Structural fragmentation of linguistic brain networks predicts aphasia severity, but not response to treatment.

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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.

Event Abstract Back to Event A Comparison of Two Treatment Approaches for Agrammatic Broca's Aphasia: Script Therapy vs. Verb Network Strengthening Treatment Maureen Costello-Yacono1, 2* and Venugopal Balasubramanian1* 1 Seton Hall University, Speech Language Pathology, United States 2 La Salle University, Communication Sciences and Disorders, United States Background/Introduction: Individuals with agrammatic Broca’s aphasia frequently are treated at single word level, verb priming, or simple sentence structure treatments. In this study, an impairment specific treatment such as Verb Network Strengthening Treatment (VNeST) was explored as well as a social functional approach such as Script Therapy. These two approaches were assessed by the outcome measures of rate of speech, subject-verb-object production, and error rates during probe tasks. Objective: To examine the impact of two treatment approaches: Script Therapy and Verb Network Strengthening Treatment for two individuals with chronic agrammatic Broca’s aphasia. Method: The method used in this study was a single subject multiple baseline alternating treatment across participants’ design. Each participant received each therapy for 9 weeks and both treatments were counterbalanced. Generalization probes were administered on the second session of each treatment per week to assess pre-to-post outcome measures including rate of speech, subject- verb-object production (SVO), and error rate. Effect sizes were calculated for baseline through maintenance outcome measures. To analyze the inter-therapeutic effects of the two treatment, the Percentage of data Exceeding the Median (PEM) was used. Results: Both participants improved over the 18 weeks on rate of speech and subject verb-object (SVO) production during probe tasks. For P1, Error rates decreased from baseline to maintenance phases. Effect sizes were calculated for the baseline to maintenance phases using the Busk & Serlin’s d2 formula (1992). The effects size calculations were compared using the Beeson & Robey (2006) benchmarks for lexical and syntactic metanalyses for aphasia. For the baseline to maintenance effects, small effect sizes were found for both participants for rate of speech. For P1, a medium to large effect was noted for SVO production. P2’s effect size for SVO production revealed no effect. Error rates for P1 revealed no effect. P2’s error rate produced a small unfavorable effect. Conclusions: Both participants benefitted from the two treatment approaches in individual ways. It is possible that the multi-modal nature of the training between VNeST and Script that engaged functional sentence production and a linguistic approach for sentence production contributed to a positive language change for these participants. 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Integrating the message level into treatment for agrammatism using story retelling. Aphasiology, 18(5-7), 429-441. Retrieved from http://search.proquest.com/docview/85329796?accountid=11999 Olswang, L. B. (1993). Treatment efficacy research: A paradigm for investigating clinical practice and theory. Journal of Fluency Disorders, 18(2-3), 125-131. Plowman, E., Hentz, B., & Ellis, C. (2012). Post-stroke aphasia prognosis: A review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice, 18(3), 689-694. doi:10.1111/j.1365-2753.2011.01650.x Raymer, A. M., & Ellsworth, T. A. (2002). Response to contrasting verb retrieval treatments: A case study. Aphasiology, 16(10), 1031-1045. doi:10.1080/026870401430000609 Raymer, A. M., & R Keywords: agrammatic aphasia, Script Therapy, Verb network strengthening treatment, impairment specific approach, social conversation approach Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018. Presentation Type: poster presentation Topic: not eligible for a student prize Citation: Costello-Yacono M and Balasubramanian V (2019). A Comparison of Two Treatment Approaches for Agrammatic Broca's Aphasia: Script Therapy vs. Verb Network Strengthening Treatment. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00020 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 16 Apr 2018; Published Online: 22 Jan 2019. * Correspondence: Dr. Maureen Costello-Yacono, Seton Hall University, Speech Language Pathology, South Orange, NJ, 07079, United States, costellom3@lasalle.edu Dr. Venugopal Balasubramanian, Seton Hall University, Speech Language Pathology, South Orange, NJ, 07079, United States, balasuve@shu.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Maureen Costello-Yacono Venugopal Balasubramanian Google Maureen Costello-Yacono Venugopal Balasubramanian Google Scholar Maureen Costello-Yacono Venugopal Balasubramanian PubMed Maureen Costello-Yacono Venugopal Balasubramanian Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

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.

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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Background: Semantic feature analysis (SFA) is a prominent treatment for the word retrieval deficits of aphasia. Generalisation of improved word retrieval on picture naming to discourse production has been an important factor for evaluating the effectiveness of SFA treatment. Unfortunately, generalisation of word retrieval improvements to discourse production following SFA has been modest. Aims: Because of the previous, albeit limited, success of SFA in producing improved word retrieval for discourse we further examined the utility of SFA for reducing noun and verb retrieval failures in aphasic discourse. Rather than use SFA as a means for improving generalisation of picture naming or as a compensatory strategy for lexical failures during discourse, we applied SFA as an a priori means to reduce the frequency of word retrieval failures in discourse. Methods & Procedures: Semantic feature analysis was applied to object and action word retrieval failures appearing during picture descriptions and procedural questions by two participants with anomic aphasia. A single case time-series design across behaviours with replication was used to assess changes in discourse production as well as generalisation of treatment effects to untrained pictures resulting from SFA. Outcomes & Results: Increases were observed in verbal productivity for both participants, while the informativeness of the participant's discourse, as measured by correct information unit analyses, also improved. Minimal changes were observed in the frequency and type of word-finding behaviours evinced by the participants; this finding was attributed to a masking effect arising from the participants' increased quantity of verbal output. Evidence was also found that targeting word finding behaviours in connected speech generalised to naming of untrained object and action pictures. Conclusions: The changes effected by this discourse-based approach to SFA were as robust and as consistent as has been achieved previously with SFA treatment. The choice to use a discourse-based versus a picture-based approach to SFA treatment might be based on the ecological validity of the discourse-based approach.

<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.

Transcranial direct current stimulation to treat aphasia: Longitudinal analysis of a randomized controlled trial

IntroductionAnomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting. MethodsIn a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication. ResultsParticipants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group. ConclusionsGroup intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.

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.

Purpose: This study investigates whether inner speech—the mental rehearsal of words without articulation—facilitates naming recovery in individuals with aphasia. We hypothesized that items with preserved inner speech but impaired overt naming at baseline would improve more after speech therapy than items without inner speech. We explored the extent to which a change in inner speech across the study supported naming recovery. Method: Nineteen participants with chronic, expressive aphasia participated in three pre-treatment naming sessions, nine treatment sessions (semantic feature analysis), and three post-treatment naming sessions. For each pre- and post-treatment naming session, participants named ~300 items (pictures of nouns) aloud and also indicated whether they had inner speech for each item. Based on pre-treatment naming sessions, 30 individualized items (“Treated30”) were trained using semantic feature analysis. Mixed-effects models analyzed the effect of treatment, inner speech, psycholinguistic properties, and aphasia severity on naming outcomes immediately post-treatment. Results: There was a significant proportional improvement on overt naming and inner speech for the Treated30 from baseline to follow-up. In a series of mixed models, the most significant predictor was the interaction between treatment and inner speech across the study. Baseline inner speech, on its own, did not significantly predict post-treatment naming outcomes. Conclusions: Findings suggest a bidirectional relationship between inner and overt speech: importantly, improvements in inner speech significantly influence therapy-related gains in naming. Age of acquisition also explained naming outcomes, though to a lesser extent. These results suggest that inner speech-focused interventions may improve outcomes by providing a cognitive scaffold for speech production.

What Can Neuroimaging Tell Us About Aphasia?

Background: Up to 60% of people with aphasia experience persistent word-finding difficulties into the chronic stage, starting six months after the stroke. Semantic Feature Analysis (SFA) and Phonological Components Analysis (PCA) are two common word-finding interventions that use the generation of semantic features for SFA (e.g. category) and phonological features for PCA (e.g. first sound) to improve naming. Despite inconsistent support for the generalization to untreated items, studies have shown improvements on probe word naming for treated items. However, research concerning within-intervention effects and generalization to alternative contexts has been limited. Aim: This study investigated the effect of treatment for SFA and PCA probe word naming as well as their within-intervention effects in four individuals with chronic post-stroke aphasia. Methods & Procedures: Baseline and follow-up measures included standardized assessments and image naming tasks. The image naming task was used to generate three lists: an SFA treated list, a PCA treated list, and an untreated list. One SFA session and one PCA session per week were then provided concurrently to each participant for a period of six weeks. Outcomes & Results: While only one participant experienced significant gains on treated probe word naming, these gains were maintained four weeks after the intervention. Exploratory results suggested that effects could transfer to two types of generalization items: different pictures of the same items and pictures of items shown in a natural context. Furthermore, while generalization to untreated items did not reach significance for any participant, some generalization of gains to standardized assessments was observed. Although rarely equivalent for SFA and PCA interventions, all participants also experienced some degree of within-intervention improvement over the progression of sessions. These improvements included a reduction in the number of forced choices required for feature generation and/or a reduction in the number of words never named during intervention sessions. Conclusion: The results support additional avenues of investigation for SFA and PCA therapies for individuals with post-stroke aphasia, namely within intervention effects and the potential for generalization to different contexts.

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.