A discourse-based approach to semantic feature analysis for the treatment of aphasic word retrieval failures

To date, studies have not explored whether a dual diagnosis of aphasia plus apraxia of speech (AOS) versus aphasia alone (APH) affects the response to language-based naming treatments. To compare the effects of semantic feature analysis (SFA) treatment for individuals with APH versus aphasia plus AOS, and to test if the presence of AOS impacted the effects of treatment. A non-randomized experimental group study was conducted to explore the treatment, generalization and maintenance effects between the AOS and APH groups. Participants included nine individuals with aphasia and 11 with concomitant aphasia and AOS. Dependent measures included lexical accuracy, number of sound-level distortions, and lexical stress and syllable segmentation errors. Both groups showed significantly improved naming accuracy of trained items for up to 2 months post-treatment. Improvement on naming accuracy of untrained items post-treatment, both semantically related and unrelated to trained items, was lower in magnitude. That this may have been due to effects of repeated probing (which included target repetition) or regression to the mean cannot be excluded. There was a tendency for the AOS group to respond slightly better to treatment than the APH group overall, which was not correlated with aphasia severity. Also, measures of phonetic accuracy and fluency improved for both groups, with no main effect of group. Treatment effects did not generalize to formal measures of (untrained) picture naming or expression of correct information units in discourse in a story retelling task. Findings indicate that individuals with aphasia plus AOS can gain equivalent benefits in word retrieval and production from the language-based SFA treatment as individuals with aphasia alone. This may be, in part, due to the tendency for SFA to incorporate principles of practice that are known to support motor learning in AOS, such as high intensity, random stimulus presentation and variable practice. Findings provide further support for high-intensity practice and use of self-generated features to facilitate maintenance of effects. What this paper adds What is already known on the subject SFA treatment is the most common intervention for word-finding difficulties for individuals with aphasia. AOS is a common concomitant disorder to aphasia. However, it is not clear whether the effects of language-based SFA treatment are mitigated by the presence of AOS, which tends to respond well to treatments focused on articulatory-kinematic aspects of speech movement. What this paper adds to the existing knowledge This study compares the effects of SFA in a group of individuals with aphasia alone and a group with similar severity of aphasia but with concomitant AOS, ranging from mild to moderate-severe. Overall, AOS did not have a negative effect on response to the treatment. What are the potential or actual clinical implications of this work? Individuals with aphasia plus AOS can be expected to benefit to a similar degree from SFA as people with aphasia alone. It is likely that the use of practice principles of high intensity, random stimulus presentation and varied practice are important components of the protocol.

Background Semantic Feature Analysis (SFA) treatment has been proven to be effective in alleviating word finding difficulties in individuals with aphasia. However, there is no consensus on the impact of SFA on naming abilities and general language skills in bilingual persons with aphasia (BiPWAs), nor on factors that determine the success of the SFA treatment. Aims This study aimed to investigate the efficacy of SFA treatment in a group of L1-Russian – L2-Hebrew chronic stage BiPWAs and to evaluate the contribution of background factors, language and cognitive measures on the treatment success. Methods & Procedures The current study included two groups of BiPWAs. In the experimental group (n=10), six individuals received SFA therapy in both languages and four individuals in L2. The delayed-treatment group (n=10) did not receive therapy and served as a control group. All BiPWAs completed the Bilingual Aphasia Test (BAT) in both languages, as well as a battery of 10 cognitive tests and linguistic background questionnaires. Outcome & Results The results indicated a direct effect of SFA treatment on naming as well as within-language generalization and cross-language transfer. Importantly, we found significant improvements of general language skills in the treated and untreated languages in BiPWAs who received SFA treatment, while no such improvement was observed in the control group. Non-verbal inhibition and verbal working memory in L1-Russian predicted success of SFA treatment in BiPWAs. Conclusions SFA therapy has positive effects on naming ability of BiPWAs. In addition, SFA therapy affects general language skills in BiPWAs. Yet, within-language generalization, cross-linguistic transfer, and maintenance of the treatment results vary across individuals. The success of SFA treatment in BiPWAs is predicted by cognitive functions rather than background factors of bilingualism.

<b>PB-PG-0609-18074 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>SemaFoRe: Semantic Feature and Repetition therapy in aphasia: A pilot RCT<br /> <br /> <b>Authors: </b>Dr Julie Morris - Newcastle University<br /> Professor David Howard - Newcastle University&nbsp;<br /> Mrs Frauke Buerk - Newcastle upon Tyne Hospitals Trust<br /> <br /> <b>Plain language summary</b><br /> This project focused on therapy for word finding difficulties in aphasia, an acquired communication problem, often following stroke . The project was designed as a pilot study to inform future research, looking at whether the research was feasible and acceptable. It examined two treatments to improve word finding: ‘Semantic Feature Analysis’ (SFA) and ‘Repetition in the Presence of a Picture’ (RIPP). In SFA, you generate ideas around a particular word. RIPP involves repeating words. Participants’ communication was assessed before and after therapy, including the ability to retrieve words via naming and describing pictures. Participants’ views of their communication and therapy were collected.<br /> <br /> In terms of findings about feasibility and acceptability of the research, we considered recruitment to the study, retention and acceptability (whether people stayed in the study and what they thought about it). We had 41 people referred to the study with 25 suitable. We aimed to recruit 30 in total. Recruitment was slightly slower than we had anticipated at the start. Of the 25 who took part, 23 completed every aspect of the study; this is a major achievement given the commitment (8-9 month period). The 2 people who did not complete were unable to because of ill health. Participants reported favourably about therapy; they liked both therapies with little they would change. It therefore appears that the research is feasible and acceptable to participants.<br /> <br /> In terms of more specific results, though this is a pilot study, our results do not completely replicate previous findings. Importantly, both treatments appear only to have an effect on the words treated; previous evidence suggested that SFA would improve word finding generally but this study did not find that, certainly in correct retrieval of words. Additionally, participants appear to benefit from either both or neither treatment.<br /> The implications of our research is that the methods used are acceptable to participants and it was possible to recruit and retain participants. The findings, whilst a pilot study, are based on results from 23 people; this is a larger sample than typical when such well defined therapies are investigated. Results suggest effects of these therapies are restricted to treated items; if this is the case, this has important implications for selection of treatment words. Further research in this area is warranted and we are currently developing a proposal to take to funders.<br /> <br /> <b>Keywords</b><br /> Aphasia, Anomia, Word-finding, Semantic feature analysis, Therapy, Treatment, Rehabilitation<br /> <br /> <b>Summary of research findings</b><br /> BACKGROUND<br /> This study aims to contribute to the development of research and the evidence base about treatment for word retrieval in aphasia. Aphasia is an acquired communication problem, usually after stroke or head injury. One of the most frequent difficulties experienced is a problem with word retrieval; this is therefore a frequent goal of intervention. One of the treatments in clinical use is Semantic Feature Analysis (SFA). In SFA the person is shown a picture and asked to retrieve semantic information about it (e.g. what it is used for). This treatment is of interest as some evidence suggests that treatment effects generalise to words not worked on in therapy. This is in contrast to other word retrieval therapies where effects have been shown to be restricted to treated words. If working on one word can effect change in another (untreated) word, this is an attractive treatment option; the impact of treatment is maximised. However, although widely used, there is a limited evidence base for SFA (limited by number of participants and items as well as other aspects of methodology). The evidence base also describes a set of word retrieval interventions which are more phonological in nature, involving pairing of phonology with meaning, often involving repeating the word. We have called this Repetition in the Presence of a Picture (RIPP). In RIPP, treatment effects are restricted to words seen in treatment. This study involved both treatment approaches, within a pilot cross over randomised control trial.&nbsp;<br /> <br /> AIMS AND OBJECTIVES<br /> This study is a pilot RCT which aimed:<br /> 1. To determine the approximate effect size for the primary outcome measure to inform the power calculation for a trial.<br /> 2. To assess whether the randomised crossover design is an appropriate trial design in this context.<br /> 3. To establish patterns of recruitment, consent and retention, including whether the burden of data collection required by multiple assessments in a cross-over design is acceptable.<br /> 4. To evaluate whether all planned assessment points are necessary to inform the study.<br /> 5. To evaluate overall satisfaction for the people with aphasia with the delivery of therapy.<br /> <br /> METHODS<br /> Participants were recruited by speech and language therapists (SLTs) across several hospital trusts. Participants were at least 3 months post stroke and had word retrieval difficulties, scoring 10%-60% on a naming test. They had no other significant cognitive difficulties. Participants stopped SLT for the study period, though could attend support groups. Following consent, a brief screen of speech production, comprehension and cognitive skills took place. Eligible participants were randomly assigned to one of two treatment orders; SFA followed by RIPP or RIPP followed by SFA. The random allocation was generated via an external randomisation service (Newcastle Clinical Trials Unit).&nbsp;<br /> Each therapy took place twice weekly over a 6 week period with sessions of 1 hour, either in University rooms or the participant’s home. Treatment protocols were established based on literature and discussion with the primary authors in each field. The person administering therapy worked with another SLT to refine the protocols and then to ensure adherence to the protocols.<br /> The items used in therapy were subsets of a 150 item word/picture set. In each phase of therapy, one sub-set of 50 items was treated. The sub-sets were specific to participants; the division into sets A (used in therapy A), B (used in therapy B) and C (control; never treated) was on pre-therapy performance and matched for word frequency and length. Within these constraints, items were randomly allocated to the three sets.&nbsp;<br /> An SLT administered therapy, with assessments carried out by a different SLT who was both blind to treatment condition (SFA vs. RIPP) and item set (set A, B, C). It was not possible for participants to be blind to condition since this was obvious during therapy. For analysis of connected speech, the person transcribing and analysing the samples was completely blinded using anonymised, time referent free samples. Participants’ performance was assessed after each treatment phase, with a gap between the two phases of therapy (of equivalent duration to a therapy period). This led to seven assessment points (Ax.1 &amp; Ax.2 prior to any therapy, Ax.3 following therapy A, Ax.4 prior to therapy B, Ax.5 following therapy B, Ax.6 six weeks and then Ax.7 ten weeks after all treatment ended), with approximately equal gaps between assessments 1-6.&nbsp;<br /> The primary outcome measure was the percentage of the 150 words named correctly. Secondary outcome measures were a comprehension task involving the 150 words, measures of connected speech and a measure of the participant’s perception of change in their communication.&nbsp;<br /> <br /> KEY FINDINGS<br /> There are two aspects to the findings from this study. The first relates to the pilot nature of the study and concerns the feasibility of the methods and design. The second concerns the findings in relation to the treatment effects. Taking the pilot aspects first and considering recruitment: of the 41 people recruited to the study, 25 people were appropriate. Reasons for not being included in the study were typically that word retrieval abilities were above or below the 10-60% criteria. Rates of recruitment were therefore reasonable, with a relatively high referral to consent to participation ratio (i.e. appropriate people were referred). Recruitment was slightly slow in the initial phases and improved. In terms of retention, of the 25 people recruited to the study, there was excellent retention. Only 2 participants were lost to the study due to ill health. 23 participants completed therapy and took part in assessment at all 7 points (spanning approx. 8-9 months), representing a significant commitment. Participants completed an aphasia friendly post-therapy questionnaire (at assessment time points 3 and 5). Participants were overwhelmingly positive about therapy, with very little that they would change. Within the questionnaire, 13 participants stated they had no preference for one therapy, 9 preferred SFA and 1 preferred RIPP.<br /> <br /> In terms of participants’ response to treatment, we found an average effect size (primary outcome measure) for treatment of 11.0 extra items with RIPP (95% CI 16.5-5.4, d=0.49), and 3.3 with SFA (7.7-1.0, d=0.15). The difference was highly significant (CI: 12.5-2.8, d=0.34). Across all 23 participants there was a significant overall improvement: a linear trend (z=8.79, p&lt;&lt;.0001). We also saw differences between people: homogeneity test χ2 (22) = 197.4, p&lt;&lt;0.0001 (which is unsurprising given the variation within aphasia). When the treatment effect was examined by therapy period and considering whether items had been within the treated set or not, the results demonstrated that both treatments were effective; however there was significantly larger effect of treatment for RIPP than for SFA. For both treatments the effect was seen for those items seen within treatment (contrary to predictions for SFA). Analysis of this pilot data also suggests that participants benefited from both or neither therapy. The predictor variables available to us in this study (background language, wider cognitive and demographic variables) did not allow us to predict the benefit.<br /> In considering the secondary outcome measures, there was small but significant change for the semantic verification task and also for the participant rating measure (COAST) over time. We are continuing to analyse the data from the connected speech measures, with a focus on the picture description task from the Comprehensive Aphasia Test, which was completed across each assessment point and for which there is data on the reliability and validity of scoring.<br /> <br /> All seven assessment points appear important and feasible to deliver on. The two pre therapy assessments facilitated item selection to treatment sets, it is essential to have pre and post therapy assessment to allow comparison of performance and the final post-therapy measurements are clearly important both to the clinical community and to participants (with questions at dissemination events about the longer term benefits of treatment).&nbsp;<br /> <br /> EXPECTED IMPACT AND CONCLUSION<br /> This study demonstrates the feasibility of a crossover RCT of specific aphasia therapies. Referral to a study of this type is feasible; our experience suggests that in future, the recruitment drive needs to start before the study is ready to recruit to facilitate consultation with potential participants. This study only used SLT recruiters; it was not possible to utilise the resources of the (then) Stroke Research Network. Strong support was given to the study, but referrers needed to know in detail about potential participants’ aphasia and about other therapy needs. Retention within the study and acceptability to participants were both excellent, suggesting the design and methods are appropriate. However, it is important to remember that one therapist delivered all intervention, with one research site and so participants had a great deal of consistency and this may have contributed to this success.&nbsp;<br /> The study, whilst a pilot, also generated interesting results regarding the two treatments. Both were effective, but RIPP more so; neither treatment showed generalisation to untreated items on the primary outcome measure (contrary to predictions). This has a potential impact on treatment choices for word retrieval; if the more complex SFA treatment cannot be demonstrated to have an advantage, then RIPP may be the treatment of choice for this specific aspect of aphasia rehabilitation. Results from this pilot study suggest we need to better understand the impact of treatment on everyday communication and confidence in communication, whether we can get generalisation of treatment effects, what might predict benefit and also explore whether there is a more efficient way to deliver the repetition therapy.&nbsp;<br /> <br /> <b>Patient and public involvement</b><br /> Involvement of patients has grown with this project and spread beyond this project to influence subsequent projects (from PhD studies to project grants). In developing the original project proposal, a small Aphasia Research User Group (ARUG) was set up, and has discussed (in varying depth) this project on 6 occasions. Aphasia adds a challenge to involvement of patients; people have communication difficulties which can affect their understanding of spoken and written communication and their ability to convey their ideas. This has meant meetings need to be facilitated; both in terms of understanding (of spoken and written material) and expression of ideas. Meetings have been small (typically 4-5 members with 2 facilitators who are qualified SLTs). Over time, we have developed our skills in ensuring members are able to truly contribute their views, but importantly members have gained experience and the confidence to put forward their ideas. We have also recently invited a family member to join the group, to widen consultation. We have also worked with one member, a gentleman with aphasia and with a scientific background, who has been able to comment on specific queries via e-mail (this project, and others) and this has been useful. He has commented on the lay summary of this report and has been sent the full report. We remain mindful of ensuring people with aphasia themselves are able to fully contribute. The importance of considering what to consult about, and what amount has been important as has building on information over time. The group appears to have a sense of ownership of this particular project.<br /> <br /> ARUG has gone on to be involved with other projects (e.g. Reading Comprehension in Aphasia) and to shape ideas within that project. We also encourage students (PhD, UG) who are completing projects involving people with aphasia, to present to and consult with ARUG as part of their research training (e.g. Fiona Menger, Stroke Association Fellow).&nbsp;<br /> We are now looking at ways to ensure ARUG is sustainable over time. This is both in terms of members but also in terms of the researchers' time involved. Ideally there needs to be some consistency of faciltitator and/or overall coordinator. We are looking to a model where in future these costs might be met by funded grants (by having a costing model for any future grants). The aim would be to enable ARUG to continue consultation in the very early stages (when there is no identified funding stream) into a funded role in funded projects. ARUG members have not wanted remibursement for their time to date, but this, along with other principles, would need revisiting over time. ARUG would like to develop a web presence and a set of guidelines for researchers, drawing on its experience.<br /> <br /> The project also held a wider PPI event in November 2014, inviting participants, family members and referring speech and language therapists to a dissemination and future plans event. Results of the project were discussed and then small groups discussed their views on possible future directions for the research (summary available on request). These are being taken forward as we consider the next stages.&nbsp;<br /> As seen in the ResearchFish submission, there has been on-going engagement of the SLT profession, particularly regionally, who have been engaged in discussion about this project since the outset.<br /> &nbsp;<br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0609-18074). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between March 2011 and November 2014. This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

The effect of semantic feature analysis (SFA) treatment on confrontation naming and discourse production was examined in 2 persons, 1 with anomic aphasia and 1 with Wernicke's aphasia. Results indicated that confrontation naming of treated nouns improved and generalized to untreated nouns for both participants, who appeared to have different lexical access impairments. Both participants demonstrated improvement in some aspects of discourse production associated with the confrontation naming SFA treatment. However, there was no change in most manifestations of lexical retrieval difficulty during discourse for either participant. These findings support previous work regarding improved and generalized naming associated with SFA treatment and indicate a need to examine effects of improved confrontation naming on more natural speaking situations.

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Background: Semantic feature analysis (SFA) is a treatment approach aimed at enhancing lexical retrieval by improving access to the semantic network in speakers with aphasia. Although there are promising results on trained items, previous studies exploring the impact of SFA on verb production in monolingual speakers have shown mixed results for generalisation to untrained items and discourse. There are few published studies investigating SFA and action naming in multilingual speakers.Aims: The study explores the impact of SFA on trained and untrained verbs, semantics and syntax, and narrative production in the trained and untrained languages of a multilingual speaker (Japanese–English–German–Norwegian) with moderate non-fluent aphasia. Treatment was conducted in a late-acquired language (Norwegian).Methods & Procedures: SFA was provided during an intensive schedule of about 22 hr of therapy, with approximately 10 hr per week over two and a half weeks. The treatment focused on the production of verbs in sentence contexts.Outcomes & Results: Outcome measures include the Bilingual Aphasia Test, an action-naming test, and production of semi-spontaneous narratives.Outcomes in the treated language: Overall, the participant responded positively to the SFA treatment. The trained verbs improved significantly, but no transfer was observed to untrained verbs. There were no changes in the formal testing of semantics or syntax, but improvements were noted in narrative production.Cross-linguistic outcomes: Transfer to verbs in untreated German was evident. There were significant increases in the semantics and syntax in both English and German. The participant showed an improvement in discourse in English and German, although not in Japanese.Conclusions: SFA treatment in a late-acquired language can lead to gains in the treated language and transfer to both stronger and weaker languages, with different patterns for the various languages. This indicates that SFA may be a promising method for treating multilingual speakers with aphasia. The authors further advocate the use of narratives as an assessment tool. In addition to enhancing the ecological validity of the findings, the narratives provided information not obtainable from the other assessment tools for within- and cross-linguistic therapy gains for the participant.

Background: Generalization of treatment effects is the ultimate goal of therapy. However, treatment generalization across language modalities is not well understood in the aphasia literature and requires further investigation. This work examined the generalization effects of two word retrieval therapies, Phonomotor Treatment (PMT) and Semantic Feature Analysis (SFA), to reading performance in individuals with aphasia. Aims: This cross-modal generalization investigation was motivated by the Primary Systems Hypothesis, which proposes reading ability is related to and dependent upon underlying phonological and semantic abilities. Therefore, this study sought to determine if enhanced phonological or semantic knowledge following anomia treatment could influence reading ability. Methods & Procedures: Reading data collected in a randomized control trial for anomia treatment were retrospectively analyzed. Fifty-eight participants with chronic aphasia were randomly assigned to receive intensive PMT (n = 28) or SFA (n = 30) treatment for 56–60 hours over 6–7 weeks. Reading measures were administered pre-, post- and 3 months after treatment. To identify and compare the extent of treatment generalization to reading, within-group and between-group analyses of variance were performed. Outcomes & Results: On average, participants in both groups showed positive changes in reading. The PMT group demonstrated significantly improved reading of regularly and irregularly spelled words. The SFA group showed significant gains in reading of regularly spelled words and sentence-level reading comprehension. No statistically significant differences in oral reading or reading comprehension were found between the groups before or after therapy. Conclusions: These preliminary findings support the Primary Systems Hypothesis and suggest a link between reading ability and phonological and semantic abilities. Results show that one anomia treatment was not superior to the other and the positive influence of both PMT and SFA suggests that reading might be enhanced via intensively delivered treatments that focus on the underlying phonological or semantic impairment. Further investigations of cross-modal treatment generalization are needed to help better understand this relationship between word retrieval and reading and its implication for aphasia treatment.

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This study tested the effectiveness of a modified semantic feature analysis (SFA) treatment protocol that incorporated metacognitive strategy training (MST). Regarding its restitutive component, SFA most reliably results in improved word retrieval for treated items and untreated, semantically related items, but evidence of response generalization is often small/inconsistent. Regarding its substitutive component, SFA is thought to facilitate successful communication via habituation of the SFA circumlocution strategy. However, repeated practice with SFA's strategy in the absence of direct MST may not result in independent strategy use and/or generalization. Furthermore, people with aphasia's independent use of the SFA strategy in moments of anomia is presently underreported. To address these limitations, we incorporated MST into SFA and directly measured substitutive outcomes. Four people with aphasia participated in 24 treatment sessions of SFA + MST in a single-subject, A-B experimental design with repeated measurements. We measured word retrieval accuracy, strategy use, and explicit strategy knowledge. We calculated effect sizes to measure changes in word retrieval accuracy and strategy use and used visual inspection to assess gains in explicit strategy knowledge from pre- to posttreatment and retention. Participants achieved marginally small to medium effects in word retrieval accuracy for treated; untreated, semantically related; and untreated, semantically unrelated items and marginally small to large effects in independent strategy use. Explicit strategy knowledge was variable. Across participants, SFA + MST yielded positive changes in word retrieval accuracy or strategy use, or both. Positive changes in word retrieval accuracy were comparable to other SFA studies. Positive changes in strategy use demonstrate preliminary evidence of this treatment's ability to yield restitutive and substitutive gains. Overall, this study offers preliminary evidence of SFA + MST's effectiveness and highlights the importance of directly measuring SFA's substitutive outcomes, which showed that people with aphasia can respond to this treatment in multiple successful ways-not just improved target word production.

Background: Impairment-focused aphasia treatment has an ultimate goal of improving language production in connected speech and communication in daily life. Although impairment-based treatment has typically been carried out in words or sentences, investigations have begun to explore the efficacy of treatment during discourse production. Focusing treatment on an impaired linguistic process during discourse production is a complex and challenging endeavour. Aims: This paper aims to review investigations of discourse treatment for word retrieval impairment in aphasia in order to identify and discuss variables that emerge as being important considerations in clinical practice and continued research. Main Contribution: Seven investigations that applied treatments during structured discourse production to improve word retrieval in participants with aphasia were reviewed. Treatment methods used in the investigations included phonologic and orthographic cues, semantic feature analysis, contingency-based cueing hierarchies, and repeated conversational engagement. The discourse contexts used for treatment were structured conversations or structured narrative discourse. All investigations reported positive outcomes for improved word retrieval abilities. Although treated vocabulary items did not improve in all cases, improvements in general processes of word retrieval were reported. Focusing treatment on the linguistic process of word retrieval resulted in changes to discourse macrostructure, at least in terms of the informativeness of the discourse. When attitudes and perceptions of the participants with aphasia or of naïve judges were assessed, the outcomes were generally favourable. One investigation provided evidence that treatment in structured discourse was related to improved word retrieval in real-life conversations. Conclusions: There are several promising discourse treatment approaches for word retrieval impairments in aphasia. Systematic analysis of changes in the macrolinguistic processes of discourse, in real-life conversations, and in the attitudes and perceptions of participants with aphasia and others in future discourse treatment studies would enhance our insights about their efficacy.

Introduction. Patients with a fluent type of aphasia have semantically poor discourse, which is often uninformative for the interlocutor, having consequences for their daily life. One of the treatment methods used in clinical practice is the semantic feature analysis (SFA). The aim of this study was to determine the impact of this treatment method on the content of discourse in patients with fluent aphasia. Methods. The sample consisted of 30 subjects with fluent aphasia, namely: Wernicke's aphasia (9 subjects), conductive aphasia (6 subjects), transcortical sensory aphasia (8 subjects), and anomic aphasia (7 subjects). To assess the formation of narrative discourse, the picture subtest "Cake theft" from the Boston diagnostic test for aphasia was used. The content of the discourse was assessed by two experienced speech therapists - aphasiologists. Results. After the treatment using the semantic feature analysis, an increase in the number of content words was observed in all patients (H = 22.53, df = 3, p &lt; .001; H = 23.42, df = 3, p &lt; .001; H = 23.10, df = 3, p &lt; .001). Patients with Wernicke's and transcortical sensory aphasia had most impairment in the content/informativeness of discourse. Uninformative discourse was observed in 5 (33.33%) patients with Wernicke's and 4 (26.67%) patients with transcortical sensory aphasia. The type and severity of aphasia were shown to affect the informativeness of discourse. Conclusion. The semantic feature analysis treatment method leads to a significant improvement of narrative discourse in patients with milder forms of aphasia, such as anomic and conductive aphasia.

This study evaluated treatment fidelity for an ongoing randomized controlled trial comparing two variants of semantic feature analysis (SFA) treatment for naming impairment in aphasia. In this trial, participants are being randomized to treatment conditions (many- or few-features) in which they are asked to generate either 11 or five features per SFA trial. Treatment fidelity was addressed via study design, manualization of the treatment, provider training, and maintenance of daily treatment logs, among other approaches. Fidelity was assessed through protocol adherence checks, interrater reliability of feature counting, and analysis of treatment dosage. Protocol adherence was measured using a 20-item checklist. Interrater reliability was evaluated for feature counts on 10% of treatment sessions. Treatment dosage was analyzed to confirm differentiation between many-features and few-features groups in terms of features generated and exposed and equivalence in terms of total treatment time. Overall protocol adherence was 99%. Interrater reliability for feature counting showed good-to-excellent agreement. Analysis of treatment dosage in terms of features per trial confirmed clear differentiation between groups, with the many-features group generating or being exposed to approximately 10-11 features per trial compared to four to five features for the few-features group. Analysis of other aspects of dosage also suggested good fidelity to the design. This ongoing trial of SFA is being implemented with high levels of treatment fidelity. The study demonstrates the importance and feasibility of comprehensive fidelity monitoring in aphasia treatment research. Detailed fidelity procedures and outcomes support interpretation, replication, and clinical implementation of study findings. https://doi.org/10.23641/asha.29230937.

Purpose This meta-analysis synthesizes results from published studies that used semantic feature analysis (SFA) treatment to improve naming for people with aphasia. It examines how both person- and treatment-related variables affected the likelihood of correct naming responses in individual probe sessions for both acquisition (treated) and generalization (untreated) stimuli. Method The meta-analysis compiled data from 12 studies analyzing a total of 35 participants with aphasia. It used mixed-effects models as a novel statistical tool to examine the effects of 2 sets of variables on naming performance: treatment-related variables, including treatment phase (baseline vs. treatment), dosage (number of treatment sessions), and stimulus type (treated vs. untreated, semantically related vs. unrelated items), and person-specific variables, including degree of language impairment and demographic variables (age, time poststroke). Results Results of the meta-analysis revealed that SFA intervention promoted increased naming accuracy during naming probes when comparing baseline and treatment phases. In addition, increased dosages of SFA were associated with increased naming accuracy, and treatment-related gains were larger for acquisition (treated) than generalization (untreated) stimuli, likewise for related versus unrelated generalization stimuli. Furthermore, a subset of person-specific variables was predictive of SFA-related gains: Language impairment variables were related to treatment-related changes in naming performance, but demographic variables were not. Conclusion These results provide group-level evidence for the efficacy of SFA as well as preliminary estimates of how much naming performance benefit is engendered by varying dosages of SFA. The results also provide promising and previously unobserved evidence of potential person-level predictors of SFA treatment response.

Purpose: There is a growing body of evidence showing the benefit of Semantic Feature Analysis in the treatment of word finding abilities in people with aphasia. The original technique was grounded in the hypothesis that the activation of semantic features spreads to the target and thereby facilitates its subsequent retrieval. However, it remains unclear the extent to which the focus on semantic features influences the treatment effects. The aim of this study was therefore to shed light on this issue by examining the effect of priming with semantic features (parts and functions) on target retrieval across a case series of people with aphasia. Method: 10 people with aphasia and word retrieval impairments were primed with spoken forms of words that were either the target name (identity condition, e.g. car), parts of the target (e.g. wheel) or functions of the target (e.g. drive) before later being asked to name a picture of that target. An unrelated prime condition (e.g. employ) was used as a control for test-retest effects. Result: At a group level, there was speeding of reaction times in picture naming in the identity condition relative to the unrelated condition; however, no effect of priming was found for either parts or functions. There was significantly better response accuracy in post-priming naming, but this effect did not reach significance for any individual experimental condition (identity, parts, functions) as compared to the unrelated condition, although the identity condition showed numerical improvement while the other two conditions showed decline. Conclusion: Given the lack of evidence for facilitatory effects from parts and functions of a target in a priming task, this research suggests that further research is warranted on the extent to which the improvement in word retrieval subsequent to Semantic Feature Analysis is caused by the emphasis on production of semantic features rather than from the repetition of the target name.