Donald B. Freed

Long-term effectiveness of PROMPT treatment in a severely apractic-aphasic speaker

This study examined the acquisition and long-term maintenance of a functional core vocabulary by a severely apractic-aphasic speaker following the application of Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) treatment. The subject was a 24-year-old male who had suffered a single left- hemisphere thrombotic CVA approximately 2 years prior to the beginning of this investigation. Treatment and maintenance were monitored over a 41-week period. The results showed that the 30 target words and phrases were produced accurately during the treatment phases of the study and after treatment was discontinued.

The Effect of Personalized Cueing on Long-Term Naming of Realistic Visual Stimuli

Associative learning techniques have been used successfully to teach word pair lists to subjects with brain damage. However, these techniques have not been used systematically to improve naming of complex visual stimuli such as might be found in aphasia therapy. This study examined the effect of an associative learning procedure, personalized cueing, on long-term naming of 40 realistic stimuli by 10 subjects with aphasia and 10 subjects without brain damage. The results showed that subjects without brain damage had significantly higher levels of naming accuracy than subjects with aphasia; however, subjects with aphasia were able to recall approximately 50% of the trained stimuli on both the 1-week and 30-day post-training probes. These results show that subjects with aphasia are able to use personalized cueing to learn effectively the names of items pictured in realistic visual stimuli and that the effects of training can be durable over time.

Comparison of Semantically and Phonemically Based Training Procedures in An Overlearned Naming Task

This article presents a pilot study in which the effects of overlearning on two learning tasks were compared. One task used semantically based training cues (deep processing) in the training; the other used phonemically based cues (shallow processing). 30 subjects were trained on the names of complex visual stimuli, using one of the two training procedures until 200% overlearning was accomplished. Naming probes were conducted 1 wk., 1 mo., and 6 mo. after training was completed. Analysis indicated no significant difference between the two conditions. Several factors may have contributed to this finding, including the possibility that overlearning masked potential differences between the two training procedures.

Effects of personalised cue form on the learning of subordinate category names by aphasic and non-brain-damaged subjects

Background. Personalised cueing is a training method designed to facilitate naming of unknown, realistic visual stimuli (dog breed names). Creation of a personalised cue is similar to the use of mnemonic devices by normal individuals to remember important bits of information. Theoretical support for the method comes from Craik and Lockharts depth-of-processing model of memory (1972). Several studies have shown that training with personalised cueing methods results in significantly higher levels of long-term naming accuracy than when subjects are trained with phonological cueing techniques. However, it has also been observed that all individuals are not equally proficient in creating personalised cues and that the nature of the information in personalised cues varies markedly from individual to individual. Aims. The objective of this study was to determine if the type of information contained in a personalised cue (cue form) affects the degree to which these cues facilitate learning of subordinate category names (dogs). Methods & Procedures. 600 personalised cues developed by 15 non-brain-damaged (NBD) and 15 aphasic individuals to learn the names of unknown dog breeds (e.g., Maltese) were examined. The cues were classified as one of five cue forms by three judges on two separate occasions approximately 1 month apart. Examination of intra-judge agreements for the cue forms yielded a total of 251 cues for analysis of cue form effects (127 aphasic; 124 non-brain-damaged). Outcomes and Results. To examine the effects of cue form on facilitation of naming, weighted recall scores were calculated for each cue based on accurate naming on probes one week, one month, and 6 months after training. Kruskal-Wallis analysis of variance by ranks (KWANOVA) was used to determine the effects of cue form on learning of the subordinate category names. Significant cue forms effects were found for aphasic but not non-brain-damaged participant cues. Mann-Whitney post-hoc comparisons of aphasic cues revealed that cues containing semantic information had significantly higher mean rankings than those containing phonological information and those containing a combination of phonological and semantic information. Conclusions. Two implications arise from the study with respect to the use of personalised cueing as a clinical procedure. One is that it may be necessary to exert some limited control over the creative process of developing a personalised cue to ensure the inclusion of semantic information in the cue itself. A second is that individuals who have problems accessing semantic information may require some training before attempting to create personalised cues. In such instances, it would be important to obtain information about the source of the individuals anomic deficits through careful testing before embarking on a training programme featuring personalised cueing.

Communicative efficiency in severe aphasia

The communicative efficiency of three severely aphasic clients was assessed with a 10-item message exchange task. The three clients demonstrated distinctively different communication profiles. Client M.D. communicated verbally; B.D. relied on drawing and writing; J.S. employed elaborate gestures. Three groups of eight raters assessed the communicative efficiency (CE) and degree of communicative burden (CB) assumed by the partner for each message exchange using a visual analogue scale. One group was aware of the content of the message exchanges (Full Content); a second received partial information about message contents in the form of a cue (Partial Content); a third received no information (No Content). Mean ratings of CE and CB differed significantly for the three clients. Many of these differences can be explained in relation to the clients severity of aphasia and abilities to effectively employ output modalities available to them to convey messages. CE ratings were higher and CB ratings were lower in the No Content viewing condition than the Partial and Full Content conditions. Several possible explanations are offered for this surprising result.

Generalisation of personalised cueing to enhance word finding in natural settings

Background: Personalised cueing is a treatment method for naming deficits in patients with aphasia. As part of the treatment patients choose their own cues to help recall a target word. These cues usually include personally relevant semantic information, which is hypothesised to enhance long-term naming abilities. Previous research has shown that personalised cueing can improve long-term naming accuracy in persons with aphasia. However, no research has shown that personalised cueing carries over to improved naming in natural settings. Aims: The study aimed to examine the long-term generalisation of improved word finding using the personalised cueing method. Methods & Procedures: Three individuals participated in 12 training trials using the personalised cueing method; 40 unnamed stimulus items were chosen for each participant. Pre-training measures of the Sentence Production Task (SPT) and Message Exchange Task (MET) were administered for each participant. Of the 40 stimulus items, 20 were then trained using the personalised cueing method across 12 training sessions. Post-training measures of the SPT and MET were then collected, along with measures on a Caregiver Partner Rating scale to assess naming accuracy in natural settings. The 20 untrained stimulus items were also probed to assess generalisation to untrained stimuli. Outcomes & Results: Two of the three participants showed improvement in naming trained items in natural settings, but little improvement was noted on the untrained stimulus items. Results for these patients were consistent with other studies on the personalised cueing method. The third participant demonstrated a slight increase in naming accuracy over time. Shortly after this study that participant was diagnosed with Alzheimers disease. Conclusions: Results suggest that personalised cueing is an effective method of improving naming in certain individuals with aphasia. It also suggests that the effects of personalised cueing are maintained over time and are evident in natural settings.

Lexical Retrieval Behaviors of Subjects With Aphasia and Subjects Without Brain Damage on a Rebus Riddle Task

This study compared the lexical retrieval behaviors of subjects with aphasia (APH) and subjects with no brain damage (NBD) on a Rebus Riddle task. Most differences between the groups were quantitat...

Reading comprehension treatment in aphasia: a systematic review

ABSTRACT Background: Reading difficulties often present as a consequence of aphasia. The specific nature of reading deficits varies widely in manifestation, and the cause of these deficits may be the result of a phonological, lexical semantic, or cognitive impairment. Several treatments have been developed to address a range of impairments underlying reading difficulty. Aims: The purpose of this review is to describe the current research on reading comprehension treatments for persons with aphasia, assess the quality of the research, and summarize treatment outcomes. Methods & Procedures: A systematic review of the literature was conducted based on a set of a priori questions, inclusion/exclusion criteria, and pre-determined search parameters. Results were summarized according to treatment type, methodologic rigor, and outcomes. Outcomes & Results: Fifteen studies meeting criteria were identified. A variety of reading comprehension treatments was implemented including: oral reading, strategy-based, cognitive treatment, and hierarchical reading treatments. Quality ratings were highly variable, ranging from 3 to 9 (on a 12-point scale). Overall, 14 of the 18 individuals for whom individual data were provided demonstrated some degree of improvement (oral reading 4/5 participants, strategy based 4/6, and cognitive treatment 6/7). Gains were also evident for hierarchical reading treatment administered to participant groups via computer; however, the degree to which improvement reached statistical significance varied among studies. Conclusions: Reading comprehension treatments have the potential to improve reading comprehension ability in persons with aphasia; however, outcomes were variable within and among treatment methods. We suggest focusing future research on factors such as participant candidacy and treatment intensity using increased methodological rigor.

A short history of the Veterans Administration's influence on aphasia assessment tools

Background: The United States Veterans Administration (VA) has a long history of supporting medical developments, including those in the rehabilitation sciences. Its large patient population, numerous facilities, and funding of research, education, and training have resulted in many medical advances. Its positive influences also have extended to the profession of speech‐language pathology, particularly regarding the assessment and treatment of aphasia. Aims: This paper is a short review of how the VA has contributed significantly to the development of aphasia assessment tools. Beginning with the Minnesota Test for Differential Diagnosis of Aphasia in 1948, the VA has played an essential role in the creation of a number of well‐known, widely used aphasia tests. Methods & Procedures: Ten major aphasia assessment tools that had significant VA involvement are examined. The features of each test are described, as well as how the VA contributed to the tests development. Conclusions: VAs substantial support was an essential part in the development of these important aphasia assessment tools.