Abstract
Speech production impairment is a frequent deficit observed in aphasic patients and rehabilitation programs have been extensively developed. Nevertheless, there is still no agreement on the type of rehabilitation that yields the most successful outcomes. Here, we ran a detailed meta-analysis of 39 studies of word production rehabilitation involving 124 patients. We used a model-driven approach for analyzing each rehabilitation task by identifying which levels of our model each task tapped into. We found that (1) all rehabilitation tasks are not equally efficient and the most efficient ones involved the activation of the two levels of the word production system: the phonological output lexicon and the phonological output, and (2) the activation of the speech perception system as it occurs in many tasks used in rehabilitation is not successful in rehabilitating word production. In this meta-analysis, the effect of the activation of the phonological output lexicon and the phonological output cannot be assessed separately. We further conducted a rehabilitation study with DPI, a patient who suffers from a damage of the phonological output lexicon. Our results confirm that rehabilitation is more efficient, in terms of time and performance, when specifically addressing the impaired level of word production.
Highlights
Production difficulties are reported to be the most frustrating and distressing aspects of aphasia and one of the first causes of social drop out and depression among patients [1]
Several authors have claimed after years of research that no clear connection between the type of impairment and the most effective therapy can be established. We argue that such questions can be clarified by relying on a single language processing model used simultaneously for the diagnosis of the deficit and for the design of rehabilitation tasks
Three types of analyses were conducted: Performance after each pretest and after each of the four rehabilitation phases was assessed in all pictures in order to assess whether the rehabilitation program is successful and determine which phase is the most successful; Performance in each trained set before and after the rehabilitation phase was assessed in order to investigate whether trained items were successfully named at the end of the phase
Summary
Production difficulties are reported to be the most frustrating and distressing aspects of aphasia and one of the first causes of social drop out and depression among patients [1]. Restoring language production through rehabilitation is of considerable clinical interest. There is still considerable disagreement regarding the most efficient rehabilitation strategy, and it is still unclear whether it should target the language faculty broadly or focus on the specific disorder at hand. We argue that such questions can be clarified by relying on a single language processing model used simultaneously for the diagnosis of the deficit and for the design of rehabilitation tasks. We illustrate this point with a statistical meta-analysis of 39 rehabilitation studies, and a case study of the rehabilitation of an aphasic patient
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