Treatment intensity and the effect of repetition priming on naming performance in individuals with anomia

Clinical aphasia researchers have demonstrated efficacy across both phonological and semantic treatment approaches for individuals with anomia (e.g., Boyle, 2004; Kendall, et al., 2008; Renvall et al., 2007). As this research continues to emerge, clinicians are gaining invaluable knowledge about the ideal treatment approach to select for each client or treatment context. Simultaneously, neuroscience research is progressing rapidly and clinical researchers have begun to manipulate principles of neuroplasticity to optimize treatment paradigms (e.g., Kleim & Jones, 2008; Kurland, et al., 2010; Ludlow et al., 2008). One variable that has gained a substantial amount of attention is treatment intensity; participants who receive a greater number of treatment sessions improve to a greater degree than those who receive conventional aphasia therapy (e.g., Brady, et al., 2012; Meinzer et al., 2011). Research protocols have yet to be designed that systematically manipulate intensity variables to estimate the amount of treatment required to best facilitate improved language skills in persons with aphasia (PWA). That is, a majority of the treatment intensity evidence comes from studies that were designed to assess the efficacy of specific treatment approaches. The purpose of this study was to directly investigate the influence of intensity and repetition on naming performance, while simultaneously removing the issue of treatment approach. A repetition priming paradigm was used to assess the influence of treatment intensity and stimulus dosage on the acquisition and maintenance of picture naming accuracy for PWA

Examining inhibition during spoken word production in aphasia

None

On-line sentence reading in people with aphasia: Evidence from eye tracking

People with aphasia (PWA) often exhibit impaired sentence comprehension. According to the Lexical Bias Hypothesis (e.g., Gahl, 2002), these comprehension impairments may emerge due to conflicts between sentence structure and the biases of the words in the sentence. It is unclear whether this hypothesis can be extended to include biases – or expectations – based on the relative frequency of different syntactic structures. For example, there is a lot of evidence that PWA have more difficulty understanding structurally complex sentences (e.g., object clefts - example 2) compared to simpler sentences (e.g., subject clefts - example 1). In this case, structural complexity reflects a variety of features, including deviation from the typical subject-verb-object word order of English. However, subject clefts also occur more frequently than object clefts. Thus, it is possible that both structural complexity and frequency affect how PWA process these sentences types. 1. Subject Cleft: It was the father that entertained the baby during the party last week. 2. Object Cleft: It was the baby that the father entertained during the party last week. Recent work identified patterns of reading times associated with both building a complex structure and violations of syntactic expectations (Staub, 2010). Staub reported slower reading times for college-age adults for both the embedded verb and the second noun phrase in sentences with object versus subject relative clauses. Longer reading times for the verb in object relatives are typically interpreted as evidence of operations associated with building a more complex syntactic structure. However, the second noun phrase is the first point in the sentence at which the object relative structure can be detected. On this basis, Staub claimed that processing disruptions at the second noun phrase occurred because the participants’ expectation for the more common structure (i.e., the subject relative) was violated. The present study asked whether PWA would show effects of complexity and frequency when reading object and subject cleft sentences, as would be expected if the Lexical Bias Hypothesis can be extended to syntactic biases

Normative data for the WAB-R: A comparison of monolingual English speakers, Asian Indian-English bilinguals, and Spanish-English bilinguals

The United States population is more culturally and linguistically diverse (CLD) than it has ever been (U.S. Census, 2010). The incidence of many neurological disorders, such as cerebrovascular disease, is also higher for particular ethnic and racial minorities, including Hispanics, African Americans, and Asians than for the general population (Healthy People 2020; Schiller et al., 2012). Therefore, CLD clients, many of whom are second language (L2) English speakers, constitute a large and growing proportion of the caseload in adult neurorehabilitation settings. Speech language pathologists (SLPs) working in such settings have rated aphasia as the most difficult condition to assess and treat for CLD clients (Centeno, 2009, in preparation). A primary challenge is accurate assessment of language abilities for several reasons: L2 speakers may have limited English proficiency, bilingualism affects test performance of even highly proficient bilinguals (Gollan et al., 2007), CLD groups differ widely in familiarity with test stimuli, and the normative samples of most diagnostic tests are not representative of CLD populations (Langdon & Wiig, 2009). The dearth of normative data on L2 speakers is a serious concern that could limit the validity of an aphasia diagnosis. Despite knowledge of these issues, SLPs report using standardized English language tests with L2 speakers (Caesar & Kohler, 2007). Hence there is a critical need to validate the diagnostic accuracy of standardized English tests for CLD adults to distinguish genuine language deficits from differences in language experience (Centeno, 2009; Mungas et al., 2011). The main goal of this study is to collect and report additional normative data for the Western Aphasia Battery-Revised (WAB-R, Kertesz, 2006). The WAB-R was normed on just twenty individuals: 6 neurologically healthy and 14 with aphasia (Kertesz, 2006, pg. 106). Given that it is one of the most widely used aphasia batteries (Simmons-Mackie, Threats, & Kagan, 2005), it is crucial to expand the normative sample of the WAB-R. This study focuses on two of the most rapidly growing bilingual demographic groups in the United States (U.S. Census, 2010): Asian Indian-English (AI-E) and Spanish-English (S-E) speakers. There were three specific aims: 1) to collect and compare normative data for AI-E, S-E and monolingual English speakers, 2) to compare the three groups’ overall severity (Aphasia Quotient: AQ) and individual subtest scores, and 3) to identify particular areas of difficulty across subtests or participant groups

Effects of Individual and Group Therapies on Verb Production in Aphasia

Language interventions are frequently classified along a continuum (Paul & Cascella, 2007). At one end of the continuum are impairment-based approaches that aim to remediate a particular language skill. Successful treatments often utilize models of cognitive-linguistic processing and have been shown to improve language performance in individuals with aphasia (Thompson & Shapiro, 2005; Whitworth, Webster, & Howard, 2005, Wertz et al 1981). At the other end of the continuum is the participant-centered approach. These types of interventions place the client at the center of the intervention. Group treatment is a socially oriented intervention and an example of a participant-centered approach. Studies support the use of conversation group treatments to improve language performance in individuals with aphasia (Wertz et al., 1981, Elman & Bernstein-Ellis, 1999b). Considerable evidence exists in the literature to support both these types of interventions and both interventions seek to improve communication in the individual with aphasia (Martin, Thompson & Worrall, 2008). However, there have been no studies that compare the effects of these two approaches. This study compared the effect of these two approaches on remediation of verb production in aphasia. The goals were 1) to determine if performance on verbs trained in an impairment-based approach, a participant-centered approach, or an integrated context that used both approaches improved to a greater extent, and 2) to determine whether combining these training approaches led to improvements in related language functions and in verbal communication

Core Lexicon and Main Concept Production during Picture Description

Discourse is a highly complex and individualized communication act wherein individuals not only transmit and receive information for survival and cooperation, but also use spoken language for ritual purposes (e.g., relationships, fellowship, co-participation; Carey, 1988; Dimbleby & Burton, 1998). Discourse in typical and clinical populations has been investigated with a variety of structuralist, functionalist, and hybrid techniques (see Armstrong, 2000), and is known to be a good predictor of quality of life and life participation in persons with aphasia (PWAs). Discourse analysis, however, generally requires specialized training and can be time-consuming. MacWhinney, Fromm Holland, Forbes, & Wright (2010) suggested that analysis of a core lexicon during structured narrative tasks could provide a time-efficient and informative index of functional communication abilities. For example, clinicians could bypass lengthy transcriptions, instead generating a list of words spoken during narration for later comparison to a core lexicon (CoreLex). Using various methods, CoreLex has so far been investigated for the Cinderella story, a monologic story retell narrative task (Author1, Dillow, & Author2, 2013; MacWhinney et al., 2010) and a procedural narrative task where patients describe how to make a PB&J sandwich (Fromm, Forbes, Holland, & MacWhinney, 2013). CoreLex performance is strongly correlated with main concept (MC) production, a measure of narrative adequacy, during Cinderella retelling (Author1, Dillow, & Author2, 2013). Similar investigations for other narrative tasks are needed. The aims of this study were to 1) determine the CoreLex of a picture sequence description task included in the AphasiaBank protocol (Breaking Window), 2) calculate a CoreLex score for controls and PWAs, and 3) determine how well CoreLex predicts narrative adequacy, as judged by MC analysis

A Moderately Intensive Functional Treatment For Severe Auditory Comprehension Deficits Associated with Aphasia

Severe, chronic, auditory comprehension deficits secondary to aphasia can adversely impact an individual’s quality of life by limiting successful communication interactions (Bose et al., 2009). Furthermore, individuals lacking awareness of comprehension deficits may be less inclined to compensate for communication breakdowns (Knollman-Porter, Dietz, & Groh, 2012). Interventions utilizing intense and repetitive stimulation are recommended to promote neuroplasticity, and therefore, language function following a stroke (Kleim & Jones, 2008; Kurland et al., 2012). More specifically, highly intensive treatment protocols (two hours a day, five days a week for three weeks) for severe comprehension deficits have demonstrated promising gains in word comprehension and awareness with corrective feedback and researcher-selected stimuli (Knollman-Porter et al., 2012). However, not all clients and caregivers can tolerate intensive treatment protocols. Additionally, the importance of stimuli type, particularly personally relevant stimuli, has been suggested in promoting treatment outcomes (Hinckley & Carr, 2005; McKelvey et al., 2010). Therefore, further research is needed to examine more functional treatment options for individuals with comprehension deficits. This study investigated the impact of a moderately intensive treatment protocol using personally relevant stimuli and corrective feedback on auditory comprehension and self-awareness in individuals with severe, chronic, aphasia

Measuring Outcomes in Aphasia and Apraxia of Speech in the Context of a Learning Health Care System

None

Evolution of aphasic naming errors following phonomotor treatment

The primary outcome measures for aphasia treatment investigations targeting anomia typically include naming accuracy of trained and untrained words. Recently, several treatment investigations have also included error analyses that closely look at the way in which word retrieval breaks down pre-treatment vs. post-treatment (Gordon, 2007; Kendall, Pompon, Brookshire, Minkina, & Bislick, 2013; Kiran & Johnson, 2008, Kiran & Thompson, 2003). In one such analysis, Kendall et al. (2013) investigated treatment-induced changes in aphasic naming errors following a phonomotor treatment for anomia. The study was rooted in an interactive two-stage model of word retrieval, in which world retrieval is initiated with activation of semantic representations, allowing for access of the word’s lemma (which holds grammatical properties), while phonological representations are accessed in the second stage (Dell, 1986). In the analyses of confrontation naming errors in ten people with aphasia, several trends were noted immediately following treatment: a decrease in the proportion of omissions on trained words, and an increase in the proportion of mixed (phonologically and semantically related) errors on untrained words. These results suggested that treatment led to more precise activation of nodes supporting word retrieval. The present study sought to replicate this error proportion analysis in a larger group of participants and expand the analysis to explore changes in raw numbers of errors. The following research questions were asked both for trained and untrained words: Preliminary research question 1) Is there a significant difference between picture naming accuracy pre-treatment vs. immediately post-treatment, and pre-treatment vs. three months post-treatment? Main research questions 2) Is there a significant difference in raw numbers of various error types made during picture naming pre-treatment vs. immediately post-treatment, and pre-treatment vs. three months post-treatment? 3) Is there a significant difference in error type proportions (the number of each error type divided by the total errors made) observed during picture naming pre-treatment vs. immediately post-treatment, and pre-treatment vs. three months post-treatment

Script Therapy or VNeST for Agrammatic Aphasia? A Pilot Study

Fluent language production can be determined by a number of linguistic factors including the ability to produce appropriate morphology, lexical retrieval, sentence production, grammatical form, and conversational discourse. Individuals with agrammatic aphasia may exhibit impaired lexical processing which greatly impedes their ability to construct sentences and communicate fluently. In particular, individuals with agrammatic aphasia exhibit difficulty in understanding or producing complex lexical items specifically in verb morphology as well as presenting with non-fluent, reduced speech lacking grammatical features, and a decrease in the production of verbs and nouns (Ballard & Thompson, 1999; Edmonds & Babb, 2011; Edmonds, Nadeau, & Kiran, 2009; Martin, Fink, & Laine, 2004; Nickels, 2002; & Raymer, & Ellsworth, 2002). Similarly, these individuals may demonstrate lexical retrieval deficits that are semantic in nature with difficulty accessing meaning and producing the correct forms of words (Libben, 2008). Also, these individuals may present difficulty both socially and linguistically processing discourse and conversation due to the nature of the interaction. This study investigated which treatment, Script Therapy or Verb Network Strengthening Treatment (VNeST), was more beneficial in improving sentence production and conversational discourse with two individuals with agrammatic aphasia. Script therapy was chosen as it is a functional approach to aphasia therapy that can facilitate participation in personally relevant conversational activities. Structurally-based VNeST aims to improve lexical retrieval of content words in sentence context by promoting retrieval of verbs and their thematic roles (Edmonds et al., 2009). Previous studies suggest that both treatments help increase fluency in more complex sentence production that is necessary for discourse and conversation in individuals with agrammatic aphasia (Edmonds & Babb, 2011; Edmonds et al., 2009)