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The Rehabilitation Treatment Specification System (RTSS) provides a framework to identify specific components of treatments developed within various rehabilitation disciplines (eg, physical, occupational, or speech-language therapy). Furthermore, this framework offers the opportunity to identify the target and active ingredients of a therapy approach as well as the mechanism of action by which it is hypothesized to effect change in abilities or functions. In this article, we apply the RTSS framework to the characterization of a sample of treatments for aphasia that are based on cognitive-linguistic models of language processing. Our discussion of these applications centers on the benefits of this classification system and additional criteria to consider when evaluating cognitive-linguistic treatments for aphasia. [ABSTRACT FROM AUTHOR]

This study investigated the effects of typicality-based semantic feature analysis (SFA) treatment on generalisation across three levels: untrained related items, semantic/phonological processing tasks, and measures of global language function. Using a single-subject design with group-level analyses, 27 persons with aphasia (PWA) received typicality-based SFA to improve their naming of atypical and/or typical exemplars. Progress on trained, untrained, and monitored items was measured weekly. Pre- and post-treatment assessments were administered to evaluate semantic/phonological processing and overall language ability. Ten PWA served as controls. For the treatment participants, the likelihood of naming trained items accurately was significantly higher than for monitored items over time. When features of atypical items were trained, the likelihood of naming untrained typical items accurately was significantly higher than for untrained atypical items over time. Significant gains were observed on semantic/phonological processing tasks and standardised assessments after therapy. Different patterns of near and far transfer were seen across treatment response groups. Performance was also compared between responders and controls. Responders demonstrated significantly more improvement on a semantic processing task than controls, but no other significant change score differences were found between groups. In addition to positive treatment effects, typicality-based SFA naming therapy resulted in generalisation across multiple levels. [ABSTRACT FROM AUTHOR]

Neuroimaging studies of individuals with brain damage seek to link brain structure and activity to cognitive impairments, spontaneous recovery, or treatment outcomes. To date, such studies have relied on the critical assumption that a given anatomical landmark corresponds to the same functional unit(s) across individuals. However, this assumption is fallacious even across neurologically healthy individuals. Here, we discuss the severe implications of this issue, and argue for an approach that circumvents it, whereby: (i) functional brain regions are defined separately for each subject using fMRI, allowing for inter-individual variability in their precise location; (ii) the response profile of these subject-specific regions are characterized using various other tasks; and (iii) the results are averaged across individuals, guaranteeing generalizabliity. This method harnesses the complementary strengths of single-case studies and group studies, and it eliminates the need for post hoc “reverse inference” from anatomical landmarks back to cognitive operations, thus improving data interpretability. [ABSTRACT FROM AUTHOR]

Recovery in bilingual adults with aphasia (BAA) following treatment is a dynamic process that is accompanied by changes in the functional organization of language in the brain. Lesion data and functional imaging methods can improve our understanding of language deficit and recovery in BAA. This review article aims to inform clinicians about the neuroimaging methods employed to examine the neural correlates of language treatment in BAA and the evidence of the functional changes that occur within and across the language processing and the language control systems as a function of language treatment. [ABSTRACT FROM AUTHOR]

Purpose: The current study examined treatment outcomes and generalization patterns following 2 sentence comprehension therapies: object manipulation (OM) and sentence-to-picture matching (SPM). Findings were interpreted within the framework of specific deficit and resource reduction accounts, which were extended in order to examine the nature of generalization following treatment of sentence comprehension deficits in aphasia. Method: Forty-eight individuals with aphasia were enrolled in 1 of 8 potential treatment assignments that varied by task (OM, SPM), complexity of trained sentences (complex, simple), and syntactic movement (noun phrase, wh-movement). Comprehension of trained and untrained sentences was probed before and after treatment using stimuli that differed from the treatment stimuli. Results: Linear mixed-model analyses demonstrated that, although both OM and SPM treatments were effective, OM resulted in greater improvement than SPM. Analyses of covariance revealed main effects of complexity in generalization; generalization from complex to simple linguistically related sentences was observed both across task and across movement. Conclusions: Results are consistent with the complexity account of treatment efficacy, as generalization effects were consistently observed from complex to simpler structures. Furthermore, results provide support for resource reduction accounts that suggest that generalization can extend across linguistic boundaries, such as across movement type. [ABSTRACT FROM AUTHOR]

Developing language treatments that not only improve trained items but also promote generalisation to untrained items is a major focus in aphasia research. This study is a replication and extension of previous work which found that training abstract words in a particular context-category promotes generalisation to concrete words but not vice versa (Kiran, Sandberg, & Abbott, 2009). Twelve persons with aphasia (five female) with varying types and degrees of severity participated in a generative naming treatment based on the Complexity Account of Treatment Efficacy (CATE; Thompson, Shapiro, Kiran, & Sobecks, 2003). All participants were trained to generate abstract words in a particular context-category by analysing the semantic features of the target words. Two other context-categories were used as controls. Ten of the twelve participants improved on the trained abstract words in the trained context-category. Eight of the ten participants who responded to treatment also generalised to concrete words in the same context-category. These results suggest that this treatment is both efficacious and efficient. We discuss possible mechanisms of training and generalisation effects. [ABSTRACT FROM AUTHOR]

Background: Evidence from the picture–word interference literature reveals that picture–word pairs bearing a non-categorical relationship (e.g.,RING—expensive) will facilitate naming more than picture–word pairs bearing a categorical relationship (e.g.,BRACELET—earrings). It is not known whether these differential effects would be found within a naming treatment paradigm for aphasia; however, if it is the case that one type of semantic relations will yield more robust treatment effects than another, this would provide a more efficient and effective delivery of treatment. Moreover, since semantic errors are commonly produced by individuals with aphasia, an approach which helps strengthen the semantic network will, in turn, strengthen lexical retrieval and access processes. Aim: The aim of the study was to compare a features condition, or a condition in which attributes were used, to a categorical condition, or a condition in which categorical members were used to see which would yield greater naming improvements in aphasia. Methods & Procedures: Eight individuals with aphasia were recruited for the study. A multiple-baseline design across behaviours with a crossover component was used. A categorical–features sequence was used in four participants, and a features–categorical sequence was used in four other participants. Accuracy of correct naming was calculated to determine improvements in treatment. The types of naming errors produced by individuals with positive treatment effects in the trained condition were compared to the types of naming errors produced in the control condition. Outcome & Results: A range of small to large treatment effect sizes was obtained in six of the eight participants when considering both treated conditions. However, no overwhelming advantage was found for either condition. Analyses of naming error patterns indicated increased lexical access and retrieval of the targeted picture name. Conclusions: Approaches that use cues focusing either on categorical membership or attributes will facilitate naming abilities in individuals with aphasia whether naming per cent accuracy is calculated or naming error types are tallied. However, the current results did not indicate an overwhelming advantage in using one or the other condition. Future studies should specify the type of features used (e.g., associative cues, thematic cues or perceptual cues) to determine whether such a differentiation will yield clearer differential treatment effects. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this paper is to discuss experimental design options available for establishing the effects of treatment in studies that aim to examine the neural mechanisms associated with treatment-induced language recovery in aphasia, using functional magnetic resonance imaging (fMRI). We present both group and single-subject experimental or case-series design options for doing this and address advantages and disadvantages of each. We also discuss general components of and requirements for treatment research studies, including operational definitions of variables, criteria for defining behavioral change and treatment efficacy, and reliability of measurement. Important considerations that are unique to neuroimaging-based treatment research are addressed, pertaining to the relation between the selected treatment approach and anticipated changes in language processes/functions and how such changes are hypothesized to map onto the brain. [Copyright &y& Elsevier]

Current research on bilingual aphasia highlights the paucity in recommendations for optimal rehabilitation for bilingual aphasic patients (Edmonds & Kiran, 2006; Roberts & Kiran, 2007). In this paper, we have developed a computational model to simulate an English-Spanish bilingual language system in which language representations can vary by age of acquisition (AoA) and relative proficiency in the two languages to model individual participants. This model is subsequently lesioned by varying connection strengths between the semantic and phonological networks and retrained based on individual patient demographic information to evaluate whether or not the model's prediction of rehabilitation matches the actual treatment outcome. In most cases the model comes close to the target performance subsequent to language therapy in the language trained, indicating the validity of this model in simulating rehabilitation of naming impairment in bilingual aphasia. Additionally, the amount of cross-language transfer is limited both in the patient performance and in the model's predictions and is dependent on that specific patient s AoA, language exposure and language impairment. It also suggests how well alternative treatment scenarios would have fared, including some cases where the alternative would have done better. Overall, the study suggests how computational modeling could be used in the future to design customized treatment recipes that result in better recovery than is currently possible. [ABSTRACT FROM AUTHOR]

Purpose: Two new treatments, 1 based on sentence to picture matching (SPM) and the other on object manipulation (OM), that train participants on the thematic roles of sentences using pictures or by manipulating objects were piloted. Method: Using a single-subject multiple-baseline design, sentence comprehension was trained on the affected sentence type in 1 task-related protocol in 15 participants with aphasia. The 2 tasks were SPM and OM; the treatment stimuli were object relatives, object clefts, passives, and unaccusatives, as well as two control structures-object relatives with a complex noun phrase (NP) and active sentences with three NPs. Results: The criteria for efficacious treatment was an increase in the level of performance from the pretreatment probes to the posttreatment probes for the treated structure such that accuracy rose from at or below chance to above chance and either (a) accuracy rose by 33% or (b) the effect size was 2.6. Based on these criteria, the success rate for training the target structure was 2/6 participants in the SPM condition and 4/7 participants in the OM condition. Conclusion: The outcome of this study illustrates the utility of this theoretically motivated and efficacious treatment for sentence comprehension deficits in individuals with aphasia. [ABSTRACT FROM AUTHOR]

Purpose: Kiran and colleagues (Kiran, 2007, 2008; Kiran & Johnson, 2008; Kiran & Thompson, 2003) previously suggested that training atypical examples within a semantic category is a more efficient treatment approach to facilitating generalization within the category than training typical examples. In the present study, the authors extended previous work examining the notion of semantic complexity within goal-derived (ad hoc) categories in individuals with aphasia. Methods: Six individuals with fluent aphasia (age range = 39- 84 years) and varying degrees of naming deficits and semantic impairments were involved. Thirty typical and atypical items, each from 2 categories, were selected after an extensive stimulus norming task. Generative naming for the 2 categories was tested during baseline and treatment. Results: As predicted, training atypical examples in the category resulted in generalization to untrained typical examples in 5 of 5 patient-treatment conditions. In contrast, training typical examples (which was examined in 3 conditions) produced mixed results. One patient showed generalization to untrained atypical examples, whereas 2 patients did not show generalization to untrained atypical examples. Conclusion: Results of the present study supplement existing data on the effect of a semantically based treatment for lexical retrieval by manipulating the typicality of category examples. [ABSTRACT FROM AUTHOR]

Background: The significance of imageability and concreteness as factors for lexical tasks in aphasic individuals is under debate. No previous treatment studies have looked specifically at training abstract words compared to concrete for improved lexical retrieval in patients with chronic aphasia. Aims: The goal of the present study was to determine the efficacy of a treatment for lexical retrieval that is based on models of lexical processing by utilising abstractness as a mode of complexity. It was hypothesised that training abstract words in a category will result in improvement of those words and generalisation to untrained target concrete words in the same category. However, training concrete words in a category will result in the retrieval of trained concrete words, but not generalisation to target abstract words. Methods & Procedures: A single-participant experimental design across participants and behaviours was used to examine treatment and generalisation. Generative naming for three categories (church, hospital, courthouse) was tested during baseline and treatment. Each treatment session was carried out in five steps: (1) category sorting, (2) feature selection, (3) yes/no feature questions, (4) word recall, and (5) free generative naming. Outcomes & Results: Although participant 1 demonstrated neither significant learning nor generalisation during abstract or concrete word training, participants 2, 3, and 4 showed significant learning during abstract word training and generalisation to untrained concrete words. Participants 3 and 4 were also trained on concrete words, on which they improved, but did not show generalisation to untrained abstract words. Conclusions: The results of the present experiment support our hypothesis that training abstract words would result in greater learning and generalisation to untrained concrete words. They also tentatively support the idea that generalisation is facilitated by treatment focusing on more complex constructions (Kiran & Thompson, 2003; Thompson, Shapiro, Kiran, & Sobecks, 2003). [ABSTRACT FROM AUTHOR]

Purpose: The typicality treatment approach on improving naming was investigated within 2 inanimate categories (furniture and clothing) using a single-subject experimental design across participants and behaviors in 5 patients with aphasia. Method: Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, whereas generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results: Results indicated that 2 out of 4 patients trained on naming of atypical examples demonstrated generalization to naming untrained typical examples. One patient showed trends toward generalization but did not achieve criterion. Furthermore, all 4 patients trained on typical examples demonstrated no generalized naming to untrained atypical examples within the category. Also, analysis of errors indicated an evolution of errors as a result of treatment, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Conclusion: These results extend our previous findings (S. Kiran & C. K. Thompson, 2003a) to patients with nonfluent aphasia and to inanimate categories such as furniture and clothing. Additionally, the results provide support for the claim that training atypical examples is a more efficient method of facilitating generalization to untrained items within a category than training typical examples (S. Kiran, 2007). [ABSTRACT FROM AUTHOR]

The article discusses several issues to address during planning and implementation of clinical speech language pathology training programs and integrate it from different learning models. Using a cookbook as a metaphor, the studies of learning under different conditions and the literature comparing new and expert learners are examined. A two-dimensional, phased model of clinical teaching is presented based on the learning studies. The benefit of a phased approach is that the theory-to-practice connection is strengthened when students have the opportunity to develop, implement, and test the assessment and intervention proposals.

This article reviews the basic principles and evidence for the effectiveness of a semantic-based treatment for naming deficits in aphasia. This article focuses on three aspects of semantic-based treatment. First, the theoretical basis for semantic treatment approaches to alleviate naming deficits is explained. Second, the different types of semantic treatment approaches (i.e., substitutive and restitutive treatments) are reviewed. More attention is provided to restitutive treatment approaches, and some ideas regarding why these treatments may be effective are discussed. We argue that strengthening access to impaired semantic and phonologic representations and facilitating generalization to untrained but related targets are two factors determining the success of a restitutive-based semantic treatment. Finally, in the third section of the article, the effect of semantic treatment on the overall communicative effectiveness and suggestions for future research in this field are discussed. [ABSTRACT FROM AUTHOR]

Previous findings have shown that subjects respond to an alteration, or shift, of auditory feedback pitch with a change in voice fundamental frequency (F0). When pitch shifts exceeding 500 ms in duration were presented, subjects' averaged responses appeared to consist of both an early and a late component. The latency of the second response was long enough to be produced voluntarily. To test the hypothesis that there are two responses to pitch-shift stimuli and to clarify the role of intention, subjects were instructed to change their voice F0 in the opposite direction of the pitch-shift stimulus, in the same direction, or not to respond at all. In a second group, subjects were tested under the above conditions as well as under instructions to raise voice F0 or to lower F0 as rapidly as possible upon hearing a pitch shift. Results showed that, when given instructions to produce a voluntary response, subjects made both an early vocal response (VR1) and a later vocal response (VR2). The second response, VR2, was almost always made in the instructed direction, whereas VR1 was often made incorrectly. The latency of VR1 was reduced under instructions to respond to feedback pitch shifts by changing voice F0 in the opposite direction, compared with that when told to ignore the pitch shifts. Latency and amplitude measures of VR2 differed under the various experimental conditions. These results demonstrate that there are two responses to pitch-shift stimuli. The first is relatively automatic but may be modulated by instructions to the participant. The second response is probably a voluntary one. [ABSTRACT FROM AUTHOR]

BackgroundAimsMethods & ProceduresOutcomes & ResultsConclusionsThe Complexity Account for Treatment Efficacy (CATE) has been applied to semantic typicality in aphasia naming therapy, i.e. training atypical items of a category would improve naming of typical untrained-related items. However, most aphasia treatment studies have implemented a binary scoring system to measure response accuracy, which may not thoroughly reveal linguistic mechanisms underlying aphasia recovery.The current study investigated the evolution of error patterns following typicality-based Semantic Features Analysis (SFA) treatment in individuals with post-stroke aphasia.Thirty individuals with chronic aphasia participated in a typicality-based SFA treatment, and ten individuals with chronic aphasia served as controls. The treatment participants and controls completed a naming screener before and after either a treatment period or a no-treatment period, respectively. Responses were coded using an error coding scale and analyzed with mixed-effects models.Treatment participants demonstrated significant treatment and generalization effects, as captured by significant improvements on the error coding system for both trained and untrained items. However, the group-level analysis did not reveal significant generalization from training atypical items to untrained typical items. Subgroup analyses based on participants’ performance in treatment showed significant gains in naming untrained typical items from training atypical items in responders, but improved naming of untrained atypical items from training typical items in nonresponders.These findings suggest different linguistic mechanisms underlying aphasia recovery and highlight the importance of investigating treatment and generalization effects using a fine-grained error coding system as a complement to a binary scoring system. [ABSTRACT FROM AUTHOR]

The neural mechanisms that underlie generalization of treatment-induced improvements in word finding in persons with aphasia (PWA) are currently poorly understood. This study aimed to shed light on changes in functional network connectivity underlying generalization in aphasia. To this end, we used fMRI and graph theoretic analyses to examine changes in functional connectivity after a theoretically-based word-finding treatment in which abstract words were used as training items with the goal of promoting generalization to concrete words. Ten right-handed native English-speaking PWA (7 male, 3 female) ranging in age from 47 to 75 (mean=59) participated in this study. Direct training effects coincided with increased functional connectivity for regions involved in abstract word processing. Generalization effects coincided with increased functional connectivity for regions involved in concrete word processing. Importantly, similarities between training and generalization effects were noted as were differences between participants who generalized and those who did not. [ABSTRACT FROM AUTHOR]

Abstract: Functional magnetic resonance imaging is the most widely used imaging technique to study treatment-induced recovery in post-stroke aphasia. The longitudinal design of such studies adds to the challenges researchers face when studying patient populations with brain damage in cross-sectional settings. The present review focuses on issues specifically relevant to neuroimaging data analysis in aphasia treatment research identified in discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). In particular, we aim to provide the reader with a critical review of unique problems related to the pre-processing, statistical modeling and interpretation of such data sets. Despite the fact that data analysis procedures critically depend on specific design features of a given study, we aim to discuss and communicate a basic set of practical guidelines that should be applicable to a wide range of studies and useful as a reference for researchers pursuing this line of research. [Copyright &y& Elsevier]