Repetition Priming Treatment for Anomia: Effects of Single- and Multiple-Exemplar Protocols.

INTRODUCTION: Repetition priming can lead to improved naming ability in people with aphasia, but concerns have arisen from prior research about using only a single picture exemplar for each target. Specifically, it is unclear whether the observed improvements were due to learning simple correspondences between particular words and pictures rather than changes at a deeper level of lexical-semantic processing. In addition, implications for generalization after training with single exemplars were unclear. This study replicated and extended previous work to address these questions. METHOD: Five participants with chronic aphasia participated in this repeated-measures design study, which repeatedly paired words and pictures with no feedback provided. Two participants engaged in a single-exemplar condition, with a single picture exemplar of each target used for every presentation of that target. The remaining three participants engaged in a multiple-exemplar condition, with several different pictures used for each target. Half of these targets used training pictures during naming probes, whereas half did not. RESULTS: Primed items led to greater improvements in naming than items that were practiced but not primed. The data indicate that improvements may extend beyond stimulus-specific correspondences. Maintenance and generalization effects were mixed. CONCLUSIONS: These data provide further support for the efficacy of repetition priming treatment for anomia. Implications and future directions are discussed.

Repetition Priming in Treatment of Anomia.

PURPOSE: Repetition priming has been suggested as a method for targeting implicit processes in anomia treatment. Prior studies have used masked priming for this purpose. This study extends that work with visible primes, a more clinically feasible approach. METHOD: This study used a single-subject design across three participants with aphasia. Treatment involved repeated exposure to identity primes (trained condition) or sham primes (untrained condition) paired with pictures. Analyses assessed acquisition effects for trained items and untrained items that were seen during the training period, generalization to untrained items that had not been seen, and generalization to broader language skills, immediately and 3 months post-treatment. RESULTS: All participants improved in naming trained items immediately after treatment, with greater improvements for trained than for untrained items. All participants maintained some degree of improvement on trained items 3 months post-treatment, although the degree differed across participants. Inconsistent generalization occurred to unexposed items. Improvements were noted in some areas of broader language ability, although these varied. CONCLUSIONS: These data suggest a repetition priming treatment paradigm may increase naming accuracy for individuals with anomia and may benefit other aspects of language. Participant factors may have influenced response to treatment. Directions for future investigation are discussed.

The role and use of event-related potentials in aphasia: A scoping review.

Event-related potentials (ERPs) can provide important insights into underlying language processes in both unimpaired and neurologically impaired populations and may be particularly useful in aphasia. This scoping review was conducted to provide a comprehensive summary of how ERPs have been used with people with aphasia (PWA), with the goal of exploring the potential clinical application of ERPs in aphasia assessment and treatment. We identified 117 studies that met inclusionary criteria, reflecting six thematic domains of inquiry that relate to understanding both unimpaired and aphasic language processing and the use of ERPs with PWA. In these studies, a wide variety of ERP components were reported. Inconsistencies in reporting of participant characteristics and study protocols limit our ability to generalize beyond the individual studies and understand implications for clinical applicability. We discuss the potential roles of ERPs in aphasia management and make recommendations for further developing ERPs for clinical utility in PWA.

Identifying Verbal Short-Term Memory and Working Memory Impairments in Individuals With Latent Aphasia.

Purpose This study was undertaken to explore whether measures of verbal short-term memory and working memory are sensitive to impairments in people with latent aphasia, who score within normal limits on typical aphasia test batteries. Method Seven individuals with latent aphasia and 24 neurotypical control participants completed 40 tasks from the Temple Assessment of Language and Short-term Memory in Aphasia (TALSA) that assess various aspects of verbal short-term memory, working memory, and language processing. Subtests were identified that differentiated between the two groups of participants. Results Twenty-one TALSA tasks were identified on which the participants with latent aphasia had significantly different performance than the typical control participants. All of these subtests engaged verbal short-term memory, and some involved working memory as well. Furthermore, the TALSA detected individual differences in linguistic profiles among participants with latent aphasia. Conclusions People with latent aphasia may be identified by tests that tap verbal short-term memory and working memory. In addition, the TALSA was found to be sensitive to the heterogeneity of this population. Further development of these measures will improve identification and treatment of this challenging population.

Effects of Phonomotor Therapy and Semantic Feature Analysis on Discourse Production.

Background Anomia treatments typically focus on single word retrieval, although the ultimate goal of treatment is to improve functional communication at the level of discourse in daily situations. Aims The focus of this study was to investigate the impact of two effective anomia treatments on discourse production as measured by a story retell task. Method and Procedure Fifty-seven people with aphasia were randomized to receive either a phoneme-based treatment, Phonomotor Therapy (PMT; 28 participants), or a lexical-semantic treatment, Semantic Feature Analysis (SFA; 29 participants). Groups were matched for age, aphasia severity, education, and years post onset. All received 56-60 hr of treatment in a massed treatment schedule. Therapy was delivered for a total of 8-10 hr/week over the course of 6-7 weeks. All participants completed testing 1 week prior to treatment (A1), immediately following treatment (A2), and again 3 months later (A3). Discourse was analyzed through the percentage of correct information units at each time point. Outcomes and Results Both groups showed nonsignificant improvements from pretreatment to immediately posttreatment. The PMT group showed significant improvement 3 months posttreatment, while the SFA group returned to near-baseline levels. Conclusion These results add to our understanding of the effects of both PMT and SFA. Future research should address understanding variability in discourse outcomes across studies and the effects of aphasia severity and individual participant and treatment factors on treatment outcomes for both of these approaches.

The time course of priming in aphasia: An exploration of learning along a continuum of linguistic processing demands.

This study investigates learning in aphasia as manifested through automatic priming effects. There is growing evidence that people with aphasia have impairments beyond language processing that could affect their response to treatment. Therefore, better understanding these mechanisms would be beneficial for improving methods of rehabilitation. This study assesses semantic and repetition priming effects at varied interstimulus intervals, using stimuli that are both non-linguistic and linguistic in tasks that range from requiring nearly no linguistic processing to requiring both lexical and semantic processing. Results indicate that people with aphasia maintain typical patterns of learning across both linguistic and non-linguistic tasks as long as the implicit prime-target relationship does not depend on deep levels of linguistic processing. As linguistic processing demands increase, those with agrammatic aphasia may require more time to take advantage of learning through implicit prime-target relationships, and people with both agrammatic and non-agrammatic aphasia are more susceptible to breakdown of the semantic networks as processing demands on that system increase.

Empirical Evaluation of Computer-Adaptive Alternate Short Forms for the Assessment of Anomia Severity.

Purpose The purpose of this study was to verify the equivalence of 2 alternate test forms with nonoverlapping content generated by an item response theory (IRT)-based computer-adaptive test (CAT). The Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996)was utilized as an item bank in a prospective, independent sample of persons with aphasia. Method Two alternate CAT short forms of the PNT were administered to a sample of 25 persons with aphasia who were at least 6 months postonset and received no treatment for 2 weeks before or during the study. The 1st session included administration of a 30-item PNT-CAT, and the 2nd session, conducted approximately 2 weeks later, included a variable-length PNT-CAT that excluded items administered in the 1st session and terminated when the modeled precision of the ability estimate was equal to or greater than the value obtained in the 1st session. The ability estimates were analyzed in a Bayesian framework. Results The 2 test versions correlated highly (r = .89) and obtained means and standard deviations that were not credibly different from one another. The correlation and error variance between the 2 test versions were well predicted by the IRT measurement model. Discussion The results suggest that IRT-based CAT alternate forms may be productively used in the assessment of anomia. IRT methods offer advantages for the efficient and sensitive measurement of change over time. Future work should consider the potential impact of differential item functioning due to person factors and intervention-specific effects, as well as expanding the item bank to maximize the clinical utility of the test. Supplemental Material https://doi.org/10.23641/asha.11368040.

The Influence of Phonomotor Treatment on Word Retrieval: Insights From Naming Errors.

Purpose An increasing number of anomia treatment studies have coupled traditional word retrieval accuracy outcome measures with more fine-grained analysis of word retrieval errors to allow for more comprehensive measurement of treatment-induced changes in word retrieval. The aim of this study was to examine changes in picture naming errors after phonomotor treatment. Method Twenty-eight individuals with aphasia received 60 hr of phonomotor treatment, an intensive, phoneme-based therapy for anomia. Confrontation naming was assessed pretreatment, immediately posttreatment, and 3 months posttreatment for trained and untrained nouns. Responses were scored for accuracy and coded for error type, and error proportions of each error type (e.g., semantic, phonological, omission) were compared: pre- versus posttreatment and pretreatment versus 3 months posttreatment. Results The group of treatment participants improved in whole-word naming accuracy on trained items and maintained their improvement. Treatment effects also generalized to untrained nouns at the maintenance testing phase. Additionally, participants demonstrated a decrease in proportions of omission and description errors on trained items immediately posttreatment. Conclusions Along with generalized improved whole-word naming accuracy, results of the error analysis suggest that a global (i.e., both lexical-semantic and phonological) change in lexical knowledge underlies the observed changes in confrontation naming accuracy following phonomotor treatment.

The Link Between Verbal Short-Term Memory and Anomia Treatment Gains.

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

Effects of Phonomotor Treatment on discourse production.

BACKGROUND: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with every person with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse. AIMS: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment, on discourse production. METHODS & PROCEDURES: Twenty-six PWA participated in 60 hours of Phonomotor Treatment, which focuses on building a person's ability to recognise, produce, and manipulate phonemes in progressively longer non-word and real-word contexts. Language samples were collected prior to, immediately after, and three months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated. OUTCOMES & RESULTS: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and three months later, as well as significantly improved percent CIUs, relative to baseline, three months following treatment. CONCLUSIONS: Phonomotor Treatment, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production.

Masked Repetition Priming Treatment for Anomia.

Purpose: Masked priming has been suggested as a way to directly target implicit lexical retrieval processes in aphasia. This study was designed to investigate repeated use of masked repetition priming to improve picture naming in individuals with anomia due to aphasia. Method: A single-subject, multiple-baseline design was used across 6 people with aphasia. Training involved repeated exposure to pictures that were paired with masked identity primes or sham primes. Two semantic categories were trained in series for each participant. Analyses assessed treatment effects, generalization within and across semantic categories, and effects on broader language skills, immediately and 3 months after treatment. Results: Four of the 6 participants improved in naming trained items immediately after treatment. Improvements were generally greater for items that were presented in training with masked identity primes than items that were presented repeatedly during training with masked sham primes. Generalization within and across semantic categories was limited. Generalization to broader language skills was inconsistent. Conclusion: Masked repetition priming may improve naming for some individuals with anomia due to aphasia. A number of methodological and theoretical insights into further development of this treatment approach are discussed.

Speech-Language Pathologists' Use of Hearing Screening for Clients With Aphasia: Challenges, Potential Solutions, and Future Directions.

PURPOSE: The co-occurrence of aphasia and hearing loss can lead to compounded receptive communication impairment that is significantly worse than in either disorder alone. Therefore, identifying potential hearing loss is a critical part of communication assessment for clients with neurogenic communication disorders, many of whom have aphasia. This clinical focus article explores speech language pathologists' (SLPs') hearing-screening practices with this population, identifies patterns of concern, and presents potential solutions and future research needs. METHOD: SLPs completed an online survey. Data were obtained from 102 SLPs who work with adults with aphasia. RESULTS: Most respondents indicated that they do some form of hearing screening, although few do them in a reliable, valid manner. Awareness of American Speech-Language-Hearing Association hearing-screening guidelines was low. The most common reasons given for not conducting screenings included cost and lack of proper equipment and time. CONCLUSIONS: SLPs are an important resource for identifying potential hearing loss in individuals with aphasia. These data suggest that hearing screenings are being conducted only inconsistently with this population, often using nonstandardized methods. The results demonstrate a need to develop hearing-screening tools that are affordable, easily accessible, and validated for aphasia, and to raise awareness of currently available hearing-screening protocols and tools.

Language treatment prior to anterior temporal lobe surgery: Can naming skills be preserved?

Epilepsy affects 1% of the general population and is highly prevalent among Veterans. The purpose of this phase I study was to investigate a presurgical linguistically distributed language treatment program that could potentially diminish effects of proper-name retrieval deficits following left anterior temporal lobe resection for intractable epilepsy. A single-subject multiple-baseline design was employed for three individuals with late-onset chronic left temporal lobe epilepsy. Word retrieval treatment was administered prior to anterior temporal lobe resection. The primary outcome measure was confrontation naming of proper nouns. Immediately posttreatment (before surgery), there was a positive effect for all trained stimuli in the form of improved naming as compared with pretreatment. In addition, trained stimuli were found to be better after surgery than they were at pretreatment baseline, which would not be expected had language treatment not been provided. This series of case studies introduces two fundamentally novel concept: that commonly occurring deficits associated with left temporal lobe epilepsy can be treated despite the presence of damaged neural tissue and that providing this treatment prior to surgery can lead to better preservation of language function after surgery than would be expected if the treatment were not provided.

Masked Repetition Priming in Treatment of Anomia: A Phase 2 Study.

PURPOSE: Previous research has demonstrated that exposure to masked primes may improve naming accuracy for individuals with anomia. This study investigates the effect of repeated exposures to masked identity primes paired with pictures over multiple trials, sessions, and days on the ability of people with anomia to name those pictures. METHOD: Four participants with anomia completed this single-subject, multiple-baseline design study. Twelve treatment sessions were conducted for each of 2 semantic categories. Comparisons of performance on naming probes were made between items that were primed, unprimed but seen the same number of times, and unprimed and seen only during naming probes. RESULTS: All participants showed some gains in naming trained items although to varying degrees, and trained (primed) items generally showed greater improvement than untrained items seen the same number of times. Cross-category generalization was observed for some participants, but little to no within-category generalization occurred. Minimal changes occurred on measures of general language ability. CONCLUSIONS: These data provide continued evidence that masked repetition priming can have a positive effect on naming for people with anomia. Factors that may influence participant response and additional questions that must be settled for this line of research to continue are discussed.

Treatment of proper name retrieval deficits in an individual with temporal lobe epilepsy.

PURPOSE: Studies investigating language deficits in individuals with left temporal-lobe epilepsy have consistently demonstrated impairments in proper name retrieval. The aim of this Phase I rehabilitation study was to investigate the effects of a linguistically distributed word retrieval treatment on proper name retrieval in an individual with left temporal-lobe epilepsy. METHOD: A 61-year old right-handed male with left temporal-lobe epilepsy (clinical onset at the age of 50) and a deficit in proper name retrieval participated in this study. A single-subject, repeated-probe ABAA design with testing before, immediately after, and 3 months after treatment completion was employed. Proper name retrieval treatment was administered 2 hr per day for 5 days. RESULTS: Results demonstrated improved naming on trained items and maintenance of trained items 3 months after treatment completion. CONCLUSION: Treatment, which took advantage of the individual's undamaged linguistic networks, promoted the reorganization of networks supporting proper naming, leading to improved proper name retrieval. Further research replicating these findings in individuals with varying degrees of proper name retrieval impairment is warranted. Additionally, the mechanism behind the observed improvements in proper name retrieval needs to be investigated further using functional neuroimaging.

Masked priming effects in aphasia: evidence of altered automatic spreading activation.

PURPOSE: Previous research has suggested that impairments of automatic spreading activation may underlie some aphasic language deficits. The current study further investigated the status of automatic spreading activation in individuals with aphasia as compared with typical adults. METHOD: Participants were 21 individuals with aphasia (12 fluent, 9 nonfluent) and 31 typical adults. Reaction time data were collected on a lexical decision task with masked repetition primes, assessed at 11 different interstimulus intervals (ISIs). Masked primes were used to assess automatic spreading activation without the confound of conscious processing. The various ISIs were used to assess the time to onset and duration of priming effects. RESULTS: The control group showed maximal priming in the 200-ms ISI condition, with significant priming at a range of ISIs surrounding that peak. Participants with both fluent and nonfluent aphasia showed maximal priming effects in the 250-ms ISI condition and primed across a smaller range of ISIs than did the control group. CONCLUSIONS: Results suggest that individuals with aphasia have slowed automatic spreading activation and impaired maintenance of activation over time, regardless of fluency classification. These findings have implications for understanding aphasic language impairment and for development of aphasia treatments designed to directly address automatic language processes.

Providing audiological services to individuals with aphasia: considerations, preliminary recommendations, and a call for research.

PURPOSE: The populations most susceptible to hearing loss and to aphasia overlap substantially, creating a high likelihood that audiologists will be called on to assess and treat individuals with aphasia. There is, however, scarce research available to guide best practices for serving this population. METHOD: The available relevant literature is reviewed to summarize what is already known, providing basic information about aphasia and its potential impact on audiological diagnostic and intervention processes. CONCLUSION: Suggestions for managing aphasia in the clinical audiology setting are provided, and areas of needed research are identified so that services for individuals with aphasia can be optimized.

Perception of visually masked stimuli by individuals with aphasia: A methodological assessment and preliminary theoretical implications.

BACKGROUND: Studies of the automatic processes supporting language processing and dysfunction in aphasia often rely on priming paradigms. The ability to confidently interpret these studies in terms of understanding the relative contributions of automatic vs. controlled processing, however, depends on the ability to isolate only automatic processes. One way this may be accomplished is through the use of visual masking. The effective use of visual masking, however, depends on verification that there was no task-relevant information consciously available from the prime item. AIMS: The study reported here was designed to assess the visibility of visually masked stimuli, for both typical adults and adults with aphasia. METHODS #ENTITYSTARTX00026; PROCEDURES: This experiment involved 31 typical adults and 21 individuals with aphasia. Visual masking sequences were presented on a computer screen, with 11 different interstimulus intervals assessed. Participants made lexical decisions on the masked stimuli. The two participant groups were compared in terms of their ability to distinguish the word/non-word status of masked stimuli at the various intervals. OUTCOMES #ENTITYSTARTX00026; RESULTS: Participants with aphasia showed an overall poorer ability to discriminate between visually masked words and non-words than typical adults. CONCLUSIONS: The visual masking sequence effectively interfered with task-relevant conscious perception of some masked stimuli for typical adults and all masked stimuli for participants with aphasia. This finding, combined with preliminary data collected on a similar task that involved a simple presence/absence judgment on masked items, suggests that there may be differences in the ability of individuals with aphasia to process rapidly presented masked stimuli, even when there is minimal linguistic processing required.

Simulation of aphasic naming performance in non-brain-damaged adults.

Discussion abounds in the literature as to whether aphasia is a deficit of linguistic competence or linguistic performance and, if it is a performance deficit, what are its precise mechanisms. Considerable evidence suggests that alteration of nonlinguistic factors can affect language performance in aphasia, a finding that raises questions about the modularity of language and the purity of linguistic mechanisms underlying the putative language deficits in persons with aphasia. This study investigated whether temporal stress plus additional cognitive demands placed on non-brain-damaged adults would produce aphasic-like performance on a picture naming task. Two groups of non-brain-damaged participants completed a picture naming task with additional cognitive demands (use of low frequency words and making semantic judgments about the stimuli). A control group performed this task at their own pace, and an experimental group was placed under time constraints. Naming errors were identified and coded by error type. Errors made by individuals with aphasia from a previous study (S. E. Kohn and H. Goodglass, 1985) were recoded with the coding system used in the present study and were then compared with the types of errors produced by the 2 non-brain-damaged groups. Results generally support the hypothesis that the language performance deficits seen in persons with aphasia exist on a continuum with the language performance of non-brain-damaged individuals. Some error type differences between groups warrant further investigation.