Therapy for phonological assembly difficulties: A case series

Abstract

Background: One of the few studies to describe therapy specifically for phonological assembly difficulties in aphasia is a single-case study by Franklin, Buerk, and Howard (2002). Their client made a significant improvement in picture naming for both treated and untreated words after therapy comprising two phases, the first aimed at improving auditory awareness and the second aimed at improving self-monitoring. Aims: This study aimed to determine whether the treatment programme used by Franklin et al. (2002) is replicable with other people with impaired phonological assembly as the main part of their aphasia, and to explore any differences in the outcomes for participants. Methods & Procedures: A case series of four participants with aphasia with mixed impairments including phonological assembly difficulties received a replication of the treatment protocol described by Franklin et al. (2002). Outcomes & Results: None of the participants responded to therapy in the same way as Franklin et al.’s (2002) original client. Three participants improved on naming after the first, auditory discrimination, phase of therapy, but only one participant made further gains in naming following the second, monitoring, phase of therapy, and all improvements seen were for treated items only. One participant did not show any significant improvement on naming of treated or untreated items after either phase of therapy. Conclusions: Whereas Franklin et al.’s (2002) original client had a relatively pure post-lexical phonological assembly impairment, the three participants in the current study whose speech improved after therapy had a combination of lexical and post-lexical phonological impairments, and it is proposed that their item-specific improvements in picture naming occurred as a result of improved mapping between semantics and the phonological output lexicon. The participant in this study whose speech did not improve following therapy had a combination of phonological assembly difficulties and apraxia of speech. This study demonstrates that the same therapy can work at different levels for different individuals, depending on many factors, including their profile of linguistic and cognitive impairments.