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de Grosbois J, Canthiya L, Philipp-Muller AE, Hickey NK, Hodzic-Santor B, Heleno MC, Jokel R, Meltzer JA. Asynchronous, online spaced-repetition training alleviates word-finding difficulties in aphasia. Neuropsychol Rehabil 2023; 33:1672-1696. [PMID: 36378584 DOI: 10.1080/09602011.2022.2143822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
Word-finding difficulties for naming everyday objects are often prevalent in aphasia. Traditionally, treating these difficulties has involved repeated drilling of troublesome items with a therapist. Spaced repetition schedules can improve the efficiency of such training. However, spaced repetition in a therapy environment can be both difficult to implement and time-consuming. The current study evaluated the potential utility of automated, asynchronous, online spaced repetition training for the treatment of word-finding difficulties in individuals with aphasia. Twenty-one participants completed a two-week training study, completing approximately 60 minutes per day of asynchronous online drilling. The training items were identified using a pretest, and word-finding difficulties were evaluated both at the end of training (i.e., a post-test) and four weeks later (i.e., a retention test). The trained items were separated into three different spaced-repetition schedules: (1) Short-spacing; (2) Long-spacing; and (3) Adaptive-spacing. At the retention-test, all trained items outperformed non-trained items in terms of accuracy and reaction time. Further, preliminary evidence suggested a potential reaction time advantage for the adaptive-spacing condition. Overall, online, asynchronous spaced repetition training appears to be effective in treating word-finding difficulties in aphasia. Further research will be required to determine if different spaced repetition schedules can be leveraged to enhance this effect.
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Affiliation(s)
- John de Grosbois
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Lathushikka Canthiya
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Aaron E Philipp-Muller
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Natasha K Hickey
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | | | - Madeline C Heleno
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Regina Jokel
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Jed A Meltzer
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
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Navarrete-Orejudo L, Cerda-Company X, Olivé G, Martin N, Laine M, Rodríguez-Fornells A, Peñaloza C. Expressive recall and recognition as complementary measures to assess novel word learning ability in aphasia. BRAIN AND LANGUAGE 2023; 243:105303. [PMID: 37453400 DOI: 10.1016/j.bandl.2023.105303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/24/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Novel word learning ability has been associated with language treatment outcomes in people with aphasia (PWA), and its assessment could inform prognosis and rehabilitation. We used a brief experimental task to examine novel word learning in PWA, determine the value of phonological cueing in assessing learning outcomes, and identify factors that modulate learning ability. Twelve PWA and nineteen healthy controls completed the task, and recall and recognition tests of learning ability. Most PWA showed comparable learning outcomes to those of the healthy controls. Learning assessed via expressive recall was more clearly evidenced with phonological cues. Better single word processing abilities and phonological short-term memory and higher integrity of the left inferior frontal gyrus were related to better learning performance. Brief learning tasks like this one are clinically feasible and hold promise as screening tools of verbal learning in PWA once validated and evaluated for their capacity to predict treatment outcomes.
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Affiliation(s)
- Lara Navarrete-Orejudo
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Xim Cerda-Company
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, 08097 L'Hospitalet de Llobregat, Spain; Universitat Autonoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Guillem Olivé
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, 08097 L'Hospitalet de Llobregat, Spain
| | - Nadine Martin
- Department of Communication Sciences and Disorders, Eleanor M. Saffran Center for Cognitive Neuroscience, Temple University, 1701 N. 13th Street, Philadephia, PA 19122, USA
| | - Matti Laine
- Department of Psychology, Abo Akademi University, Tehtaankatu 2, 20500 Turku, Finland
| | - Antoni Rodríguez-Fornells
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, 08097 L'Hospitalet de Llobregat, Spain; Institute of Neurosciences, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Passeig Lluís Companys 23, 08010 Barcelona, Spain
| | - Claudia Peñaloza
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n, 08097 L'Hospitalet de Llobregat, Spain; Institute of Neurosciences, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain.
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Nunn K, Vallila-Rohter S. Theory-driven treatment modifications: A discussion on meeting the linguistic, cognitive, and psychosocial needs of individual clients with aphasia. JOURNAL OF COMMUNICATION DISORDERS 2023; 103:106327. [PMID: 37060857 PMCID: PMC10247540 DOI: 10.1016/j.jcomdis.2023.106327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 06/03/2023]
Abstract
There is a growing body of literature demonstrating that language rehabilitation can improve naming impairments for individuals with aphasia. However, there are challenges applying evidence-based research to clinical practice. Well-controlled clinical studies often consist of homogenous samples and exclude individuals who may confound group-level results. Consequently, the findings may not generalize to the diverse clients serviced by speech-language therapists. Within evidence-based guidelines, clinicians can leverage their experiences and theoretical rationale to adapt interventions to meet the needs of individual clients. However, modifications to evidence-based interventions should not alter aspects of treatment that are necessary to produce change within the treatment target. The current discussion paper uses errorless learning, errorful learning, and retrieval practice for naming in aphasia to model how treatment theories can guide clinicians in making theory-informed modifications to interventions. First, we briefly describe the learning mechanisms hypothesized to underlie errorless learning, errorful learning, and retrieval practice. Next, we identify ways clinicians can provide targeted supports to optimize learning for individual clients. The paper ends with a reflection on how well-defined treatment theories can facilitate the generation of practice-based evidence and clinically relevant decision making.
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Affiliation(s)
- Kristen Nunn
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA.
| | - Sofia Vallila-Rohter
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts, USA
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Nunn K, Vallila-Rohter S, Middleton EL. Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:668-687. [PMID: 36729701 PMCID: PMC10023178 DOI: 10.1044/2022_jslhr-22-00251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/27/2022] [Accepted: 10/25/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE Increasingly, mechanisms of learning are being considered during aphasia rehabilitation. Well-characterized learning mechanisms can inform "how" interventions should be administered to maximize the acquisition and retention of treatment gains. This systematic scoping review mapped hypothesized mechanisms of action (MoAs) and treatment ingredients in three learning-based approaches targeting naming in aphasia: errorless learning (ELess), errorful learning (EFul), and retrieval practice (RP). The rehabilitation treatment specification system was leveraged to describe available literature and identify knowledge gaps within a unified framework. METHOD PubMed and CINHAL were searched for studies that compared ELess, EFul, and/or RP for naming in aphasia. Independent reviewers extracted data on proposed MoAs, treatment ingredients, and outcomes. RESULTS Twelve studies compared ELess and EFul, six studies compared ELess and RP, and one study compared RP and EFul. Hebbian learning, gated Hebbian learning, effortful retrieval, and models of incremental learning via lexical access were proposed as MoAs. To maximize treatment outcomes within theorized MoAs, researchers manipulated study ingredients including cues, scheduling, and feedback. Outcomes in comparative effectiveness studies were examined to identify ingredients that may influence learning. Individual-level variables, such as cognitive and linguistic abilities, may affect treatment response; however, findings were inconsistent across studies. CONCLUSIONS Significant knowledge gaps were identified and include (a) which MoAs operate during ELess, EFul, and RP; (b) which ingredients are active and engage specific MoAs; and (c) how individual-level variables may drive treatment administration. Theory-driven research can support or refute MoAs and active ingredients enabling clinicians to modify treatments within theoretical frameworks.
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Affiliation(s)
- Kristen Nunn
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Sofia Vallila-Rohter
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Erica L. Middleton
- Research Department, Moss Rehabilitation Research Institute, Elkins Park, PA
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Middleton EL, Duquette KL, Rawson KA, Mirman D. An examination of retrieval practice and production training in the treatment of lexical-semantic comprehension deficits in aphasia. Neuropsychology 2022; 36:730-752. [PMID: 36048069 PMCID: PMC9976587 DOI: 10.1037/neu0000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Little research has addressed the treatment of lexical-semantic comprehension deficits (i.e., difficulty retrieving the meanings of words) in people with aphasia (PWA). Research suggests that practice retrieving names for depicted objects from long-term memory (production-based retrieval practice) more strongly benefits word retrieval for production in PWA compared to errorless learning (i.e., word repetition), which eschews retrieval practice. This study assessed whether production-based and comprehension-based retrieval practice enhance performance on errorful word-comprehension items in PWA measured relative to nonretrieval forms of training and untrained control items. METHOD In a within-participant group study of PWA, errorful comprehension items were assigned to (a) a production-based training module (retrieval practice vs. errorless learning); (b) a comprehension-based training module (a receptive form of retrieval practice vs. restudy). Each module comprised one training session and a 1-day and 1-week comprehension posttest on the module's trained items and an untrained item set. RESULTS The comprehension module conditions produced similar and superior posttest performance relative to untrained items. Both production module conditions improved posttest performance relative to untrained items, with retrieval practice conferring more durable learning and generalization indicative of refinement of semantic representations compared to errorless learning. CONCLUSIONS Results suggest comprehension- and production-based forms of training are both beneficial for improving lexical-semantic deficits in aphasia, with production-based retrieval practice conferring additional benefits to the targeted deficit compared to errorless learning. Future studies should examine these learning factors in schedules of training more commensurate with clinical practice and in other neurological populations (e.g., semantic dementia). (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Quique YM, Cavanaugh R, Lescht E, Evans WS. Applying adaptive distributed practice to self-managed computer-based anomia treatment: A single-case experimental design. JOURNAL OF COMMUNICATION DISORDERS 2022; 99:106249. [PMID: 35882077 DOI: 10.1016/j.jcomdis.2022.106249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There is a pressing need to improve computer-based treatments for aphasia to increase access to long-term effective evidence-based interventions. The current single case design incorporated two learning principles, adaptive distributed practice and stimuli variability, to promote acquisition, retention, and generalization of words in a self-managed computer-based anomia treatment. METHODS Two participants with post-stroke aphasia completed a 12-week adaptive distributed practice naming intervention in a single-case experimental design. Stimuli variability was manipulated in three experimental conditions: high exemplar variability, low exemplar variability, and verbal description prompt balanced across 120 trained words. Outcomes were assessed at 1-week, 1-month, and 3-months post-treatment. Statistical comparisons and effect sizes measured in the number of words acquired, generalized, and retained were estimated using Bayesian generalized mixed-effect models. RESULTS Participants showed large and robust acquisition, generalization, and retention effects. Out of 120 trained words, participant 1 acquired ∼77 words (trained picture exemplars) and ∼63 generalization words (untrained picture exemplars of treated words). Similarly, participant 2 acquired ∼57 trained words and ∼48 generalization words. There was no reliable change in untrained control words for either participant. Stimuli variability did not show practically meaningful effects. CONCLUSIONS These case studies suggest that adaptive distributed practice is an effective method for re-training more words than typically targeted in anomia treatment research (∼47 words on average per Snell et al., 2010). Generalization across experimental conditions provided evidence for improved lexical access beyond what could be attributed to simple stimulus-response mapping. These effects were obtained using free, open-source flashcard software in a clinically feasible, asynchronous format, thereby minimizing clinical implementation barriers. Larger-scale clinical trials are required to replicate and extend these effects.
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Affiliation(s)
- Yina M Quique
- Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States of America.
| | - Robert Cavanaugh
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Erica Lescht
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - William S Evans
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, United States of America
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Rawson KA, Dunlosky J. Successive Relearning: An Underexplored but Potent Technique for Obtaining and Maintaining Knowledge. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221100484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Successive relearning involves practicing a task until it is performed correctly and then practicing it again until it is performed correctly during other spaced practice sessions. Despite its widespread use outside of education, few students use this approach to obtain and maintain knowledge in formal educational settings. We review evidence that demonstrates its potency and emphasize how investigations of successive relearning will shift research agendas away from single-session studies in which time on task is fixed toward studies involving multiple practice sessions in which time on task is tailored for students and is treated as an outcome variable of interest. Doing so arguably will align the outcomes of cognitive-education research with real-world learning objectives by revealing not only the benefits of using successive relearning (or any learning technique) but also the time required to obtain those benefits.
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Affiliation(s)
| | - John Dunlosky
- Department of Psychological Sciences, Kent State University
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Quique YM, Evans WS, Ortega-Llebaría M, Zipse L, Dickey MW. Get in Sync: Active Ingredients and Patient Profiles in Scripted-Sentence Learning in Spanish Speakers With Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1478-1493. [PMID: 35230881 DOI: 10.1044/2021_jslhr-21-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Script training is a well-established treatment for aphasia, but its evidence comes almost exclusively from monolingual English speakers with aphasia. Furthermore, its active ingredients and profiles of people with aphasia (PWA) that respond to this treatment remain understudied. This study aimed to adapt a scripted-sentence learning protocol to Colombian Spanish speakers with aphasia, investigate speech entrainment (i.e., unison production of sentences) as an active ingredient for scripted-sentence learning, and identify patient profiles associated with better scripted-sentence learning. METHOD Fourteen monolingual Spanish speakers with aphasia learned a set of 30 sentences. To examine speech entrainment as an active ingredient for scripted-sentence learning, we investigated whether sentences containing externally added rhythmic cues (involving stress-aligned vs. metronomic rhythmic cues) would result in better scripted-sentence learning compared with control sentences. Learning was measured via postsession probes and analyzed using mixed-effects logistic regression models. The relationship between scripted-sentence learning and baseline language and rhythmic processing measures was also examined. RESULTS Significant scripted-sentence learning over time indicated a successful adaptation of a script-training protocol to Spanish. PWA learned significantly more scripted sentences in the rhythmically enhanced conditions compared with the control condition. There were no differences between rhythmically enhanced conditions (stress-aligned vs. metronomic). In terms of patient profiles, it was found that PWA with more severe aphasia demonstrated larger learning gains, but rhythmic processing showed little association with learning estimates. CONCLUSIONS To our knowledge, this study provides the first adaptation of a scripted-sentence learning protocol for monolingual Spanish speakers with aphasia, demonstrating cross-linguistic benefits of script training interventions. Highlighting rhythmic features during speech entrainment facilitated scripted-sentence learning in Spanish speakers with aphasia, suggesting that speech entrainment may be an active ingredient for scripted-sentence learning. More severe aphasia was associated with better scripted-sentence learning, suggesting that more severely impaired individuals are likely to benefit most from this treatment. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19241847.
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Affiliation(s)
- Yina M Quique
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - William S Evans
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | | | - Lauryn Zipse
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Michael Walsh Dickey
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
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Martin N, Obermeyer J, Schlesinger J, Wiley RW. Treatment of the Linguistic and Temporal Components of Lexical Activation to Improve Word Retrieval in Aphasia. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:824684. [PMID: 36188998 PMCID: PMC9397957 DOI: 10.3389/fresc.2022.824684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022]
Abstract
Current approaches to treatments for word processing impairments in aphasia emphasize two components to target, the linguistic content, semantic or phonological representations of words, and the processing component, access to and retrieval of those representations. In this study, we explore these two components of a treatment to improve lexical activation that supports access and retrieval of word representations. Five people with aphasia participated. The treatment task was repetition of concrete word pairs after a 5-s response delay which was intended to provide practice in maintaining activation of the words for that 5-s period before reproducing them. Two of the five participants demonstrated a difficulty in maintaining activation of single words in repetition, with accuracy decreasing significantly after the 5-s interval. The treatment was applied to all participants, however, to determine if its benefit was specific to those with the activation maintenance impairment. Results confirmed that the activation maintenance treatment in the context of this repetition task led to more treatment gains for the two participants who demonstrated this specific impairment. They made gains on four of the nine measures compared to improvements on one to two measures for the other participants. A second question addressed in this study was the relative importance of the item component (linguistic content) of the treatment and the processing component, maintenance of activation. To that end, there were two conditions of treatment probes, (1) repeated content for all treatment, immediate post-treatment and 3-month maintenance probes and (2) novel content for probes in these three phases of treatment. Only one participant showed significant improvement in treatment when items were novel for all probes. We discuss the possibility that this outcome reflects a more specific deficit in the temporal processing component of lexical activation compared to the two other participants who showed better performance on probes with repeated items in treatment and post-treatment phases. Clinical implications of this study and directions of future research are discussed.
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Affiliation(s)
- Nadine Martin
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, United States
| | - Jessica Obermeyer
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Julie Schlesinger
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, United States
| | - Robert W. Wiley
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
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Patra A, Traut HJ, Stabile M, Middleton EL. Effortful Retrieval Practice Effects in Lexical Access: A Role for Semantic Competition. LANGUAGE, COGNITION AND NEUROSCIENCE 2022; 37:948-963. [PMID: 36419750 PMCID: PMC9678354 DOI: 10.1080/23273798.2022.2027991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 01/04/2022] [Indexed: 06/16/2023]
Abstract
Word retrieval difficulty (lexical access deficit) is prevalent in aphasia. Studies have shown that practice retrieving names from long-term memory (retrieval practice) improves future name retrieval for production in people with aphasia (PWA), particularly when retrieval is effortful. To explicate such effects, this study examined a potential role for semantic competition in the learning mechanism(s) underlying effortful retrieval practice effects in lexical access in 6 PWA. Items were trained in a blocked-cyclic naming task, in which repeating sets of pictures drawn from semantically-related versus unrelated categories underwent retrieval practice with feedback. Naming accuracy was lower for the related items at training, but next-day accuracy did not differ between the conditions. However, greater semantic-relatedness of an item to its set in the related condition was associated with lower accuracy at training but higher accuracy at test. Relevance to theories of lexical access and implications for naming treatment in aphasia are discussed.
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Affiliation(s)
- Abhijeet Patra
- Correspondence concerning this article should be addressed to Abhijeet Patra, Research Department, Moss Rehabilitation Research Institute, 50 Township Line Rd., Elkins Park, PA, 19027, USA.
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Harvey S, Carragher M, Dickey MW, Pierce JE, Rose ML. Dose effects in behavioural treatment of post-stroke aphasia: a systematic review and meta-analysis. Disabil Rehabil 2020; 44:2548-2559. [PMID: 33164590 DOI: 10.1080/09638288.2020.1843079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Aphasia is a debilitating chronic acquired language disorder that impacts heavily on a person's life. Behavioural treatments aim to remediate language processing skills or to enhance communication between the person with aphasia and others, and a number of different treatments are efficacious. However, it is unclear how much of a particular treatment a person needs in order to optimise recovery of language and communication skills following stroke. MATERIALS AND METHODS Systematic search for and meta-analysis of experimental studies that directly compared different amounts of the same behavioural aphasia treatment, following PRISMA guidelines. RESULTS Treatment dose research in aphasia is an emerging area. Just six studies comparing different doses of the same intervention met all criteria for inclusion. Evidence from these studies was synthesised and meta-analysed, where possible. Meta-analyses were inconclusive due to limited data; however, there are indications that suggest increased dose may confer greater improvement on language and communication measures, but with diminishing returns over time. Aphasia severity and chronicity may affect dose-response relationships. CONCLUSIONS There is currently insufficient evidence to determine the effect of dose on treatment response. A dedicated and coordinated research agenda is required to systematically explore dose-response relationships in post-stroke aphasia interventions.A video abstract is available in the Supplementary Material.Implications for rehabilitationThe investigation of the effect of dose on treatment outcomes in post-stroke aphasia is an emerging research area with few studies reporting comparison of different amounts of the same intervention.In the acute phase of recovery following stroke, higher doses of treatment provided over short periods may not be preferable, tolerable, or superior to lower doses of the same treatment.In the chronic phase, providing additional blocks of treatment may confer additional benefit for some people with aphasia but with diminishing returns.People with chronic aphasia can achieve and maintain significant gains in picture naming after a relatively brief period of high-dose treatment.
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Affiliation(s)
- Sam Harvey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Michael Walsh Dickey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E Pierce
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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