Felicity Osborne

Phonological therapy for word-finding difficulties: A re-evaluation

Background: Treatments for word-finding difficulties in aphasia using semantic techniques have been shown to be effective (e.g., Marshall, Pound, White-Thomson, & Pring, 1990). The evidence with regard to phonological treatment is more equivocal, however, with some studies reporting only short-term improvement in word retrieval (e.g., Howard, Patterson, Franklin, Orchard-Lisle, & Morton, 1985a) and other studies reporting lasting effects (e.g., Miceli, Amitrano, Capasso, & Caramazza, 1996). There is also little in the literature on the use of orthographic cues in treatment (Howard & Harding, 1998). Additionally, whereas several studies have reported the results of using cues in facilitation of word-finding difficulties (e.g., Patterson, Purrell, & Morton, 1983), none so far has attempted to relate response to facilitation and response to treatment using similar techniques in the same individuals. Aims: This study set out to investigate whether the use of phonological and orthographic cues in the treatment of word-finding difficulties could produce lasting improvements in word retrieval. The response of the participants to phonological and orthographic cues in a facilitation study was also related to their response to treatment using similar cues. Methods & Procedures: The study used a case series design. The participants were eight people with acquired aphasia who were all at least 1 year post-onset, had a single left CVA, and had word-finding difficulties as a significant aspect of their aphasia. Detailed assessment of each participant was carried out to identify the nature of their word-finding difficulties and this was related to response to treatment. Outcomes & Results: Results are given for the eight participants, seven of whom benefited overall from treatment. Both phonological and orthographic cues were effective in improving word retrieval. For the group as a whole there was a significant correlation between the overall outcome of facilitation and response to treatment.

Do picture‐naming tests provide a valid assessment of lexical retrieval in conversation in aphasia?

Background: Word‐finding problems commonly occur in aphasia and can significantly affect communication. Assessment of this deficit typically involves naming pictures. However, this method has been criticised as lacking ecological validity. Alternative methods include the measurement of lexical retrieval in narration or conversation, although few published studies have quantified word finding in the latter. Aims: We aimed to identify a reliable and valid assessment of lexical retrieval in conversation, and to elucidate the nature of the relationship between lexical retrieval in picture naming and in conversation. Methods and Procedures: We developed a quantitative measure of word finding in conversation in aphasia and established the reliability and stability of the method. We compared the scores of a group of people with aphasia on this measure with their scores on a picture‐naming test. Outcomes and Results: We found significant relationships between picture‐naming scores and a number of key variables analysed in the conversation measure. We propose that scores on picture naming relate to the ability to retrieve nouns in everyday conversation for the people with aphasia who took part in this study. Conclusions: The use of picture‐naming tasks is justified, providing a valid and rich means of assessment of lexical retrieval. Further research is required to replicate these results with more people with aphasia. We offer the quantitative assessment of conversation developed here for use in research and clinical spheres.

Phonological and orthographic facilitation of word-retrieval in aphasia: Immediate and delayed effects

In the literature on repetition priming of word-production in normal participants, long-lasting effects can be found from a single prime. This contrasts with the findings with adults with anomia (as part of their aphasia) where phonological cues, such as first sound or rhyme, have been shown to have very short-lasting effects on word retrieval (Patterson, Purell, & Morton, 1983). In addition, the research into treatment of anomia suggests that semantic techniques produce longer-lasting effects than phonological techniques (Howard et al., 1985b). One difference between phonological and semantic techniques is in the element of choice available. Typically phonological cues are simply provided. This contrasts with semantic techniques where a choice is available, for example selecting from a set of pictures to match a word. This study, using a case series design, set out to replicate the finding, that phonological techniques have only short-lasting effects on word retrieval in aphasia and to investigate the influence of providing a choice of cues. Items that participants with aphasia were unable to name after 5 seconds were allocated to one of three conditions: extra time (control condition), single cue, and choice of two cues. Naming was assessed immediately and at a delay (over 10 minutes later). Four different cue types were used: whole word, spoken CV, written CV, and rime. The results were surprising. The cues influenced immediate naming, as predicted. However, this effect was still significant a delayed naming. Additionally, the benefits from a choice of cues were generally similar to those from a single cue. Different patterns of cue effectiveness were found for different participants. Further investigations shed some light on the mechanisms of cueing, orthographic cueing in particular.

Combining lexical and interactional approaches to therapy for word finding deficits in aphasia

Background: There are two distinct theoretical positions underlying approaches to aphasia therapy. The first addresses the language impairment directly through tasks designed to improve performance in that language function. This form of therapy was employed in a related study involving the participants reported here (Hickin et al., 2002a). The second seeks to bypass the language impairment by, for example promoting alternative forms of communication, and stressing the importance of successful rather than normal communication. There are few studies that combine the structured principled methods of the first with the ecologically valid basis of the second approach. Aims: Our aim was to investigate the effectiveness of combining a lexical therapy, targeting a discrete set of items and using cues to prompt name retrieval, with communicative use of those items, in tasks ranging from naming to definition through to structured conversation. We investigated the effects of the therapy in terms of gains in picture naming, and performance in a task simulating communication situations (production of nouns in everyday communication). Methods & Procedures: The study is a case series design involving six people with aphasia. All were adult English speakers aged 39 and upwards who were aphasic following a single left hemisphere stroke. Picture naming and production of nouns in everyday communication was assessed prior to and after therapy. Outcomes & Results: The combined therapy described here was effective for five of the six participants in terms of gains in picture naming, and an increase in communicatively effective responses in the noun production task. One person, for whom the lexical therapy described in Hickin et al. (2002a) was not effective, did however respond to the therapy reported here. For one of the six participants, the therapy was not effective. Conclusions: Therapy that targets a specific set of words, and encourages their use in tasks approaching everyday communication, can be effective in improving word finding in picture naming and in a functional speech task. As therapy effects are restricted to items undergoing therapy on the whole it is essential that words are selected for therapy on the basis of their functional use to the participant. This therapy was effective for most of the six participants and we are unable at this stage to identify exclusion criteria for undergoing this therapy.

Treatment of word retrieval in aphasia: generalisation to conversational speech.

The question of whether treatment gains in picture naming generalise to conversation remains relatively unexplored. Several difficulties surround data collection and analysis. A quantitative measure of word retrieval in aphasia is presented along with relevant details relating to the reliability of the measure, and the relationship between word retrieval in picture naming and noun retrieval in conversation. We discuss the clinical application of the measure and its applicability outside the field of aphasia.

TREATING WORD-FINDING DIFFICULTIES - BEYOND PICTURE NAMING

This paper presents some preliminary findings from research into the phonological treatment of word-finding difficulties in aphasia focusing on two areas of investigation. Firstly we report on the effects of giving a choice of phonological cues on word-finding. Secondly we describe our findings concerning the reliability of a measure of real-life interaction.

PHONOLOGICAL AND ORTHOGRAPHIC APPROACHES TO THE TREATMENT OF WORD RETRIEVAL IN APHASIA

We present a preliminary report on a study of the treatment of word finding difficulties in aphasia using phonological and orthographic cues. These techniques although often used to cue word finding in the immediate term have been little evaluated in terms of therapy designed to improve word retrieval in the long term. The first phase using cued word retrieval in a picture naming task was followed by a second phase designed to facilitate use of treated words in real-life contexts. The results from both phases were encouraging with improved word retrieval for three out of the four participants. The implications for clinical practice are discussed.