A comparison of drawing and writing on facilitating word retrieval in individuals with aphasia

ABSTRACT

Background: Drawing has long been a focus in aphasia research as a compensatory strategy for improving functional communication in individuals with aphasia, but fewer studies have addressed drawing as a facilitative tool to improve their verbal output.

Aims: The purpose of the current study was to investigate differences in naming accuracy in individuals with aphasia during a drawing versus a writing condition. Two research questions were formed to examine the role of drawing in facilitating naming: 1) Will participants perform better when naming with drawing compared to confrontation naming only or when naming with writing? and 2) Is the quality of the picture drawn related to the naming accuracy?

Methods & Procedures: Across three separate one-hour sessions, fifteen individuals with aphasia (n = 15) aged 44–81 years (M = 61.47, SD = 13.27) were evaluated using two standardized language assessments, the Western Aphasia Battery-Revised and Pyramid and Palm Tree Test, and three naming tasks designed to assess the effect of writing and drawing on naming performance. The three naming conditions consisted of confrontation naming only, naming with drawing, and naming with writing.

Outcomes & Results: A one-way, repeated measures analysis of variance (ANOVA) was computed to analyze the impact of naming conditions on the participants’ naming accuracy. The main effect of naming conditions was statistically significant, F (1, 14) = 5.87, p < 0.05, and Bonferroni correction revealed that the participants performed significantly better in the naming with drawing condition than with writing condition. In addition, no correlation between the quality of the pictures drawn and the participants’ naming performance was found which suggested that the quality of drawing did not affect the accuracy of naming.

Conclusions: When attempting to name a picture along with drawing its representation, the act of drawing may facilitate word retrieval by stimulating the semantic network associated with the word and involving the right cerebral hemisphere in the word retrieval process. Through drawing, these semantic features of the target word are more strongly activated than other related words. When the semantic features are more strongly activated, the probabilities of retrieving the target word may increase. In contrast, writing heavily relies on the left hemisphere and linguistic systems. Thus, naming when attempting to write the associated word may be a more cognitively and linguistically demanding task for individuals with aphasia.     

Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity

Background: The significance of imageability and concreteness as factors for lexical tasks in aphasic individuals is under debate. No previous treatment studies have looked specifically at training abstract words compared to concrete for improved lexical retrieval in patients with chronic aphasia.

Aims: The goal of the present study was to determine the efficacy of a treatment for lexical retrieval that is based on models of lexical processing by utilising abstractness as a mode of complexity. It was hypothesised that training abstract words in a category will result in improvement of those words and generalisation to untrained target concrete words in the same category. However, training concrete words in a category will result in the retrieval of trained concrete words, but not generalisation to target abstract words.

Methods & Procedures: A single‐participant experimental design across participants and behaviours was used to examine treatment and generalisation. Generative naming for three categories (church, hospital, courthouse) was tested during baseline and treatment. Each treatment session was carried out in five steps: (1) category sorting, (2) feature selection, (3) yes/no feature questions, (4) word recall, and (5) free generative naming.

Outcomes & Results: Although participant 1 demonstrated neither significant learning nor generalisation during abstract or concrete word training, participants 2, 3, and 4 showed significant learning during abstract word training and generalisation to untrained concrete words. Participants 3 and 4 were also trained on concrete words, on which they improved, but did not show generalisation to untrained abstract words.

Conclusions: The results of the present experiment support our hypothesis that training abstract words would result in greater learning and generalisation to untrained concrete words. They also tentatively support the idea that generalisation is facilitated by treatment focusing on more complex constructions (Kiran & Thompson, 2003 Kiran, S. and Thompson, C. K. 2003. The role of semantic complexity in treatment of naming deficits: Training semantic categories in fluent aphasia by controlling exemplar typicality.. Journal of Speech, Language and Hearing Research, 46(4): 773–787.  [Google Scholar]; Thompson, Shapiro, Kiran, & Sobecks, 2003 Thompson, C. K., Shapiro, L. P., Kiran, S. and Sobecks, J. 2003. The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The complexity account of treatment efficacy (CATE).. Journal of Speech Language and Hearing Research, 46(3): 591–607.  [Google Scholar]).     

Delivering word retrieval therapies for people with aphasia in a virtual communication environment

Background: Delivering therapy remotely, via digital technology, can enhance provision for people with aphasia. EVA Park is a multi-user virtual island that can be used for such delivery. The first EVA Park study showed that daily language stimulation delivered via the platform improved functional communication and was positively received by users. This paper reports two single case studies, evaluating its capacity to deliver targeted language interventions. The first employed therapy for noun retrieval, using cued picture naming and modified Sematic Feature Analysis. The second employed modified Verb Network Strengthening Treatment (VNeST).

Aims: This study aimed to determine if treatment delivery was feasible in EVA Park, as assessed by participant compliance, treatment fidelity and participants’ views. It explored the impact of the therapies on treated and untreated word production, connected speech and functional communication.

Methods & Procedures: Two participants with aphasia each received 20 sessions of individual therapy in EVA Park, delivered over 5 weeks. Feasibility was assessed by measuring compliance with the therapy regime, recording and checking the fidelity of 20% of treatment sessions, and using post-therapy interviews to explore participant views. Treatment outcomes were evaluated via repeated measures single case designs, in which assessments were administered twice before therapy, immediately post therapy and 5 weeks later. Outcome measures included Object Picture Naming (study 1), Sentence Elicitation Pictures (study 2), Naming 84 items from the Object and Action Naming Battery (study 2), Narrative Production (Study 2), the Northwestern Assessment of Verb and Sentences: Argument Structure Production Test (Study 2) and Communication Activities of Daily Living – 2 (Study 1 and 2).

Outcomes & Results: Feasibility results were excellent. Both participants were fully compliant with the therapy regime. There was at least 90% fidelity with the treatment protocols, and participant views were positive. Outcomes varied across the studies. The noun therapy significantly improved the naming of treated words, with good maintenance. Lexical gains were less evident on the Sentence Elicitation Pictures used in the VNeST study. Neither study demonstrated generalisation to untreated words, connected speech or functional communication.

Conclusions: Two treatment approaches, designed for face-to-face delivery, could be delivered remotely in EVA Park. Outcomes for the noun treatment were comparable to previous evaluations. Comparisons with previous research were more challenging for VNeST, owing to differences in methodology. Further evaluations of other treatment approaches are warranted.     

A comparison of word versus sentence cues as therapy for verb naming in aphasia

Background: Improving verb naming in people with aphasia should enable expession of a wider range of sentence types and meanings, and may have wider benefits for connected speech. Estableshing the optimal therapy methods for improving verb naming is, therefore, of substantial clinical importance.

Aims: This study investigated whether cueing sentence production would improve verb‐naming accuracy to a greater extent than the more typical, single‐word verb‐cueing therapies. A second aim was to examine the extent to which verb picture naming improvements would generalise to naming of the same items in dynamic videos.

Methods & Procedures: Seven participants with chronic aphasia including word retrieval impairment took part in a case‐series study. Decreasing cues were used to devise two therapies to improve verb naming: word cue therapy and sentence cue therapy. A total of 60 verbs that had not been named accurately in baseline testing on three presentations were collated for each participant. These were split into three sets of 20 verbs: set A was used in word cue therapy, set B in sentence cue therapy, and set C served as control items undergoing no therapy. The sets were matched for significant psycholinguistic variables such as word frequency, imageability, length, and number of noun arguments. Therapy consisted of 10 sessions over 5 weeks. Post‐therapy assessments consisted of an immediate naming assessment (1 week following therapy) and a follow‐up assessment 5 weeks later. Naming of the target verbs in set A for each participant was also assessed using a dynamic video presentation.

Outcomes & Results: Both therapies resulted in highly significant gains in naming accuracy for treated verbs with little, if any, carry‐over to untreated verbs. There were no significant differences between the therapies for individual participants. At the group level there was a significantly greater benefit for word cue over sentence cue therapy at the follow‐up naming assessment. The gains in verb naming post therapy generalised from the static depictions used in therapy to naming of the same items in the dynamic video presentation format.

Conclusions: Both word and sentence cue therapy for verb naming were effective in improving naming accuracy. Gains from word cue therapy can generalise to naming of very different exemplars of the same verb targets. Word cue therapy resulted in significantly greater gains than sentence cues at the level of the group, but the difference was not substantial enough to be significant at the individual participant level. Generalisation, as an effect following intervention, can be examined in terms of naming different exemplars of a word, as well as its more typical meaning of generalisation from treated to untreated items in therapy.     

Treatment of word retrieval impairment in chronic Broca's aphasia

Background : The present study describes a treatment approach that was applied to improve word retrieval for an individual with chronic Broca's aphasia. The procedure combined elements of loose training with aspects of structured treatment. Treatment involved presentation of semantic cues according to semantic feature analysis [SFA] (Boyle & Coelho, 1995), as well as a forward chaining technique as in response elaboration training [RET] (Kearns, 1985). The technique was intended to elicit the targeted response by activating a semantic network without inhibiting related or creative responses. Aims : The purpose was to investigate whether the combined SFA-RET treatment approach would improve naming accuracy of object noun pictures. This study also focused on an issue related to degradation in word retrieval, but instead of frequency of occurrence the focus was familiarity. Familiarity was based on to how often the individual with aphasia encountered the object nouns in her everyday life. Methods & Procedures : The individual studied, LP, was a 57-year-old, right-handed female who was 8 years post-onset of a left cerebrovascular accident and demonstrated a moderate to severe Broca's aphasia. LP's naming scores were consistent with a severe impairment and the majority of her paraphasic errors were semantic in nature. Treatment materials consisted of 30 photographs of object nouns, of which 15 represented “high-familiarity” objects and 15 represented “low-familiarity”. The 30 pictures were divided into three sets of 10 pictures. Each set consisted of five high- and five low-familiarity objects. Two sets of pictures were designated as treatment stimuli and the third as the control set. The treatment programme was carried out in an ABA single subject design. After the baseline phase the individual with aphasia was treated for 3 hours per week for 6 weeks and was seen for three follow-up sessions 6 weeks later. Outcomes & Results : Results indicated that the combined SFA-RET treatment resulted in improved naming of the treatment pictures as well as the untreated control pictures. In addition, during the treatment phase naming accuracy and consistency were greater for the high-familiarity than the low-familiarity objects. During the follow-up phase it was noted that the treatment effect was maintained at a higher level for the treatment pictures than for the control pictures. A similar trend was observed for the high- versus the low-familiarity words. Conclusions : These findings indicate that the combined treatment approach described was effective in improving this individual's word retrieval of object nouns. However, it is unclear whether the combined approach was necessary or what the individual contributions of each approach were to the final outcome. Finally, it appeared that LP was able to generate semantic features associated with the high-familiarity words and name the stimulus pictures more easily than the low-familiarity words, perhaps because of her regular contact with those objects in her daily life. This finding supports the contention that personalising treatment stimuli can be an important adjunct to any treatment task.     

Improved word comprehension in Global aphasia using a modified semantic feature analysis treatment

Limited research has investigated treatment of single word comprehension in people with aphasia, despite numerous studies examining treatment of naming deficits. This study employed a single case experimental design to examine efficacy of a modified semantic feature analysis (SFA) therapy in improving word comprehension in an individual with Global aphasia, who presented with a semantically based comprehension impairment. Ten treatment sessions were conducted over a period of two weeks. Following therapy, the participant demonstrated improved comprehension of treatment items and generalisation to control items, measured by performance on a spoken word picture matching task. Improvements were also observed on other language assessments (e.g. subtests of WAB-R; PALPA subtest 47) and were largely maintained over a period of 12 weeks without further therapy. This study provides support for the efficacy of a modified SFA therapy in remediating single word comprehension in individuals with aphasia with a semantically based comprehension deficit.     

How justice can affect jury: Training abstract words promotes generalisation to concrete words in patients with aphasia

Developing language treatments that not only improve trained items but also promote generalisation to untrained items is a major focus in aphasia research. This study is a replication and extension of previous work which found that training abstract words in a particular context-category promotes generalisation to concrete words but not vice versa (Kiran, Sandberg, & Abbott, 2009 Kiran, S., Sandberg, C., & Abbott, K. (2009). Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity. Aphasiology, 23, 835–853. doi: 10.1080/02687030802588866[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). Twelve persons with aphasia (five female) with varying types and degrees of severity participated in a generative naming treatment based on the Complexity Account of Treatment Efficacy (CATE; Thompson, Shapiro, Kiran, & Sobecks, 2003 Thompson, C., Shapiro, L., Kiran, S., & Sobecks, J. (2003). The role of syntactic complexity in treatment of sentence deficits in agrammatic aphasia: The Complexity Account of Treatment Efficacy (CATE). Journal of Speech, Language, and Hearing Research, 46, 591–607. doi: 10.1044/1092-4388(2003/047)[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). All participants were trained to generate abstract words in a particular context-category by analysing the semantic features of the target words. Two other context-categories were used as controls. Ten of the twelve participants improved on the trained abstract words in the trained context-category. Eight of the ten participants who responded to treatment also generalised to concrete words in the same context-category. These results suggest that this treatment is both efficacious and efficient. We discuss possible mechanisms of training and generalisation effects.     

Long-term maintenance of novel vocabulary in persons with chronic aphasia

Background: The study of novel word learning in aphasia can shed light on the functionality of patients' learning mechanisms and potentially help in treatment planning. Previous studies have indicated that persons with aphasia are able to learn some new vocabulary. However, these learning outcomes appear short-lived and evidence for the ability to use the newly learned words in the long term is lacking.

Aims: Participants with aphasia and matched controls underwent short training where they were taught to name novel objects with novel names. We studied the participants' word learning and particularly their long-term maintenance. We also examined whether the language and verbal short-term memory impairments of the participants with aphasia related to their ability to acquire and maintain phonological and semantic information on novel words.

Methods & Procedures: Two participants with nonfluent aphasia, LL and AR, and two matched controls took part in the experiment. They were taught to name 20 unfamiliar objects by repeating the names in the presence of the object picture. Half of the items carried a definition that was used to probe incidental semantic learning. There were four training sessions, a post-training test, and follow-up tests up to 6 months post-training. Learning measures included recognition of the trained objects, as well as spontaneous and cued recall in visual confrontation naming. Incidental semantic learning was measured by spontaneous recall of the definitions.

Outcomes & Results: Combining spontaneous and phonologically cued responses, LL acquired 70% and AR 55% of the novel words. With phonological cueing, LL named 50% of the items correctly up to 6 months post-training (vs 95–100% for the controls) and AR 25% up to 8 weeks post-training. AR's lexical-semantic processing, pseudoword repetition and verbal short-term capacity were inferior to those of LL. In line with this, AR learned fewer words and showed more decline in recognition memory for the trained items, and weaker recall of the semantic definitions.

Conclusions: Our results support previous findings that people with aphasia can learn to name novel items. More importantly, the results show for the first time that, with phonological cueing, an individual with aphasia can maintain some of this learning up to 6 months post-training. Moreover the results provide further evidence for the significance of the functional status of lexical-semantic processing on word learning success.     

Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme

Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains.

Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL).

Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination.

Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL.

Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted.     

Re-visiting "semantic facilitation" of word retrieval for people with aphasia: facilitation yes but semantic no

Previous research has shown that word-to-picture matching for targets that cannot be named at pre-test results in improved naming relative to untreated control items for people with aphasia. This paper replicates and extends this finding and investigates its source. Is the effect a result of priming of semantic representations, or of post-semantic mechanisms in word retrieval? The first experiment shows that word-to-picture matching with unrelated distractors improves naming at short (2-3 minutes) and long (up to 25 minute) lags. There was no effect of being made aware of the relationship between word-to-picture matching and picture naming. People who have a semantic impairment improve only with a short lag between word-to-picture matching and naming. Participants with less semantic impairment show larger priming effects that are equal at short and long lags between word-to-picture matching and naming. The second experiment shows that the facilitation effect is just as large for word-to-picture matching with unrelated distractors as with semantically-related distractors. Furthermore, overall there was no difference between matching with coordinate items and with associated items. The results of these experiments show that facilitation of naming by word-to-picture matching in people with aphasia cannot be a result of the priming of semantic representations. Instead they are consistent with two effects: word-to-picture matching results in priming at a lemma level for aphasic people with a semantic impairment that is only found with a short lag between word-to-picture matching and naming. Word-to-picture matching causes priming of the lemma to output lexicon entry mapping that benefits participants with less semantic impairment that is evident at both a short and long lag between word-to-picture matching and naming. These findings fit well with previous research on repetition priming of naming with normal subjects.     

The role of noun syntax in spoken word production: Evidence from aphasia

We describe MH who presents with agrammatic aphasia and anomia, and who produces semantic errors in the absence of a central semantic impairment. This pattern of performance implies damage to syntactic processes operating between semantics and phonological output. Damage here may lead to lexical selection errors and a deficit in combining words to form phrases.We investigated MH's knowledge and processing of noun syntax in mass and count nouns. She produced more count nouns than mass nouns. She showed impaired knowledge of noun syntax in judgement tasks and production tasks, with mass noun syntax being more impaired than count.We interpret these results in terms of a two-stage model of lexical retrieval. We propose that syntactic information represented at the lemma level is activated even in bare noun production, and can be differentially impaired across noun categories. That same damage can lead to semantic errors in production. For MH limited syntactic options are available to support production, and these favour count noun production. The data provide a new account of output semantic errors.     

Analysis of abstract and concrete word processing in persons with aphasia and age-matched neurologically healthy adults using fMRI

The concreteness effect occurs in both normal and language-disordered populations. Research suggests that abstract and concrete concepts elicit differing neural activation patterns in healthy young adults, but this is undocumented in persons with aphasia (PWA). Three PWA and three age-matched controls were scanned using fMRI while processing abstract and concrete words. Consistent with current theories of abstract and concrete word processing, abstract words elicited activation in verbal areas, whereas concrete words additionally activated multimodal association areas. PWA show greater differences in neural activation than age-matched controls between abstract and concrete words, possibly due to an exaggerated concreteness effect.     

A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia

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

Electrophysiological correlates of different anomic patterns in comparison with normal word production

Different forms of anomia are observed in aphasia, which can be related to impaired semantic, lexical or phonological processes. In the present study, we analysed electrophysiological correlates of different patterns of anomia in six aphasic speakers. Event-related potentials (ERPs) were recorded during picture naming in each anomic speaker and in 15 healthy controls. Waveform analysis and temporal segmentation indicated a difference between high and low frequency words in the control group between 270 and 330 msec after picture onset. The ERPs recorded in the patients were compared to the control group. The time-windows of divergent ERP correlates were very similar between successful and erroneous naming, but they were differently distributed in the 6 patients. Two patients with conduction aphasia and impaired phonological encoding had normal electro-cortical activity during the first 300 msec and abnormal patterns between 300 and 450 msec. Two patients with lexical-semantic impairment had earlier ERP abnormalities starting immediately after visual processes. The two patients with less severe anomia and preponderance of omission errors displayed abnormal ERPs between 280 and 350 msec. These results indicate that abnormal electro-cortical correlates of anomic profiles can be observed in different time-windows, which seem to correspond to the time course of the impaired encoding processes.