Julie Hickin

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.

Phonological and orthographic cueing therapy: A case of generalised improvement

Background: Phonological and orthographic cues can both be effective in the treatment of anomia, and are often used clinically. However, studies using phonological and orthographical cues in aphasia therapy have tended to be equivocal about their benefits, and most demonstrate improvements limited to treated items. Few previous studies investigate change in conversation or in peoples own views of their aphasia. Aims: The aim of the study was to investigate the effect of a weekly delivered therapy, using combined phonological and orthographic cues, on word retrieval, connected speech, conversation, and on the participants own views of his aphasia. Methods & Procedures: A person with anomia (TE) is presented as a detailed single-case study. Two baselines, 8 weeks apart, were followed by two 8-week phases of therapy, delivered weekly in a clinical setting. The first phase involved the use of combined phonological and orthographic cues to aid retrieval of a targeted set of words. The second phase encouraged the use of targeted words in connected speech and conversation. TE was reassessed after each phase of therapy and again 2 months later, after a period of no therapy. The study involved controls for improvement due to regular contact but without intervention (the baseline phase) and investigated generalisation to untreated items (treated and untreated sets were used, balanced for performance prior to therapy). Finally non-specific effects of therapy were determined by testing throughout the study on a set of language control tasks (predicted to be unaffected by the therapy). Outcome & Results: TE demonstrated significant and enduring improvements in picture naming, which had generalised to untreated items. Significant improvements were also demonstrated in the broader measures of connected speech, aspects of conversation, and his own views of his aphasia, while performance on control tasks remained fairly stable. There was a significant relationship between changes in word finding and changes in TEs views of his communication activity across the course of the study, with a pattern of stability over baseline and change with intervention, particularly the first phase of therapy, i.e., using cues. Conclusions: These findings demonstrate that a combined phonological and orthographic cueing therapy targeting word retrieval can have lasting benefits, not just on targeted items but also on untreated words, connected speech, and the views of the person with aphasia. Furthermore, such improvements can be achieved within a prevalent service delivery model.

Aphasia rehabilitation: Does generalisation from anomia therapy occur and is it predictable? A case series study

INTRODUCTION The majority of adults with acquired aphasia have anomia which can respond to rehabilitation with cues. However, the literature and clinical consensus suggest change is usually limited to treated items. We investigated the effect of an experimentally controlled intervention using progressive cues in the rehabilitation of noun retrieval/production in 16 participants with chronic aphasia. METHOD Participants were sub-divided relative to the group according to performance on semantic tasks (spoken/written word to picture matching) and phonological output processing (presence/absence of word length effect and proportion of phonological errors in picture naming) in order to investigate outcome in relation to language profile. Cueing therapy took place weekly for 8 weeks. RESULTS Intervention resulted in significant improvement on naming treated items for 15/16 participants, with stable performance on control tasks. Change occurred at the point of intervention and not during pre-therapy assessments. We predicted particular patterns of generalisation which were upheld. Only participants classified as having relatively less of a semantic difficulty and more of a phonological output deficit demonstrated generalisation to untreated items. Outcome did not relate to traditional aphasia classification. CONCLUSION A cueing hierarchy can improve word retrieval/production for adults with aphasia. In some cases generalisation to untreated items also occurs. The study demonstrates that the results of behavioural testing can be used to guide predictions of recovery with intervention.

A controlled study of changes in conversation following aphasia therapy for anomia

This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [1] and Best et al. [2]). In each study, therapy involved cueing with the aim of improving retrieval of a set of nouns. Naming of the experimental items was assessed twice prior to therapy and again immediately afterwards. There was a significant change in word finding, as measured by picture naming, for the group and for 11 of the 13 participants. At the same time points, we collected conversations between the person with aphasia and a regular conversational partner. We analysed these using Profile of Word Errors and Retrieval in Speech (Herbert et al. [3]) and investigated a set of conversational variables predicted to change with therapy. Unsurprisingly, the conversation data is not straightforward. There is no significant change on the conversation measures for the group but some changes for individuals. We predicted change in word retrieval after therapy would relate to change in everyday conversations and tested this by correlating the change (post-therapy minus mean pre-therapy) in picture naming with the change in conversation variables. There was a significant positive relationship between the change in picture naming and change in some conversation measures including the number of nouns produced in 5 min of conversation (r = 0.50, p < 0.05, one-tailed) and the number of nouns produced per substantive turn (r = 0.55, p < 0.05, one-tailed). The findings suggest changes in word finding following therapy for aphasia can be reflected in changes in conversation. The clinical implications of the complex results are explored.

Re-Visiting “Semantic Facilitation” of Word Retrieval for People with Aphasia: Facilitation Yes But Semantic No

Previous research has shown that word-to-picture matching for targets that cannot be named at pre-test results in improved naming relative to untreated control items for people with aphasia. This paper replicates and extends this finding and investigates its source. Is the effect a result of priming of semantic representations, or of post-semantic mechanisms in word retrieval? The first experiment shows that word-to-picture matching with unrelated distractors improves naming at short (2-3 minutes) and long (up to 25 minute) lags. There was no effect of being made aware of the relationship between word-to-picture matching and picture naming. People who have a semantic impairment improve only with a short lag between word-to-picture matching and naming. Participants with less semantic impairment show larger priming effects that are equal at short and long lags between word-to-picture matching and naming. The second experiment shows that the facilitation effect is just as large for word-to-picture matching with unrelated distractors as with semantically-related distractors. Furthermore, overall there was no difference between matching with coordinate items and with associated items. The results of these experiments show that facilitation of naming by word-to-picture matching in people with aphasia cannot be a result of the priming of semantic representations. Instead they are consistent with two effects: word-to-picture matching results in priming at a lemma level for aphasic people with a semantic impairment that is only found with a short lag between word-to-picture matching and naming. Word-to-picture matching causes priming of the lemma to output lexicon entry mapping that benefits participants with less semantic impairment that is evident at both a short and long lag between word-to-picture matching and naming. These findings fit well with previous research on repetition priming of naming with normal subjects.

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.