Word Retrieval Treatments with Aphasia

Abstract:

This single-subject study examined the effects of semantic and phonological cueing treatments on the word finding abilities of a sixty-four-year-old male with anomic aphasia, targeting the participant's specific level of lexical processing impairment (i.e. predominantly lexical-semantic, predominantly lexical-phonological, or mixed semantic-phonological). This investigation was a modified replication of a study by Wambaugh and colleagues (2001) which compared the effects of semantic and phonological cueing treatments on individuals with aphasia with differing levels of deficit. The participant received both treatments at single-word and conversational levels. Each treatment consisted of a pre-stimulation phase and a treatment phase in which response-contingent hierarchical steps were applied. Results indicated that although the participant clinically appeared to benefit from both types of treatments, there was a more positive response to the phonological cueing treatment.

Introduction:

Aphasia is known to be a highly variable, heterogeneous disorder. Few patients with aphasia follow a specific spontaneous recovery pattern, and few receive the same specific treatment for their impairment. One common form of language impairment exhibited by patients with aphasia is naming deficits. Some naming deficits in individuals with aphasia respond better to phonological cueing treatments that utilize first sound, syllable or rhyming cues to facilitate naming of target words. However, some types of naming deficits respond better to semantic cueing treatments that utilize cues such as sentence completion, the function of the target word, the location of the target word, or a superordinate of the word. Based on these different types of naming deficits, two types of treatments are typically used to address these deficits; those that target lexical-semantic levels of processing (Drew & Thompson, 1999; Kiran & Thompson 2003) and those that target lexical-phonological levels of processing (Raymer, Thompson, Jacobs, & LeGrand, 1993; Miceli, Amitrano, Capasso, Caramazza, 1996).

Treatments based on lexical processing models have been successful at facilitating generalization for patients with aphasia. If the clinician can identify the lexical level at which the breakdown occurs, specific treatment can be used to target that particular level of processing. For example, if an individual with aphasia-induced word retrieval deficits has a deficit at the lexical-semantic level of processing, semantic cueing treatments would best facilitate naming and generalization for the individual.

Tasks used to target lexical-semantic levels of processing typically involve judging semantic relatedness of items, categorizing objects or pictures, matching words to pictures, describing semantic features and providing synonyms and antonyms (Wambaugh, Linebaugh, Doyle, Martinez, Kalinyak-Fliszar, & Spencer, 2001). Drew and Thompson (1999) examined the effects of a semantic treatment on the acquisition, generalization, and maintenance of picture naming tasks to improve discrimination of perceptual, functional, and associative attributes of the pictures. The effectiveness of excluding a target word to facilitate the naming of pictures in two semantic categories, the promotion of generalization within and across semantic categories, and maintenance of trained words were targeted to measure treatment effects. Also, the addition of a phonological component to improve naming abilities was targeted to measure the effects of the treatment. Drew and Thompson (1999) concluded that treatment plans should be specifically based on the impaired level of processing in the individual and demonstrate the rationale for specifically based treatment for impaired levels of processing.