Improved vocabulary production after naming therapy in aphasia: can gains in picture naming generalise to connected speech?

Background: Naming accuracy for nouns and verbs in aphasia can vary across different elicitation contexts, for example, simple picture naming, composite picture description, narratives, and conversation. For some people with aphasia, naming may be more accurate to simple pictures as opposed to naming in spontaneous, connected speech; for others, the opposite pattern may be evident. These differences have, in some instances, been related to word class (for example, noun or verb) as well as aphasia subtype. Given that the aim of picture-naming therapies is to improve word-finding in general, these differences in naming accuracy across contexts may have important implications for the potential functional benefits of picture-naming therapies.

Aims: This study aimed to explore single-word therapy for both nouns and verbs, and to answer the following questions. (1) To what extent does an increase in naming accuracy after picture-naming therapy (for both nouns and verbs) predict accurate naming of the same items in less constrained spontaneous connected speech tasks such as composite picture description and retelling of a narrative? (2) Does the word class targeted in therapy (verb or noun) dictate whether there is ‘carry-over’ of the therapy item to connected speech tasks? (3) Does the speed at which the picture is named after therapy predict whether it will also be used appropriately in connected speech tasks?

Methods & Procedures: Seven participants with aphasia of varying degrees of severity and subtype took part in ten therapy sessions over five weeks. A set of potentially useful items was collected from control participant accounts of the Cookie Theft Picture Description and the Cinderella Story from the Quantitative Production Analysis. Twenty-four of these words (twelve verbs and twelve nouns) were collated for each participant, on the basis that they had failed to name them in either simple picture naming or connected speech tasks (picture-supported narrative and unsupported retelling of a narrative). These were placed in a larger cohort of verb and noun sets for therapy. Post-therapy assessments examined naming accuracy and speed of target items in single-word picture-naming and naming accuracy in connected speech contexts.

Outcomes & Results: There was a step-wise decrement in naming accuracy over the three naming contexts following targeted therapy. Simple pictures elicited the most correct names, followed by picture-supported narratives and lastly unsupported narratives. Picture-naming accuracy significantly predicted naming in the connected speech contexts for the group as a whole. The speed of picture naming after therapy did not predict the extent to which items were named in composite picture description and narrative tasks.

Conclusions & Implications: The findings suggest that gains in naming accuracy obtained through picture-naming therapy may generalize to naming of the same items in more linguistically and cognitively demanding connected speech tasks. Demonstrating this generalization is methodologically challenging and the method utilized in this study may serve as one starting point for gathering a larger database in order to answer the question posed by this paper more robustly.

from the International Journal of Language and Communication Disorders

Improved vocabulary production after naming therapy in aphasia: can gains in picture naming generalise to connected speech?

Background: Naming accuracy for nouns and verbs in aphasia can vary across different elicitation contexts, for example, simple picture naming, composite picture description, narratives, and conversation. For some people with aphasia, naming may be more accurate to simple pictures as opposed to naming in spontaneous, connected speech; for others, the opposite pattern may be evident. These differences have, in some instances, been related to word class (for example, noun or verb) as well as aphasia subtype. Given that the aim of picture-naming therapies is to improve word-finding in general, these differences in naming accuracy across contexts may have important implications for the potential functional benefits of picture-naming therapies.

Aims: This study aimed to explore single-word therapy for both nouns and verbs, and to answer the following questions. (1) To what extent does an increase in naming accuracy after picture-naming therapy (for both nouns and verbs) predict accurate naming of the same items in less constrained spontaneous connected speech tasks such as composite picture description and retelling of a narrative? (2) Does the word class targeted in therapy (verb or noun) dictate whether there is ‘carry-over’ of the therapy item to connected speech tasks? (3) Does the speed at which the picture is named after therapy predict whether it will also be used appropriately in connected speech tasks?

Methods & Procedures: Seven participants with aphasia of varying degrees of severity and subtype took part in ten therapy sessions over five weeks. A set of potentially useful items was collected from control participant accounts of the Cookie Theft Picture Description and the Cinderella Story from the Quantitative Production Analysis. Twenty-four of these words (twelve verbs and twelve nouns) were collated for each participant, on the basis that they had failed to name them in either simple picture naming or connected speech tasks (picture-supported narrative and unsupported retelling of a narrative). These were placed in a larger cohort of verb and noun sets for therapy. Post-therapy assessments examined naming accuracy and speed of target items in single-word picture-naming and naming accuracy in connected speech contexts.

Outcomes & Results: There was a step-wise decrement in naming accuracy over the three naming contexts following targeted therapy. Simple pictures elicited the most correct names, followed by picture-supported narratives and lastly unsupported narratives. Picture-naming accuracy significantly predicted naming in the connected speech contexts for the group as a whole. The speed of picture naming after therapy did not predict the extent to which items were named in composite picture description and narrative tasks.

Conclusions & Implications: The findings suggest that gains in naming accuracy obtained through picture-naming therapy may generalize to naming of the same items in more linguistically and cognitively demanding connected speech tasks. Demonstrating this generalization is methodologically challenging and the method utilized in this study may serve as one starting point for gathering a larger database in order to answer the question posed by this paper more robustly.

from the International Journal of Language and Communication Disorders

Errorless and errorful therapy for verb and noun naming in aphasia

Background: The aphasiological literature has provided an extensive body of research on verb impairments but many fewer verb therapy studies. Verbs display particular complexity at various levels of linguistic analysis: phonological, morphological, semantic, and syntactic. Verb impairments can arise at any of these processing levels as well as from cognitive sources. Verb-naming therapies may therefore be relatively more vulnerable to errors, which could reduce their effectiveness. Errorless learning has been used with positive results for noun therapies.

Aims: Given the high linguistic and cognitive demands of verb processing, this study investigated whether errorless therapy would be more effective for verb naming than more traditional hierarchical cueing (relatively errorful) therapy.

Methods & Procedures: Nine participants with word-finding difficulties as a part of their chronic aphasia took part in the study.

Outcomes & Results: For the dependent variable of naming accuracy, as in previous studies, we found that errorless therapy was as effective as errorful therapy for both verb and noun naming. Three participants with most severe aphasia showed significantly greater gains in noun as opposed to verb naming. The remaining participants exhibited comparable gains in both nouns and verb naming. There was no lasting generalisation from treated to untreated therapy items. The prediction that errorless therapy would be more effective for verb naming was not upheld; errorless and errorful approaches were as effective as one another.

Conclusions: An errorless-learning approach to verb and noun naming was a time-efficient therapy, and one that was as effective as an errorful/hierarchical cueing method in improving naming accuracy, for a range of participants with varying naming skills and types of aphasia.

from Aphasiology

Regional changes in word-production laterality after a naming treatment designed to produce a rightward shift in frontal activity

Five nonfluent aphasia patients participated in a picture-naming treatment that used an intention manipulation (opening a box and pressing a button on a device in the box with the left hand) to initiate naming trials and was designed to re-lateralize word production mechanisms from the left to the right frontal lobe. To test the underlying assumption regarding re-lateralization, patients participated in fMRI of category-member generation before and after treatment. Generally, the four patients who improved during treatment showed reduced frontal activity from pre- to post-treatment fMRI with increasing concentration of activity in the right posterior frontal lobe (motor/premotor cortex, pars opercularis), demonstrating a significant shift in lateraliity toward the right lateral frontal lobe, as predicted. Three of these four patients showed no left frontal activity by completion of treatment, indicating that right posterior lateral frontal activity supported category-member generation. Patients who improved in treatment showed no difference in lateralization of lateral frontal activity from normal controls pre-treatment, but post-treatment, their lateral frontal activity during category-member generation was significantly more right lateralized than that of controls. Patterns of activity pre- and post-treatment suggested increasing efficiency of cortical processing as a result of treatment in the four patients who improved. The one patient who did not improve during treatment showed a leftward shift in lateral frontal lateralization that was significantly different from the four patients who did improve. Neither medial frontal nor posterior perisylvian re-lateralization from immediately pre- to immediately post-treatment images was a necessary condition for significant treatment gains or shift in lateral frontal lateralization. Of the three patients who improved and in whom posterior perisylvian activity could be measured at post-treatment fMRI, all maintained equal or greater amounts of left-hemisphere perisylvian activity as compared to right. This finding is consistent with reviews suggesting both hemispheres are involved in recovery of language in aphasia patients.

from the Journal of Voice

“Pre-semantic” cognition revisited: Critical differences between semantic aphasia and semantic dementia

Patients with semantic dementia show a specific pattern of impairment on both verbal and non-verbal “pre-semantic” tasks: e.g., reading aloud, past tense generation, spelling to dictation, lexical decision, object decision, colour decision and delayed picture copying. All seven tasks are characterised by poorer performance for items that are atypical of the domain and “regularisation errors” (irregular/atypical items are produced as if they were domain-typical). The emergence of this pattern across diverse tasks in the same patients indicates that semantic memory plays a key role in all of these types of “pre-semantic” processing. However, this claim remains controversial because semantically-impaired patients sometimes fail to show an influence of regularity. This study demonstrates that (a) the location of brain damage and (b) the underlying nature of the semantic deficit affect the likelihood of observing the expected relationship between poor comprehension and regularity effects. We compared the effect of multimodal semantic impairment in the context of semantic dementia and stroke aphasia on the seven “pre-semantic” tasks listed above. In all of these tasks, the semantic aphasia patients were less sensitive to typicality than the semantic dementia patients, even though the two groups obtained comparable scores on semantic tests. The semantic aphasia group also made fewer regularisation errors and many more unrelated and perseverative responses. We propose that these group differences reflect the different locus for the semantic impairment in the two conditions: patients with semantic dementia have degraded semantic representations, whereas semantic aphasia patients show deregulated semantic cognition with concomitant executive deficits. These findings suggest a reinterpretation of single case studies of comprehension-impaired aphasic patients who fail to show the expected effect of regularity on “pre-semantic” tasks. Consequently, such cases do not demonstrate the independence of these tasks from semantic memory.

from Neuropsychologia

Progranulin-associated primary progressive aphasia: a distinct phenotype?

The neuropsychological features of the primary progressive aphasia (PPA) syndromes continue to be defined. Here we describe a detailed neuropsychological case study of a patient with a mutation in the progranulin (GRN) gene who presented with progressive word-finding difficulty. Key neuropsychological features in this case included gravely impoverished propositional speech with anomia and prolonged word-finding pauses, impaired speech repetition most marked for sentences, and severely impaired verbal (with preserved spatial) short-term memory. There was a dissociated profile of performance on semantic processing tasks: visual semantic processing was intact, while within the verbal domain, verb comprehension was impaired and processing of nouns was intact on tasks requiring direct semantic processing but impaired on tasks requiring associative or inferential processing. Brain MRI showed asymmetric left cerebral atrophy particularly affecting the temporo-parietal junction, supero-lateral temporal and inferior frontal lobes. This case most closely resembles the PPA syndrome known as the logopenic/phonological aphasia variant (LPA) however there were also deficits of grammar and speech repetition suggesting an overlap with the progressive nonfluent aphasia (agrammatic) variant (PNFA). Certain prominent features of this case (in particular, the profile of semantic impairment) have not been emphasised in previous descriptions of LPA or PNFA, suggesting that GRN may cause an overlapping PPA syndrome but with a distinctive cognitive profile. This neuropsychological evidence suggests that GRN-PPA may result from damage involving the temporo-parietal junction and its functional connections in both the dorsal and ventral language networks, with implications for our understanding of language network pathophysiology.

from Neuropsychologia

Evaluation of Social Work Communication Skills to Allow People with Aphasia to be Part of the Decision Making Process in Healthcare.

The purpose of this paper is to examine how social workers are trained to interact with individuals with communication barriers in healthcare. Consent to treatment and the right to decide upon a discharge destination are enshrined in law. However, barriers such as aphasia (a communication disorder commonly resulting from a stroke) can mask competency and exclude people from the decision making process. Social workers play a vital role in the healthcare system, providing advocacy, case management, counselling, addressing capacity and assessing the patient as a whole person. But they need to be taught specialized communication skills to carry out this complex role with individuals with aphasia. A literature search and survey of universities revealed that the majority of training in supported communication is taking place in the field and driven by aphasia centres. But does the training meet the needs of social workers and their patients with aphasia, especially when someone needs a healing conversation? Results from two pilot projects show that teaching a set of skills is not sufficient; adaptation of present communication techniques is also needed to ensure that the human worth and dignity of those with communication barriers is maintained and human rights in healthcare are being met.

from Social Work Education

The contribution of the Department of Veterans Affairs to neuroimaging of aphasia: One perspective *

Abstract
Background: The Department of Veterans Affairs (VA) has made important contributions to the neuroimaging of aphasia. Through the affiliations of VA researchers with medical faculties, a broad range of questions has been addressed regarding the structural, metabolic, and functional changes that occur in the brain of individuals who develop aphasia.

Aims: This report examines some of the work that has been accomplished by VA researchers using CT, MRI, SPECT, and PET imaging approaches.

Main Contribution and Conclusions: The reviewed VA research demonstrates that aphasia results from the dynamic relationships that exist between the impact of structural brain damage on brain function in both damaged and non-damaged regions of the brain. The resulting concepts have led to innovative strategies for the neurorehabilitation of aphasia.
* This research review was supported (in part) by the Intramural Research Program of the NIH, National Institute on Aging.

from Aphasiology

Implementation of computer-based language therapy in aphasia

A first step in evaluating the use of computers in language therapy for individuals with aphasia is to establish the treatment as active in small groups prior to large-scale clinical trials. The present study evaluated a comprehensive computer-based language therapy program in a group of eight individuals with chronic in aphasia varying broadly in age, time post onset and aphasia type. Results revealed an overall therapeutic benefit in auditory comprehension, as well as positive trends in functional communication. Findings suggest that comprehensive therapy programs may be beneficial for many individuals with aphasia, and computer-based therapy may be one feasible avenue of providing this intervention.

from Therapeutic Advances in Neurological Disorders

Cross-Language Generalization following Treatment in Bilingual Speakers with Aphasia: A Review

The focus of this article is on the potential transfer or generalization of positive effects from a treated to an untreated language in bilingual or multilingual individuals with primary acquired aphasia. Twelve studies are reviewed: All were previously published in English in peer-reviewed journals. Half of these studies failed to account for spontaneous recovery. Results from the remaining case reports and single-subject studies are mixed, with four finding evidence for cross-language generalization under some conditions and two finding that improved language performance was restricted to the treated language. Collective findings are discussed within the broader literature in terms of factors to consider when planning for effective, efficient intervention with bilinguals with aphasia.

from Seminars in Speech and Language

Issues and Principles in Service Delivery to Communicatively Impaired Minority Bilingual Adults in Neurorehabilitation

Demographic and epidemiological trends coupled with health-care needs in minority populations highlight the imperative need to develop effective, culturally appropriate clinical approaches for minority adults with communication impairments. The steady increase in linguistic and cultural diversity in the country includes a large number of bilingual adults, which is estimated to continue. Because strokes are quite prevalent in racial/ethnic minorities, the number of bilingual adults with acquired communication disorders will similarly increase. However, members of minority groups presently confront disparities in health-care services compared with the general population that translates into reduced health outcomes. This article discusses the current clinical needs and complexities in service delivery to communicatively impaired minority adults, with a special focus on bilingual adults with aphasia.

from Seminars in Speech and Language

Nonverbal auditory agnosia with lesion to Wernicke’s area

We report the case of patient M, who suffered unilateral left posterior temporal and parietal damage, brain regions typically associated with language processing. Language function largely recovered since the infarct, with no measurable speech comprehension impairments. However, the patient exhibited a severe impairment in nonverbal auditory comprehension. We carried out extensive audiological and behavioral testing in order to characterize M’s unusual neuropsychological profile. We also examined the patient’s and controls’ neural responses to verbal and nonverbal auditory stimuli using functional magnetic resonance imaging (fMRI). We verified that the patient exhibited persistent and severe auditory agnosia for nonverbal sounds in the absence of verbal comprehension deficits or peripheral hearing problems. Acoustical analyses suggested that his residual processing of a minority of environmental sounds might rely on his speech processing abilities. In the patient’s brain, contralateral (right) temporal cortex as well as perilesional (left) anterior temporal cortex were strongly responsive to verbal, but not to nonverbal sounds, a pattern that stands in marked contrast to the controls’ data. This substantial reorganization of auditory processing likely supported the recovery of M’s speech processing.

from Neuropsychologia

Aphasia and text writing

Conclusions & Implications: Aphasia appeared to influence text writing on different linguistic levels. The impact on overall structure and coherence was in line with earlier findings from the analysis of spoken and written discourse and the implication of this is that the written modality should also be included in language rehabilitation.

from the International Journal of Language and Communication Disorders

Apraxic agraphia: An insight into the writing disturbances of posterior aphasias Gopee Krishnan1, Soorya Narayana Rao2, Bellur Rajashekar1 1 Department of Speech and Hearing, Kasturba Hospital, Manipal University, India 2 Department of Neurology, Kasturba Hospital, Manipal University, India

Background: Reading and writing disturbances are common accompaniments of aphasia following brain damage. However, impaired writing in the absence of apparent primary linguistic disturbances is infrequently reported in the literature. Materials and Methods: A 67-year-old right-handed subject underwent neurological, neuroradiological, and linguistic investigations following development of a minimal right upper limb weakness. Result: The patient had polycythemia and the neurological investigation revealed right upper limb paresis. The neuroradiological investigation revealed hypodense areas involving the gray-white matter of the left postero-parietal and frontal lobe, left caudate and lentiform nuclei, and the anterior limb of the internal capsule, suggesting an infarct. The linguistic investigation revealed a mild anomic aphasia with apraxic agraphia. This mild anomic aphasia resulted primarily from the relatively poor scores on the verbal fluency tests. Discussion: The marked writing impairment, even with the left hand, points to disturbances in written output – apraxic agraphia – in the presence of near-normal spoken output. This finding should raise suspicion about hidden apraxic agraphia in subjects with posterior aphasias.

from the Annals of Indian Academy of Neurology

Aphasia among Young Patients with Ischemic Stroke on Long-term Follow-up

Results
The study comprised 195 patients still alive after a mean follow-up of 6 years. Twenty (10.3%) patients had aphasia. Aphasia was associated with cardiac embolism (P = .007), myocardial infarction (P = .005), epilepsy (P < .001), loss of employment (P = .021), and social isolation (P = .054). On follow-up, 13 patients with aphasia underwent further assessment. These patients had all improved into milder aphasia subtypes.

Conclusion
Our study suggests that relatively few young patients with ischemic stroke have clinically significant aphasia on long-term follow-up. However, there are clinically significant differences between patients with and without aphasia that should be the focus of future research.

from