Sandra Wright

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.

Effects of a combined semantic/phonologic cueing treatment on word retrieval in discourse

Background: The application of word‐finding treatments for aphasia, as well as the study of their effects, has typically centred on retrieval of single lexical items (Nickels, 2002b). Little is known about the effects of word‐finding treatments on lexical retrieval in discourse tasks. This research was supported by Rehabilitation Research and Development, Department of Veterans Affairs. Thanks are extended to Michelene Kalinyak‐Fliszar for her assistance with this project. Aims: The purpose of this investigation was to study the effects of a combined semantic/phonologic cueing treatment on trained and untrained single words produced in the context of story retells. Generalisation to additional connected speech tasks was also assessed. Methods & Procedures: A well‐studied story retell procedure (Doyle et al., 2000) was used to guide selection of items for treatment and for measurement of treatment effects. A semantic/phonologic cueing hierarchy was applied to information units (IUs) that were consistently absent from the story retells produced by five participants with aphasia. Treatment effects on retrieval of targeted IUs and overall IUs were measured using single‐subject multiple‐baseline designs. Analyses of efficiency and informativeness of additional discourse tasks were performed prior to and following intervention. Outcomes & Results: Four of five participants demonstrated improved retrieval of targeted IUs and negligible generalisation to production of overall IUs for both treated story forms. The remaining participant exhibited minimal improvements in production of both targeted and untrained IUs for both applications of treatment, but was the only individual who increased informativeness of discourse on a post‐treatment measure of connected speech. Conclusions: Findings indicated that a combined semantic/phonologic cueing treatment may be effective for increasing production of targeted words at a discourse level for some individuals with aphasia, but the effects may vary across speakers.

Semantic feature analysis: Application to confrontation naming of actions in aphasia

Background: Despite advances in the development and testing of therapies for verb retrieval impairments in aphasia, generalisation effects of treatment remain a challenge. Semantic Feature Analysis (SFA) is a word retrieval treatment that has been reported to result in generalised responding to untrained object names with persons with aphasia. The theorised therapeutic mechanisms of SFA appeared to be appropriate for facilitating retrieval of trained and untrained action names. Aims: This investigation was designed to extend pilot research in which SFA was applied to verb retrieval. The primary purpose of the current study was to examine the acquisition and response generalisation effects of SFA applied to action naming with four persons with chronic aphasia. Additional purposes were to examine changes in production of content in discourse and to explore the correspondence of accuracy of naming during treatment to probe performance. Methods & Procedures: SFA was modified slightly to be appropriate for application to action naming as opposed to object naming; several feature categories were changed, but all other procedures were retained. Treatment was applied sequentially to two sets of action names in the context of multiple baseline designs across behaviours and participants. Accuracy of naming of trained and untrained actions in probes was measured repeatedly throughout all phases of the design. Production of correct information units (CIUs) in discourse was measured prior to and following treatment. The relationship of probe-naming performance to naming performance during treatment sessions was examined using correlational analyses. Outcomes & Results: Increased accuracy of naming of trained action names was associated with treatment for three of the four participants. The remaining participant did not demonstrate improvement in naming on probes, despite some gains during treatment. Generalisation to untrained action names did not occur for any of the participants. Increases in CIU production were observed for only one of the participants. For the participants with positive naming outcomes, probe performance correlated well with naming performance during treatment. For the participant who demonstrated some improvements in treatment, but did not show gains in naming on probes, weak correlations were obtained. Conclusions: SFA appears to have potential for promoting improved action naming in aphasia. However, more research is warranted to explore treatment modifications to promote generalisation. Correlational analyses indicated that gains in naming during treatment may not always be reflected in probe performance and thus, require verification through probing in non-treatment conditions.

Sound Production Treatment: Effects of Blocked and Random Practice

PURPOSE This investigation was designed to further the development of a treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT), by examining the effects of blocked and random practice. METHOD A multiple-baseline design across participants and behaviors was used with 6 speakers with chronic AOS and aphasia. Accuracy of production of target sounds in treated and untreated words produced in probe sessions served as the primary dependent variable. Stimulus generalization was also measured to phrase production and sentence completion. Participants received SPT applied with blocked presentation of treatment words (SPT-blocked) and SPT applied with random presentation of treatment words (SPT-random). RESULTS Increases in accuracy of articulation of target sounds in treated words were observed for all participants for both conditions of treatment. SPT-random appeared to be associated with better maintenance for 2 participants. Generalization to untreated words was positive for all participants for SPT-random and SPT-blocked. Stimulus generalization effects varied across participants and measurement conditions; patterns of generalization did not appear to be associated with treatment condition. CONCLUSIONS There may be an advantage for SPT-random for some speakers with AOS. Findings from the nonspeech motor learning literature may not translate directly to the treatment of AOS.

Improved effects of word‐retrieval treatments subsequent to addition of the orthographic form

Background: The participant, an individual with moderate–severe Wernickes aphasia, had not benefited from two word‐retrieval cueing treatments in a previous investigation. The participant insisted that her performance would have been improved if the written word had been provided as part of the cueing process. This research was supported by Department of Veterans Affairs, Rehabilitation Research and Development. Aims: The purpose of this investigation was to examine the effects of adding the orthographic form of targeted action names to a semantic cueing treatment (SCT) and a phonologic cueing treatment (PCT). Methods & Procedures: The participant received SCT and PCT applied to the retrieval of action names. The treatments both provided the written word form paired with the pictured action in conjunction with cueing hierarchies. Two, sequential multiple baseline designs across behaviours were employed to examine the acquisition and response generalisation effects of treatment. Outcomes & Results: Improved accuracy of action naming was found for both treatments. Gains were limited to trained items; no changes were observed in naming of untrained actions. Conclusions: It appeared that the participant utilised the orthographic word form to develop associations between the visual object recognition system and the orthographic input lexicon, thus facilitating access to the phonological output lexicon.

Sound production treatment for acquired apraxia of speech: Effects of blocked and random practice on multisyllabic word production

Abstract Purpose: This study was designed to examine the effects of practice schedule, blocked vs random, on outcomes of a behavioural treatment for acquired apraxia of speech (AOS), Sound Production Treatment (SPT). Method: SPT was administered to four speakers with chronic AOS and aphasia in the context of multiple baseline designs across behaviours and participants. Treatment was applied to multiple sound errors within three-to-five syllable words. All participants received both practice schedules: SPT-Random (SPT-R) and SPT-Blocked (SPT-B). Result: Improvements in accuracy of word production for trained items were found for both treatment conditions for all participants. One participant demonstrated better maintenance effects associated with SPT-R. Response generalisation to untreated words varied across participants, but was generally modest and unstable. Stimulus generalisation to production of words in sentence completion was positive for three of the participants. Stimulus generalisation to production of phrases was positive for two of the participants. Conclusion: Findings provide additional efficacy data regarding SPT’s effects on articulation of treated items and extend knowledge of the treatment’s effects when applied to multiple targets within multisyllabic words.

Combined Aphasia and Apraxia of Speech Treatment (CAAST): Effects of a Novel Therapy

PURPOSE This investigation was designed to examine the effects of a newly developed treatment for aphasia and acquired apraxia of speech (AOS). Combined Aphasia and Apraxia of Speech Treatment (CAAST) targets language and speech production simultaneously, with treatment techniques derived from Response Elaboration Training (Kearns, 1985) and Sound Production Treatment (Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998). The purpose of this study was to determine whether CAAST was associated with positive changes in verbal language and speech production with speakers with aphasia and AOS. METHOD Four participants with chronic aphasia and AOS received CAAST applied sequentially to sets of pictures in the context of multiple baseline designs. CAAST entailed elaboration of participant-initiated utterances, with sound production training applied as needed to the elaborated productions. The dependent variables were (a) production of correct information units (CIUs; Nicholas & Brookshire, 1993) in response to experimental picture stimuli, (b) percentage of consonants correct in sentence repetition, and (c) speech intelligibility. RESULTS AND CONCLUSIONS CAAST was associated with increased CIU production in trained and untrained picture sets for all participants. Gains in sound production accuracy and speech intelligibility varied across participants; a modification of CAAST to provide additional speech production treatment may be desirable.

Modified Response Elaboration Training: A systematic extension with replications

Background: Response Elaboration Training (RET; Kearns, 1985) has been found to consistently result in increased production of content in discourse with persons with aphasia. Positive treatment effects have been reported for persons representing a variety of aphasia types and severities. RET was modified for application with persons with acquired apraxia of speech and aphasia and positive outcomes were also associated with the modified treatment (Wambaugh & Martinez, 2000). Although RET has received systematic study, its stimulus generalisation effects are not well understood. Aims: This investigation was designed to measure the stimulus generalisation effects of modified RET (M-RET) in a variety of conditions as well as to further study the effects of M-RET applied to a personal recount condition. Methods & Procedures: Multiple baseline designs (across behaviours and participants) were utilised to examine treatment effects. Treatment was applied sequentially to picture sets and a personal recount condition with six persons with chronic aphasia. Production of correct information units (CIUs) was measured in the following conditions: (1) discourse production in response to sets of trained and untrained pictures, (2) home conversations, and (3) production of discourse in structured tasks. Formal measures of functional communication were also completed prior to and following treatment. Outcomes & Results: Increases in production of CIUs in response to pictures were observed for 11 of the 12 applications of M-RET to picture sets. Response generalisation to untrained picture sets was associated with M-RET applied to pictures sets; increases were slight and were greater for untrained sets that were probed more frequently. Maintenance of gains was generally strong for the participants with nonfluent aphasia, but was minimal for the participant with fluent aphasia. Gains were not evident for M-RET applied to personal recounts; only one participant evidenced changes possibly associated with treatment in the personal recount condition. Improvements in structured discourse samples and a functional communication measure were observed for the majority of the participants following treatment. Lack of compliance in completion of recordings of home conversations limited the utility of that measure. Conclusions: M-RET applied to pictures resulted in improvements in production of content in treated and untreated picture conditions for the majority of the participants. Treatment effects extended to additional outcome measures. Although some positive changes were observed for the participant with fluent aphasia, maintenance was problematic. Application of M-RET to a personal recount condition was not associated with improved performance for most of the participants.

Semantic Feature Analysis: Further Examination of Outcomes.

PURPOSE The purpose of this investigation was to systematically examine outcomes associated with Semantic feature analysis, which is an established treatment for word-retrieval deficits in aphasia. Attributes of the experimental design and stimuli were manipulated to evaluate generalized naming of semantically related and unrelated items. In addition, the study was designed to examine changes in production of semantic information. METHOD Semantic feature analysis was applied in the context of multiple-baseline designs with 5 persons with chronic aphasia. Experimental items were controlled for semantic category membership, number of naming attempts, and provision of item names. Acquisition, generalization, and maintenance effects were measured in probes of naming performance. Production of semantic information was also measured in response to experimental items and in discourse tasks. RESULTS Treatment was associated with systematic increases in naming of trained items for 4 of the 5 participants. Positive generalization to untrained exemplars of trained categories was found for repeatedly exposed items but not for limited-exposure items. Slight increases in production of semantic content were observed. CONCLUSION Repeated attempts to name untreated items appeared to play a role in generalization. Provision of the names of untrained items may have enhanced generalized responding for 2 participants.

Combined aphasia and apraxia of speech treatment (CAAST): Systematic replications in the development of a novel treatment

Abstract Purpose: The purpose of this investigation was to examine the effects of a modified version of a newly developed therapy for aphasia and acquired apraxia of speech (AOS), Combined Aphasia and Apraxia of Speech Treatment (CAAST). Method: Four speakers with chronic AOS and aphasia received CAAST in the context of multiple baseline designs. Dependent variables included language measures (i.e. production of correct information units (CIUs)) and speech production measures (i.e. speech intelligibility and percent correct consonants (PCC) in sentence repetition). Result: Three of the participants demonstrated improved CIU production with treated picture sets and two also demonstrated generalization to untreated sets. All participants achieved substantially increased CIU production in an untrained discourse context. Speech intelligibility increased for three of the participants and increases in PCC were observed for all of the participants at two weeks post-treatment. However, PCC improvements were maintained for only two of the speakers at six weeks post-treatment. Conclusion: The revised CAAST protocol was associated with improved changes in speech and generalization across contexts in comparison to the previous iteration of CAAST. However, focus on sentence production in generalization practice may have been detrimental to CIU production for one participant.