Christine Taylor

Treatment of word retrieval impairments in aphasia: Evaluation of a self-administered home programme using personally chosen words

Background: While previous research has shown that a number of tasks can be successful in improving word retrieval following aphasia, the majority of studies result in improvement restricted to treated items. This has two major implications: first it is essential that personally relevant items of communicative value are treated. Second, treatment is likely to be required long term. Therapy provided as a self-administered home programme has the potential to improve the long-term accessibility of therapy and to be more cost effective. This research was part of a larger investigation into treatment for lexical retrieval difficulties in adults with aphasia. Our earlier research found that treatment using repetition in the presence of a picture conducted by a clinician was effective in improving the later retrieval of treated words. In this study we modified the treatment programme such that it could be carried out independently by the participants as a home programme using personally chosen words. Aims: The aims of our study were first, to determine if a home treatment programme for word retrieval with personally chosen words could result in significant improvements in lexical retrieval, and second, to observe if there would be carry over to improved word retrieval in conversation. Methods & Procedures: Three people with aphasia participated, and selected 60 personally relevant words for treatment. These stimuli were treated in two sets, each for eight sessions over 2 weeks. Outcomes of treatment were evaluated by comparing naming of these items on three pre-treatment baselines, with naming following the completion of the programme. Semi-structured conversations based around topics relating to the target words were sampled prior to treatment and following treatment to observe generalisation to conversation. Outcomes & Results: Two participants showed evidence of increased accuracy for naming of treated items following the home programme with no change in naming of unseen controls. The conversation outcomes were less clear, with only one participant showing any evidence of greater production of treated items in conversation. Conclusions: This study found that the home treatment programme using personally chosen words improved word retrieval for some participants. However, the outcomes were less robust than those of a clinician-directed therapy study previously conducted by the researchers. There were limitations in the sensitivity of the measures of transfer to conversation and further investigation is required into the extent to which benefits in single word retrieval carry over into word retrieval in conversation.

Applying empirical methods in clinical practice: Introducing the model for assessing treatment effect

Background:One challenge in rehabilitation is determining whether improvement in the patient is a treatment-specific effect or due to extraneous factors (eg, the passage of time, spontaneous recovery). Design:Descriptive, model building, and 2 cases illustrating the model. Method:The Model for Assessing Treatment Effect (MATE) incorporates the conceptual frameworks of the International Classification of Functioning, Disability, and Health (ICF), along with single-case experimental methodology. Results:The MATE contains 7 levels organized in a hierarchy, representing (i) increasing specificity of evaluation procedures and (ii) control of extraneous variables during therapy. Two illustrative cases of patients with traumatic brain injury undergoing inpatient rehabilitation for, inter alia, cognitive-communication impairments are described to illustrate common clinical practice (level 2 of MATE) and a superior method using a multiple-baseline design across behaviors, enabling rigorous evaluation of treatment effect (level 6 of MATE). Conclusions:The MATE offers a systematic, evidence-based approach for implementing ICF-informed goals into clinical practice. It also provides a benchmark against which a clinical service can be evaluated in terms of the rigor of its therapy program.