Untreated Items Research Articles

Clear Masks Do Not Prevent Gains During Dynamic Temporal and Tactile Cueing Treatment: An Explanatory Sequential Mixed Methods Pilot Study

Purpose: This study aimed to determine the outcomes and impact of Dynamic Temporal and Tactile Cueing (DTTC) treatment when clear vinyl masks were worn. DTTC is one of the few evidence-based treatments for children with childhood apraxia of speech (CAS). Given that DTTC relies on visual, auditory, and tactile cues, it was unknown if treatment gains would be demonstrated when masks were worn and how masking would impact the therapy experience for clinicians and caregivers. Method: A sequential mixed methods design was used to study the efficacy of DTTC treatment in children with CAS when clear masks were worn. The quantitative phase used a multiple-baseline across-participants design. Four children (each 4 years of age) participated in the treatment protocol in which 24 sessions of DTTC were provided over 8 weeks while clear vinyl face masks were worn by participants and clinicians. Whole word accuracy on treated items and generalization to easy and hard untreated items were assessed during baseline, treatment, and follow-up. Semistructured interviews were conducted with clinicians and caregivers following treatment to explore the experience of masks being worn during treatment. Qualitative data were analyzed using descriptive thematic analysis. Results: Three children completed the treatment protocol. Visual and statistical analyses revealed that two participants demonstrated significant treatment effects, with one also demonstrating generalization. The remaining participant demonstrated marginal treatment gains. Qualitative findings revealed two main themes: “mask wearing was inconvenient but did not prevent therapy gains” and “in-person therapy with face masks was preferable to teletherapy.” Conclusions: Masks did not prohibit treatment gains during DTTC therapy, with treatment effects of varying degrees shown for the three participants who completed the protocol. Together, quantitative and qualitative results indicate that mask wearing was, for most, a minor inconvenience that did not substantially interfere with the efficacy of DTTC treatment. Supplemental Material: https://doi.org/10.23641/asha.26408854

Combining executive function training and anomia therapy in chronic post-stroke aphasia: A preliminary study of multidimensional effects

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.

Effectiveness of French Phonological Components Analysis in individuals with chronic aphasia.

Over 50% of individuals with aphasia face ongoing word-finding issues. Studies have found phonologically oriented therapy helpful for English speakers, but this has not yet been studied in French. It is essential to assess the effectiveness of such a therapy in French, considering the distinct linguistic typologies between both languages, which may impact the outcomes of phonologically oriented interventions. This paper evaluates the effectiveness of French Phonological Component Analysis (Fr-PCA) on communication skills of individuals with chronic aphasia and the impact of individual factors on treatment success. Eighteen individuals with chronic aphasia received 15 h of Fr-PCA therapy over 5 weeks. Naming accuracy for treated and untreated words was measured before and after therapy, as well as at 3- and 6-month follow-ups. Secondary outcome measures included standardized tests measuring within-level generalization (object and action naming) and across-level generalization (repetition, verbal fluency, oral comprehension, communication effectiveness reported by a frequent communication partner). Fr-PCA led to improved accuracy for treated (17 participants out of 18) and untreated words (9 participants out of 18), with gains maintained at 6-month follow-up (7 participants out of 10 for treated and 6 participants out of 10 for untreated), and generalization to communication effectiveness reported by a frequent communication partner (11 participants out of 16). Age, apraxia of speech severity and initial anomia severity impacted therapy gains. Though more research is needed, results suggest Fr-PCA benefits French individuals living with aphasia. Identifying individual factors influencing therapy gains could enable clinicians to improve therapy tailoring. What is already known on this subject Phonological Component Analysis (PCA) improves naming of treated and untreated items in individuals living with aphasia. There is also evidence supporting long-lasting benefits following PCA. However, PCA has never been studied in French, a language presenting with a different linguistic typology than English, and we know little as to which individual factors can influence PCA therapy benefits. What this paper adds to existing knowledge Through group-level analyses on both personalized sets and standardized tests, this study shows that PCA constitutes an effective therapy protocol for francophone individuals living with aphasia. The gains are measured on treated and untreated items and generalized to levels other than naming, such as communication effectiveness. Individual factors such as age, initial anomia severity and apraxia of speech severity influence therapy outcomes. What are the potential or actual clinical implications of this work? There is now evidence supporting PCA in French, a language with strong morphological-phonological interactions. Furthermore, when working with individuals living with aphasia and severe anomia or apraxia of speech, gains can still be made, but might be longer to attain.

Improving lexical retrieval with LingoTalk: an app-based, self-administered treatment for clients with aphasia

IntroductionLingoTalk is a German speech-language app designed to enhance lexical retrieval in individuals with aphasia. It incorporates automatic speech recognition (ASR) to provide therapist-independent feedback. The execution and effectiveness of a self-administered intervention with LingoTalk was explored in a case series study.MethodsThree individuals with chronic aphasia participated in a highly individualized, supervised self-administered intervention lasting 3 weeks. The LingoTalk app closely monitored the frequency, intensity and progress of the intervention. Treatment efficacy was assessed using a multiple baseline design, examining both item-specific treatment effects and generalization to untreated items, an untreated task, and spontaneous speech.ResultsAll participants successfully completed the intervention with LingoTalk, although one participant was not able to use the ASR feature. None of the participants fully adhered to the treatment protocol. All participants demonstrated significant and sustained improvement in the naming of practiced items, although there was limited evidence of generalization. Additionally, there was a slight reduction in word-finding difficulties during spontaneous speech.DiscussionThis small-scale study indicates that self-administered intervention with LingoTalk can improve oral naming of treated items. Thus, it has the potential to complement face-to-face speech-language therapy, such as within in a “flipped speech room” approach. The choice of feedback mode is discussed. Transparent progress monitoring of the intervention appears to positively influence patients' motivation.

Improved comprehension of irony and indirect requests following a severe traumatic brain injury: two case studies

ABSTRACT Background Following a traumatic brain injury (TBI), people frequently have difficulty understanding nonliteral language, including irony and indirect requests. Despite the handicap that these disorders can represent in daily life, they are rarely treated clinically, and remediation studies are scarce. Aims The present study thus aimed to evaluate the effectiveness of an explicit metapragmatic therapy targeting nonliteral language comprehension and taking into account cognitive processes likely to underlie this comprehension (i.e., contextual processing, theory of mind, and executive functions). Methods & Procedure This study was registered on the ClinicalTrials.gov system (ID: NCT04708561) before participant recruitment. Two adults with severe TBI took part in the study. An ABA design with multiple baselines was used to assess the evolution of treated and non-treated written literal and nonliteral story comprehension, as well as ecological tasks and tasks assessing the cognitive processes of interest (theory of mind and executive functions). An interview was also conducted at the end of treatment to assess participant satisfaction. Outcomes & results Therapy resulted in significant improvement in treated items, with one-month maintenance of gains and generalisation to untreated items in both participants. The generalisation to a working memory task was also observed in one participant. Finally, participant satisfaction with the treatment was high. Conclusions & implications Our study demonstrated for the first time the potential of a therapy targeting irony and indirect request comprehension in TBI individuals. Clinically, it offers concrete therapeutic avenues and fills a critical gap in the TBI population’s evidence for the remediation of nonliteral language comprehension.

Pattern-Based Target Selection for Treatment of Irregular Past Tense: A Single-Case Experimental Design for Children With Developmental Language Disorder.

Many children with developmental language disorder (DLD) demonstrate difficulty inflecting irregular past tense verbs. We evaluated using phonological-based patterns (i.e., schemas) to select targets for treatment of irregular verb inflection for children with DLD. We hypothesized this approach would result in acquisition of treated verbs, generalization to untreated verbs within the same phonological schema, and increased use of correct irregular verbs in naturalistic contexts. Treatment was provided to three 7-year-old participants with DLD in the context of multiple baseline designs across behaviors and participants. Phonological schemas included vowel change, final alveolar, and dual change irregular verbs. Treatment was provided using established therapeutic approaches, including narrative generation, sentence imitation, and naturalistic play activities. Acquisition of treated and untreated targets was assessed at the beginning of sessions, and use of verbs in naturalistic contexts was observed throughout treatment sessions. Positive acquisition effects were noted for two of three participants. Generalization to untreated items occurred within and across treatment sets for two participants, whereas increases in accurate irregular verb production in naturalistic contexts were not observed. Outcomes demonstrated support for a pattern-based approach to target selection for treatment of irregular past tense verbs. One participant, who demonstrated general difficulty with the probe and treatment tasks, showed no treatment effect, suggesting that the treatment may be effective for some children with DLD. Further research is warranted to determine what factors might have influenced these variable outcomes across participants. https://doi.org/10.23641/asha.23671500.

Focusing on the locus of the breakdown for treatment of anomia: a pilot study

ABSTRACT 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.

Early within therapy naming probes as a clinically-feasible predictor of anomia treatment response

ABSTRACT This study investigated the relationship between early within-therapy probe naming performance and anomia therapy outcomes in individuals with aphasia. Thirty-four adults with chronic, post-stroke aphasia participated in the Aphasia Language Impairment and Functioning Therapy (Aphasia LIFT) programme, comprised of 48 h of comprehensive aphasia therapy. Sets of 30 treated and 30 untreated items identified at baseline were probed during impairment therapy which targeted word retrieval using a combined semantic feature analysis and phonological component analysis approach. Multiple regression models were computed to determine the relationship between baseline language and demographic variables, early within-therapy probe naming performance (measured after 3 h of impairment therapy) and anomia treatment outcomes. Early within-therapy probe naming performance emerged as the strongest predictor of anomia therapy gains at post-therapy and at 1-month follow-up. These findings have important clinical implications, as they suggest that an individual’s performance after a brief period of anomia therapy may predict response to intervention. As such, early within-therapy probe naming may provide a quick and accessible tool for clinicians to identify potential response to anomia treatment.

Outcomes from a pilot dose comparison study of naming therapy in aphasia

ABSTRACT Background People with aphasia vary considerably in response to aphasia treatments. Treatment dose is likely to be an important factor in understanding treatment response variability and optimising aphasia recovery; however, there is limited empirical evidence to guide dose prescription in post-stroke aphasia rehabilitation. In the present study, we used a novel approach to personalise dose prescription and explored the effect of dose on treatment response in chronic post-stroke aphasia. Aims Examine the effect of providing personalised doses of a cued picture naming treatment (Kendall et al., 2014) on acquisition and maintenance of picture naming outcomes. Method This pilot study used a multiple-baselines design with follow-up at 4- and 12-weeks with replication across four people with chronic post-stroke anomia. Prior to treatment, a comprehensive battery of cognitive and language tests was completed. Participants then undertook a period of cued picture naming treatment (45-minute sessions, five days per week for three weeks) totalling 15 sessions (11.25 hours). Participants were allocated four picture sets – one each for three treated conditions (low dose, moderate dose, and high dose) and one for an untreated control set. The number of naming opportunities provided per dose condition was calibrated against individuals’ pre-treatment picture naming accuracy and speed. Generalised linear mixed effects models were used to evaluate learning effects during treatment, maintenance of these effects, and dose-response relationships. Outcomes Participants received 99% of prescribed treatment doses (i.e., number of naming opportunities provided over the course of treatment). As anticipated, individual treatment responses varied substantially. Three participants demonstrated significantly improved picture naming accuracy on probed items during treatment, with varying response profiles by participant and dose. All participants were able to name more pictures accurately on a bespoke 298-item object picture naming test following treatment. However, no participant demonstrated significant pre-post treatment gains relative to untreated items, although one person demonstrated improved naming four weeks after treatment for items treated under the high dose condition. Dose-response relationships amongst these participants exhibited a greater number of significant results on naming probes in the high dose condition, possibly suggesting superiority of the high dose condition over lower doses of cued picture naming treatment. Conclusion Modest treatment effects and variable dose-response relationships were observed. We explore the role of dose, cognitive factors such as self-monitoring abilities, and linguistic factors such as underlying lexical-semantic and phonological processing that may have influenced treatment response in these participants. Avenues for future research are identified.

French Phonological Component Analysis and aphasia recovery: A bilingual perspective on behavioral and structural data.

Studies show bilingualism entails an advantage in cognitive control tasks. There is evidence of a bilingual advantage in the context of aphasia, resulting in better cognitive outcomes and recovery in bilingual persons with aphasia compared to monolingual peers. This bilingual advantage also results in structural changes in the right hemisphere gray matter. Very few studies have examined the so-called bilingual advantage by reference to specific anomia therapy efficacy. This study aims to compare the effect of French-Phonological Component Analysis (Fr-PCA) in monolinguals and bilingual persons with aphasia, both at the linguistic and cognitive control level, and to examine the structural impact of left hemisphere lesion location and right hemisphere structural data. Eight participants with chronic aphasia received Fr-PCA for a total of 15 h over 5 weeks. The results showed improved accuracy for treated words and generalization to untreated items and discourse in both groups, and improved Flanker task performance for some participants. Bilingual participants improved more than monolinguals for picture-naming tasks and narrative discourse. Damage to the left postcentral gyrus and the middle frontal gyrus was associated with less therapy-induced improvement. Additionally, left hemisphere damage to the inferior parietal gyrus and postcentral gyrus was associated with reduced cognitive control pre-therapy. Undamaged right hemisphere cortical thicknesses were significantly different between groups; the inferior frontal gyrus and the middle frontal gyrus were greater for the bilingual participants and correlated with cognitive control skills. These results suggest a bilingual advantage in anomia recovery following Fr-PCA, potentially resulting from enhanced cognitive control abilities that could be supported by right hemisphere neural reserve.

A self-administered home-based approach for treating anomia in Alzheimer’s disease

ABSTRACT Background New technologies show promise in the construction of self-administered home-based programs for targeting language impairments, in overcoming mobility problems and in providing access to care in a cost-effective and time-saving way. Aims In the present study, we investigated the feasibility and effectiveness of a self-administered home-based program for treating word-finding difficulties in persons with Alzheimer’s disease. Methods & procedures Ten participants practised word repetition training on a smart tablet for two weeks. Two slightly different training conditions were adopted; they varied as to the order of the presentation of the word to be repeated and the corresponding picture. Outcomes & Results Both training modalities proved effective in improving naming accuracy on the treated items. There were hints of greater treatment efficacy when the picture was presented before the word to be repeated. Furthermore, when the trial started with the word, the degree of general cognitive impairment and lexical semantic deficits correlated with the effect size of the training benefit. By contrast, the picture first training did not have this modulatory effect. Finally, no generalisation to untreated items was observed in naming accuracy, but was detectable with a more sensitive stem completion task. Conclusions Our study provides compelling evidence in favour of the feasibility and efficacy of a homebased program for remediating anomia in AD.

Generalization outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech: relationship to treatment dosage

ABSTRACT Background Dosage is an important aspect of treatment for acquired apraxia of speech (AOS) that has received little attention. Knowledge concerning the association of dosage to treatment outcomes is crucial for informing clinical practice and treatment research. Dosage metrics, representing the number of treatment sessions and teaching episodes (TEs) required to achieve specific performance milestones with Sound Production Treatment (SPT), have recently been provided for treated items. Aims The current investigation was designed to extend AOS dosage research to untreated items. Methods and Procedures Retrospective analyses were performed using data from a previously reported SPT study (Wambaugh et al., 2017) in which 20 speakers with AOS received two applications of SPT with different practice schedules (i.e., SPT-Random and SPT-Blocked). Probe data were used to determine achievement of the following milestones: 1) change above baseline; 2) clinically relevant improvement; and 3) mastery. Follow-up data were used to examine the relationship between the dosage metrics and maintenance of accuracy. Outcomes and Results On average, change above baseline and clinically relevant improvement was achieved for untreated items following 9–10 and 7–8 treatment sessions, respectively. Mastery of untreated items occurred for 45% of targets, following an average of 16–17 treatment sessions. TEs varied widely for all dosage metrics. No statistically significant differences were found between practice schedules for any of the dosage metrics. Better maintenance was associated with earlier achievement of performance milestones. More treatment sessions and TEs were required to meet performance milestones for untreated items in comparison to treated items. Conclusions This study provides dosage metrics for response generalization outcomes which can be used for planning and guiding treatment for AOS.

Playing With BEARS: Balancing Effort, Accuracy, and Response Speed in a Semantic Feature Verification Anomia Treatment Game.

Purpose The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed-accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV). Method Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of "pass" responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed. Results Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of "pass" responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency. Conclusions BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy. Supplemental Material https://doi.org/10.23641/asha.14935812.

Elasticity Profile of Skin, Neuronal, Cardiac, and Skeletal Muscle Cells after Treatment with the Biofield Energy Healing-Based Proprietary Test Formulation

The present study aimed to evaluate the effect of the Trivedi Effect®- Biofield Energy Treated/Blessed Test formulation/item (TI) composed of minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, alpha tocopherol, cyanocobalamin, and cholecalciferol), Panax ginseng extract, CBD isolates, and β-carotene on elasticity of skin, heart, muscle, and neuronal cells in the H9C2 (rat cardiomyocytes), C2C12 (mouse myoblast cells), HaCaT (human keratinocytes), and SH-SY5Y (human neuroblastoma cells) cell line in DMEM medium. The test formulation constituents were divided into two parts; one section was defined as untreated test formulation (UT), while the other portion of test formulation received Biofield Energy Healing/Blessing Treatment (BT) by a renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. The test items were treated with Biofield Energy Healing/Blessing Treatment and divided as Biofield Energy Treated/Blessed (BT) and untreated (UT) test items. MTT data showed that the test formulation in various concentrations was found as safe and nontoxic in the tested concentrations with viability range from 73% to 307%. Young’s modulus (YM) is a measure of cell stiffness, a decrease in YM value indicates increase elasticity of the cells and vice-versa. YM in H9C2 cells were decreased by 9.6% and 66.1% in the BT-DMEM + UT-TI group at 0.1 and 1 µg/mL respectively, as compared with untreated test group. However, C2C21 cells showed increased YM by 443.9% at 1 µg/mL in the UT-DMEM + BT-TI group, while 869.6% increased YM in the BT-DMEM + UT-TI group at 1 µg/mL as compared with untreated test group. However, 314% increased YM was reported in the BT-DMEM + BT-TI group at 1 µg/mL as compared with the untreated test group. However, the value of YM was significantly decreased in the HaCaT cell line by 247.7% (at 1 µg/mL), 225.8% (at 0.1 µg/mL), and 97.9% (at 1 µg/mL) in the UT-DMEM + BT-TI, BT-DMEM + UT-TI, and BT-DMEM + BT-TI group respectively, as compared with the untreated group. In addition, YM was significantly decreased in the SH-SY5Y cell line by 92.6%, 18.1%, and 26.6% at 1 µg/mL in the UT-DMEM + BT-TI, BT-DMEM + UT-TI, and BT-DMEM + BT-TI group respectively, as compared with the untreated group. Overall, the results showed the significant decreased YM among the SH-SY5Y, HaCaT, and H9C2 cells, while it was increased in the C2C21 cell line. Thus, the mechanical properties of cells such as cellular function, including shape, motility, differentiation, division, and adhesion to its surrounding extracellular matrix were improved. Overall, it can be useful in many disease progressions with improved cellular elasticity and its associated complications/symptoms.

A Pilot Single-Case Experimental Design Study of Rapid Syllable Transition Treatment for Italian Children With Childhood Apraxia of Speech.

Background The Rapid Syllable Transition (ReST) treatment is an effective intervention designed to address the planning and programming disorder found in childhood apraxia of speech. To date, no study has considered its use with children who speak languages other than English. Aim This pilot study aimed to examine the use of ReST treatment with Italian children. We hypothesized that the ReST approach would improve the overall accuracy of the targeted behaviors of lexical stress, smoothness, and phonemic accuracy, whereas phonemic and phonetic accuracy of untreated items would remain stable. Method Two monolingual Italian-speaking children with childhood apraxia of speech received therapy in 12 one-hour sessions, 2-3 times per week, using a single-case experimental design. The treatment procedures used in English were replicated in Italian with one change: In English, two stress patterns are treated. Italian commonly uses three stress patterns; therefore, the stimuli were modified accordingly. Accuracy of articulation, lexical stress, and smoothness were assessed at pretreatment and 1 day, 1 week, and 4 months posttreatment in treated and untreated pseudowords and in real words and sentences. Results Both children improved on treated pseudowords and real words with moderate effect sizes, but only one child generalized to untreated pseudowords. Maintenance of treatment results was observed in both participants. Articulation of control phonemes did not change. Conclusions ReST treatment in Italian is feasible, and a treatment effect was found, showing that its use may be valid in languages other than English. Further research is required. Supplemental Material https://doi.org/10.23641/asha.14348060.

Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease.

Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771.

Combining Intermittent Theta Burst Stimulation (iTBS) With Computerized Working Memory Training to Improve Language Abilities in Chronic Aphasia: A Pilot Case Study

ABSTRACT Background: Intermittent theta burst stimulation (iTBS) administered to the left dorsolateral prefrontal cortex (LDLPFC) has been shown to advance working memory (WM) abilities. At the same time, WM training is widely used to enhance learning associated with low language skills. An emerging area of research is that of applying cortical stimulation as an adjunct to behavioural therapy to improve language abilities in people with aphasia (PWA) after stroke. Aim: The aim of this study was to pilot the efficacy of the iTBS protocol, targeting the LDLPFC in combination with computerized WM training by measuring the near-transfer effects on WM and fluid intelligence (Gf) and far-transfer effects on language functioning and quality of life (QoL) in an individual with stroke-induced chronic aphasia. Methods & Procedures: The participant was a 31-year old female who presented with chronic non-fluent aphasia, following a left-hemisphere stroke involving the left frontoparietal lobes. She showed prominent anomia with frequent occurrences of word-finding difficulties. The assessment battery included a screening measure of WM, a standardized aphasia battery, a non-verbal intelligence test, spontaneous speech samples, a procedural discourse task, and a questionnaire addressing quality of life. All measures were administered once at baseline, immediately after treatment was terminated, and once during follow-up testing, at 3 months post-treatment. The treatment program included 10 consecutive daily sessions of 30-minutes computer-assisted WM training preceded by 3-minutes of iTBS. Outcomes & Results: Statistically significant improvement from baseline to post-treatment was found only for the non-verbal intelligence measure, suggesting near-transfer effects. There was no improvement on the computerized WM screening measure. Although no other measures revealed a statistically significant difference, there was a trend towards better performance on untreated items of receptive and expressive language tasks (far-transfer). Conclusions: The findings revealed a trend for improvement in receptive and expressive language abilities in one individual with chronic aphasia. The iTBS protocol in combination with computerised WM training could be a promising treatment but further studies with larger number of participants are needed to establish its effectiveness for improvement of aphasia after stroke.

Identifying the components of a successful spoken naming therapy: a meta-analysis of word-finding interventions for adults with aphasia

ABSTRACT Background: Spoken word retrieval therapy forms an integral part of aphasia therapy. Due to the range of therapy options and variations, drawing clear-cut conclusions from the evidence base can be challenging. Aims: This paper consolidates recent findings (2008–2018), pertinent to spoken word-finding interventions. Specifically, we are interested in aphasia interventions: (1) that target single-word spoken naming; (2) whose participants are adults with acquired naming impairments after a stroke; and (3) whose treatment approach focusses on the use of language forms (i.e., semantics, phonology, and orthography). The over-arching objective is to determine the important therapy components underpinning successful single-word naming treatments. Methods and Procedures: A systematic literature search was conducted. This led to the compilation of a large-scale dataset (n=222 participants from 32 papers), with the heterogenous interventions dissected into their “active” therapy components. A detailed framework (“RITA”: (1) Regimen; (2) Item(s); (3) Technique(s); and (4) Application of technique(s) with their Adjuncts) was designed to organise these “active therapy ingredients”. Using random forest, we identified the crucial components responsible for the successful naming of treated and untreated items, respectively, at short-term and maintenance periods. Outcomes and Results: The role of the written form as therapeutic cues, presented either as a whole word or part-word, emerged to be a consistent and robust predictor, across the outcomes. Semantic tasks were useful in the successful naming of untreated items. Conclusions: Clinicians should consider using written prompts as part of spoken naming therapy. It is possible that the use of orthography underlies the success of multi-component techniques. Other clinical implications (e.g., homework, treatment intensity) are also discussed. In addition, we propose a comprehensive “RITA” framework, which summarises the “active” therapy components. “RITA” (available as a template in Appendix 3) is useful for clinicians and researchers as a guide to unpack language interventions. Furthermore, the paper highlights the strengths of a well-established method, random forest, as a valuable statistical tool to move aphasia research forward. Overall, the study refines our understanding of spoken naming treatment for those with aphasia, specifically individuals with word-finding deficits. Importantly, through the use of a robust statistical approach and an original framework designed to lay out language therapy components, the paper adds new clarity to the evidence base.

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

ABSTRACT 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.

Stairways to the brain: Transcutaneous spinal direct current stimulation (tsDCS) modulates a cerebellar-cortical network enhancing verb recovery

It has long been assumed that the language function is hierarchically organized into specific cortical areas. Here, for the first time, we present direct evidence that the spinal cord takes part in language processing. In a randomized-double blind design, sixteen aphasics underwent a language treatment combined with transcutaneous spinal direct current stimulation (tsDCS). During the treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (IX-X vertebrae) in two different conditions: (1) anodal, and (2) sham while performing a verb naming task. Each experimental condition was run in five consecutive daily sessions over two weeks. Before and after each condition, all patients underwent a resting state functional magnetic resonance imaging (rs-fMRI). After anodal tsDCS, significant functional connectivity changes were found in a cerebellar-cortical network recruiting regions such as the left cerebellum, the right parietal and premotor cortex known to be also involved in action-related verb processing. Indeed, this increase of connectivity significantly correlated with the greatest amount of improvement found in verb naming. In line with our experimental data, we also found a greater improvement after anodal tsDCS also on untreated items of the language test but only on tasks which required the use of verbs, such as verb naming and picture description. No significant changes were found in noun naming. Thus, this evidence emphasizes, for the first time, that the neural response due to tsDCS combined with language treatment changes during the course of recovery by enhancing activity into cortical regions which influence verb processing.