIONS

Results of the present study show equivocal support for manipulating typicality as a treatment variable within well-defined categories. Instead, these results indicate that acquisition and generalization effects within well-defined categories such as shapes are overshadowed by their inherent abstractness.

[Professor TIAN Cong-huo's experience on clinical acupuncture]

Professor TIAN's experiences on acupuncture treatment of various difficult diseases with different acupuncture methods based on syndrome differentiation of different patients, for example, para-acupuncture for treatment of migraine, triple puncture at Dazhui (GV 14) for recurrent depression, lifting and thrusting point Shexiaxue for treatment of aphasia, electroacupuncture at Shuigou (GV 26) and Baihui (GV 20) for treatment of schizophrenia, etc. are introduced.

Evidence-based systematic review: effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia

PURPOSE

This systematic review summarizes evidence for intensity of treatment and constraint-induced language therapy (CILT) on measures of language impairment and communication activity/participation in individuals with stroke-induced aphasia.

METHOD

A systematic search of the aphasia literature using 15 electronic databases (e.g., PubMed, CINAHL) identified 10 studies meeting inclusion/exclusion criteria. A review panel evaluated studies for methodological quality. Studies were characterized by research stage (i.e., discovery, efficacy, effectiveness, cost-benefit/public policy research), and effect sizes (ESs) were calculated wherever possible.

RESULTS

In chronic aphasia, studies provided modest evidence for more intensive treatment and the positive effects of CILT. In acute aphasia, 1 study evaluated high-intensity treatment positively; no studies examined CILT. Four studies reported discovery research, with quality scores ranging from 3 to 6 of 8 possible markers. Five treatment efficacy studies had quality scores ranging from 5 to 7 of 9 possible markers. One study of treatment effectiveness received a score of 4 of 8 possible markers.

CONCLUSION

Although modest evidence exists for more intensive treatment and CILT for individuals with stroke-induced aphasia, the results of this review should be considered preliminary and, when making treatment decisions, should be used in conjunction with clinical expertise and the client's individual values.

Bilingual aphasia: a theoretical and clinical review

PURPOSE

To provide an overview of the potential bilingual client population in the United States, present current neurolinguistic and psycholinguistic views of bilingualism in adults with and without aphasia, review related bilingual aphasia recovery patterns and the factors that might influence these recovery patterns, and provide insight into diagnostic and therapy procedures for addressing the needs of bilingual clients with aphasia.

METHOD

A review of the literature was conducted to summarize and synthesize previously published research in the area of bilingual aphasia, highlight unique aspects of aphasia recovery, assessment, and treatment, and identify areas in need of future research.

CONCLUSIONS

Despite a growing understanding of bilingualism and the various recovery patterns identified with bilingual aphasia, there remains a dire need for empirically validated management techniques, particularly in terms of determining which language to target, identifying which aspects of various languages are most vulnerable to insult as well as most responsive to treatment, and establishing how to exploit language similarities to maximize treatment efficiency.

Bridging the gap: can impairment-based therapy for anomia have an impact at the psycho-social level?

BACKGROUND

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

AIMS

To explore the outcome of a therapy for anomia using the Communication Disability Profile (CDP), focusing particularly on participants' ratings of 'activity'.

METHODS & PROCEDURES

Overall eight people with aphasia and their conversation partners participated in the study. There was a range of severity and type of aphasia. Following two baselines (at least 8 weeks apart), there were two phases of therapy for anomia each lasting 8 weeks. This first involved the use of spoken and written cues to aid word finding. The second encouraged the use of targeted words in connected speech and conversation. Eight weeks later, after no further therapy, participants were reassessed.

OUTCOMES & RESULTS

Participants' word finding in picture-naming improved significantly, as did their activity ratings. The relationship between the group's word-retrieval scores and CDP activity ratings over the course of the study tended towards significance, although there was considerable variation across individuals. Furthermore, all participants rated participation in activities requiring communication higher at the end than the start of the project.

CONCLUSIONS

The findings suggest that therapy which targets word retrieval can have an impact on people with aphasia's views of their communicative activity and life participation. The findings support therapists' clinical insight that impairment-based interventions can effect change beyond scores on language tests.

Fact and theory in recovery from the aphasias

Clinical evidence has suggested that the form of an aphasia--and perhaps potential for recovery therefrom--can be related to an exceedingly wide range of variables. Such anatomico-physiological considerations as size, depth, location and nature (e.g. penetrating missile injury, stroke, tumour, closed head injury) of the injury are frequently held to be crucial correlates, as are associated neurological deficits (e.g. presence of hemiplegia, sensory and visual field defects). Subject variables, such as age, sex and 'handedness" (including familial handedness), complicate the picture still further, as may differences in education personality and cognitive style. Given a multidimensional problem of this magnitude the first objective of theory is to indicate putative constrainst on patterns of impaired performance. Studies of the normal population--that is, the population from which cases of brain injury are later drawn--may, we believe, aid in the elucidation of individual differences seen after injury. A more detailed knowledge of the range of possibilities concerning cerebral specialization of function and variations in task strategies seems to be required. In this context we shall review some recent reports on dichotic listening and split visual field experiments with both normal and brain-damaged subjects and also consider the role that linguistic descriptions of aphasic impairment could play in suggesting retraining procedures appropriate to the individual patient.

Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke

BACKGROUND

Constraint-induced aphasia therapy (CIAT) offers potential benefits to individuals with history of aphasia-producing ischemic stroke. The goals of this pilot study were to implement the original German CIAT protocol, refine the treatment program, and confirm its efficacy in patients with chronic aphasia.

MATERIAL/METHODS

We translated and modified the original CIAT protocol to include a hierarchy of individual skill levels for semantic, syntactic, and phonological language production, while constraining non-use behaviors. Three male participants with moderate to severe post-stroke aphasia received CIAT 3-4 hours/day for 5 consecutive days. Pre and post-testing included formal language evaluation, linguistic analysis of story retell, and mini-Communication Activity Log (mini-CAL).

RESULTS

Substantial improvements in comprehension and verbal skills were noted in 2 patients with an increase in the total number of words (31% and 95%) and in number of utterances for story-retell task (57% and 75%). All participants demonstrated an improvement on at least one linguistic measure. No subjective improvements on mini-CAL were noted by any of the participants.

CONCLUSIONS

Given that the duration of treatment was only 1 week, these linguistic improvements in post stroke aphasia participants were remarkable. The results indicate that the CIAT protocol used in this study may be a useful tool in language restoration after stroke. These initial findings should be confirmed in a larger, randomized study.

Multiple voices in clinical discourse and as clinical intervention

BACKGROUND

Grounded in sociocultural theories of language development and use, this paper explores the concept of dialogic voice. Building on the term 'dialogue', dialogic voice points to the fundamentally social nature of language-in-use. From this perspective, language emerges from specific histories and thus carries the multiple voices of previous speakers. People draw on these voices to think about and represent the world, communicate with others, construct their own identities, and engage in play. Prior (2001) identified three key dimensions of dialogic voicing: typified social voices, re-envoicing others' words and acts, and personalized voice.

AIMS

To present a theoretical framing for dialogic voice; to detail the dimensions of dialogic voice; and to offer a preliminary analysis of dialogic voicing in clinical discourse.

METHODS & PROCEDURES

Data consisted of ten treatment sessions for a 67-year-old man with amnesia and aphasia, using a collaborative barrier task protocol. Discourse analysis and selective coding were used to identify the three dimensions of dialogic voice in both clinician and client utterances.

OUTCOMES & RESULTS

During this collaborative task, the client and clinician produced an array of voices, including: (1) typified social voices to display professional expertise, family identities, and shared interests; (2) re-envoicing others' words and acts in both task and non-task interactions; and (3) personalized voicing, displayed mostly in the client's discourse.

CONCLUSIONS

Attention to dialogic voicing offers a way to see and reflect on the heterogeneity of discourse and the multiple identities that clinicians and clients alike can, and do, display in clinical settings. Tracing the complex interplay of multiple voices provides us with insights into rich communicative environments that, from a sociocultural perspective, provide opportunities for initiating change in the communicative practices of clients, their communicative partners, and ultimately clinical practice itself.

Exposed and embedded corrections in aphasia therapy: issues of voice and identity

BACKGROUND

Because communication after the onset of aphasia can be fraught with errors, therapist corrections are pervasive in therapy for aphasia. Although corrections are designed to improve the accuracy of communication, some corrections can have social and emotional consequences during interactions. That is, exposure of errors can potentially silence the 'voice' of a speaker by orienting to an utterance as unacceptable. Although corrections can marginalize speakers with aphasia, the practice has not been widely investigated.

AIMS

A qualitative study of corrections during aphasia therapy was undertaken to describe corrections in therapy, identify patterns of occurrence, and develop hypotheses regarding the potential effects of corrections.

METHODS & PROCEDURES

Videotapes of six individual and five group aphasia therapy sessions were analysed. Sequences consistent with a definition of a therapist 'correction' were identified. Corrections were defined as instances when the therapist offered a 'fix' for a perceived error in the client's talk even though the intent was apparent.

OUTCOMES & RESULTS

Two categories of correction were identified and were consistent with Jefferson's (1987) descriptions of exposed and embedded corrections. Exposed corrections involved explicit correcting by the therapist, while embedded corrections occurred implicitly within the ongoing talk. Patterns of occurrence appeared consistent with philosophical orientations of therapy sessions. Exposed corrections were more prevalent in sessions focusing on repairing deficits, while embedded corrections were prevalent in sessions focusing on natural communication events (e.g. conversation). In addition, exposed corrections were sometimes used when client offerings were plausible or appropriate, but were inconsistent with therapist expectations.

CONCLUSIONS

The observation that some instances of exposed corrections effectively silenced the voice or self-expression of the person with aphasia has significant implications for outcomes from aphasia therapy. By focusing on accurate productions versus communicative intents, therapy runs the risk of reducing self-esteem and communicative confidence, as well as reinforcing a sense of 'helplessness' and disempowerment among people with aphasia. The results suggest that clinicians should carefully calibrate the use of exposed and embedded corrections to balance linguistic and psychosocial goals.

Embodiment in communication--aphasia, apraxia and the possible role of mirroring and imitation

The role of embodiment in communication is attracting an increased interest. This interest is to some extent caused by hypotheses and findings concerning mirror neurons in macaques, that is, neurons that are activated by production as well as perception of, for example, a certain movement of action. Mirror neurons seem to provide a fairly simple mechanism for acting, perceiving, imitating and pantomime, which could be crucial to the development of human communication and language. A number of theories try to extend similar ideas in describing human embodied communication. Some of the consequences of these theories are: (1) the close relation between speech and gestures; (2) the close relation between speech/language and praxis; and (3) the reconsideration of the importance for communication of more automatized versus more controlled processing. The purpose here is to point to possible consequences for clinical research and therapy concerning language disorders.

Computerized script training for aphasia: preliminary results

PURPOSE

This article describes computer software that was developed specifically for training conversational scripts and illustrates its use with 3 individuals with aphasia.

METHOD

Three participants with chronic aphasia (Broca's, Wernicke's, and anomic) were assessed before and after 9 weeks of a computer script training program. For each participant, 3 individualized scripts were developed, recorded on the software, and practiced sequentially at home. Weekly meetings with the speech-language pathologist occurred to monitor practice and assess progress. Baseline and posttreatment scripts were audiotaped, transcribed, and compared to the target scripts for content, grammatical productivity, and rate of production of script-related words. Interviews with the person with aphasia and his or her significant other were conducted at the conclusion of treatment.

RESULTS

All measures (content, grammatical productivity, and rate of production of script-related words) improved for each participant on every script. Two participants gained more than 5 points on the Aphasia Quotient of the Western Aphasia Battery. Five positive themes were consistently identified from the exit interviews-increased verbal communication, improvements in other modalities and situations, communication changes noticed by others, increased confidence, and satisfaction with the software.

CONCLUSION

Computer-based script training potentially may be an effective intervention for persons with chronic aphasia.

Translational research in aphasia: from neuroscience to neurorehabilitation

PURPOSE

In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005.

METHOD

In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles.

CONCLUSION

Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

Self-administered cued naming therapy: a single-participant investigation of a computer-based therapy program replicated in four cases

PURPOSE

This study examined the benefits of a self-administered, clinician-guided, computer-based, cued naming therapy. Results of intense and nonintense treatment schedules were compared.

METHOD

A single-participant design with multiple baselines across behaviors and varied treatment intensity for 2 trained lists was replicated over 4 participants. Two lists of words were treated sequentially. The same methods and equal numbers of treatment sessions were used, but the number of sessions per week differed across word lists: nonintense (2/week) or intense (5/week). Probes of performance on both word lists were carried out to examine acquisition, maintenance, and generalization.

RESULTS

There was strong evidence of improved naming (acquisition) of trained words in 3 of the 4 participants regardless of treatment intensity. There was strong evidence of maintenance for 1 participant and moderate evidence for the remaining 3 participants. Evidence of generalization to untrained words was weak.

CONCLUSIONS

Results suggest that self-administered, computer-based, cued naming therapy using a common mixed-cue protocol may be beneficial to a wide range of persons with aphasia regardless of treatment schedule. If results are replicated with a larger sample, treatments such as this may be a low-cost supplement or extension to traditional aphasia therapy.