Laura Laird

Mapping therapy for sentence production impairments in nonfluent aphasia

This study investigated a new treatment in which sentence production abilities were trained in a small group of individuals and nonfluent aphasia. It was based upon a mapping therapy approach which holds that sentence production and comprehension impairments are due to difficulties in mapping between the meaning form (thematic roles) and the syntactic form of sentences. We trained production of both canonical and noncanonical reversible sentences. Three patients received treatment and two served as control participants. Patients who received treatment demonstrated acquisition of all trained sentence structures. They also demonstrated across-task generalisation of treated and some untreated sentence structures on two tasks of constrained sentence production, and showed some improvements on a narrative task. One control participant improved on some of these measures and the other did not. There was no noted improvement in sentence comprehension abilities following treatment. Results are discussed with reference to the heterogeneity of underlying impairments in sentence production impairments in nonfluent patients, and the possible mechanisms by which improvement in sentence production might have been achieved in treatment.

Treating naming impairments in aphasia: Findings from a phonological components analysis treatment

Background: A new phonologically based treatment that we developed for addressing naming deficits in aphasia—the phonological components analysis (PCA) treatment—is presented. The PCA was modelled after the semantic feature analysis (SFA) approach (Boyle & Coelho, 1995). The SFA approach was chosen as a model for two reasons. First, results from the semantic therapies that have used SFA have been encouraging (e.g., Boyle, 2004; Boyle & Coelho, 1995; Coelho, McHugh, & Boyle, 2000; Conley & Coelho, 2003; Lowell, Beeson, & Holland, 1995). Second, SFA incorporates the principle of choice, a factor that has been identified by some as being important in producing longer‐lasting effects of treatment (e.g., Hickin, Best, Herbert, Howard, & Osborne, 2002). The PCA was developed to serve as a comparable phonological comparison for the SFA approach with the future goal of comparing the relative effects of both types of therapies. Portions of this work were presented at the Academy of Aphasia meetings in New York, October 2002 (Rochon, Leonard, & Laird, 2002) and Victoria, October 2006 (Rochon et al., 2006a), at the American Speech and Hearing Association meeting, Philadelphia, November 2004, and at the Rotman Research Conference, Toronto, March 2006 (Rochon et al., 2006b). This project was supported by grant number 44069 from the Canadian Institutes of Health Research and by grant number NA 5379 from the Heart and Stroke Foundation of Ontario. The authors are grateful to the North York Aphasia Institute, the York Durham Aphasia Centre, and the Aphasia Centre of Ottawa‐Carleton for allowing us to recruit participants from their institutions, and to all the individuals who participated in this research. James Andrews, Eleanor Arabia, Jennifer Cupit, Kit Flynn, Heather McCallum, Lauren Reznick, and Patty Vlachos, provided valuable assistance on this project. Thank you also to two anonymous reviewers for their helpful comments. Aims: The primary aim of this investigation was to document the effectiveness of PCA treatment for the remediation of naming deficits in aphasia. In addition, we wished to examine potential maintenance and generalisation effects associated with this treatment. Methods & Procedures: The PCA treatment followed the protocol of Coelho et al. (2000). The target picture was presented in the centre of a chart and the participant was asked to name it. Irrespective of his/her ability to name the picture, the participant was asked to identify five phonological components related to the target item (i.e., rhymes with, first sound, first sound associate, final sound, number of syllables). For each component targeted, if a participant could not spontaneously provide a response, he/she was asked to choose one from a list. A single‐subject multiple‐baseline across behaviours design was employed, with maintenance effects examined 4 weeks post‐treatment. Generalisation effects were examined by comparing pre‐ and post‐treatment scores on the Philadelphia Naming Test (Roach, Schwartz, Martin, Grewal, & Brecher, 1996). Ten individuals with aphasia participated. Outcomes & Results: Of the 10 individuals, 7 demonstrated notable treatment effects. Follow‐up testing indicated maintenance of treatment gains over a 4‐week period, with some generalisation to untreated items. Conclusions: This investigation was successful in demonstrating the effectiveness of a new phonological approach to the remediation of naming deficits in aphasia and in supporting the notion that a components analysis treatment protocol (similar to a semantic feature based treatment) is useful in strengthening activations within the lexical system with the potential result of longer‐lasting effects.

Neural changes after phonological treatment for anomia: An fMRI study

Functional magnetic resonance imaging (fMRI) was used to investigate the neural processing characteristics associated with word retrieval abilities after a phonologically-based treatment for anomia in two stroke patients with aphasia. Neural activity associated with a phonological and a semantic task was compared before and after treatment with fMRI. In addition to the two patients who received treatment, two patients with aphasia who did not receive treatment and 10 healthy controls were also scanned twice. In the two patients who received treatment, both of whose naming improved after treatment, results showed that activation patterns changed after treatment on the semantic task in areas that would have been expected (e.g., left hemisphere frontal and temporal areas). For one control patient, there were no significant changes in brain activation at the second scan; a second control patient showed changes in brain activation at the second scan, on the semantic task, however, these changes were not accompanied with improved performance in naming. In addition, there appeared to be bilateral, or even more right than left hemisphere brain areas activated in this patient than in the treated patients. The healthy control group showed no changes in activation at the second scan. These findings are discussed with reference to the literature on the neural underpinnings of recovery after treatment for anomia in aphasia.

Behavioural and neural changes after a “choice” therapy for naming deficits in aphasia: preliminary findings

Background: Anomia, difficulty producing words, is a pervasive symptom of many individuals with aphasia. We have developed a treatment for naming deficits—the Phonological Components Analysis (PCA) protocol—that has proven efficacious in improving word-finding abilities for individuals with post-stroke aphasia. Aims: The aim of this investigation is to present preliminary findings exploring the potential influence of choice—that is the active engagement of a participant in therapy—on our PCA treatment. Methods & Procedures: Five individuals with aphasia were treated in one of two conditions—Choice or No Choice. Potential changes in neural activation as a function of the treatment were also investigated. Two individuals (one from each condition) underwent functional MRI (fMRI) pre- and post-therapy. Outcomes & Results: All the individuals demonstrated a significant treatment effect immediately post-treatment and at a 4-week follow-up and four of the five participants at an 8-week follow-up. Three also demonstrated generalisation to untrained items. Unfortunately, no clear-cut patterns emerged to allow us to make claims about the influence of choice, per se, on the behavioural manifestations of improved naming. Interestingly, the participant from the Choice condition showed neural activation changes post-treatment in frontal and parietal regions that were not evident for the participant in the No Choice condition. Moreover, these changes were accompanied by a larger treatment effect for that individual and generalisation to a novel naming task. Conclusion: The efficacy of PCA treatment for naming deficits is further supported. In addition, the neuroimaging data suggest the possibility that active engagement of an individual in his/her therapy (in this case choosing phonological attributes of a target word) may exercise executive functions important for success in treating anomia. Also, continued exploration of task factors that may promote even better treatment effects using this protocol is warranted, as is continued investigation of the neural underpinnings associated with treatment effects.

A Usability Study of Internet-Based Therapy for Naming Deficits in Aphasia

Purpose This study aimed to evaluate the usability of delivering the Phonological Components Analysis treatment for anomia (Leonard, Rochon, & Laird, 2008) remotely via the Internet to individuals with chronic poststroke aphasia. A secondary aim was to probe the experiences and satisfaction of clinicians in administering treatment at a distance. Method Six individuals with mild-moderate aphasia and 2 trained clinicians participated in this usability study. Participants and clinicians underwent approximately 6 hr of treatment under observation by an independent observer. The usability characteristics of effectiveness, efficiency, and satisfaction were assessed. Results Individuals with aphasia used the Internet-based Phonological Components Analysis therapy successfully, demonstrating independence and very few errors in completing online tasks. Overall, participant satisfaction was high, despite occasional difficulties with technical aspects of the system. Clinicians found the application easy to use but raised concerns about the participant-clinician interaction, perceiving rapport-building and communicating to be more difficult online than face-to-face. Conclusions It is important to consider usability and the clinicians perspective in developing telepractice applications in speech-language pathology. Future directions include assessing the efficacy of remote treatment and collecting a larger sample of clinician data.

How should we measure improvement after aphasia therapy? A look at the use of social validation

How should we measure improvement after aphasia therapy? A look at the use of social validation Jennifer M. Cupit , Elizabeth A. Rochon , Carol Leonard , Laura Laird a a Department of Speech-Language Pathology, University of Toronto, 500 University Avenue, Toronto, Ont., Canada M5G 1V7 b Toronto Rehabilitation Institute, 550 University Avenue, Toronto, Ont., Canada M5G 2A2 c Audiology and Speech-Language Pathology Program, University of Ottawa, 451 Smyth Road, Ottawa, Ont., Canada K1H 8M5 E-mail address: jennifer.cupit@utoronto.ca (J.M. Cupit)

Social validation: Examining its sensitivity and the factors that influence raters’ judgments

The aphasiology literature is replete with studies aimed at improving the communication skills of individuals with aphasia. Objective language assessments are commonly used to measure changes in a person’s communicative competence after treatment. However, many contend that success on a language assessment does not necessarily translate into improvement in a person’s overall communicative ability (e.g., Lapointe, Katz, & Braden, 1999), which is presumably the goal of language therapy. One solution, having a family member complete rating assessments before and after treatment, is flawed, open as it is to a placebo effect. Social validation on the other hand, can provide an evaluation of a person’s overall ability to communicate, while avoiding reliance on someone invested in the treatment outcome (e.g., a spouse). This is a process in which people who are naive to the treatment process judge pre- and post-treatment language samples on specific parameters. The development of social validation measures is currently undergoing examination, as researchers investigate how best to obtain an accurate subjective assessment of a person’s communicative abilities. The main goal of the current research was to evaluate the sensitivity of a specific method of social validation, by having raters judge narratives produced by two groups of individuals with aphasia: one group that received treatment for a naming impairment and a group that did not. It was predicted that across Time 1 and Time 2, raters would detect a positive change in the narratives of the treated group, but not in the untreated group. The current study also aimed to further the examination of social validation by investigating the influence of specific factors, such as knowledge of aphasia (Hickey & Rondeau, 2005) and length and/or completeness of the language sample (Lustig & Tompkins, 2002) on raters’ judgments.

Therapy-Induced Neuroplasticity in Chronic Aphasia After Phonological Component Analysis: A Matter of Intensity

Despite the growing evidence regarding the importance of intensity and dose in aphasia therapy, few well-controlled studies contrasting the effects of intensive and non-intensive treatment have been conducted to date. Phonological components analysis (PCA) treatment for anomia has been associated with improvements in some patients with chronic aphasia; however, the effect of treatment intensity has not yet been studied with PCA. Thus, the aim of the present study was to identify the effect of intensity on neural processing associated with word retrieval abilities after PCA treatment. We used functional magnetic resonance imaging to examine therapy-induced changes in activation during an overt naming task in two patients who suffered from a stroke in the left middle cerebral artery territory. P1 received intensive PCA treatment whereas P2 received the standard, non-intensive, PCA treatment. Behavioral results indicate that both standard and intensive conditions yielded improved naming performance with treated nouns, but the changes were only significant for the patient who received the intensive treatment. The improvements were found to be long lasting as both patients maintained improved naming at 2-months follow-ups. The associated neuroimaging data indicate that the two treatment conditions were associated with different neural activation changes. The patient who received the standard PCA showed significant increase in activation with treatment in the right anterior cingulate, as well as extensive areas in bilateral posterior and lateral cortices. By contrast, the patient who received intensive PCA showed more decreases in activation following the treatment. Unexpectedly, this patient showed subcortical increase in activation, specifically in the right caudate nucleus. We speculate that the recruitment of the caudate nucleus and the anterior cingulate in these patients reflects the need to suppress errors to improve naming. Thus, both short-term intensive and standard, non-intensive, PCA treatment can improve word retrieval in chronic aphasia, but neuroimaging data suggest that improved naming is associated with different neural activation patterns in the two treatment conditions.