Adaptive Naming Treatment Schedules for Aphasia

Recruiting in Palo Alto (17 mi)

Overseen by William Evans, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: University of Pittsburgh

Disqualifiers: Neurological disease, Language comprehension, Drug/alcohol dependence, Mood/behavioral disorders

No Placebo Group

Prior Safety Data

Trial Summary

What is the purpose of this trial?

Aphasia is a language disorder caused by stroke and other acquired brain injuries that affects over two million people in the United States and which interferes with life participation and quality of life. Anomia (i.e., word- finding difficulty) is a primary frustration for people with aphasia. Picture-based naming treatments for anomia are widely used in aphasia rehabilitation, but current treatment approaches do not address the long-term retention of naming abilities and do not focus on using these naming abilities in daily life. The current research aims to evaluate novel anomia treatment approaches to improve long-term retention and generalization to everyday life. This study is one of two that are part of a larger grant. This record is for sub-study 2, which will evaluate the benefits of adaptive trial spacing.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the Adaptive Naming Treatment Schedules for Aphasia?

Research shows that using retrieval practice (practicing recalling names) and spacing (spreading out practice sessions) improves naming abilities in people with aphasia. These methods have been found to be more effective than simple repetition, suggesting that the adaptive treatment schedules could be beneficial for improving naming skills.

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Is the Adaptive Naming Treatment for Aphasia safe for humans?

The research articles provided do not contain specific safety data for the Adaptive Naming Treatment or its variations. They focus on the effectiveness of different treatment approaches for naming deficits in aphasia.

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How is the Adaptive Naming Treatment for Aphasia different from other treatments?

The Adaptive Naming Treatment for Aphasia is unique because it uses adaptive spacing, which adjusts the timing between practice sessions based on the patient's performance, to enhance learning and retention of word naming. This approach contrasts with traditional methods that use fixed or random intervals, and it incorporates retrieval practice, which has been shown to be more effective than simple repetition in improving naming abilities.

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Eligibility Criteria

This trial is for people who have had a stroke leading to aphasia, a language disorder, and struggle with finding words. They must be at least six months post-stroke, show specific difficulties on the Comprehensive Aphasia Test, and can use telehealth services via high-speed internet. It's not for those with other neurological diseases, severe comprehension issues, uncontrolled substance dependence or serious mood disorders.

Inclusion Criteria

I have had difficulty speaking for over 6 months due to a stroke.

You have trouble with at least two out of eight parts of the Comprehensive Aphasia Test.

Must have access to a high-speed internet connection and be able to participate in telehealth.

Exclusion Criteria

You have trouble understanding and speaking language, based on a specific test score.

I have a severe mood or behavioral disorder that needs special mental health care.

I have a history of a progressive neurological condition.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

2 visits (telehealth)

Treatment

Participants receive 10 weeks of computer-based training per condition, including one-on-one and independent practice sessions

10 weeks per condition

30 one-on-one sessions, 96 independent practice sessions (telehealth)

Follow-up

Participants are monitored for safety and effectiveness after treatment with probes administered at baseline and at 1 week, 3 months, and 6 months post-treatment

6 months

24 baseline and follow-up probe sessions (telehealth)

Participant Groups

The study tests three different ways of scheduling picture-based naming exercises to help improve long-term word recall and usage in daily life for individuals with aphasia. Participants will try adaptive spacing (adjusting intervals based on performance), or one of two fixed schedules with varying amounts of practice items.

Group I: Low-item non-adaptive spacing, then high-item non-adaptive spacing, then adaptive spacing Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group II: Low-item non-adaptive spacing, then adaptive spacing, then high-item non-adaptive spacing Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group III: High-item non-adaptive spacing, then low-item non-adaptive spacing, then adaptive spacing Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group IV: High-item non-adaptive spacing, then adaptive spacing, then low-item non-adaptive spacing Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group V: Adaptive spacing, then low-item non-adaptive spacing, then high-item non-adaptive spacing Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group VI: Adaptive spacing, then high-item non-adaptive spacing, then low-item non-adaptive spacing Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Adaptive Spacing Condition is already approved in United States for the following indications:

🇺🇸 Approved in United States as Adaptive Trial Scheduling for:

• Aphasia
• Anomia

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

Language Rehab and Cognition Lab, Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh Pittsburgh, PA

Who Is Running the Clinical Trial?

University of Pittsburgh Lead Sponsor

University of Massachusetts, Amherst Collaborator

National Institute on Deafness and Other Communication Disorders (NIDCD) Collaborator

References

1. United States pubmed.ncbi.nlm.nih.gov

Applying adaptive distributed practice to self-managed computer-based anomia treatment: A single-case experimental design. [2022] There is a pressing need to improve computer-based treatments for aphasia to increase access to long-term effective evidence-based interventions. The current single case design incorporated two learning principles, adaptive distributed practice and stimuli variability, to promote acquisition, retention, and generalization of words in a self-managed computer-based anomia treatment.

2. Italy pubmed.ncbi.nlm.nih.gov

Retrieval practice and spacing effects in multi-session treatment of naming impairment in aphasia. [2021] Retrieval practice and spacing are two factors shown to enhance learning in basic psychological research. The present study investigated the clinical applicability of these factors to naming treatment in aphasia. Prior studies have shown that naming treatment that provides retrieval practice (i.e., practice retrieving names for objects from semantic memory) improves later naming performance in people with aphasia (PWA) more so than repetition training. Repetition training is a common form of naming treatment that can support errorless production of names for objects, but it does not provide retrieval practice. Prior work has also demonstrated enhanced naming treatment benefit in PWA when an item's training trials are separated by multiple intervening trials (i.e., spacing) compared to only one intervening trial (i.e., massing). However, in those studies, items were only trained in one session. Also, the effects of the learning factors were probed after one day and one week. The goal of the present study was to examine the effects of retrieval practice and spacing in a more clinically-inspired schedule of delivery and to assess the effects of the learning factors at retention intervals of greater functional significance. Matched sets of errorful items for each of four PWA were presented for multiple trials of retrieval practice or repetition in a spaced or massed schedule in each of multiple training sessions. Mixed regression analyses revealed that retrieval practice outperformed repetition, and spacing outperformed massing, at an initial post-treatment test administered after one week. Furthermore, the advantage for retrieval practice over repetition persisted at a follow-up test administered after one month. The potential clinical relevance of retrieval practice and spacing for multi-session interventions in speech-language treatment is discussed.

3. United States pubmed.ncbi.nlm.nih.gov

Response Time Inconsistencies in Object and Action Naming in Anomic Aphasia. [2019] The effect of repeated naming on both object and action picture naming in individuals with anomic aphasia is explored. We asked whether repeatedly naming the same items leads to improved accuracy and reduced response latency.

4. United States pubmed.ncbi.nlm.nih.gov

Comparing fixed- and randomized-interval spaced retrieval in anomia treatment. [2013] Spaced retrieval (SR) has recently been modified to target anomia in persons with aphasia (PWA). It relies on a strict management of the inter-stimulus interval (ISI) where the time between stimulus presentations is doubled or halved based on response accuracy. Although SR is successful in treating anomia, it remains to be studied whether the strict ISI management is necessary. The present study compared fixed-interval spaced retrieval (FISR) to randomized-interval spaced retrieval (RISR) in anomia treatment. Using alternating treatments single subject design, three PWA were trained to name 30 target items. Although both treatments were successful, the present data did not reveal one approach as superior even though fewer FISR sessions were needed and more FISR items were maintained on the post-treatment probes. This difference was only minimal suggesting that a less stringent stimulus schedule, as used in RISR, is sufficient for successful treatment outcome.

5. England pubmed.ncbi.nlm.nih.gov

The use of semantic- and phonological-based feature approaches to treat naming deficits in aphasia. [2012] The aim of the study was to compare approaches highlighting either semantic or phonological features to treat naming deficits in aphasia. Treatment focused on improving picture naming. An alternating treatments design was used with a multiple baseline design across stimuli to examine effects of both approaches in two participants with varying degrees of anomia. The features approaches were modified in that three, rather than six, features were used. Significant differential effects were found across participants; this appeared to be a function of each participant's strengths or preferences over the course of treatment. Modest generalization effects were obtained for one participant. Naming error analyses revealed patterns suggestive of increased lexical access for both participants. These findings provide evidence that using a modified features-based protocol can improve naming when incorporating both semantic and phonological feature cues. Naming error patterns can provide additional evidence of improved naming during treatment.

6. United States pubmed.ncbi.nlm.nih.gov

Beyond Percent Correct: Measuring Change in Individual Picture Naming Ability. [2022] Meaningful changes in picture naming responses may be obscured when measuring accuracy instead of quality. A statistic that incorporates information about the severity and nature of impairments may be more sensitive to the effects of treatment.

7. United States pubmed.ncbi.nlm.nih.gov

Model-based semantic treatment for naming deficits in aphasia. [2019] An interactive activation model for picture naming was used to guide treatment of a semantic-level deficit in 4 individuals with aphasia and severe picture-naming problems. Participants exhibited a profile consistent with Broca's aphasia with severe naming deficits, part of which was attributable to a semantic impairment based on testing of the lexical system. A semantic-based treatment was used to train naming of nouns in two semantic categories using a single-participant multiple baseline across behaviors and participants. Additional treatment, which included orthographic and phonological information about target words, then was applied. Treatment responses and error patterns demonstrated that semantic treatment resulted in improved naming of both trained and untrained items for 2 of 4 participants. Two participants did not show improved naming until treatment emphasizing the phonological form of the word was provided. This study demonstrates the utility of using an interactive activation model to plan treatment based on levels of disruption in the lexical processing system.