A Treatment Sequence for “Phonological Aphasias”: Strengthening the Core Deficit

Phonological impairment is a common core deficit in individuals with left perisylvian damage resulting in the classic aphasia syndromes (Broca’s, Wernicke’s, and Conduction aphasia). The impairment is particularly evident on written language tasks that require transcoding of sound-letter correspondences, such as nonwords, but many individuals with these chronic “phonological aphasias” have limited residual ability to write real words as well. We report here on a treatment sequence intended to strengthen phonological skills in individuals with aphasia and global agraphia. Treatment outcomes from a case series of 16 participants demonstrated the value of this approach for written and spoken language

MOR evidence for the therapeutic value of multiple oral re-reading

Multiple oral re-reading (MOR) is a text-based intervention that has been used to improve reading rate and accuracy in individuals with acquired alexia. In the present study, six individuals with word-length effects for single-word reading speed were treated with MOR. Although they ranged in alexia severity, all six individuals benefitted from MOR treatment, demonstrating significantly improved single-word reading reaction times. Four of the six significantly improved text reading rates, and the remaining two (who were the mildest in severity) improved text reading accuracy following treatment. The results support the therapeutic value of MOR across a range of alexia severity

A Novel Means to Examine Response to Spelling Treatment

According to a dual-route model of written language processing, spelling of irregular words provides an index of the status of lexical spelling procedures, whereas nonword spelling provides information about non-lexical processing that relies on phoneme-grapheme conversion. Because regular words can be spelled using either route, accuracy for such words may reflect the combined function of the two routes, and may be mathematically predicted on the basis of spelling accuracy for irregular words and nonwords. Pre- and post-treatment spelling performance of a group of eight individuals with acquired spelling impairment demonstrated the utility of comparing such predictions with actual performance

A Framework to Guide Treatment Planning in Aphasia

Approximately 700 empirical research studies have been conducted that examine treatment outcomes in adults with acquired language impairment. This rich body of literature provides guidance regarding the therapeutic value of interventions that target skills across communication modalities. What appears to be lacking, however, is a comprehensive, integrated framework for treatment planning that might serve as a guide for clinical decision-making. Such a heuristic framework is proposed here for consideration. The schema is not intended to be prescriptive in a rigid sense, but rather should help to guide clinical practice and to invite further refinement and evaluation

Examining a Treatment Continuum for Acquired Impairments of Reading and Spelling

Damage to left hemisphere cortical regions can variously disrupt lexical-semantic and sublexical procedures for reading and spelling. Ideally, treatment for these impairments should be well-suited to the specific deficit(s) and support a progression toward maximal recovery. In this study, we implemented a diagnostic and treatment algorithm to address written language impairments in a heterogeneous group of individuals with acquired alexia and agraphia. Following syndrome classification, participants were entered into the appropriate stage of a treatment continuum that included lexical, phonological, and interactive approaches. Outcomes from 20 individuals characterize the therapeutic effects of each treatment relative to specific alexia/agraphia profiles

A Framework to Guide Treatment Planning in Aphasia

Approximately 700 empirical research studies have been conducted that examine treatment outcomes in adults with acquired language impairment. This rich body of literature provides guidance regarding the therapeutic value of interventions that target skills across communication modalities. What appears to be lacking, however, is a comprehensive, integrated framework for treatment planning that might serve as a guide for clinical decision-making. Such a heuristic framework is proposed here for consideration. The schema is not intended to be prescriptive in a rigid sense, but rather should help to guide clinical practice and to invite further refinement and evaluation

A Treatment Sequence for Phonological Alexia/Agraphia

We present two individuals with persistent impairment of phonological processing following damage to left perisylvian cortex. A two-stage treatment protocol was administered that strengthened sound-letter correspondences (phonological treatment), and trained interactive use of lexical and sublexical information to maximize spelling performance (interactive treatment). Both participants improved phonological processing abilities and reading/spelling via the sublexical route. They also improved spelling of real words, and were able to detect and correct most residual errors using an electronic spelling aid. In sum, treatment strengthened cognitive processes supporting reading and spelling, and provided a functional compensatory strategy to overcome residual weaknesses

Lexical Retrieval Treatment for Primary Progressive Aphasia

Similar to aphasia due to stroke, lexical retrieval difficulties are pervasive in primary progressive aphasia (PPA).  In fact, increasing word retrieval difficulties typically herald the onset of PPA, regardless of the underlying etiology or PPA subtype.  For that reason, behavioral interventions to improve or sustain word retrieval abilities have considerable potential to enhance language performance in PPA.  We report here on positive responses to lexical retrieval treatment in two individuals with fluent progressive aphasia profiles.  The treatment approach extends work accomplished in stroke-related aphasia that promotes strategic engagement of residual language abilities to promote self-cueing to resolve lexical retrieval difficulties

Neural Substrates of Improvement Following Treatment in a Case of Phonological Agraphia/Alexia

Damage to left perisylvian regions often results in phonological alexia/agraphia syndromes, which are characterized by disproportionate difficulty reading or spelling novel sequences of phonemes or graphemes (pseudowords) compared to real words. A relatively small literature has documented that a sequence of behavioral treatments directed toward phonological skills and phonology-orthography relations can improve reading and spelling performance on pseudowords, with additional functional benefits for written language skills overall (e.g. Beeson et al., 2010). However, the neural substrates supporting these improvements remain to be elucidated. Because phonological processing is a strongly left-lateralized skill in most literate adults, we hypothesized that neural support for improvement is likely to remain in the left hemisphere. To examine this hypothesis, we conducted pre and post treatment fMRI with an individual with acquired phonological alexia/agraphia due to left hemisphere stroke before and after administration of treatment sequence to improve phonological skills

Examining Durability and Generalization Following Lexical Retrieval Treatment in an Individual with Semantic Variant of Primary Progressive Aphasia

Introduction: The Semantic Variant of Primary Progressive Aphasia (PPAsv) is characterized by marked anomia, even in the earliest stages of the disease1. Despite the progressive nature of the disorder, there is evidence that lexical retrieval may improve following behavioral treatment2-4. Most approaches focus on stimulation treatment targeting specific lexical items (e.g., verbal repetition paired with written words), but outcomes are typically item specific with limited generalization, and maintenance has not been well characterized2-4. Treatment approaches that attempt to engage relatively spared cognitive processes (phonology, orthography, episodic memory) in addition to maximizing residual semantic abilities may contribute to better generalization and durability2-5. Henry and colleagues (2013)5 described one such approach, which contributed to positive treatment outcomes and generalization in an individual with PPAsv. Additional treatment was conducted with this individual two years after the first course of therapy. Here we report response to treatment at each time point, and describe performance following various intervals without treatment. Method: SV was a 60-year-old man who described increased word finding difficulties over a 1.5-year period. Comprehensive assessment revealed relatively isolated language impairment characterized by severely impaired lexical retrieval. Performance on semantic tasks was significantly below the normal range. An MRI revealed notable atrophy of the left anterior temporal lobe, consistent with PPAsv. SV participated in a two-phase lexical retrieval treatment: The Arizona Lexical Retrieval Cascade and Generative Naming Treatment5. Treatment included self-cueing for naming by engaging residual cognitive processes and further training these strategies in the context of generative naming for semantic categories (e.g., tools, animals). Direct treatment effects and generalization to untrained tasks were documented immediately following each phase, at one and four months following the initial treatment, and again two years later. At that time, SV received a second “dose” of the two-phase lexical retrieval treatment. Outcomes were documented immediately following this second round of treatment and 6-months later. Results: As depicted in Figure 1a & b, SV demonstrated notable gains following the first course of treatment, and maintained performance on treatment tasks for four months. Two years later, performance on trained tasks declined, but did not fall below baseline. SV’s response to the second course of treatment was equally robust, but performance declined slightly after six months. After each round of treatment, SV showed generalized improvement on untrained lexical retrieval tasks, and maintenance up to at least four months. Measures of non-verbal problem solving and general cognition remained relatively unchanged over time (Figure 1c). Conclusions: These findings suggest that ongoing rehabilitation for PPAsv can be beneficial, even as the disease progresses. The optimal length of time between treatment periods is not clear, but SV’s performance indicates that an interval between 6-months and two years should be considered. This case adds to the growing literature suggesting that lexical retrieval treatment capitalizing on strategic use of residual cognitive processes may contribute to generalization, and items trained using this approach may be relatively durable in the face of progressive language decline