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

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.

Examining Dose Frameworks to Improve Aphasia Rehabilitation Research.

The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.

Aphasia Recovery: When, How and Who to Treat?

PURPOSE OF REVIEW: We now know that speech and language therapy (SALT) is effective in the rehabilitation of aphasia; however, there remains much individual variability in the response to interventions. So, what works for whom, when and how? RECENT FINDINGS: This review evaluates the current evidence for the efficacy of predominantly impairment-focused aphasia interventions with respect to optimal dose, intensity, timing and distribution or spacing of treatment. We conclude that sufficient dose of treatment is required to enable clinical gains and that e-therapies are a promising and practical way to achieve this goal. In addition, aphasia can be associated with other cognitive deficits and may lead to secondary effects such as low mood and social isolation. In order to personalise individual treatments to optimise recovery, we need to develop a greater understanding of the interactions between these factors.

Influence of Cognitive Ability on Therapy Outcomes for Anomia in Adults With Chronic Poststroke Aphasia.

Purpose: The relationship between cognitive abilities and aphasia rehabilitation outcomes is complex and remains poorly understood. This study investigated the influence of language and cognitive abilities on anomia therapy outcomes in adults with aphasia. Method: Thirty-four adults with chronic aphasia participated in Aphasia Language Impairment and Functioning Therapy. A language and cognitive assessment battery, including 3 baseline naming probes, was administered prior to therapy. Naming accuracy for 30 treated and 30 untreated items was collected at posttherapy and 1-month follow-up. Multiple regression models were computed to evaluate the relationship between language and cognitive abilities at baseline and anomia therapy outcomes. Results: Both language and cognitive variables significantly influenced anomia therapy gains. Verbal short-term memory ability significantly predicted naming gains for treated items at posttherapy (ß = -.551, p = .002) and for untreated items at posttherapy (ß = .456, p = .014) and 1-month follow-up (ß = .455, p = .021). Furthermore, lexical-semantic processing significantly predicted naming gains for treated items at posttherapy (ß = -.496, p = .004) and 1-month follow-up (ß = .545, p = .012). Conclusions: Our findings suggest that individuals' cognitive ability, specifically verbal short-term memory, affects anomia treatment success. Further research into the relationship between cognitive ability and anomia therapy outcomes may help to optimize treatment techniques.

The relationship between novel word learning and anomia treatment success in adults with chronic aphasia.

INTRODUCTION: Learning capacity may influence an individual's response to aphasia rehabilitation. However, investigations into the relationship between novel word learning ability and response to anomia therapy are lacking. The aim of the present study was to evaluate the novel word learning ability in post-stroke aphasia and to establish the relationship between learning ability and anomia treatment outcomes. We also explored the influence of locus of language breakdown on novel word learning ability and anomia treatment response. MATERIAL AND METHODS: 30 adults (6F; 24M) with chronic, post-stroke aphasia were recruited to the study. Prior to treatment, participants underwent an assessment of language, which included the Comprehensive Aphasia Test and three baseline confrontation naming probes in order to develop sets of treated and untreated items. We also administered the novel word learning paradigm, in which participants learnt novel names associated with unfamiliar objects and were immediately tested on recall (expressive) and recognition (receptive) tasks. Participants completed 48 h of Aphasia Language Impairment and Functioning Therapy (Aphasia LIFT) over a 3 week (intensive) or 8 week (distributed) schedule. Therapy primarily targeted the remediation of word retrieval deficits, so naming of treated and untreated items immediately post-therapy and at 1 month follow-up was used to determine therapeutic response. RESULTS: Performance on recall and recognition tasks demonstrated that participants were able to learn novel words; however, performance was variable and was influenced by participants' aphasia severity, lexical-semantic processing and locus of language breakdown. Novel word learning performance was significantly correlated with participants' response to therapy for treated items at post-therapy. In contrast, participants' novel word learning performance was not correlated with therapy gains for treated items at 1 month follow-up or for untreated items at either time point. Therapy intensity did not influence treatment outcomes. DISCUSSION: This is the first group study to directly examine the relationship between novel word learning and therapy outcomes for anomia rehabilitation in adults with aphasia. Importantly, we found that novel word learning performance was correlated with therapy outcomes. We propose that novel word learning ability may contribute to the initial acquisition of treatment gains in anomia rehabilitation.

Evidence for Intensive Aphasia Therapy: Consideration of Theories From Neuroscience and Cognitive Psychology.

Treatment intensity is a critical component to the delivery of speech-language pathology and rehabilitation services. Within aphasia rehabilitation, however, insufficient evidence currently exists to guide clinical decision making with respect to the optimal treatment intensity. This review considers perspectives from 2 key bodies of research, the neuroscience and cognitive psychology literature, with respect to the scheduling of aphasia rehabilitation services. Neuroscience research suggests that intensive training is a key element of rehabilitation and is necessary to achieve functional and neurologic changes after a stroke occurs. In contrast, the cognitive psychology literature suggests that optimal long-term learning is achieved when training is provided in a distributed or nonintensive schedule. These perspectives are evaluated and discussed with respect to the current evidence for treatment intensity in aphasia rehabilitation. In addition, directions for future research are identified, including study design, methods of defining and measuring treatment intensity, and selection of outcome measures in aphasia rehabilitation.

Intensive Versus Distributed Aphasia Therapy: A Nonrandomized, Parallel-Group, Dosage-Controlled Study.

BACKGROUND AND PURPOSE: Most studies comparing different levels of aphasia treatment intensity have not controlled the dosage of therapy provided. Consequently, the true effect of treatment intensity in aphasia rehabilitation remains unknown. Aphasia Language Impairment and Functioning Therapy is an intensive, comprehensive aphasia program. We investigated the efficacy of a dosage-controlled trial of Aphasia Language Impairment and Functioning Therapy, when delivered in an intensive versus distributed therapy schedule, on communication outcomes in participants with chronic aphasia. METHODS: Thirty-four adults with chronic, poststroke aphasia were recruited to participate in an intensive (n=16; 16 hours per week; 3 weeks) versus distributed (n=18; 6 hours per week; 8 weeks) therapy program. Treatment included 48 hours of impairment, functional, computer, and group-based aphasia therapy. RESULTS: Distributed therapy resulted in significantly greater improvements on the Boston Naming Test when compared with intensive therapy immediately post therapy (P=0.04) and at 1-month follow-up (P=0.002). We found comparable gains on measures of participants' communicative effectiveness, communication confidence, and communication-related quality of life for the intensive and distributed treatment conditions at post-therapy and 1-month follow-up. CONCLUSIONS: Aphasia Language Impairment and Functioning Therapy resulted in superior clinical outcomes on measures of language impairment when delivered in a distributed versus intensive schedule. The therapy progam had a positive effect on participants' functional communication and communication-related quality of life, regardless of treatment intensity. These findings contribute to our understanding of the effect of treatment intensity in aphasia rehabilitation and have important clinical implications for service delivery models.