Effects of Word Retrieval Training for Semantic Anomia
Kimberly Graham, Zachary Azevedo, Beth McHose, & Anastasia M. Raymer
Department of Communication Disorders & Special Education, Old Dominion University, Norfolk, VA
BACKGROUND AND PURPOSE
Several treatment methods are effective for improving lexical
retrieval in individuals with anomia (Nickels, 2002). Fewer
studies have contrasted treatment effects to determine whether
one method is more effective than another. Across studies,
treatment effects tend to be more limited in individuals with
semantically-based anomias. The purpose of this study was to
contrast the effects of verbal+gesture (GES) treatment (Raymer
et al., 2006) and errorless naming treatment (ENT) (Fillingham
et al., 2005a, 2005b, 2006) on noun retrieval in participants with
stroke-induced aphasia. We predicted that compensatory
gesture treatment might be superior to ENT for individuals with
severe semantic anomia.
#802: Percent Correct Picture Naming
Baseline
Phase 1: ENT Training
Post-1
Phase 2: GES Training
Post-2
Age (yrs)
67
Education (yrs)
16
Gender
F
Time post CVA (mos)
16
Western Aphasia Battery-R
Spont Speech/Info
4
Auditory Comprehension
5.7
Repetition
.4
Naming
.4
WAB Aphasia Quotient
21.0
Noun Battery (n=60)% correct
(Zingeser & Berndt, 1990)
Picture Naming
0
1.7
Sentence Completion
Word/Pic Y/N Verif
70.0
Aphasia Type &
Broca’s +
AoS
Naming Impairment
Semantic
Persevs
P804
#802: Gesture Production
Baseline
Phase 1: ENT Training
Post-1
Phase 2: GES Training
26.7
40.0
51.7
Transcort
Sensory
Semantic
Persevs
Treatment Design
™Single-participant crossover design
™ Verbal+Gesture Treatment (GES) and Errorless
Naming Treatment (ENT) - randomly assigned order
Baselines and Daily Probes
™ Picture Naming/Gesture Production:
24 nouns GES training, 24 nouns ENT training,
12 untrained nouns
™ Baseline: Probe tasks administered in 3-4 sessions
™ Treatment phases: Probe tasks administered daily
prior to treatment
Effect Sizes = d
Errorless Naming Tx 1
Trained ENT Nouns - Naming
Untrained GES Nouns – Naming
Untrained Controls - Naming
P802 P804
#804: Percent Correct Picture Naming
Baseline
7.19
3.57
0
3.65
.74
-.26
.23
-3.19
0
47.62
24.81
33.76
-.50
-3.53
1.41
34.70
0
0
Phase 1: ENT Training
Post-1
Phase 2: GES Training
Post-2
#804: Percent Correct Gesture Production
Baseline
Phase 1: ENT Training
Post-1
Phase 2: GES Training
Post-2
Post-2
78
16
F
6
13
6.25
9.2
4.8
66.8
P804 Daily picture naming and gesture probes
Verbal+Gesture Tx 2
Trained GES Nouns - Naming
Untrained ENT Nouns – Naming
Untrained Controls: Naming
Trained GES Nouns – Gestures
Untrained ENT Nouns – Gestures
Untrained Controls - Gestures
METHODS
Participants: left hemisphere stroke, right handed
P802
RESULTS
P802 Daily picture naming and gesture probes
Standardized Tests
Treatment
™ 20 one-hour treatment sessions in each
treatment phase - 3 sessions/week
™Verbal+Gesture Treatment
1. Picture presented, clinician models target
spoken noun and pantomime, participant repeats
3 times
2. Participant repeats target gesture 3 times
3. Participant repeats target word 3 times
4. After 5-second interval, participant
spontaneously produces noun and gesture
™Errorless Naming Treatment:
1. Picture presented, clinician models target
noun, participant repeats 3 times
2. Participant shown picture and written word;
participant says target word 3 times;
3. Participant shown only picture; participant
names target picture 3 times;
4. After 5 sec interval, participant spontaneously
names the picture
Both Treatments – final Barrier Activity
-attempt naming without assistance
-Participant reminded at each step not to
respond unless sure of correct response
-High reliability of dependent and independent
variables confirmed
P802
P804
Western Aphasia Battery
Pre-Tx
Post-Tx 1
Post-Tx 2
Boston Naming Test
Pre-Tx
Post-Tx 1
Post-Tx 2
21.0
25.8
24.2
61.1
66.8
68.5
0
1
0
11
13
18
Communicative
Effectiveness Index
Pre-Tx
Post-Tx 1
Post-Tx2
37.9
48.6
46.0
56.29
--51.63
Error Production During Errorless Training
802
804
Total Attempts
34.58%
8.47%
References
Fillingham, J.K., Sage, K., & Lambon Ralph, M.A.
(2005a). Aphasiology, 19, 597-614.
Fillingham, J.K., Sage, K., & Lambon Ralph, M.A.
(2005b). International Journal of Language &
Communication Disorders, 40, 505-523.
Fillingham, J.K., Sage, K., & Lambon Ralph, M.A.
(2006).Neuropsychological Rehabilitation, 16, 129-154.
DISCUSSION
™ENT: both participants improved naming;
P802 generalized to untrained words
™GES: no naming improvements (loss of
gains in ENT set); Large gesture
improvements – generalized gesture
increases in P802, the more severe patient
™ENT superior to GES in Naming
improvements; gains not maintained,
™Improvements in standardized testing:
P802 limited gains (WAB); gains beyond
SEM for P804 following ENT (WAB) and
GES (BNT)
™Conversational improvements yet to be
determined
™No improvements for untrained control
items, suggesting gains related to treatment
and not extraneous factors
™Results contrast outcomes for language
versus communication measures: although
language gains somewhat limited, large
gains in gesture have potential to improve
communication in important ways
Nickels, L. (2002). Aphasiology, 16, 935-979.
Raymer, A.M., Singletary, F., Rodriguez, A., Ciampitti, M.,
Heilman, K.M., & Rothi, L.J.G. (2006). Journal of the
International Neuropsychological Society, 12, 867-882.
ACKNOWLEDGMENTS: Supported by NIH
(NIDCD) R-15 grant to Old Dominion University.