Intervention for Anomic Aphasia from a Cognitive ImpairmentBased Perspective

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Intervention for Anomic Aphasia from a Cognitive
Impairment-Based Perspective

• Nadine Martin
• Philadelphia, PA

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A simple model of word processing
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Hypothesized breakdown in word processing system
is between the semantic and lexical network.
Good repetition, good single word comprehension,
impaired naming.
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Additional testing
Word comprehension - Philadelphia Comprehension
Battery Word-to-picture Matching
Within category distractor 14/16 Across
category distractor 16/16 Synonymy
Judgments Nouns 11/15 Verbs 9/15
Sentence Comprehension Reversible semantic
arguments 53/60 Non-reversible semantic
arguments 57/60 Phonological Processing
Same-different discrimination (PALPA 1
nonwords) 69/72 Same different
discrimination (PALPA 2 words) 70/72
Word Discrimination Auditory Lexical
Decision (PALPA 5) 71/80
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Additional testing
Word Repetition PALPA 9 High
Imageability words 39/40 Low
Imageability words 33/40 Reading aloud PALPA
32 Nouns 12/20
Adjectives 10/20 Verbs 9/20
Functors 4/20 Auditory Short-term Memory
Repetition span Digits 3 Words 2
Pointing Span Digits 2 Words 3
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Treatment Approach 1. Production priming with
increasing intervals between prime and production

• This direct method aims to improve
  the ability to retrieve and maintain activation
  of a words semantic and phonological
  representations in production by facilitating
  repeated use of the pathway between semantics and
  the output word form. (Martin et al., 2006)
• Priming the production of a single word is
  accomplished by naming several different
  exemplars of a target word
• For example, for the target word fire hydrant,
  the clinician would present four pictures of fire
  hydrants, each in a different style and
  subsequently, 4 pictures of other items in the
  training set.
• In a second stage, pictures in a set (4 in all)
  would be trained in random composition (sets of
  hydrant, latch, airport, factory) as opposed to
  blocks of 4 hydrants, 4 latches, 4 airports, etc.
• In each stage, an interval (5 sec) is added
  between productions of the name in order to
  improve ability to maintain activation of that
  name for increasing amounts of time.

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Step 1 Pictures of the target words are first
presented in a blocked fashion
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X
Original
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Step 2 Pictures from each set are presented in
an Unblocked Fixed Order
Set A
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Step 2 Unblocked Fixed Order
Set B
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Step 2 Unblocked Fixed Order
Set C
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Step 3 Pictures are presented in an Unblocked
Random Order
Original
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Treatment Approach 2. Development of
self-cueing strategies to facilitate word
retrieval (Nickels, 1992).

• Goal Develop a functional strategy for WS to
  retrieve words.
• Identify core words that can be read and
  retrieved without struggle.
• Develop the ability to produce their initial
  sounds in response to written word.
• /k/ for cake
• Establish a link between each cue word and words
  that begin with that sound but cannot be
  retrieved.
• Cake /k/ car, cane, cab etc.
• Use the cue to facilitate retrieval of that word.
  i.e., WS will learn to use the cue word that
  begins with the particular sound that is the same
  initial sound as the object he is trying to name.
• Initially, written cue words will be paired with
  a picture.
• As WS becomes more familiar with written cue
  words and the initial sound, the picture cue will
  be faded out.

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Functional Aspects of the Word cueing strategy

• This aspect of treatment allows WS to use his
  ability to read some words to facilitate his word
  retrieval.
• It is, in that sense, an adaptive strategy that
  attempts to use strengths to compensate for a
  disability.

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Functional Aspects of the Priming Treatment

• Target words will be chosen by the client from a
  large pool of possible words and words that he
  chooses.
• Working directly on word retrieval is initiated
  in response to his specific desire to work on his
  ability to say the words he wants to say.

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Outcome measures

• Data analysis. Acquisition, maintenance and
  generalization.
• Progress will be measured as proportion of
  correct responses on daily administration of test
  used in baseline at the beginning of each
  treatment session.
• McNemar tests of change will be used to determine
  overall improvements in naming.
• Additionally, carryover of retrieval skills to
  extended speech will be measured by speech
  samples obtained before and after treatment
  (e.g., Cinderella story retell and picture
  description task).
• Will look for increase in expressive
  vocabulary, improvements in sentence structure.

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Summary

• Focus of treatment DIRECT - improvement of
  most prominent language deficit word retrieval
  difficulty.
• Two approaches
• One that targets the word retrieval process
  directly (production priming with short-term
  memory stimulation)
• One that enables WS to use his residual reading
  skills to self-cue retrieval of words in
  production.
• WSs overall well-being is addressed via
• the content of therapy (words that will be
  targeted in training) according to his everyday
  needs and interests.
• familys involvement is incorporated into the
  treatment plan.
• satisfies WS desire to work directly on his
  naming.

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References

• Martin, N., Fink, R., Renvall, K., Laine, M.
  (2006). Effectiveness of contextual repetition
  priming. Treatments for anomia depends on
  intact access to semantics. Journal of
  International Neuropsychological Society, 12,
  1-14.
• Nickels, L., (1992). The Autocue? Self-generated
  phonemic cues in the treatment of a disorder of
  reading and naming. Cognitive Neuropsychology,
  9, 155-182.