Speech-Language Therapy for Aphasia
(TERRA Trial)
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of South Carolina
Disqualifiers: Neurological disease, Severe speech issues, others
No Placebo Group
Trial Summary
What is the purpose of this trial?Speech-language therapy is generally found to be helpful in the rehabilitation of aphasia. However, not all patients with aphasia have access to adequate treatment to maximize their recovery. The goal of this project is to compare the efficacy of telerehabilitation or Aphasia Remote Therapy (ART) to the more traditional In-Clinic Therapy (I-CT).
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Speech-Language Therapy for Aphasia?
Research shows that phonologically-focused therapy, like Phonological Components Analysis (PCA), can significantly improve naming abilities in people with aphasia, with many maintaining improvements over time. Additionally, phonological treatments may be particularly beneficial for individuals with more severe impairments and apraxia of speech, while semantic treatments might be more effective for those with milder impairments and fluent speech.
12345Is speech-language therapy for aphasia safe for humans?
The research does not report any safety concerns for speech-language therapy methods like Phonological Cueing Treatment (PCT) and Semantic Feature Analysis (SFA) in people with aphasia, suggesting these treatments are generally safe for humans.
13456How does the Speech-Language Therapy for Aphasia treatment differ from other treatments?
This treatment is unique because it combines phonologically-focused tasks, which help with sound retrieval, and semantically-focused tasks, which aid in understanding word meanings, to improve naming abilities in people with aphasia. It is tailored to individual needs, with phonological tasks benefiting those with severe impairments and apraxia of speech, while semantic tasks are more effective for those with milder impairments and fluent speech.
23678Eligibility Criteria
This trial is for English-speaking adults aged 21-80 who've had a left hemisphere stroke at least a year ago and can consent to treatment. They must be MRI compatible without metal implants or claustrophobia, and have no history of other brain diseases or severe speech/comprehension impairments.Inclusion Criteria
I am between 21 and 80 years old.
Participants must be magnetic resonance imaging (MRI) compatible (e.g., no metal implants, not claustrophobic) on a 3-Tesla (3T) scanner.
I can give my own consent or appoint someone to do it for me.
+2 more
Exclusion Criteria
I have no history of brain injuries or neurological diseases.
I have not had a stroke affecting both sides of my brain or in the cerebellum or brainstem.
I can speak and understand well enough to participate in therapy.
+3 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive 3 weeks of daily semantically-focused treatment and 3 weeks of daily phonologically-focused treatment, either remotely or in-clinic
6 weeks
Daily sessions (remote or in-person)
Follow-up
Participants are monitored for changes in speech production and quality of life after treatment
6 months
Follow-up assessments at 6 months
Participant Groups
The TERRA study compares two types of speech-language therapy for aphasia after a stroke: one delivered remotely (ART) and the other in-clinic (I-CT). It aims to see if telerehabilitation is as effective as traditional methods.
2Treatment groups
Experimental Treatment
Active Control
Group I: Aphasia Remote Therapy (ART)Experimental Treatment2 Interventions
All participants in this group will receive 3 weeks of daily semantically-focused treatment (semantic feature analysis, semantic barrier task and verb network strengthening therapy) and 3 weeks of daily phonologically-focused treatment (phonological components analysis, phonological production task, phonological judgment task). Participants will be randomized to order of treatment.
All treatment will be done remotely with a speech-language pathologist through an online platform using therapy applications. Participants will be provided with teletherapy kits (including an Internet hotspot if needed) to complete the therapy tasks.
Group II: In-Clinic Therapy (I-CT)Active Control2 Interventions
All participants in this group will receive 3 weeks of daily semantically-focused treatment (semantic feature analysis, semantic barrier task and verb network strengthening therapy) and 3 weeks of daily phonologically-focused treatment (phonological components analysis, phonological production task, phonological judgment task). Participants will be randomized to order of treatment.
All treatment will be done in person with a speech-language pathologist at the UofSC Aphasia Lab.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of South Carolina Aphasia LabColumbia, SC
University of South CarolinaColumbia, SC
Medical University of South CarolinaCharleston, SC
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Who Is Running the Clinical Trial?
University of South CarolinaLead Sponsor
National Institute on Deafness and Other Communication Disorders (NIDCD)Collaborator
Medical University of South CarolinaCollaborator
References
A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. [2022]Therapy for naming impairments post-stroke typically involves semantic and/or phonologically-based tasks. However, the relationship between individuals' locus of breakdown in word retrieval and their response to a particular treatment approach remains unclear, and direct comparisons of treatments with different targets (semantics, phonology) yet similar formats are lacking. This study examined eight people with aphasia who each received 12 treatment sessions; half the sessions involved a semantically-based treatment task, Semantic Feature Analysis (SFA), and the other half involved a phonologically-based treatment task, Phonological Components Analysis (PCA). Pre-therapy baseline accuracy scores were compared to naming accuracy post-treatment and at follow-up assessment. Seven of the eight participants showed significant improvements in naming items treated with PCA, with six of these seven participants maintaining improvements at follow-up. Four of the eight participants showed significant improvements for items treated with SFA, with three of the four maintaining improvements at follow-up. The semantic therapy was not beneficial for participants with semantic deficits. In contrast, the phonological therapy was beneficial for most participants, despite differences in underlying impairments. Understanding the relationship between an individual's locus of breakdown in word retrieval and response to different treatment tasks has the potential to optimise targeted treatment.
Individualized response to semantic versus phonological aphasia therapies in stroke. [2022]Attempts to personalize aphasia treatment to the extent where it is possible to reliably predict individual response to a particular treatment have yielded inconclusive results. The current study aimed to (i) compare the effects of phonologically versus semantically focussed naming treatment and (ii) examine biographical and neuropsychological baseline factors predictive of response to each treatment. One hundred and four individuals with chronic post-stroke aphasia underwent 3 weeks of phonologically focussed treatment and 3 weeks of semantically focussed treatment in an unblinded cross-over design. A linear mixed-effects model was used to compare the effects of treatment type on proportional change in correct naming across groups. Correlational analysis and stepwise regression models were used to examine biographical and neuropsychological predictors of response to phonological and semantic treatment across all participants. Last, chi-square tests were used to explore the association between treatment response and phonological and semantic deficit profiles. Semantically focussed treatment was found to be more effective at the group-level, independently of treatment order (P = 0.041). Overall, milder speech and language impairment predicted good response to semantic treatment (r range: 0.256-0.373) across neuropsychological tasks. The Western Aphasia Battery-Revised Spontaneous Speech score emerged as the strongest predictor of semantic treatment response (R 2 = 0.188). Severity of stroke symptoms emerged as the strongest predictor of phonological treatment response (R 2 = 0.103). Participants who showed a good response to semantic treatment were more likely to present with fluent speech compared to poor responders (P = 0.005), whereas participants who showed a good response to phonological treatment were more likely to present with apraxia of speech (P = 0.020). These results suggest that semantic treatment may be more beneficial to the improvement of naming performance in aphasia than phonological treatment, at the group-level. In terms of personalized predictors, participants with relatively mild impairments and fluent speech responded better to semantic treatment, while phonological treatment benefitted participants with more severe impairments and apraxia of speech.
Effects of two lexical retrieval cueing treatments on action naming in aphasia. [2009]The effects of two cueing treatments, Phonological Cueing Treatment (PCT) and Semantic Cueing Treatment (SCT), were examined with three chronic speakers with aphasia. The effects of treatment on action naming were measured with the use of single-subject experimental designs. The participants had received PCT and SCT to improve object naming in a previous investigation and had responded positively to both treatments. In the current study, Speaker 1 received SCT, Speaker 2 received PCT, and Speaker 3 received both SCT and PCT. Action naming improved for Speakers 1 and 3, but not for Speaker 2. These findings indicate that PCT and SCT may have utility in facilitating action naming for some speakers with aphasia but that the effects of these treatments may vary across grammatical form classes (e.g., nouns versus verbs).
A case series comparison of semantically focused vs. phonologically focused cued naming treatment in aphasia. [2018]There is a lack of clarity in the field regarding how to best predict which naming treatment will be most beneficial for a particular individual with aphasia. The purpose of this study was to elucidate whether or not semantic or phonological therapy differentially impacts on outcomes for people with a range of different aphasic profiles when given both therapies. A single-participant design, with multiple repeated baselines for naming, replicated across four participants, was used. Participants were provided with a counterbalanced order of Semantic Feature Analysis (SFA) and Phonological Components Analysis (PCA) treatment. Findings demonstrated differential effects across participants. This seemed to be influenced by factors such as severity of anomia, order of treatment presentation, and capacity limits. Clinical implications of these findings highlight the importance of expanding our picture of a participant's behaviours to consider what other important factors can inform intervention decisions.
Using a combined working memory - Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study. [2023]The purpose of the study was to pilot a working memory (WM) - and modified Semantic Feature Analysis (SFA) approach to treat word finding deficits in a group of people with aphasia (PwA). Two research questions were posed: 1. Will the group of PwA be able to complete the WM tasks used in the approach? 2. Will the approach improve naming performance in PwA?
A Systematic Review of Semantic Feature Analysis Therapy Studies for Aphasia. [2019]The purpose of this study was to review treatment studies of semantic feature analysis (SFA) for persons with aphasia. The review documents how SFA is used, appraises the quality of the included studies, and evaluates the efficacy of SFA.
What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia. [2019]Impaired naming is one of the most common symptoms in aphasia, often treated with cued picture naming paradigms. It has been argued that semantic cues facilitate the reliable categorization of the picture, and phonological cues facilitate the retrieval of target phonology. To test these hypotheses, we compared the effectiveness of phonological and semantic cues in picture naming for a group of individuals with aphasia. To establish the locus of effective cueing, we also tested whether cue type interacted with lexical and image properties of the targets.
The effectiveness of semantic feature analysis: an evidence-based systematic review. [2018]This review examines the effectiveness of semantic feature analysis as an intervention to improve naming abilities for persons with aphasia.