1. + Treatment of Aphasia Week 12 April 1 st, 2011

2. + Review Involvement of semantic and phonological stages in naming. Differentiating features of naming impairments 1. Semantically based naming impairments: semantically related words, empty words, perseverations, confusion in comprehension tasks 2. Phonologically based naming impairments: semantic errors, no response, phonemic paraphasias, neologistic errors, and comprehension is preserved.

3. + Treatment for Anomia Word Finding Cue Responsiveness Cues are used to elicit words automatically or without training Semantic cue: provide information about the target word’s meaning Semantic cue may be said to activate an area in semantic memory Lexical or phonological cue: provide information about a word (i.e., first sound or syllable) Lexical cues point to a form in the mental lexicon Either type of cue is more effective in eliciting names than a picture alone.

4. + Cuing Hierarchies Target picture: Blouse 1. It’s clothing 2. you can button it 3. It starts with /bl/ 4. It sounds like mouse 5. Written word: Here is the word, blouse 6. Say blouse Treatment for Anomia

5. + Word Finding Cue Responsiveness Cues are more effective as the severity of naming deficit decreases Phonological cue is more effective than semantic or other lexical cues such as printed or rhyming word Some believe that phonemic cues are more useful for cases of Broca’s aphasia that have most difficulty in naming Cues are more effective for conduction aphasia than the other fluent syndromes

6. + Treatment for Anomia Word Finding Self-Cueing Training a patient to write the first letter, sound it out, and generate his own carrier phrase Use the sound as a cue

7. + Treatment for Anomia Word Finding Theory-Driven Naming Therapy The arousal power of cues indicate that aphasic impairment lies in lexical retrieval instead of being a loss of lexical storage (Howard et al., 1985) Another finding that phonological cues are superior to semantic cues could be because the stimulus object already activates semantic memory through the object recognition capacity. Semantic cues may be redundant One impression that a stroke raises the thresholds for lexical activation and that form-related cues lower the threshold or raise the activation level

8. + Treatment for Anomia Word Finding Theory-Driven Naming Therapy Treatments have been designed to repair the semantic system, the phonological output lexicon, or the route between semantic and lexical systems. The therapies have been broadly classified as Phonological (or lexical) treatment Semantic treatment

9. + Treatment for Anomia Word Finding Semantic treatments Emphasis on activating concepts associated with words Patients are not required to produce a word during the therapy One version of semantic treatment centers around word comprehension (i.e., picture-word matching) Progress in naming, especially for untreated items has been mixed.

10. + Treatment for Anomia Word Finding Semantic treatments Another version of semantic therapy is called “semantic feature analysis” Object in a naming task is accompanied by various cues An object is placed in the center of a feature analysis chart containing cues to various types of conceptual associations E.g., is used for ___, has_____, reminds me of ____ Patient has to complete the phrases and write answers in boxes surrounding the object

11. + Treatment for Anomia Word Finding Phonological treatments Phonological treatment focuses on sound structure, whereas orthographic treatment focuses on written structure or spelling.

12. + Treatment for Anomia Word Finding One study showed that both semantic and phonological impairments to be equally effective but with limited generalization Drew and Thompson (1999) were more impressed with combined treatments than with semantic treatment alone

13. + Treatment for Anomia Word Finding Results from case studies revealed that Patients with the same diagnosis do not respond well to the same treatment Too often, the treatments fail to generalize to other items and other tasks (Hillis, 2001) Basso (2005) suggested that increased frequency and longer duration of direct language treatment results in better communicative improvement The effectiveness of theory-driven naming procedures is not known for the subacute phase of recovery.

14. + Treatment for Anomia Other Naming Treatments The most common form of cueing treatment is to combine both phonological or semantic treatments Some clinicians have applied a mixed semantic- lexical procedure to the treatment of proper and common nouns. Contextual priming: Naming was preceded by repetition, which was intended to facilitate naming The treatment occurred in the following order: Spoken word-picture matching, repetition of the name, independent naming (delayed repetition)

15. + Treatment for Anomia Computer-Assisted Treatment Computer programs provide automated presentation of stimulus “frames” and feedback upon response. Parrot Software have developed sophisticated programs for work on reading comprehension, semantic categorization, visual attention, short-term memory, and reasoning. The software is capable of providing hints to correct response and data on performance over time.

16. + Treatment for Anomia Computer-Assisted Treatment MossTalk Words: it provides auditory and written cues for naming and is clinician assisted or self-guided Multicue, a program in the Netherlands for naming therapy in which the patient selects his or her best cueing hierarchy