Julie L. Wambaugh

Application of semantic feature analysis to retrieval of action names in aphasia.

This investigation examined the effects of a semantic feature training procedure on retrieval of action names in a participant with anomic aphasia. Treatment was applied sequentially across two sets of action names in the context of a multiple baseline design across behaviors. Treatment effects were evaluated in terms of naming of trained and untrained actions. Discourse production effects were also examined with respect to verbal productivity, informativeness, and production of nouns and verbs. Increased accuracy of naming was observed for both sets of trained action names, with increases being maintained at 6 weeks posttreatment. However, accuracy of responding did not reach preestablished criterion levels. Repeated exposure to stimulus items without training resulted in unstable and temporary increases in naming accuracy. No changes were observed in accuracy of naming of untrained actions that were measured only at pre- and posttreatment intervals. Increases in verbal productivity and informativeness in discourse production were associated with the treatment.

Effects of two cueing treatments on lexical retrieval in aphasic speakers with different levels of deficit

The effects of two cueing treatments for lexical retrieval were examined with three aphasic speakers who demonstrated different levels of lexical processing impairment (i.e., predominately semantic, predominately phonologic, and mixed semantic-phonologic). Each speaker received both treatments, with treatments being applied sequentially to different word lists in a multiple baseline design. Both treatments consisted of a prestimulation phase followed by the application of a response-contingent cueing hierarchy. One treatment employed semantic-level cueing, whereas the other treatment utilised phonologic-level cueing. All participants evidenced a positive response to both of the treatments and one participant (predominately phonologic-level deficit) showed a superior response to lexicalsemantic treatment.

A comparison of the relative effects of phonologic and semantic cueing treatments

Background: Lexical retrieval problems are pervasive in aphasia and are often an important focus of treatment. Although many treatments have been demonstrated to positively impact lexical retrieval in aphasia, comparisons of such treatments have been relatively rare. Aims: The purpose of this investigation was to compare the relative effects of two lexical retrieval cueing treatments when administered concurrently with a participant with chronic anomic aphasia. The cueing treatments, phonological cueing treatment (PCT) and semantic cueing treatment (SCT) were designed to target the lexical phonologic and lexical semantic levels of processing, respectively. Methods & Procedures: The participant received both treatments concomitantly in the context of an alternating treatments design and multiple baseline design across behaviours. Separate lists of words were assigned to each treatment and additional word lists were designated for generalisation assessment. Following achievement of criterion levels of performance, each treatment was then applied to the additional lists in order to attempt to replicate treatment effects. Outcomes & Results: The participant showed a positive response to both treatments. However, he achieved higher levels of accuracy of naming for items treated with SCT. This effect was observed in both phases of treatment application. Conclusions: For this participant, SCT appeared to be the preferred treatment, at least in the context of concurrent administration of the treatments. This preferential response may be related to a pretreatment pattern of responding in which the participant routinely used descriptions and semantically related sentence cues to attempt to retrieve words.

Sound production treatment for apraxia of speech: overgeneralization and maintenance effects

This investigation was designed to examine the effects of a sound production training program on the production of selected sounds from a speaker with apraxia of speech and Brocas aphasia. Treatme...

Retrieval of action names in aphasia: Effects of two cueing treatments

Background: The treatment of word-retrieval deficits in aphasia has most frequently focused on the retrieval of object names. The retrieval of action names has received relatively little attention in terms of rehabilitation despite the important role played by verbs in communication. Treatments that have been successful in promoting improved object name retrieval cannot be assumed to also facilitate improved action name retrieval. Aims: The purpose of this investigation was to examine the effects of two cueing treatments on the retrieval of action names with speakers with chronic aphasia. Methods & Procedures: The effects of two cueing treatments, Phonological Cueing Treatment (PCT) and Semantic Cueing Treatment (SCT), were examined with five speakers with aphasia. Treatment effects on action naming were measured using single subject, multiple baseline, and alternating treatments designs. Outcomes & Results: Results varied across participants. For two speakers, both treatments produced strong positive increases in naming, with effects being similar across treatments. For two other speakers, modest increases in correct naming were observed and for the remaining speaker, no increases were found. Conclusions: These findings indicate that PCT and SCT may have utility in facilitating action naming for some speakers with aphasia, but that the effects may vary across speakers.

Treatment for apraxia of speech: Effects of targeting sound groups

A multiple baseline design was used to assess the effects of a treatment programme for sound errors with a speaker with moderately severe apraxia of speech (AOS) and Brocas aphasia. Treatment consisted of training correct production of three groups of sounds (i.e. stops, fricatives, and glides/liquids) in sentences containing multiple exemplars of those sounds. The treatment combined modelling, repetition, integral stimulation, Visual cueing, and response-contingent feedback and was applied sequentially to the groups of sounds. Acquisition effects of treatment were measured by evaluating production of trained sentences in probes. Response generalization effects were assessed by examining sound production in untrained sentences containing exemplars of trained sounds and untrained sentences containing untrained sounds. Treatment resulted in improved production for trained sound groups, with response generalization closely following acquisition effects. Generalization across sound groups was negligible. Additionally, measures of sentence duration were conducted for sentences produced in two baseline, one mid-treatment, and two end-of-treatment probes. Statistically significant reductions in duration were noted at the completion of treatment in comparison to baseline measures.

The effects of rate control treatment on consonant production accuracy in mild apraxia of speech

Background: A primary feature of acquired apraxia of speech (AOS) is a slow speech rate associated with lengthened sound segments and intersegment durations (McNeil, Robin, & Schmidt, 1997). This disturbance in speech production timing has been the focus of a limited number of treatment studies designed to manipulate rate and/or rhythm of speech production with speakers with mild AOS. Aims: The purpose of this investigation was to study the effects of rate control treatment on sound production accuracy and utterance durations of multisyllabic words, phrases, and sentences in a speaker with mild AOS and aphasia. Methods & Procedures: An individual with mild AOS and aphasia was trained to produce multisyllabic words and phrases using a combination of metronomic rate control and hand tapping. The speaker was trained to produce one syllable per beat of the metronome in conjunction with hand tapping. Feedback was only provided for accuracy of hand tapping and/or syllable production to the beat of the metronome. No feedback was given regarding the accuracy of sound production. Initially, the speakers rate of production was reduced, but was then systematically increased. A multiple baseline design was used to examine the acquisition, response generalisation, and maintenance effects of treatment. Outcomes & Results: Findings revealed an increase in sound production accuracy for trained four‐syllable words and some improvement in sound production accuracy for treated phrases and untrained four‐syllable words. There was only a slight reduction in total utterance duration for treated items versus untreated items. There was a gradual decline in total utterance duration over time on untrained stimulus generalisation items with no consistent improvement on sound production accuracy. Conclusions: Treatment resulted in an improvement in sound production accuracy in an individual with AOS and aphasia. Positive changes were observed for treated four‐syllable words, phrases, and untrained four‐syllable words, although treatment did not directly target sound production accuracy (i.e., feedback was not given regarding accuracy of productions). The study represents an initial investigation of the effects of rate control treatment specifically increasing rate of production in a speaker with mild AOS and aphasia. This type of treatment appears to have promise in terms of improving sound production accuracy and warrants further investigation.

Effects of rate and rhythm control treatment on consonant production accuracy in apraxia of speech

A speaker with apraxia of speech and aphasia was trained to produce multisyllabic words using a combination of metronomic rate control and hand-tapping. A multiple baseline design was used to examine the effects of treatment on sound production. Treatment was applied to three syllable words with primary stress on the first syllable while generalization was measured to: (1) untrained exemplars; (2) three syllable words with different stress patterns; (3) four syllable words; and (4) s-blend words. Positive sound changes were noted for trained and untrained words. Treatment was extended to a second set of words to which generalization had been incomplete and additional improvement was observed.

Modification of sound production treatment for apraxia of speech: Acquisition and generalisation effects

Background: Sound errors are characteristic of acquired apraxia of speech (AOS) and are frequently the focus of treatment. One treatment for AOS, Sound Production Treatment (SPT), has been shown to facilitate improved sound production in trained sounds and untrained exemplars of those sounds (Wambaugh, Kalinyak‐Fliszar, West, & Doyle, 1998a). Although the effects of SPT are relatively well understood when the treatment has been applied sequentially to single sounds in words, little is known about its application to multiple sounds. Additionally, the stimulus generalisation effects of SPT have not been well specified. Aims: This investigation was designed to further investigate the acquisition and stimulus generalisation effects of SPT for AOS. Treatment application was modified from previous investigations to allow for application with multiple sounds and in a different treatment context. Methods & Procedures: A multiple baseline design across behaviours and contexts was used to assess the effects of treatment with a speaker with chronic AOS and aphasia. Treatment was initially applied within the context of words elicited through repetition. In order to assess stimulus generalisation, the nine consonants of interest were elicited in words through sentence completion. Additionally, the target sounds were elicited in a different word position (i.e., word‐final) from that utilised in treatment (i.e., word‐initial). Outcomes & Results: Treatment resulted in increased correct productions of the target sounds in trained contexts. Generalisation to the different stimulus contexts was limited and varied across sounds. Treatment was extended to the sentence completion context and additional treatment gains were observed. Conclusions: The application of SPT to multiple sounds and to an additional treatment context appears to have promise in the treatment of AOS. Additional replications are required for external validity.

Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012

Objectives The aim was for the appointed committee of the Academy of Neurological Communication Disorders and Sciences to conduct a systematic review of published intervention studies of acquired apraxia of speech (AOS), updating the previous committees review article from 2006. Method A systematic search of 11 databases identified 215 articles, with 26 meeting inclusion criteria of (a) stating intention to measure effects of treatment on AOS and (b) data representing treatment effects for at least 1 individual stated to have AOS. Results All studies involved within-participant experimental designs, with sample sizes of 1 to 44 (median = 1). Confidence in diagnosis was rated high to reasonable in 18 of 26 studies. Most studies (24/26) reported on articulatory-kinematic approaches; 2 applied rhythm/rate control methods. Six studies had sufficient experimental control for Class III rating according to the Clinical Practice Guidelines Process Manual (American Academy of Neurology, 2011), with 15 others satisfying all criteria for Class III except use of independent or objective outcome measurement. Conclusions The most important global clinical conclusion from this review is that the weight of evidence supports a strong effect for both articulatory-kinematic and rate/rhythm approaches to AOS treatment. The quantity of work, experimental rigor, and reporting of diagnostic criteria continue to improve and strengthen confidence in the corpus of research.