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Cavanaugh R, Dickey MW, Hula WD, Fromm D, Golovin J, Wambaugh J, Fergadiotis G, Evans WS. Determinants of Multilevel Discourse Outcomes in Anomia Treatment for Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3094-3112. [PMID: 39146383 PMCID: PMC11427423 DOI: 10.1044/2024_jslhr-24-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE Individuals with aphasia identify discourse-level communication (i.e., language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, are poorly understood, and vary greatly among individuals with aphasia. In response, this study consisted of a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis (SFA) clinical trials. Aim 1 evaluated changes in theoretically motivated discourse outcomes representing lexical-semantic processing, lexical diversity, grammatical complexity, and discourse informativeness. Aim 2 explored the potential moderating role of nonlanguage cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes. METHOD This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for n = 60 (Aim 1) and a subset n = 44 (Aim 2). Outcome measures included lexical-semantic processing (% semantic errors), lexical diversity (moving average type-token ratio), grammatical complexity (mean utterance length), and discourse informativeness (% correct information units). Bayesian generalized mixed-effects models were used to examine changes across four study time points: enrollment, entry, exit, and 1-month follow-up. RESULTS The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after SFA when measured using standard, general-topic discourse stimuli. There was weak and inconsistent evidence that nonlanguage cognitive factors may play a role in moderating treatment response. CONCLUSIONS These findings indicate a clear need to pair theoretically informed treatments designed to facilitate generalization to discourse with intentional measurement paradigms designed to capture it. Furthermore, there is a clear need to examine how established treatments, restorative or compensatory, can better facilitate generalization to discourse-level communication. These priorities are critical for meaningfully improving everyday communication and reducing the profound communication and psychosocial consequences of aphasia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26524081.
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Affiliation(s)
- Robert Cavanaugh
- Northeastern University, Portland, ME
- University of Pittsburgh, PA
- VA Pittsburgh Healthcare System, PA
| | | | - William D Hula
- University of Pittsburgh, PA
- VA Pittsburgh Healthcare System, PA
| | | | | | | | | | - William S Evans
- University of Pittsburgh, PA
- VA Pittsburgh Healthcare System, PA
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Lammers B, Sydnor MJ, Cust S, Kim JH, Yenokyan G, Hillis AE, Sebastian R. Protocol for Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR): A randomized, double-blind, sham-controlled trial. PLoS One 2024; 19:e0298991. [PMID: 39186573 PMCID: PMC11346736 DOI: 10.1371/journal.pone.0298991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024] Open
Abstract
In this randomized, double-blind, sham-controlled trial of Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR), we will determine the effectiveness of cathodal tDCS (transcranial direct current stimulation) to the right cerebellum for the treatment of chronic aphasia (>6 months post stroke). We will test the hypothesis that cerebellar tDCS in combination with an evidenced-based anomia treatment (semantic feature analysis, SFA) will be associated with greater improvement in naming untrained pictures (as measured by the change in Philadelphia Picture Naming Test), 1-week post-treatment, compared to sham plus SFA. We will also evaluate the effects of cerebellar tDCS on naming trained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. Finally, we will identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. We expect to enroll 60 participants over five years. Participants will receive 15, 25-minute sessions of cerebellar tDCS (3-5 sessions per week) or sham tDCS combined with 1 hour of SFA treatment. Participants will be evaluated prior to the start of treatment, one-week post-treatment, 1-, 3-, and 6-months post-treatment on primary and secondary outcome variables. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent language therapy for treatment of chronic aphasia. Trial registration: The trial is registered with ClinicalTrials.gov NCT05093673.
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Affiliation(s)
- Becky Lammers
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Myra J. Sydnor
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sarah Cust
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Argye E. Hillis
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States of America
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
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Boukrina O, Madden EB, Giordano N, Karim D, Staples R, Graves WW. Targeting Phonology or Semantics to Improve Reading Aloud Response Times and Accuracy: A Case Series Investigation of Stroke Survivors With Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-33. [PMID: 39146330 DOI: 10.1044/2024_ajslp-23-00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE Acquired reading deficits, or alexia, affect a significant proportion of individuals with aphasia. We sought to improve treatment for alexia by targeting specific cognitive information-processing components critical to reading (i.e., phonology or semantics). METHOD To target either phonological or semantic processing, we administered two anomia treatments, phonomotor treatment (PMT) and semantic feature analysis, modified to include a focus on reading throughout the therapy. Chronic left-hemisphere stroke survivors (N = 5) completed one or two 60-hr treatment rounds. Based on predictions from a computational reading model, three participants received the treatment recommended for their specific reading challenges (e.g., PMT for phonological deficits), while two participants had the nonrecommended treatment first, followed by the recommended model-matched treatment. Changes in reading aloud accuracy and response times (RTs) from before to after treatment were examined as a function of matching treatment to the deficit profile, type of treatment, therapy round, and word characteristics. RESULTS Participants' reading aloud accuracy improved after treatment relative to baseline with higher accuracy for high-frequency words and shorter words. After the first treatment round, participants' accuracy and RT improved, irrespective of whether treatment was matched to the deficit profile. Furthermore, participants who completed the second treatment round continued achieving accuracy gains. Following treatment, participants demonstrated enhanced reading efficiency and generalized improvements on the selected sections of the Woodcock Reading Mastery Test. CONCLUSIONS While larger studies are needed to test for the effects of matching treatment type to the deficit profile, we conclude that treatments targeting specific information-processing components can effectively improve reading. Doubling the treatment dose offers small but significant gains. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26517319.
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Affiliation(s)
- Olga Boukrina
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Elizabeth B Madden
- School of Communication Science and Disorders, College of Communication and Information, Florida State University, Tallahassee
| | - Nicole Giordano
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Dima Karim
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ
| | - Ryan Staples
- Georgetown-Howard Universities Center for Clinical and Translational Science, Georgetown University Medical Center, Washington, DC
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Department of Neurology, Georgetown University Medical Center, Washington, DC
| | - William W Graves
- Department of Psychology, Rutgers, The State University of New Jersey, Newark
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Whitworth A. Elizabeth Usher memorial lecture. Models, mind maps, and metacognition: How theory is the true hero. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:304-316. [PMID: 38982689 DOI: 10.1080/17549507.2024.2369146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Within the educational context of identifying the critical ingredients of an effective speech-language pathologist, this paper highlights the centrality of theory in underpinning every level of our practice. A spotlight is placed on us knowing how language and communication work, what makes our interventions work, how we can make the most difference through our choices in therapy, and what makes both us and our clients respond. So, what are the critical ingredients of an effective speech-language pathologist, of an effective therapy, of an effective therapeutic alliance, and why is this so important? While there are many foundational and guiding habits upon which new graduates, early career, and experienced clinicians shape their practice, no one habit is regarded as more important than us exploring the theoretical underpinnings of what we are doing and why. To underscore the role of theory in our everyday practice, a discourse level intervention for people with aphasia is used as an exemplar to track the complex contribution of different theories to a single intervention. Discourse level interventions are relatively new on the scene in the area of acquired language disorders. Child language interventions, on the other hand, have frequently revolved around the story, aiming to bridge the oral-literate divide through the development of narrative structure. This paper will aim to weave its own story around discourse level interventions, combining the narrative genre with the everyday genres used by adults in conversation. I will highlight how this approach taps into lexical theories, sentence processing theories, discourse organisation, and the cognitive underpinnings of language, and closely examine how this multilayering of language in context may hold some of the answers to questions around generalisation, impact, and making the greatest difference to individuals.
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Affiliation(s)
- Anne Whitworth
- Speech Pathology, School of Health Sciences, University of Tasmania, Launceston, Australia
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Shekari E, Mehrpour M, Joghataei MT, Modarres Zadeh A, Valinejad V, Adineh HA, Seyfi M, Goudarzi S. Focusing on the locus of the breakdown for treatment of anomia: a pilot study. CLINICAL LINGUISTICS & PHONETICS 2024; 38:477-507. [PMID: 37303193 DOI: 10.1080/02699206.2023.2221374] [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: 10/11/2021] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
The primary goal of this study was to evaluate the treatment effects of semantic feature analysis (SFA) and phonological components analysis (PCA) on word retrieval processing in persons with aphasia (PWAs). After identifying the locus of the breakdown in lexical retrieval processing, 15 monolingual native Persian speakers with aphasia were divided into two groups. After three naming trials, participants with dominant semantic deficits received SFA, and participants with primary phonological deficits were provided with PCA three times a week for eight weeks. Both approaches improved participants' naming and performance on language tests, including spontaneous speech, repetition, comprehension, and semantic processing. However, the correct naming of treated and untreated items was higher in mild-to-moderate participants, with mostly circumlocution and semantic paraphasias in the SFA group. The same holds for mild-to-moderate participants with mostly phonemic paraphasia who received PCA therapy. Moreover, the results showed that participants' baseline naming performance and semantic abilities could be associated with the treatment outcomes. Although limited by a lack of a control group, this study provided evidence supporting the possible benefits of focusing on the locus of the breakdown for treating anomia through SFA and PCA approaches, specifically in participants with mild to moderate aphasia. However, for those with severe aphasia, the treatment choice may not be as straightforward because several variables are likely to contribute to this population's word-finding difficulties. Replication with larger, well-stratified samples, use of a within-subjects alternating treatment design and consideration of treatments' long-term effects are required to better ascertain the effects of focusing on the locus of breakdown for treatment of anomia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Innovation in Medical Education, Faculty of Medicine, Ottawa University, Ontario, Canada
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech-Language Pathology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech-Language Pathology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossain Ali Adineh
- Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
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Scimeca M, Peñaloza C, Kiran S. Multilevel factors predict treatment response following semantic feature-based intervention in bilingual aphasia. BILINGUALISM (CAMBRIDGE, ENGLAND) 2024; 27:246-262. [PMID: 38586504 PMCID: PMC10993298 DOI: 10.1017/s1366728923000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Semantic feature-based treatments (SFTs) are effective rehabilitation strategies for word retrieval deficits in bilinguals with aphasia (BWA). However, few studies have prospectively evaluated the effects of key parameters of these interventions on treatment outcomes. This study examined the influence of intervention-level (i.e., treatment language and treatment sessions), individual-level (baseline naming severity and age), and stimulus-level (i.e., lexical frequency, phonological length, and phonological neighborhood density) factors on naming improvement in a treated and untreated language for 34 Spanish-English BWA who completed 40 hours of SFT. Results revealed significant improvement over time in both languages. In the treated language, individuals who received therapy in their L1 improved more. Additionally, higher pre-treatment naming scores predicted greater response to treatment. Finally, a frequency effect on baseline naming accuracy and phonological effects on accuracy over time were associated with differential treatment gains. These findings indicate that multilevel factors are influential predictors of bilingual treatment outcomes.
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Affiliation(s)
- Michael Scimeca
- Department of Speech, Language, and Hearing Sciences, Boston University, MA, USA
| | - Claudia Peñaloza
- Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Swathi Kiran
- Department of Speech, Language, and Hearing Sciences, Boston University, MA, USA
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Bontemps M, Servières-Bordes M, Moritz-Gasser S. Combining executive function training and anomia therapy in chronic post-stroke aphasia: A preliminary study of multidimensional effects. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-19. [PMID: 38356392 DOI: 10.1080/17549507.2023.2289351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
PURPOSE The influential relationship between executive functioning and aphasia rehabilitation outcomes has been addressed in a number of studies, but few have studied the effect of adding executive function training to linguistic therapies. The present study aimed to measure the effects of combining, within therapy sessions, executive function training and anomia therapy on naming and discourse abilities in people with chronic aphasia. METHOD A single-case experimental design with multiple baselines across participants was used. Four persons with chronic post-stroke aphasia received 12 sessions of a tailored treatment combining executive function training and semantic feature analysis (SFA) therapy. Naming accuracy of treated items was examined over the course of the treatment while control naming scores of untreated items and discourse measures were collected pre-treatment, immediately post-treatment, and 4 weeks post-treatment, in order to investigate the multidimensional effects of the treatment and their maintenance. RESULT Naming skills improved in all participants for treated and untreated items, were maintained over time, and were accompanied by improved discourse abilities. Visual and statistical analyses showed a significant treatment effect for naming skills in three out of the four participants. CONCLUSION A combination of executive function training and SFA treatment in people with chronic aphasia may improve both naming skills and discourse efficiency. Further studies are needed to substantiate these promising preliminary results.
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Affiliation(s)
- Mélanie Bontemps
- Department of Speech-Language Pathology, University of Montpellier, Montpellier, France
| | | | - Sylvie Moritz-Gasser
- Department of Speech-Language Pathology, University of Montpellier, Montpellier, France
- Departments of Neurology and Neurosurgery, University Hospital of Montpellier, Montpellier, France
- Institute of Functional Genomics INSERM U 1191, Montpellier, France
- Praxiling UMR 5267 CNRS, Montpellier, France
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Lammers B, Sydnor MJ, Cust S, Kim JH, Yenokyan G, Hillis AE, Sebastian R. Protocol for Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR): A randomized, double-blind, sham-controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.05.24302365. [PMID: 38370630 PMCID: PMC10871367 DOI: 10.1101/2024.02.05.24302365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
In this randomized, double-blind, sham-controlled trial of Cerebellar Stimulation for Aphasia Rehabilitation (CeSAR), we will determine the effectiveness of cathodal tDCS (transcranial direct current stimulation) to the right cerebellum for the treatment of chronic aphasia (>6 months post stroke). We will test the hypothesis that cerebellar tDCS in combination with an evidenced-based anomia treatment (semantic feature analysis, SFA) will be associated with greater improvement in naming untrained pictures (as measured by the change in Philadelphia Picture Naming Test), 1-week post treatment, compared to sham plus SFA. We will also evaluate the effects of cerebellar tDCS on naming trained items as well as the effects on functional communication, content, efficiency, and word-retrieval of picture description, and quality of life. Finally, we will identify imaging and linguistic biomarkers to determine the characteristics of stroke patients that benefit from cerebellar tDCS and SFA treatment. We expect to enroll 60 participants over five years. Participants will receive 15, 25-minute sessions of cerebellar tDCS (3-5 sessions per week) or sham tDCS combined with 1 hour of SFA treatment. Participants will be evaluated prior to the start of treatment, one-week post-treatment, 1-, 3-, and 6-months post treatment on primary and secondary outcome variables. The long-term aim of this study is to provide the basis for a Phase III randomized controlled trial of cerebellar tDCS vs sham with concurrent language therapy for treatment of chronic aphasia. Trial registration: The trial is registered with ClinicalTrials.gov NCT05093673.
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Affiliation(s)
- Becky Lammers
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Myra J. Sydnor
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sarah Cust
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Argye E. Hillis
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
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Strunk K, Weiss S, Müller HM. High-Frequency Language Therapy with Semantic Feature Analysis (SFA) and Transcranial Direct Current Stimulation (tDCS): A Longitudinal Single-Case Report of Semantic Variant of Primary Progressive Aphasia (svPPA). Brain Sci 2024; 14:133. [PMID: 38391708 PMCID: PMC10886986 DOI: 10.3390/brainsci14020133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The goal of this study was to investigate whether the combination of semantic feature analysis (SFA) and transcranial direct current stimulation (tDCS) is effective in treating word retrieval in the semantic variant of primary progressive aphasia (svPPA) and how long the potential effects last. METHODS A 56-year-old woman diagnosed with frontotemporal dementia (FTD) and svPPA participated in this longitudinal single-subject design. A total of four 2-week stimulation phases were conducted over a 14-month period, each of which was started depending on the participant's language performance. Follow-up testing was conducted shortly after the stimulation period, approximately 2 weeks, and approximately 4 weeks thereafter. RESULTS Significant improvement in word retrieval occurred after SFA and tDCS therapy. Two weeks after the end of each stimulation phase, approx. 80% of the trained words could be named correctly. For the untrained words, also significantly more words were correctly named at follow-ups compared to the baseline. Furthermore, the Boston Naming Test (BNT) demonstrated a significant increase in naming performance and showed that phonological cues facilitated word retrieval compared to semantic cues. CONCLUSION The combination of SFA and tDCS was able to counteract the expected language deterioration of a participant with svPPA. This effect increased until approximately 2 weeks after each intervention. In addition, a generalization of the effect to untrained words was shown.
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Affiliation(s)
- Katharina Strunk
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Sabine Weiss
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Inspiration 1, 33619 Bielefeld, Germany
- Clinical Linguistics, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Horst M Müller
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
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Hashimoto N. Using a combined working memory - Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106384. [PMID: 37871472 DOI: 10.1016/j.jcomdis.2023.106384] [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: 12/05/2022] [Revised: 08/30/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION The purpose of the study was to pilot a working memory (WM) - and modified Semantic Feature Analysis (SFA) approach to treat word finding deficits in a group of people with aphasia (PwA). Two research questions were posed: 1. Will the group of PwA be able to complete the WM tasks used in the approach? 2. Will the approach improve naming performance in PwA? METHOD Three individuals with mild - moderate aphasia participated in this singlesubject multiple baseline treatment design. Pre-treatment assessments of language, and pre- to post-treatment assessments of WM abilities were carried out. The treatment protocol incorporated WM and linguistic tasks in order to improve naming accuracy across two treatment lists. Probes were carried out prior to treatment on each list, and at one-month following completion of treatment. Two outcome measures were obtained: Percent accuracy in completing the WM steps, and treatment effect sizes (Beeson & Robey, 2006). Additionally, modified t-tests (Crawford & Garthwaite, 2012; Crawford & Howell, 1998), were calculated in which post-treatment WM measures were compared against neurotypical control groups to detect any improvements in WM functions. RESULTS All three participants completed the WM steps with a high degree of accuracy. A range of small to large ESs were obtained for all three participants across the two treated lists, while no meaningful ESs were obtained for the control (untreated) list. All three participants demonstrated improved scores across most of the WM measures with significant improvements noted on certain WM assessments. CONCLUSIONS The findings revealed that the WM - SFA approach can be used successfully in individuals with mild - moderate aphasia. The proposed approach holds promise as feasible intervention designed to remediate anomia in PwA.
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Shekari E, Seyfi M, Modarres Zadeh A, Batouli SA, Valinejad V, Goudarzi S, Joghataei MT. Mechanisms of brain activation following naming therapy in aphasia: A systematic review on task-based fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:780-801. [PMID: 35666667 DOI: 10.1080/23279095.2022.2074849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Seyed Amirhossein Batouli
- Neuroimaging and Analysis Group, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology and Toxicology, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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Lyalka O, Nickels L, Morris J, Howard D. The effect of processing semantic features on spoken word retrieval in a case series of people with aphasia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:768-786. [PMID: 36017636 DOI: 10.1080/17549507.2022.2110278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: There is a growing body of evidence showing the benefit of Semantic Feature Analysis in the treatment of word finding abilities in people with aphasia. The original technique was grounded in the hypothesis that the activation of semantic features spreads to the target and thereby facilitates its subsequent retrieval. However, it remains unclear the extent to which the focus on semantic features influences the treatment effects. The aim of this study was therefore to shed light on this issue by examining the effect of priming with semantic features (parts and functions) on target retrieval across a case series of people with aphasia.Method: 10 people with aphasia and word retrieval impairments were primed with spoken forms of words that were either the target name (identity condition, e.g. car), parts of the target (e.g. wheel) or functions of the target (e.g. drive) before later being asked to name a picture of that target. An unrelated prime condition (e.g. employ) was used as a control for test-retest effects.Result: At a group level, there was speeding of reaction times in picture naming in the identity condition relative to the unrelated condition; however, no effect of priming was found for either parts or functions. There was significantly better response accuracy in post-priming naming, but this effect did not reach significance for any individual experimental condition (identity, parts, functions) as compared to the unrelated condition, although the identity condition showed numerical improvement while the other two conditions showed decline.Conclusion: Given the lack of evidence for facilitatory effects from parts and functions of a target in a priming task, this research suggests that further research is warranted on the extent to which the improvement in word retrieval subsequent to Semantic Feature Analysis is caused by the emphasis on production of semantic features rather than from the repetition of the target name.
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Affiliation(s)
- Oksana Lyalka
- Department of Cognitive Science, Macquarie University, Australia
- School of Education, Communication and Language Sciences, Newcastle upon Tyne, UK
- International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Newcastle University (UK), Macquarie University (AU), University of Potsdam (DE), University of Groningen (NL), University of Trento (IT), UK
- Department of Neurooncology and Functional Neurosurgery, Regional Clinical Center of Neurosurgery and Neurology at Transcarpathian Region Council, Ukraine
| | - Lyndsey Nickels
- Department of Cognitive Science, Macquarie University, Australia
| | - Julie Morris
- School of Education, Communication and Language Sciences, Newcastle upon Tyne, UK
| | - David Howard
- School of Education, Communication and Language Sciences, Newcastle upon Tyne, UK
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Georgiou AM, Kambanaros M. Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1674. [PMID: 37763793 PMCID: PMC10537631 DOI: 10.3390/medicina59091674] [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: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.
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Affiliation(s)
- Anastasios M. Georgiou
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus;
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14
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Tilton-Bolowsky VE, Brock L, Nunn K, Evans WS, Vallila-Rohter S. Incorporating Metacognitive Strategy Training Into Semantic Treatment Promotes Restitutive and Substitutive Gains in Naming: A Single-Subject Investigation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1979-2020. [PMID: 37433115 PMCID: PMC10561971 DOI: 10.1044/2023_ajslp-22-00230] [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: 07/22/2022] [Revised: 10/22/2022] [Accepted: 02/17/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE This study tested the effectiveness of a modified semantic feature analysis (SFA) treatment protocol that incorporated metacognitive strategy training (MST). Regarding its restitutive component, SFA most reliably results in improved word retrieval for treated items and untreated, semantically related items, but evidence of response generalization is often small/inconsistent. Regarding its substitutive component, SFA is thought to facilitate successful communication via habituation of the SFA circumlocution strategy. However, repeated practice with SFA's strategy in the absence of direct MST may not result in independent strategy use and/or generalization. Furthermore, people with aphasia's independent use of the SFA strategy in moments of anomia is presently underreported. To address these limitations, we incorporated MST into SFA and directly measured substitutive outcomes. METHOD Four people with aphasia participated in 24 treatment sessions of SFA + MST in a single-subject, A-B experimental design with repeated measurements. We measured word retrieval accuracy, strategy use, and explicit strategy knowledge. We calculated effect sizes to measure changes in word retrieval accuracy and strategy use and used visual inspection to assess gains in explicit strategy knowledge from pre- to posttreatment and retention. RESULTS Participants achieved marginally small to medium effects in word retrieval accuracy for treated; untreated, semantically related; and untreated, semantically unrelated items and marginally small to large effects in independent strategy use. Explicit strategy knowledge was variable. CONCLUSIONS Across participants, SFA + MST yielded positive changes in word retrieval accuracy or strategy use, or both. Positive changes in word retrieval accuracy were comparable to other SFA studies. Positive changes in strategy use demonstrate preliminary evidence of this treatment's ability to yield restitutive and substitutive gains. Overall, this study offers preliminary evidence of SFA + MST's effectiveness and highlights the importance of directly measuring SFA's substitutive outcomes, which showed that people with aphasia can respond to this treatment in multiple successful ways-not just improved target word production.
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15
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Stockbridge MD, Elm J, Breining BL, Tippett DC, Sebastian R, Cassarly C, Teklehaimanot A, Spell LA, Sheppard SM, Vitti E, Ruch K, Goldberg EB, Kelly C, Keator LM, Fridriksson J, Hillis AE. Transcranial Direct-Current Stimulation in Subacute Aphasia: A Randomized Controlled Trial. Stroke 2023; 54:912-920. [PMID: 36912144 PMCID: PMC10050116 DOI: 10.1161/strokeaha.122.041557] [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] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS) is a promising adjunct to therapy for chronic aphasia. METHODS This single-center, randomized, double-blind, sham-controlled efficacy trial tested the hypothesis that anodal tDCS augments language therapy in subacute aphasia. Secondarily, we compared the effect of tDCS on discourse measures and quality of life and compared the effects on naming to previous findings in chronic stroke. Right-handed English speakers with aphasia <3 months after left hemisphere ischemic stroke were included, unless they had prior neurological or psychiatric disease or injury or were taking certain medications (34 excluded; final sample, 58). Participants were randomized 1:1, controlling for age, aphasia type, and severity, to receive 20 minutes of tDCS (1 mA) or sham-tDCS in addition to fifteen 45-minute sessions of naming treatment (plus standard care). The primary outcome variable was change in naming accuracy of untrained pictures pretreatment to 1-week posttreatment. RESULTS Baseline characteristics were similar between the tDCS (N=30) and sham (N=28) groups: patients were 65 years old, 53% male, and 2 months from stroke onset on average. In intent-to-treat analysis, the adjusted mean change from baseline to 1-week posttreatment in picture naming was 22.3 (95% CI, 13.5-31.2) for tDCS and 18.5 (9.6-27.4) for sham and was not significantly different. Content and efficiency of picture description improved more with tDCS than sham. Groups did not differ in quality of life improvement. No patients were withdrawn due to adverse events. CONCLUSIONS tDCS did not improve recovery of picture naming but did improve recovery of discourse. Discourse skills are critical to participation. Future research should examine tDCS in a larger sample with richer functional outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02674490.
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Affiliation(s)
- Melissa D. Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Jordan Elm
- Department of Public Health Science, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Bonnie L. Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Christy Cassarly
- Department of Public Health Science, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Abeba Teklehaimanot
- Department of Public Health Science, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Leigh Ann Spell
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
- Department of Communication Sciences & Disorders, Chapman University, Orange, CA 92866, United States
| | - Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Kristina Ruch
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Catherine Kelly
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Lynsey M. Keator
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
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16
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Kristinsson S, Basilakos A, den Ouden DB, Cassarly C, Spell LA, Bonilha L, Rorden C, Hillis AE, Hickok G, Johnson L, Busby N, Walker GM, McLain A, Fridriksson J. Predicting Outcomes of Language Rehabilitation: Prognostic Factors for Immediate and Long-Term Outcomes After Aphasia Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1068-1084. [PMID: 36827514 PMCID: PMC10205105 DOI: 10.1044/2022_jslhr-22-00347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/23/2022] [Accepted: 11/30/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aphasia therapy is an effective approach to improve language function in chronic aphasia. However, it remains unclear what prognostic factors facilitate therapy response at the individual level. Here, we utilized data from the POLAR (Predicting Outcomes of Language Rehabilitation in Aphasia) trial to (a) determine therapy-induced change in confrontation naming and long-term maintenance of naming gains and (b) examine the extent to which aphasia severity, age, education, time postonset, and cognitive reserve predict naming gains at 1 week, 1 month, and 6 months posttherapy. METHOD A total of 107 participants with chronic (≥ 12 months poststroke) aphasia underwent extensive case history, cognitive-linguistic testing, and a neuroimaging workup prior to receiving 6 weeks of impairment-based language therapy. Therapy-induced change in naming performance (measured as raw change on the 175-item Philadelphia Naming Test [PNT]) was assessed 1 week after therapy and at follow-up time points 1 month and 6 months after therapy completion. Change in naming performance over time was evaluated using paired t tests, and linear mixed-effects models were constructed to examine the association between prognostic factors and therapy outcomes. RESULTS Naming performance was improved by 5.9 PNT items (Cohen's d = 0.56, p < .001) 1 week after therapy and by 6.4 (d = 0.66, p < .001) and 7.5 (d = 0.65, p < .001) PNT items at 1 month and 6 months after therapy completion, respectively. Aphasia severity emerged as the strongest predictor of naming improvement recovery across time points; mild (ß = 5.85-9.02) and moderate (ß = 9.65-11.54) impairment predicted better recovery than severe (ß = 1.31-3.37) and very severe (ß = 0.20-0.32) aphasia. Age was an emergent prognostic factor for recovery 1 month (ß = -0.14) and 6 months (ß = -0.20) after therapy, and time postonset (ß = -0.05) was associated with retention of naming gains at 6 months posttherapy. CONCLUSIONS These results suggest that therapy-induced naming improvement is predictable based on several easily measurable prognostic factors. Broadly speaking, these results suggest that prognostication procedures in aphasia therapy can be improved and indicate that personalization of therapy is a realistic goal in the near future. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22141829.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leigh Ann Spell
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia
| | - Argye E. Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD
| | - Gregory Hickok
- Department of Cognitive Sciences, School of Social Sciences, University of California, Irvine
| | - Lisa Johnson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Natalie Busby
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Grant M. Walker
- Department of Cognitive Sciences, School of Social Sciences, University of California, Irvine
| | - Alexander McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
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Pillay SB, Gross WL, Heffernan J, Book DS, Binder JR. Semantic network activation facilitates oral word reading in chronic aphasia. BRAIN AND LANGUAGE 2022; 233:105164. [PMID: 35933744 PMCID: PMC9948519 DOI: 10.1016/j.bandl.2022.105164] [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: 06/25/2021] [Revised: 03/22/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
People with aphasia often show partial impairments on a given task. This trial-to-trial variability offers a potential window into understanding how damaged language networks function. We test the hypothesis that successful word reading in participants with phonological system damage reflects semantic system recruitment. Residual semantic and phonological networks were defined with fMRI in 21 stroke participants with phonological damage using semantic- and rhyme-matching tasks. Participants performed an oral word reading task, and activation was compared between correct and incorrect trials within the semantic and phonological networks. The results showed a significant interaction between hemisphere, network activation, and reading success. Activation in the left hemisphere semantic network was higher when participants successfully read words. Residual phonological regions showed no difference in activation between correct and incorrect trials on the word reading task. The results provide evidence that semantic processing supports successful phonological retrieval in participants with phonological impairment.
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Affiliation(s)
- Sara B Pillay
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
| | - William L Gross
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Joseph Heffernan
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Diane S Book
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Jeffrey R Binder
- Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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18
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Stampacchia S, Hallam GP, Thompson HE, Nathaniel U, Lanzoni L, Smallwood J, Lambon Ralph MA, Jefferies E. Training flexible conceptual retrieval in post-stroke aphasia. Neuropsychol Rehabil 2022; 32:1429-1455. [PMID: 33715583 PMCID: PMC7614451 DOI: 10.1080/09602011.2021.1895847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Semantic therapy in post-stroke aphasia typically focusses on strengthening links between conceptual representations and their lexical-articulatory forms to aid word retrieval. However, research has shown that semantic deficits in this group can affect both verbal and non-verbal tasks, particularly in patients with deregulated retrieval as opposed to degraded knowledge. This study, therefore, aimed to facilitate semantic cognition in a sample of such patients with post-stroke semantic aphasia (SA) by training the identification of both strong and weak semantic associations and providing explicit pictorial feedback that demonstrated both common and more unusual ways of linking concepts together. We assessed the effects of this training on (i) trained and untrained items; and (ii) trained and untrained tasks in eleven individuals with SA. In the training task, the SA group showed improvement with practice, particularly for trained items. A similar untrained task using pictorial stimuli (Camel and Cactus Test) also improved. Together, these results suggest that semantic training can be beneficial in patients with SA and may show some degree of generalization to untrained situations. Future research should seek to understand which patients are most likely to benefit from this type of training.
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Affiliation(s)
- Sara Stampacchia
- Department of Psychology and York Neuroimaging Centre, University of York, York, UK.,Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Glyn P Hallam
- Department of Psychology and York Neuroimaging Centre, University of York, York, UK.,Department of Psychology, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Upasana Nathaniel
- Department of Psychology and York Neuroimaging Centre, University of York, York, UK.,Psychology Department, University of Haifa, Haifa, Israel
| | - Lucilla Lanzoni
- Department of Psychology and York Neuroimaging Centre, University of York, York, UK
| | - Jonathan Smallwood
- Department of Psychology and York Neuroimaging Centre, University of York, York, UK.,Queen's University, Kingston, Canada
| | | | - Elizabeth Jefferies
- Department of Psychology and York Neuroimaging Centre, University of York, York, UK
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Tierney-Hendricks C, Schliep ME, Vallila-Rohter S. Using an Implementation Framework to Survey Outcome Measurement and Treatment Practices in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1133-1162. [PMID: 34890256 DOI: 10.1044/2021_ajslp-21-00101] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Best practices in the field of aphasia rehabilitation increasingly acknowledge a whole-person approach that values interventions aimed at reducing impairments, while also recognizing the impact of aphasia on participation and quality of life. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to examine whether current clinical practices along levels of service provision reflect this whole-person, multifaceted approach. METHOD Speech-language pathologists (SLPs) in the United States who provide intervention to people with aphasia across the continuum of care completed this cross-sectional online survey. Current outcome measurement and treatment practices were evaluated within the Living With Aphasia: Framework for Outcome Measurement via multiple-choice and open-text response questions. Data were analyzed descriptively and using ordinal logistic regression models to compare clinical practices along levels of service provision. RESULTS Data from 90 SLPs revealed that language and cognitive skills are assessed with equal consistency across clinical settings; however, functional communication, participation, and quality of life domains are prioritized in settings providing care to clients within the community. Psychological well-being is rarely assessed within clinical practice along most of the rehabilitation process and prioritized within the university clinic setting when clients are in the chronic stage of recovery. CONCLUSIONS Clinical practices related to a multifaceted approach to aphasia intervention are variable across levels of service provision. Further exploration of barriers and facilitators to multifaceted aphasia care along the domains of the CFIR is needed to provide an informed approach to implementing change.
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Kristensson J, Saldert C, Östberg P, Smith SR, Åke S, Longoni F. Naming vs. non-naming treatment in aphasia in a group setting-A randomized controlled trial. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106215. [PMID: 35367876 DOI: 10.1016/j.jcomdis.2022.106215] [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: 03/15/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting. METHODS In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication. RESULTS Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group. CONCLUSIONS Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.
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Affiliation(s)
- Joana Kristensson
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden.
| | - Charlotta Saldert
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Per Östberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Rödseth Smith
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Sabina Åke
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Francesca Longoni
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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DeMetropolis SM, Goldfarb R. Semantic Versus Orthographic Preferences in Aphasia: Behavioral Evidence. Percept Mot Skills 2022; 129:624-643. [PMID: 35343301 DOI: 10.1177/00315125221080922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we compared the orthographic and semantic preferences of healthy adults and age and gender matched adults with aphasia, an acquired language disorder. Previous research in word retrieval and word associations has addressed semantic and phonological connections, but it has not as often included analyses of orthographic skills. We matched (on age and gender) 10 neurotypical adults and 11 older adults with aphasia and administered to both groups a lexical discrimination task requiring them to select, from 18 choices, those words that were most different from three words (daughter, laughter, son). Among the choices were foil words (e.g., daughter), orthographic similarities (laughter) and semantic similarities (son). Results revealed that individuals with aphasia focused on orthographic differences, while healthy adults chose semantic differences. Further studies should further explore this orthographic focus to develop treatment strategies, using behavioral and objective measures, for word-finding deficits in aphasia.
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Vuković M, Milovanović T, Jerkić L. Current methods in treatment of aphasia (Métodos actuales en el tratamiento de la afasia). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2021.2015225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cherney LR, Carpenter J. Behavioral interventions for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:197-220. [PMID: 35078599 DOI: 10.1016/b978-0-12-823384-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Department of Communication Sciences & Disorders, Northwestern University, Chicago, IL, United States.
| | - Julia Carpenter
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States
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What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation. Neuropsychol Rev 2022; 32:937-973. [PMID: 35076868 PMCID: PMC9630202 DOI: 10.1007/s11065-021-09531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.
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Tabrizi R, Walton L, Simon E, Silkes JP. Repetition Priming in Treatment of Anomia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:48-66. [PMID: 34029115 DOI: 10.1044/2021_ajslp-20-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Repetition priming has been suggested as a method for targeting implicit processes in anomia treatment. Prior studies have used masked priming for this purpose. This study extends that work with visible primes, a more clinically feasible approach. METHOD This study used a single-subject design across three participants with aphasia. Treatment involved repeated exposure to identity primes (trained condition) or sham primes (untrained condition) paired with pictures. Analyses assessed acquisition effects for trained items and untrained items that were seen during the training period, generalization to untrained items that had not been seen, and generalization to broader language skills, immediately and 3 months post-treatment. RESULTS All participants improved in naming trained items immediately after treatment, with greater improvements for trained than for untrained items. All participants maintained some degree of improvement on trained items 3 months post-treatment, although the degree differed across participants. Inconsistent generalization occurred to unexposed items. Improvements were noted in some areas of broader language ability, although these varied. CONCLUSIONS These data suggest a repetition priming treatment paradigm may increase naming accuracy for individuals with anomia and may benefit other aspects of language. Participant factors may have influenced response to treatment. Directions for future investigation are discussed.
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Affiliation(s)
- Rana Tabrizi
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Logan Walton
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Emily Simon
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - JoAnn P Silkes
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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BONEs not CATs attract DOGs: Semantic context effects for picture naming in the lesioned language network. Neuroimage 2021; 246:118767. [PMID: 34856377 DOI: 10.1016/j.neuroimage.2021.118767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
The breakdown of rapid and accurate retrieval of words is a hallmark of aphasic speech and a prime target of therapeutic intervention. Complementary, psycho- and neurolinguistic research have developed a spectrum of models, how and by which neuronal network uncompromised speakers can rely on remarkable lexical retrieval capacities. Motivated by both lines of research we invited 32 participants with a chronic left hemispheric brain lesion to name pictures in the presence of distractor words. This picture-word-interference (PWI) paradigm is widely used in psycho- and neurolinguistic research. We find that also after brain lesion categorically related words (CAT → [dog]picture) impede naming, while associatively related words (BONE → [dog]picture) ease access, when compared to unrelated distractor words. The effects largely affecting latencies in neurotypical populations, are reproduced for error rate in our participants with lesions in the language network. Unsurprisingly, overall naming abilities varied greatly across patients. Notably, however, the two effects (categorical interference / associative facilitation) differ between participants. Correlating performance with lesion patterns we find support for the notion of a divergence of brain areas affording different aspects of the task: (i) lesions in the left middle temporal gyurs (MTG) deteriorate overall naming, confirming previous work; more notably, (ii) lesions comprising the inferior frontal hub (inferior frontal gyrus, IFG) of the language-network increase the interference effect for the categorical condition; on the contrary, (iii) lesions to the mid-to-posterior temporal hub (posterior middle and superior temporal gyri, pMTG/ pSTG) increase the facilitatory effect for the associative condition on error rates. The findings can be accommodated in a neuro-linguistic framework, which localizes lexical activation but also lexical interference in posterior parts of the language network (pMTG/pITG); conversely, selection between co-activated categorically related entries is afforded by frontal language areas (IFG). While purely experimental in nature our study highlights that lesion site differentially influences specific aspects of word retrieval. Since confrontational naming is a cornerstone of aphasia rehabilitation, this may be of note when designing and evaluating novel therapeutic regimes.
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Evaluating Cognitive-Linguistic Approaches to Interventions for Aphasia Within the Rehabilitation Treatment Specification System. Arch Phys Med Rehabil 2021; 103:590-598. [PMID: 34822844 DOI: 10.1016/j.apmr.2021.07.816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/26/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022]
Abstract
The Rehabilitation Treatment Specification System (RTSS) provides a framework to identify specific components of treatments developed within various rehabilitation disciplines (eg, physical, occupational, or speech-language therapy). Furthermore, this framework offers the opportunity to identify the target and active ingredients of a therapy approach as well as the mechanism of action by which it is hypothesized to effect change in abilities or functions. In this article, we apply the RTSS framework to the characterization of a sample of treatments for aphasia that are based on cognitive-linguistic models of language processing. Our discussion of these applications centers on the benefits of this classification system and additional criteria to consider when evaluating cognitive-linguistic treatments for aphasia.
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Cherney LR, DeDe G, Hoover EL, Murray L, Obermeyer J, Pompon RH. Applying the Rehabilitation Treatment Specification System (RTSS) to Functional Communication Treatment Approaches for Aphasia. Arch Phys Med Rehabil 2021; 103:599-609. [PMID: 34742706 DOI: 10.1016/j.apmr.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
There are many different approaches to the rehabilitation of aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called "functional communication interventions" aims to enhance communication success as opposed to solely improve linguistic abilities. This approach encompasses many skills (e.g., gesturing) and factors (e.g., access to communication supports) that support sending and receiving messages in "real world" daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes three connected elements - a single target, one or more ingredients, and a mechanism of action - that, taken together, attempt to explain how and why a treatment works. While the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics' Communicative Effectiveness (PACE), Modified Response Elaboration Training (M-RET), Script Training, Conversation Treatment, and Communication Partner Training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.
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Affiliation(s)
- Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, IL; Physical Medicine and Rehabilitation, Communication Sciences and Disorders, Northwestern University, Chicago, IL.
| | - Gayle DeDe
- Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | | | - Laura Murray
- Communication Disorders and Sciences, Western University, London, Ontario, CA
| | - Jessica Obermeyer
- Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC
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Langton-Frost N, Brodsky MB. Speech-language pathology approaches to neurorehabilitation in acute care during COVID-19: Capitalizing on neuroplasticity. PM R 2021; 14:217-226. [PMID: 34595841 PMCID: PMC8661644 DOI: 10.1002/pmrj.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022]
Abstract
Neurologic manifestations associated with a coronavirus disease 2019 (COVID‐19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID‐19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech‐language pathologists are an integral part of both the critical care and neurologic disorders multi‐disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech‐language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive‐linguistic impairments such as aphasia, thereby increasing the need for communication‐based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID‐19 often experience physical, cognitive, and mental health impairments collectively called post‐intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech‐language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.
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Affiliation(s)
- Nicole Langton-Frost
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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Simic T, Leonard C, Laird L, Stewart S, Rochon E. The effects of intensity on a phonological treatment for anomia in post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106125. [PMID: 34166970 DOI: 10.1016/j.jcomdis.2021.106125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The evidence regarding optimal treatment intensity is mixed, and differing definitions have further confounded existing findings. The primary objective of this study was to compare the efficacy of Phonological Components Analysis (PCA) treatment for anomia delivered at intense and non-intense schedules, using a well-controlled design. The number of teaching episodes and active ingredients of therapy are important considerations when defining intensity. We hypothesized that an active ingredient of PCA is the self-generation of phonological components during therapy sessions. Our secondary aim was to examine whether component generation predicted treatment outcome. METHODS Sixteen adults (M = 52.63 years old, SD = 11.40) with chronic post-stroke aphasia (M = 4.52 years post-onset, SD = 5.55) were randomly assigned to intensive (IT) or standard (ST) PCA treatment conditions. Cumulative treatment intensity in both conditions was equivalent: ST participants received PCA 1 hour/day, 3 days/week for 10 weeks, whereas IT participants received PCA 3 hours/day, 4 days/week for 2.5 weeks. The primary outcome was naming accuracy on a set of treated and (matched) untreated words, measured pre- and post-treatment, and at four- and eight-week follow-ups. RESULTS IT and ST conditions were similarly efficacious. However, secondary analyses suggest an advantage for the IT condition in naming of the treated words immediately post-treatment, but not at follow-ups. The self-generation of phonological components emerged as a significant positive predictor of naming accuracy for both the treated and untreated words. However, this relationship did not reach significance once baseline anomia severity was accounted for. CONCLUSIONS Although replication in a larger sample is warranted, results suggest that PCA treatment is similarly efficacious when delivered at different intensities. Other factors related to the quality of treatment (i.e., active ingredients such as cue-generation) may play an important role in determining treatment efficacy and must also be considered when comparing treatment intensities.
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Affiliation(s)
- Tijana Simic
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; Department of Psychology, Université de Montréal, 90 Vincent d'Indy Avenue, Montreal, QC H2V 2S9, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal (CRIUGM), 4545 Queen Mary Rd., Montreal, QC H3W 1W4, Canada.
| | - Carol Leonard
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H 8M5, Canada
| | - Laura Laird
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
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Lindsey A, Coelho C. Passive Elaborative Cueing of Retrieval ProcessesFollowing Traumatic Brain Injury. Brain Inj 2021; 35:1168-1183. [PMID: 34514915 DOI: 10.1080/02699052.2021.1953595] [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: 06/30/2020] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Purpose: Semantic elaboration is a process in which target information is analyzed in relation to content associated in meaning. The goal of the present study was to examine the use of phrasal cues intended to engage elaborative processes theorized to bolster cognitive performance.Methods: Twenty-two individuals with a history of traumatic brain injury (TBI) and twenty-six neurotypical (NT) individuals were studied. Short phrases intended to elicit elaborative encoding were presented prior to the introduction of a prospective memory task and word-stem completions. Phrases embodied one of three conditions: repeated, semantic, or unrelated information. The stem-completion task was presented between each prospective memory task with fixations serving as cues signaling task completion or functioning as distractors. Event-related potentials (ERPs) were captured during the presentation of word-stems. Following the completion of all word-stems, participants were presented with an old/new recognition task.Results: Linear mixed-effects model analyses revealed a significant effect of condition with respect to word retrieval and recognition memory. Captured ERPs revealed neural signatures resembling a P200.Conclusion: Semantic content increased stimulus saliency, facilitated lexical retrieval, and enhanced retention with the latter process revealing use of semantic cues as a more adept rehearsal strategy than repetition.
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Affiliation(s)
- André Lindsey
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, United States
- Speech-Language Pathology, Department of Education, Nevada State College, Henderson, NV
| | - Carl Coelho
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut, United States
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Evans WS, Cavanaugh R, Quique Y, Boss E, Starns JJ, Hula WD. Playing With BEARS: Balancing Effort, Accuracy, and Response Speed in a Semantic Feature Verification Anomia Treatment Game. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3100-3126. [PMID: 34255979 DOI: 10.1044/2021_jslhr-20-00543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed-accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV). Method Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of "pass" responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed. Results Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of "pass" responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency. Conclusions BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy. Supplemental Material https://doi.org/10.23641/asha.14935812.
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Affiliation(s)
- William S Evans
- Department of Communication Science and Disorders, University of Pittsburgh, PA
| | - Robert Cavanaugh
- Department of Communication Science and Disorders, University of Pittsburgh, PA
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
| | - Yina Quique
- Center for Education in Health Sciences, Northwestern University, Chicago, IL
| | - Emily Boss
- Integrative Reconnective Aphasia Therapy, Pittsburgh, PA
| | - Jeffrey J Starns
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | - William D Hula
- Department of Communication Science and Disorders, University of Pittsburgh, PA
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
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Scholl DI, McCabe P, Nickels L, Ballard KJ. Outcomes of semantic feature analysis treatment for aphasia with and without apraxia of speech. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:485-500. [PMID: 33590683 DOI: 10.1111/1460-6984.12597] [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: 06/30/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND To date, studies have not explored whether a dual diagnosis of aphasia plus apraxia of speech (AOS) versus aphasia alone (APH) affects the response to language-based naming treatments. AIMS To compare the effects of semantic feature analysis (SFA) treatment for individuals with APH versus aphasia plus AOS, and to test if the presence of AOS impacted the effects of treatment. METHODS AND PROCEDURES A non-randomized experimental group study was conducted to explore the treatment, generalization and maintenance effects between the AOS and APH groups. Participants included nine individuals with aphasia and 11 with concomitant aphasia and AOS. Dependent measures included lexical accuracy, number of sound-level distortions, and lexical stress and syllable segmentation errors. OUTCOMES AND RESULTS Both groups showed significantly improved naming accuracy of trained items for up to 2 months post-treatment. Improvement on naming accuracy of untrained items post-treatment, both semantically related and unrelated to trained items, was lower in magnitude. That this may have been due to effects of repeated probing (which included target repetition) or regression to the mean cannot be excluded. There was a tendency for the AOS group to respond slightly better to treatment than the APH group overall, which was not correlated with aphasia severity. Also, measures of phonetic accuracy and fluency improved for both groups, with no main effect of group. Treatment effects did not generalize to formal measures of (untrained) picture naming or expression of correct information units in discourse in a story retelling task. CONCLUSIONS AND IMPLICATIONS Findings indicate that individuals with aphasia plus AOS can gain equivalent benefits in word retrieval and production from the language-based SFA treatment as individuals with aphasia alone. This may be, in part, due to the tendency for SFA to incorporate principles of practice that are known to support motor learning in AOS, such as high intensity, random stimulus presentation and variable practice. Findings provide further support for high-intensity practice and use of self-generated features to facilitate maintenance of effects. What this paper adds What is already known on the subject SFA treatment is the most common intervention for word-finding difficulties for individuals with aphasia. AOS is a common concomitant disorder to aphasia. However, it is not clear whether the effects of language-based SFA treatment are mitigated by the presence of AOS, which tends to respond well to treatments focused on articulatory-kinematic aspects of speech movement. What this paper adds to the existing knowledge This study compares the effects of SFA in a group of individuals with aphasia alone and a group with similar severity of aphasia but with concomitant AOS, ranging from mild to moderate-severe. Overall, AOS did not have a negative effect on response to the treatment. What are the potential or actual clinical implications of this work? Individuals with aphasia plus AOS can be expected to benefit to a similar degree from SFA as people with aphasia alone. It is likely that the use of practice principles of high intensity, random stimulus presentation and varied practice are important components of the protocol.
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Affiliation(s)
- Dominique I Scholl
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Patricia McCabe
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lyndsey Nickels
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Frontotemporal Dementia Research Group (FRONTIER), Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Evans WS, Cavanaugh R, Gravier ML, Autenreith AM, Doyle PJ, Hula WD, Dickey MW. Effects of Semantic Feature Type, Diversity, and Quantity on Semantic Feature Analysis Treatment Outcomes in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:344-358. [PMID: 32571091 DOI: 10.1044/2020_ajslp-19-00112] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Semantic feature analysis (SFA) is a naming treatment found to improve naming performance for both treated and semantically related untreated words in aphasia. A crucial treatment component is the requirement that patients generate semantic features of treated items. This article examined the role feature generation plays in treatment response to SFA in several ways: It attempted to replicate preliminary findings from Gravier et al. (2018), which found feature generation predicted treatment-related gains for both trained and untrained words. It examined whether feature diversity or the number of features generated in specific categories differentially affected SFA treatment outcomes. Method SFA was administered to 44 participants with chronic aphasia daily for 4 weeks. Treatment was administered to multiple lists sequentially in a multiple-baseline design. Participant-generated features were captured during treatment and coded in terms of feature category, total average number of features generated per trial, and total number of unique features generated per item. Item-level naming accuracy was analyzed using logistic mixed-effects regression models. Results Producing more participant-generated features was found to improve treatment response for trained but not untrained items in SFA, in contrast to Gravier et al. (2018). There was no effect of participant-generated feature diversity or any differential effect of feature category on SFA treatment outcomes. Conclusions Patient-generated features remain a key predictor of direct training effects and overall treatment response in SFA. Aphasia severity was also a significant predictor of treatment outcomes. Future work should focus on identifying potential nonresponders to therapy and explore treatment modifications to improve treatment outcomes for these individuals. Supplemental Material https://doi.org/10.23641/asha.12462596.
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Affiliation(s)
- William S Evans
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | - Rob Cavanaugh
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | - Michelle L Gravier
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
- Department of Speech, Language, and Hearing Sciences, California State University at East Bay, Hayward
| | - Alyssa M Autenreith
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
| | - Patrick J Doyle
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | - William D Hula
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | - Michael Walsh Dickey
- Geriatric Research Education and Clinical Center, VA Healthcare System, Pittsburgh, PA
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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Silkes JP, Fergadiotis G, Graue K, Kendall DL. Effects of Phonomotor Therapy and Semantic Feature Analysis on Discourse Production. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:441-454. [PMID: 32628509 DOI: 10.1044/2020_ajslp-19-00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Anomia treatments typically focus on single word retrieval, although the ultimate goal of treatment is to improve functional communication at the level of discourse in daily situations. Aims The focus of this study was to investigate the impact of two effective anomia treatments on discourse production as measured by a story retell task. Method and Procedure Fifty-seven people with aphasia were randomized to receive either a phoneme-based treatment, Phonomotor Therapy (PMT; 28 participants), or a lexical-semantic treatment, Semantic Feature Analysis (SFA; 29 participants). Groups were matched for age, aphasia severity, education, and years post onset. All received 56-60 hr of treatment in a massed treatment schedule. Therapy was delivered for a total of 8-10 hr/week over the course of 6-7 weeks. All participants completed testing 1 week prior to treatment (A1), immediately following treatment (A2), and again 3 months later (A3). Discourse was analyzed through the percentage of correct information units at each time point. Outcomes and Results Both groups showed nonsignificant improvements from pretreatment to immediately posttreatment. The PMT group showed significant improvement 3 months posttreatment, while the SFA group returned to near-baseline levels. Conclusion These results add to our understanding of the effects of both PMT and SFA. Future research should address understanding variability in discourse outcomes across studies and the effects of aphasia severity and individual participant and treatment factors on treatment outcomes for both of these approaches.
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Affiliation(s)
| | | | - Kasey Graue
- Speech and Hearing Sciences Department, Portland State University, OR
| | - Diane L Kendall
- Department of Speech and Hearing Sciences, University of Washington, Seattle
- University of Pretoria South Africa
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Jacobs M, Briley PM, Fang X, Ellis C. Telepractice Treatment for Aphasia: Association Between Clinical Outcomes and Client Satisfaction. TELEMEDICINE REPORTS 2021; 2:118-124. [PMID: 33834179 PMCID: PMC8020822 DOI: 10.1089/tmr.2020.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 05/16/2023]
Abstract
Introduction: Health services research has demonstrated the association between patient satisfaction and treatment outcomes illustrating the importance of satisfaction in determining favorable treatment outcomes. Despite abundant evidence in the acute care setting, few researchers have explored these associations among patients receiving speech rehabilitation or therapeutic treatment particularly those receiving treatment through nontraditional delivery methods. Objective: To examine the satisfaction with a community-based telepractice approach for treating aphasia among stroke survivors who reside in rural areas and assess potential correlations between satisfaction and patient outcomes. Methods: In total, 22 adults with poststroke aphasia who resided in rural areas received comprehensive language-oriented treatment (LOT) for aphasia through community-based telepractice. Post-treatment satisfaction with the telepractice approach was assessed using the Client Satisfaction Questionnaire-8 (CSQ-8). Results: After 12 sessions of LOT, Western Aphasia Battery-revised (WAB-R) aphasia quotients (AQs) improved on average 4.64 U. Mean scores on the CSQ-8 averaged 31.0/32.0, indicating a high level of satisfaction with the telepractice approach. In addition, each 1 U of improvement in patient satisfaction was associated with a 1.75 U increase in the WAB-R AQ. Conclusions: Examination of post-treatment satisfaction indicated that satisfaction was highly predictive of effectiveness-a one-point increase in satisfaction was associated with a nearly two-point increase in WAB-R AQ. Results echo findings from acute care studies underscoring the importance of the patient experience in treatment efficacy.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina, USA
| | - Patrick M. Briley
- Communication Equity and Outcomes Laboratory, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Xiangming Fang
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Charles Ellis
- Communication Equity and Outcomes Laboratory, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
- Address correspondence to: Charles Ellis, PhD, CCC-SLP, Communication Equity and Outcomes Laboratory, College of Allied Health Sciences, East Carolina University, 3310AA Health Sciences Building, MS 668, Greenville, NC 27834, USA
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Jacobs M, Briley P, Ellis C. Quantifying Experiences with Telepractice for Aphasia Therapy: A Text Mining Analysis of Client Response Data. Semin Speech Lang 2020; 41:414-432. [PMID: 32998165 DOI: 10.1055/s-0040-1716887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Measures of satisfaction following treatment for aphasia have been limited. The challenge associated with reduced verbal output among many persons with aphasia (PWA) has reportedly been a key reason measures of treatment satisfaction have been limited. A novel approach to measure treatment satisfaction is the use of content analysis (CA), which uses the presence of certain words, themes, or concepts to explore outcomes such as treatment satisfaction particularly among individuals who generate limited output. CA utilizes responses and response patterns to assign meaning to client responses. The aim of this study was to use CA to measure posttreatment satisfaction with a telepractice approach for aphasia treatment. Seventeen PWA received 12 treatment sessions over a 6-week period. At the conclusion of the treatment, CA was utilized to explore patient satisfaction with this treatment approach. The participants reported an overall positive sentiment for the telepractice approach. Two primary topics emerged which were healthcare provider and healthcare delivery, where text analysis revealed discussion of these topics to be centered around being "helpful" and "being effective." This study demonstrated that CA can be an effective approach for determining satisfaction with aphasia treatment particularly among PWA with limited verbal abilities.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services and Information Management, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina
| | - Patrick Briley
- Communication Equity and Outcomes Laboratory, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina.,Department of Communication Sciences and Disorders, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina
| | - Charles Ellis
- Communication Equity and Outcomes Laboratory, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina.,Department of Communication Sciences and Disorders, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina
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Clough S, Duff MC. The Role of Gesture in Communication and Cognition: Implications for Understanding and Treating Neurogenic Communication Disorders. Front Hum Neurosci 2020; 14:323. [PMID: 32903691 PMCID: PMC7438760 DOI: 10.3389/fnhum.2020.00323] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023] Open
Abstract
When people talk, they gesture. Gesture is a fundamental component of language that contributes meaningful and unique information to a spoken message and reflects the speaker's underlying knowledge and experiences. Theoretical perspectives of speech and gesture propose that they share a common conceptual origin and have a tightly integrated relationship, overlapping in time, meaning, and function to enrich the communicative context. We review a robust literature from the field of psychology documenting the benefits of gesture for communication for both speakers and listeners, as well as its important cognitive functions for organizing spoken language, and facilitating problem-solving, learning, and memory. Despite this evidence, gesture has been relatively understudied in populations with neurogenic communication disorders. While few studies have examined the rehabilitative potential of gesture in these populations, others have ignored gesture entirely or even discouraged its use. We review the literature characterizing gesture production and its role in intervention for people with aphasia, as well as describe the much sparser literature on gesture in cognitive communication disorders including right hemisphere damage, traumatic brain injury, and Alzheimer's disease. The neuroanatomical and behavioral profiles of these patient populations provide a unique opportunity to test theories of the relationship of speech and gesture and advance our understanding of their neural correlates. This review highlights several gaps in the field of communication disorders which may serve as a bridge for applying the psychological literature of gesture to the study of language disorders. Such future work would benefit from considering theoretical perspectives of gesture and using more rigorous and quantitative empirical methods in its approaches. We discuss implications for leveraging gesture to explore its untapped potential in understanding and rehabilitating neurogenic communication disorders.
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Affiliation(s)
- Sharice Clough
- Communication and Memory Lab, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Sandberg CW, Gray T. Abstract Semantic Associative Network Training: A Replication and Update of an Abstract Word Retrieval Therapy Program. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1574-1595. [PMID: 32628510 DOI: 10.1044/2020_ajslp-19-00066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose We report on a study that replicates previous treatment studies using Abstract Semantic Associative Network Training (AbSANT), which was developed to help persons with aphasia improve their ability to retrieve abstract words, as well as thematically related concrete words. We hypothesized that previous results would be replicated; that is, when abstract words are trained using this protocol, improvement would be observed for both abstract and concrete words in the same context-category, but when concrete words are trained, no improvement for abstract words would be observed. We then frame the results of this study with the results of previous studies that used AbSANT to provide better evidence for the utility of this therapeutic technique. We also discuss proposed mechanisms of AbSANT. Method Four persons with aphasia completed one phase of concrete word training and one phase of abstract word training using the AbSANT protocol. Effect sizes were calculated for each word type for each phase. Effect sizes for this study are compared with the effect sizes from previous studies. Results As predicted, training abstract words resulted in both direct training and generalization effects, whereas training concrete words resulted in only direct training effects. The reported results are consistent across studies. Furthermore, when the data are compared across studies, there is a distinct pattern of the added benefit of training abstract words using AbSANT. Conclusion Treatment for word retrieval in aphasia is most often aimed at concrete words, despite the usefulness and pervasiveness of abstract words in everyday conversation. We show the utility of AbSANT as a means of improving not only abstract word retrieval but also concrete word retrieval and hope this evidence will help foster its application in clinical practice.
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Affiliation(s)
- Chaleece W Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA
| | - Teresa Gray
- Department of Speech, Language and Hearing Sciences, San Francisco State University, CA
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Hickin J, Cruice M, Dipper L. A Systematically Conducted Scoping Review of the Evidence and Fidelity of Treatments for Verb Deficits in Aphasia: Verb-in-Isolation Treatments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:530-559. [PMID: 31652412 DOI: 10.1044/2019_ajslp-cac48-18-0234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Aphasia research demonstrates increasing interest in the treatment of verb retrieval deficits. This systematically conducted scoping review reports on the level and fidelity of the current evidence for verb treatments; on its effectiveness regarding the production of trained and untrained verbs, functional communication, sentences, and discourse; and on the potential active ingredients. Recommendations to guide clinical decision making and future research are made. Method The computerized database search included studies from January 1980 to September 2018. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to the treatment methods used. Results Thirty-seven studies were accepted into the review, and all but 1 constituted a low level of evidence. Thirty-three studies (89%) described treatment in sufficient detail to allow replication, dosage was poorly reported, and the fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were phonological and semantic cueing in 25 (67.5%) and 20 (54%) studies, respectively. Retrieval of trained verbs improved for 80% of participants, and improvements generalized to untrained verbs for 15% of participants. There was not sufficient detail to evaluate the impact of treatment on sentence production, functional communication, and discourse. Conclusions The evidence for verb treatments is predominantly of a low level. There are encouraging findings in terms of treatments being replicable; however, this is tempered by poor monitoring of treatment fidelity. The quality of verb treatment research would be improved by researchers reaching consensus regarding outcome measures (including generalization to, e.g., sentences and discourse) by manualizing treatment to facilitate implementation and exploring the opinions of participants. Finally, while treatment is largely effective in improving production of trained verbs, lack of generalization to untrained items leads to the recommendation that personally relevant verbs are prioritized.
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Affiliation(s)
- Julie Hickin
- Division of Language and Communication Science, City, University of London, United Kingdom
| | - Madeline Cruice
- Division of Language and Communication Science, City, University of London, United Kingdom
| | - Lucy Dipper
- Division of Language and Communication Science, City, University of London, United Kingdom
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Ballard KJ, Etter NM, Shen S, Monroe P, Tien Tan C. Feasibility of Automatic Speech Recognition for Providing Feedback During Tablet-Based Treatment for Apraxia of Speech Plus Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:818-834. [PMID: 31306595 DOI: 10.1044/2018_ajslp-msc18-18-0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Individuals with neurogenic speech disorders require ongoing therapeutic support to achieve functional communication goals. Alternative methods for service delivery, such as tablet-based speech therapy applications, may help bridge the gap and bring therapeutic interventions to the patient in an engaging way. The purpose of this study was to evaluate an iPad-based speech therapy app that uses automatic speech recognition (ASR) software to provide feedback on speech accuracy to determine the ASR's accuracy against human judgment and whether participants' speech improved with this ASR-based feedback. Method Five participants with apraxia of speech plus aphasia secondary to stroke completed an intensive 4-week at-home therapy program using a novel word training app with built-in ASR. Multiple baselines across participants and behaviors designs were employed, with weekly probes and follow-up at 1 month posttreatment. Four sessions a week of 100 practice trials each were prescribed, with 1 being clinician-run and the remainder done independently. Dependent variables of interest were ASR-human agreement on accuracy during practice trials and human-judged word production accuracy over time in probes. Also, user experience surveys were completed immediately posttreatment. Results ASR-human agreement on accuracy averaged ~80%, which is a common threshold applied for interrater agreement. All participants demonstrated improved word production accuracy over time with the ASR-based feedback and maintenance of gains after 1 month. All participants reported enjoying using the app with support of a speech pathologist. Conclusion For these participants with apraxia of speech plus aphasia due to stroke, satisfactory gains were made in word production accuracy with an app-based therapy program providing ASR-based feedback on accuracy. Findings support further testing of this ASR-based approach as a supplement to clinician-run sessions to assist clients with similar profiles in achieving higher amount and intensity of practice as well as empowering them to manage their own therapy program. Supplemental Material https://doi.org/10.23641/asha.8206628.
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Affiliation(s)
- Kirrie J Ballard
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Nicole M Etter
- Department of Communication Sciences and Disorders, Pennsylvania State University, University Park
| | - Songjia Shen
- Games Studio, University of Technology Sydney, New South Wales, Australia
| | - Penelope Monroe
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Chek Tien Tan
- InfoComm Technology Cluster, Singapore Institute of Technology, Singapore
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Monaco E, Jost LB, Gygax PM, Annoni JM. Embodied Semantics in a Second Language: Critical Review and Clinical Implications. Front Hum Neurosci 2019; 13:110. [PMID: 30983983 PMCID: PMC6449436 DOI: 10.3389/fnhum.2019.00110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/12/2019] [Indexed: 12/20/2022] Open
Abstract
The role of the sensorimotor system in second language (L2) semantic processing as well as its clinical implications for bilingual patients has hitherto been neglected. We offer an overview of the issues at stake in this under-investigated field, presenting the theoretical and clinical relevance of studying L2 embodiment and reviewing the few studies on this topic. We highlight that (a) the sensorimotor network is involved in L2 processing, and that (b) in most studies, L2 is differently embodied than L1, reflected in a lower degree or in a different pattern of L2 embodiment. Importantly, we outline critical issues to be addressed in order to guide future research. We also delineate the subsequent steps needed to confirm or dismiss the value of language therapeutic approaches based on embodiment theories as a complement of speech and language therapies in adult bilinguals.
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Affiliation(s)
- Elisa Monaco
- Laboratory for Cognitive and Neurological Sciences, Neurology Unit, Medicine Section, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Lea B. Jost
- Laboratory for Cognitive and Neurological Sciences, Neurology Unit, Medicine Section, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Pascal M. Gygax
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Jean-Marie Annoni
- Laboratory for Cognitive and Neurological Sciences, Neurology Unit, Medicine Section, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Neurology Unit, Fribourg Cantonal Hospital, Fribourg, Switzerland
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