Phonological treatment approaches for spoken word production in aphasia

This paper provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically-based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sub-lexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multi-modal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The paper concludes with suggestions for clinical application and implementation.The United States Department of Veterans Affairshttps://www.thieme-connect.com2018-02-28hb2017Speech-Language Pathology and Audiolog

Generalisation and maintenance across word classes : comparing the efficacy of two anomia treatments in improving verb naming

BACKGROUND : Many language treatments have been developed to remediate anomia, a debilitating and pervasive symptom of aphasia. The two major types of anomia treatments, semantic and phonological, have been shown to improve spoken production of trained words. However, generalisation to untrained words has been considerably variable and few studies have examined the improvement of untrained words from a different word class despite the presence of unbalanced noun-verb impairments in the majority of people with aphasia. AIM : This retrospective study investigated within and between treatment group effects of two anomia treatments (Semantic Feature Analysis, SFA, and Phonomotor Treatment, PMT) on naming of untrained verbs. METHODS AND PROCEDURES : The data for this study were retrospectively analysed from a randomised controlled trial with 57 persons with aphasia randomised to one of two treatment groups. Each participant received 56–60 hours of intensively delivered treatment over 6 weeks, with testing before, immediately after, and three months after treatment termination. OUTCOMES AND RESULTS : There was no significant between-group difference on confrontation naming of untrained verbs immediately post-treatment or three months following treatment termination (maintenance). Significant within-group findings were evident immediately post-treatment for the individuals in the SFA group and at maintenance for the PMT group. CONCLUSIONS : Our results show that neither SFA nor PMT was superior at inducing generalisation effects across word class (i.e. from nouns to verbs). These findings were consistent with the between-group results from the larger randomised controlled trial from which these data are analysed (Kendall, Oelke, Allen, Torrence, & Nadeau, 2018) in that there was no between-group difference in generalization to untrained words that do not share semantic or phonological sequence features. However, the within-treatment group results in the maintenance phase add to evidence from prior studies that Phonomotor Treatment is more likely to facilitate generalisation. Although generalisation to untrained stimuli was minimally maintained after SFA treatment, there was further improvement to untrained exemplars over time following Phonomotor Treatment.VA RR&D Merit Review Grant #C6572Rhttps://www.tandfonline.com/loi/paph20hj2020Speech-Language Pathology and Audiolog

Modifying and validating a measure of chronic stress for people with aphasia

PURPOSE : Chronic stress is likely a common experience among people with the language impairment of aphasia. Importantly, chronic stress reportedly alters the neural networks central to learning and memory—essential ingredients of aphasia rehabilitation. Before we can explore the influence of chronic stress on rehabilitation outcomes, we must be able to measure chronic stress in this population. The purpose of this study was to (a) modify a widely used measure of chronic stress (Perceived Stress Scale [PSS]; Cohen & Janicki-Deverts, 2012) to fit the communication needs of people with aphasia (PWA) and (b) validate the modified PSS (mPSS) with PWA. METHOD : Following systematic modification of the PSS (with permission), 72 PWA completed the validation portion of the study. Each participant completed the mPSS, measures of depression, anxiety, and resilience, and provided a sample of the stress hormone cortisol extracted from the hair. Pearson's product–moment correlations were used to examine associations between mPSS scores and these measures. Approximately 30% of participants completed the mPSS 1 week later to establish test–retest reliability, analyzed using an interclass correlation coefficient. RESULTS : Significant positive correlations were evident between the reports of chronic stress and depression and anxiety. In addition, a significant inverse correlation was found between reports of chronic stress and resilience. The mPSS also showed evidence of test–retest reliability. No association was found between mPSS score and cortisol level. CONCLUSION : Although questions remain about the biological correlates of chronic stress in people with poststroke aphasia, significant associations between chronic stress and several psychosocial variables provide evidence of validity of this emerging measure of chronic stress.VA Rehabilitation Research & Development Career Development Award (1IK1RX001934).http://jslhr.pubs.asha.orghj2019Speech-Language Pathology and Audiolog

Effects of phonomotor therapy and semantic feature analysis on discourse production

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.U.S. Department of Veterans Affairs Office of Rehabilitation Research and Development Merit Review Granthttps://pubs.asha.org/journal/ajslphj2022Speech-Language Pathology and Audiolog

Exploring associations between a biological marker of chronic stress and reported depression and anxiety in people with aphasia

PURPOSE : Living with the communication impairment of aphasia can be stressful. Chronic stress, depression, and anxiety are intimately linked, may be more pervasive in people with poststroke aphasia than the general population, and may influence cognitive function and treatment outcomes. In this project, we explored the psychological constructs of depression and anxiety and their associations with a biomarker measure of chronic stress in people with aphasia. METHOD : Fifty-seven participants with aphasia completed measures of depression and anxiety and provided a hair sample from which to extract the stress hormone cortisol. Pearson product–moment correlational analyses were used to identify associations between depression, anxiety, and long-term level of cortisol via hair sample. RESULTS : While cortisol level was not associated with depression and anxiety across this sample of people with aphasia, a post hoc analysis showed a significant, positive correlation between a subset of participants with moderate and higher levels of depression and elevated cortisol level. CONCLUSIONS : Chronic stress, depression, and anxiety have been little explored in people with aphasia to date, yet they are associated with future health consequences and impaired cognitive function, motivating further research as well as consideration of these factors in aphasia rehabilitation.VA Rehabilitation Research and Developmenthttps://pubs.asha.org/journal/jslhrgl2020Speech-Language Pathology and Audiolog

Phonomotor versus semantic feature analysis treatment for anomia in 58 persons with aphasia : a randomized controlled trial

PURPOSE : The ultimate goal of anomia treatment should be to achieve gains in exemplars trained in the therapy session, as well as generalization to untrained exemplars and contexts. The purpose of this study was to test the efficacy of phonomotor treatment, a treatment focusing on enhancement of phonological sequence knowledge, against semantic feature analysis (SFA), a lexical-semantic therapy that focuses on enhancement of semantic knowledge and is well known and commonly used to treat anomia in aphasia. METHOD : In a between-groups randomized controlled trial, 58 persons with aphasia characterized by anomia and phonological dysfunction were randomized to receive 56–60 hr of intensively delivered treatment over 6 weeks with testing pretreatment, posttreatment, and 3 months posttreatment termination. RESULTS : There was no significant between-groups difference on the primary outcome measure (untrained nouns phonologically and semantically unrelated to each treatment) at 3 months posttreatment. Significant within-group immediately posttreatment acquisition effects for confrontation naming and response latency were observed for both groups. Treatment-specific generalization effects for confrontation naming were observed for both groups immediately and 3 months posttreatment; a significant decrease in response latency was observed at both time points for the SFA group only. Finally, significant within-group differences on the Comprehensive Aphasia Test–Disability Questionnaire (Swinburn, Porter, & Howard, 2004) were observed both immediately and 3 months posttreatment for the SFA group, and significant within-group differences on the Functional Outcome Questionnaire (Glueckauf et al., 2003) were found for both treatment groups 3 months posttreatment. DISCUSSION : Our results are consistent with those of prior studies that have shown that SFA treatment and phonomotor treatment generalize to untrained words that share features (semantic or phonological sequence, respectively) with the training set. However, they show that there is no significant generalization to untrained words that do not share semantic features or phonological sequence features.Veterans Affairs Rehabilitation Research and Development Merit Review Grant C6572R.https://pubs.asha.org/journal/jslhrhj2020Speech-Language Pathology and Audiolog

Identifying verbal short-term memory and working memory impairments in individuals with latent aphasia

PURPOSE : This study was undertaken to explore whether measures of verbal short-term memory and working memory are sensitive to impairments in people with latent aphasia, who score within normal limits on typical aphasia test batteries. METHOD : Seven individuals with latent aphasia and 24 neurotypical control participants completed 40 tasks from the Temple Assessment of Language and Short-term Memory in Aphasia (TALSA) that assess various aspects of verbal short-term memory, working memory, and language processing. Subtests were identified that differentiated between the two groups of participants. RESULTS : Twenty-one TALSA tasks were identified on which the participants with latent aphasia had significantly different performance than the typical control participants. All of these subtests engaged verbal short-term memory, and some involved working memory as well. Furthermore, the TALSA detected individual differences in linguistic profiles among participants with latent aphasia. CONCLUSIONS : People with latent aphasia may be identified by tests that tap verbal short-term memory and working memory. In addition, the TALSA was found to be sensitive to the heterogeneity of this population. Further development of these measures will improve identification and treatment of this challenging population.The National Institute on Deafness and Other Communication Disordershttps://pubs.asha.org/journal/ajslphj2022Speech-Language Pathology and Audiolog

What can speech production errors tell us about crosslinguistic processing in bilingual aphasia? Evidence from four English/Afrikaans bilingual individuals with aphasia

INTRODUCTION : The aim of this study is contribute to clinical practice of bilinguals around the globe, as well as to add to our understanding of bilingual aphasia processing, by analysing confrontation naming data from four Afrikaans/English bilingual individuals with acquired aphasia due to a left hemisphere stroke. METHODS : This is a case series analysis of four Afrikaans/English bilingual aphasic individuals following a left cerebrovascular accident. Error analysis of confrontation naming data in both languages was performed. Research questions were directed toward the between language differences in lexical retrieval abilities, types of errors produced and degree of cognate overlap. RESULTS : Three of the four participants showed significantly higher naming accuracy in first acquired language (L1) relative to the second acquired language (L2) and the largest proportion of error type for those three participants in both L1 and L2 was omission. One of the four participants (linguistically balanced) showed no between language accuracy difference. Regarding cognate overlap, there was a trend for higher accuracy for higher cognate words (compared to low). DISCUSSION : This study showed that naming performance in these four individuals was reflective of their relative language proficiency and use patterns prior to their stroke. These findings are consistent with the hierarchical model, in normal bilingual speakers and with persons with bilingual aphasia.http://www.sajcd.org.zaam2016Speech-Language Pathology and Audiolog

What can speech production errors tell us about crosslinguistic processing in bilingual aphasia? Evidence from four English/Afrikaans bilingual individuals with aphasia

INTRODUCTION : The aim of this study is contribute to clinical practice of bilinguals around the globe, as well as to add to our understanding of bilingual aphasia processing, by analysing confrontation naming data from four Afrikaans/English bilingual individuals with acquired aphasia due to a left hemisphere stroke. METHODS : This is a case series analysis of four Afrikaans/English bilingual aphasic individuals following a left cerebrovascular accident. Error analysis of confrontation naming data in both languages was performed. Research questions were directed toward the between language differences in lexical retrieval abilities, types of errors produced and degree of cognate overlap. RESULTS : Three of the four participants showed significantly higher naming accuracy in first acquired language (L1) relative to the second acquired language (L2) and the largest proportion of error type for those three participants in both L1 and L2 was omission. One of the four participants (linguistically balanced) showed no between language accuracy difference. Regarding cognate overlap, there was a trend for higher accuracy for higher cognate words (compared to low). DISCUSSION : This study showed that naming performance in these four individuals was reflective of their relative language proficiency and use patterns prior to their stroke. These findings are consistent with the hierarchical model, in normal bilingual speakers and with persons with bilingual aphasia.http://www.sajcd.org.zaam2016Speech-Language Pathology and Audiolog

Experimental support of the scaling rule for demographic stochasticity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73613/1/j.1461-0248.2006.00903.x.pd