Naming gains and within-intervention progression following semantic feature analysis (SFA) and phonological components analysis (PCA) in adults with chronic post-stroke aphasia

Introduction Individual response to aphasia therapy is highly variable and difficult to predict. While different therapies for word retrieval are often given based on assumptions regarding the underlying breakdown, behavioural symptoms do not consistently predict which type of naming therapy will be most effective. Measures of cortical connectivity derived from EEG before and after therapy may provide additional important information for predicting and understanding response to therapy. Methods Twenty-three adults were recruited including eight adults with chronic, post-stroke aphasia who successfully completed 12 therapy sessions over 4 weeks, alternating between semantic and phonological approaches to word retrieval based on semantic feature analysis and phonological components analysis. Fifteen age-matched healthy controls were included for comparison. High-density electroencephalography (128 channel EEG) was measured during a picture-word judgement task performed before and after treatment for the aphasia group. Analysis of EEG via a dynamic causal modelling (DCM) approach was used to assess semantic and phonological processing pre and post therapy. DCM was applied using five fronto-temporo-parietal regions of interest based on source imaging analysis in the control and aphasia groups. Results Post-treatment naming improvement was associated with cortical responses measured bilaterally in a DCM connectivity model. Specifically, naming improvement for items treated with semantic feature analysis was correlated with (a) increased pre-treatment coupling between the left inferior parietal lobule and left inferior frontal gyrus (r = 0.63, pFDR=0.016) (b) increased coupling from left to right inferior parietal lobule (r = .77, FDRp = .0005) and (c) decreased pre-treatment coupling between the right inferior parietal lobule and right anterior middle temporal gyrus (r = -0.76, pFDR = 0.03). Post-treatment, reduced coupling between right inferior frontal gyrus and right posterior superior temporal gyrus was also significantly correlated with naming improvement for semantic treatment items (r= −0.53, pFDR=0.010). Conclusions This preliminary study on a small cohort of individuals with chronic aphasia has demonstrated the potential of DCM connectivity models derived from EEG data to predict and understand aphasia therapy response. In addition to highlighting the importance of connectivity within left hemisphere networks and inter-hemispheric coupling for treatment, the observation of reduced right intrahemispheric coupling in those individuals with improved outcomes supports the view that right hemisphere mechanisms may not invariably support treatment-induced recovery. Elucidating effective ipsilateral and contralateral connectivity before and after aphasia treatment provides new insights into therapy-induced reorganisation of cortical networks associated with successful therapy outcomes.

Therapy for naming impairments post-stroke typically involves semantic and/or phonologically-based tasks. However, the relationship between individuals' locus of breakdown in word retrieval and their response to a particular treatment approach remains unclear, and direct comparisons of treatments with different targets (semantics, phonology) yet similar formats are lacking. This study examined eight people with aphasia who each received 12 treatment sessions; half the sessions involved a semantically-based treatment task, Semantic Feature Analysis (SFA), and the other half involved a phonologically-based treatment task, Phonological Components Analysis (PCA). Pre-therapy baseline accuracy scores were compared to naming accuracy post-treatment and at follow-up assessment. Seven of the eight participants showed significant improvements in naming items treated with PCA, with six of these seven participants maintaining improvements at follow-up. Four of the eight participants showed significant improvements for items treated with SFA, with three of the four maintaining improvements at follow-up. The semantic therapy was not beneficial for participants with semantic deficits. In contrast, the phonological therapy was beneficial for most participants, despite differences in underlying impairments. Understanding the relationship between an individual's locus of breakdown in word retrieval and response to different treatment tasks has the potential to optimise targeted 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.

The primary goal of this study was to evaluate the treatment effects of semantic feature analysis (SFA) and phonological components analysis (PCA) on word retrieval processing in persons with aphasia (PWAs). After identifying the locus of the breakdown in lexical retrieval processing, 15 monolingual native Persian speakers with aphasia were divided into two groups. After three naming trials, participants with dominant semantic deficits received SFA, and participants with primary phonological deficits were provided with PCA three times a week for eight weeks. Both approaches improved participants’ naming and performance on language tests, including spontaneous speech, repetition, comprehension, and semantic processing. However, the correct naming of treated and untreated items was higher in mild-to-moderate participants, with mostly circumlocution and semantic paraphasias in the SFA group. The same holds for mild-to-moderate participants with mostly phonemic paraphasia who received PCA therapy. Moreover, the results showed that participants’ baseline naming performance and semantic abilities could be associated with the treatment outcomes. Although limited by a lack of a control group, this study provided evidence supporting the possible benefits of focusing on the locus of the breakdown for treating anomia through SFA and PCA approaches, specifically in participants with mild to moderate aphasia. However, for those with severe aphasia, the treatment choice may not be as straightforward because several variables are likely to contribute to this population’s word-finding difficulties. Replication with larger, well-stratified samples, use of a within-subjects alternating treatment design and consideration of treatments’ long-term effects are required to better ascertain the effects of focusing on the locus of breakdown for treatment of anomia.

The effects of intensity on a phonological treatment for anomia in post-stroke aphasia

Neural activity associated with semantic versus phonological anomia treatments in aphasia

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BackgroundPeople with aphasia present with language and communication deficits, most notably in lexical retrieval (naming). Although positive outcomes in naming have been observed following speech-language treatment, many individuals with aphasia continue to face impairments after the acute phase of rehabilitation. Mobile app–based therapies are increasingly being used by speech-language pathologists in the rehabilitation of people with aphasia as an adjunct to or in lieu of traditional in-person therapy approaches. These apps can increase the intensity of treatment and have been shown to result in meaningful outcomes across several domains.ObjectiveVoiceAdapt is a mobile therapy app addressing naming impairments, designed within a user-centered design framework. The VoiceAdapt app uses two evidence-based lexical retrieval treatments to engage people with aphasia to improve their naming abilities through interaction with the app. The purpose of this study was to conduct a randomized controlled trial to examine the preliminary clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia.MethodsA two-arm, waitlist-controlled, crossover group randomized controlled trial was conducted at two sites within Canada. During the intervention phase, participants completed 5 weeks of independent training with the app, which involved naming practice using Semantic Features Analysis and Phonological Components Analysis. The primary outcome measure was naming performance (Boston Naming Test); secondary outcomes included measures of overall language and naming (Western Aphasia Battery-Revised), communication (Communication Effectiveness Index), and quality of life (Stroke and Aphasia Quality of Life Scale-39).ResultsA total of 37 people with aphasia in the chronic stages (average 4.6 y postonset of aphasia) participated in this study. Participants used the app for an average of 20 hours over the 5-week intervention phase. Training with VoiceAdapt resulted in an increase of 1.6 points on the Boston Naming Test (Cohen d=0.3). Evidence for improved naming was also observed on trained items, as well as subtests of naming or word-finding on the WAB-R. Training with the app also resulted in a significant increase in participants’ perceptions of their communication quality of life (increase of 0.1 points; Cohen d=0.3), but no other measures (WAB-R Aphasia Quotient, Communicative Effectiveness Index) were significant.ConclusionsIndividuals with aphasia who used the VoiceAdapt app for 5 weeks to target naming skills demonstrated measurable gains in naming and communication-based quality of life. Notably, these changes were observed in a remotely delivered program, in participants who were in the chronic stages of aphasia. These findings inform the profession on the use of app-based home therapy programs as an accessible, cost-effective option for individuals in the chronic stages of recovery who often have limited options for rehabilitation.

ABSTRACTThere is a lack of clarity in the field regarding how to best predict which naming treatment will be most beneficial for a particular individual with aphasia. The purpose of this study was to elucidate whether or not semantic or phonological therapy differentially impacts on outcomes for people with a range of different aphasic profiles when given both therapies. A single-participant design, with multiple repeated baselines for naming, replicated across four participants, was used. Participants were provided with a counterbalanced order of Semantic Feature Analysis (SFA) and Phonological Components Analysis (PCA) treatment. Findings demonstrated differential effects across participants. This seemed to be influenced by factors such as severity of anomia, order of treatment presentation, and capacity limits. Clinical implications of these findings highlight the importance of expanding our picture of a participant’s behaviours to consider what other important factors can inform intervention decisions.

Purpose The influential relationship between executive functioning and aphasia rehabilitation outcomes has been addressed in a number of studies, but few have studied the effect of adding executive function training to linguistic therapies. The present study aimed to measure the effects of combining, within therapy sessions, executive function training and anomia therapy on naming and discourse abilities in people with chronic aphasia. Method A single-case experimental design with multiple baselines across participants was used. Four persons with chronic post-stroke aphasia received 12 sessions of a tailored treatment combining executive function training and semantic feature analysis (SFA) therapy. Naming accuracy of treated items was examined over the course of the treatment while control naming scores of untreated items and discourse measures were collected pre-treatment, immediately post-treatment, and 4 weeks post-treatment, in order to investigate the multidimensional effects of the treatment and their maintenance. Result Naming skills improved in all participants for treated and untreated items, were maintained over time, and were accompanied by improved discourse abilities. Visual and statistical analyses showed a significant treatment effect for naming skills in three out of the four participants. Conclusion A combination of executive function training and SFA treatment in people with chronic aphasia may improve both naming skills and discourse efficiency. Further studies are needed to substantiate these promising preliminary results.

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Elucidating the mechanisms of successful word retrieval by anomia therapy could improve our knowledge about language processing and also help design effective treatments. The two main subcomponents of resting-state networks related to language processing are the default mode network (DMN) and the language network (LN). To study how changes in brain activation occur due to anomia therapy, we investigated pre-and-post changes in the DMN and LN activation nodes in a deficit-based treatment of 15 persons with aphasia (PWAs). In this method, seven participants (mean age 46.71 ± 8.99) with predominant semantic type errors received the semantic feature analysis (SFA) treatment approach, and 8 participants (mean age 46.5 ± 10.47) with mostly phonological type errors were treated with phonological components analysis (PCA) intervention. Both treatments improved word retrieval and had generalization effects on the language function. Increased activation in frontoparietal areas was observed after PCA therapy, while naming improvement after SFA was associated with increased activation in frontotemporal areas. These findings show that focusing on the impaired level of word retrieval processing may also be associated with changes in activation in brain areas related to that impaired level. Future studies could investigate the DMN and LN networks of the resting state-functional magnetic resonance imaging (rs-fMRI) to understand the mechanisms involved in aphasia therapy.

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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.