Learning Strategies for Naming in Aphasia
Recruiting in Palo Alto (17 mi)
Overseen byWilliam 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 1, which will adaptively balance effort and accuracy using speeded naming deadlines.
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 is best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the Learning Strategies for Naming in Aphasia treatment?
Research shows that using retrieval practice (actively recalling information) and spacing (spreading out learning sessions) in naming treatments for aphasia can improve naming performance and retention better than repetition or errorless methods. These strategies help people with aphasia remember names more effectively over time.
12345Is the Learning Strategies for Naming in Aphasia treatment safe for humans?
The studies reviewed do not report any safety concerns related to the Learning Strategies for Naming in Aphasia treatment, including errorless and errorful learning methods, suggesting it is generally safe for humans.
24678How does the Learning Strategies for Naming in Aphasia treatment differ from other treatments for aphasia?
This treatment is unique because it combines different learning strategies, such as errorless learning (where patients are shown pictures and given the correct name) and effortful learning (where patients try to name pictures and receive feedback), to improve naming in aphasia. It focuses on balancing accuracy and effort, which may enhance learning and retention compared to traditional methods that do not integrate these approaches.
34679Eligibility Criteria
This trial is for people who have had a stroke at least 6 months ago, resulting in chronic aphasia, which is difficulty with language and naming things. They must struggle on certain parts of a language test but can't have severe comprehension issues or other neurological diseases, unmanaged 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.
Exclusion Criteria
I have a severe mood or behavioral disorder that needs special mental health care.
I have a history of a progressive neurological condition.
You have problems with drugs or alcohol that are not being treated.
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Initial Assessment
Comprehensive initial battery of standardized assessments characterizing aphasia severity and overall language profile
2 sessions
2 visits (in-person)
Treatment
Participants receive 8 sessions of treatment per condition over 4 weeks, with a total of 24 treatment sessions
10 months
24 visits (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment with probes administered at baseline and 1 week, 3 months, and 6 months post-treatment
6 months
24 visits (in-person)
Participant Groups
The study tests three ways to help people with aphasia improve their ability to name pictures and use these skills in daily life. It compares treatments that focus on maximum effort, balance between effort and accuracy, and maximum accuracy using speeded naming tasks.
6Treatment groups
Experimental Treatment
Group I: Effort-maximized, then effort-accuracy balanced, then accuracy-maximizedExperimental Treatment3 Interventions
All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.
Group II: Effort-maximized, then accuracy-maximized, then effort-accuracy balancedExperimental Treatment3 Interventions
All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.
Group III: Effort-accuracy balanced, then effort-maximized, then accuracy maximizedExperimental Treatment3 Interventions
All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.
Group IV: Effort-accuracy balanced, then accuracy-maximized, then effort-maximizedExperimental Treatment3 Interventions
All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.
Group V: Accuracy-maximized, then effort-maximized, then effort-accuracy balancedExperimental Treatment3 Interventions
All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.
Group VI: Accuracy-maximized, then effort-accuracy balanced, then effort-maximizedExperimental Treatment3 Interventions
All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.
Find a Clinic Near You
Research Locations NearbySelect 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 PittsburghPittsburgh, PA
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Who Is Running the Clinical Trial?
University of PittsburghLead Sponsor
University of Massachusetts, AmherstCollaborator
National Institute on Deafness and Other Communication Disorders (NIDCD)Collaborator
References
Treatment of naming in nonfluent aphasia through manipulation of intention and attention: a phase 1 comparison of two novel treatments. [2022]Twenty-three chronic nonfluent aphasia patients with moderate or severe word-finding impairments and 11 with profound word-finding impairments received two novel picture-naming treatments. The intention treatment initiated picture-naming trials with a complex left-hand movement and was designed to enhance right frontal participation during word retrieval. The attention treatment required patients to view visual stimuli for picture-naming trials in their left hemispace and was designed to enhance right posterior perisylvian participation during word retrieval. Because the intention treatment addressed action mechanisms and nonfluent aphasia reflects difficulty initiating or maintaining action (i.e., language output), it was hypothesized that intention component of the treatment would enhance re-acquisition of picture naming more than the attention component. Patients with moderate and severe word-finding impairment showed gains with both treatments but greater incremental improvement from one treatment phase to the next with the intention than the attention treatment. Thus, the hypothesis that intention component would be a more active constituent than the attention component was confirmed for these patients. Patients with profound word-finding impairment showed some improvement with both treatments but no differential effects for the intention treatment. Almost all patients who showed treatment gains on either treatment also demonstrated generalization from trained to untrained items.
Decreasing cues for a dynamic list of noun and verb naming targets: a case-series aphasia therapy study. [2016]Errorless learning has had positive reports across both clinical and non-clinical domains. Within aphasia therapy studies, decreasing cue methods have been proposed as the optimal combination of low error and high effort. This study aimed to evaluate a modification to the decreasing cue method in which the set size of target nouns and verbs for training was extended dependent on participant progress in naming therapy. Four participants with word retrieval symptoms as part of their aphasia took part in a case-series study in which a decreasing cue hierarchy was applied to a dynamic list of noun and verb targets. An assessment probe at the start of each session determined how many new items were to be taken on in therapy, dependent on participant responsiveness to that point. All participants made significant improvements in naming accuracy for treated items from baseline and compared to control items. Two participants continued to take on new items which reflected consistent trajectories of improving naming accuracy, while two participants reached saturation points at which the frequency of errors in naming accuracy limited their set sizes. The varying trajectories of the participants were evaluated in relation to their baseline language and cognitive skills. Clinical implications from the findings and themes for further research were also considered.
Test-enhanced learning versus errorless learning in aphasia rehabilitation: testing competing psychological principles. [2022]Because individuals with acquired language disorders are frequently unable to reliably access the names of common everyday objects (i.e., naming impairment), rehabilitation efforts often focus on improving naming. The present study compared 2 rehabilitation strategies for naming impairment, reflecting contradictory prescriptions derived from different theoretical principles. The prescription derived from psychological research on test-enhanced learning advocates providing patients opportunities to retrieve target names from long-term memory (i.e., retrieval practice) in the course of treatment. In contrast, the errorless learning approach derived from cognitive rehabilitation research eschews retrieval practice in favor of methods that minimize naming errors, and thus the potential for error learning, in the course of treatment. The present study directly compared these approaches and showed that, despite superior (and errorless) performance during errorless treatment, treatment that prioritized retrieval practice produced greater retention 1-day and 1-week following treatment. These findings have implications for clinical practice, as well as theoretical accounts of lexical access and test-enhanced learning.
Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients. [2023]Increasingly, mechanisms of learning are being considered during aphasia rehabilitation. Well-characterized learning mechanisms can inform "how" interventions should be administered to maximize the acquisition and retention of treatment gains. This systematic scoping review mapped hypothesized mechanisms of action (MoAs) and treatment ingredients in three learning-based approaches targeting naming in aphasia: errorless learning (ELess), errorful learning (EFul), and retrieval practice (RP). The rehabilitation treatment specification system was leveraged to describe available literature and identify knowledge gaps within a unified framework.
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.
Do errors matter? Errorless and errorful learning in anomic picture naming. [2019]Errorless training methods significantly improve learning in memory-impaired patients relative to errorful training procedures. However, the validity of this technique for acquiring linguistic information in aphasia has rarely been studied. This study contrasts three different treatment conditions over an 8 week period for rehabilitating picture naming in anomia: (1) errorless learning in which pictures are shown and the experimenter provides the name, (2) errorful learning with feedback in which the patient is required to generate a name but the correct name is then supplied by the experimenter, and (3) errorful learning in which no feedback is given. These conditions are compared to an untreated set of matched words. Both errorless and errorful learning with feedback conditions led to significant improvement at a 2-week and 12-14-week retest (errorful without feedback and untreated words were similar). The results suggest that it does not matter whether anomic patients are allowed to make errors in picture naming or not (unlike in memory impaired individuals). What does matter is that a correct response is given as feedback. The results also question the widely held assumption that it is beneficial for a patient to attempt to retrieve a word, given that our errorless condition involved no retrieval effort and had the greatest benefits.
Theory-driven treatment modifications: A discussion on meeting the linguistic, cognitive, and psychosocial needs of individual clients with aphasia. [2023]There is a growing body of literature demonstrating that language rehabilitation can improve naming impairments for individuals with aphasia. However, there are challenges applying evidence-based research to clinical practice. Well-controlled clinical studies often consist of homogenous samples and exclude individuals who may confound group-level results. Consequently, the findings may not generalize to the diverse clients serviced by speech-language therapists. Within evidence-based guidelines, clinicians can leverage their experiences and theoretical rationale to adapt interventions to meet the needs of individual clients. However, modifications to evidence-based interventions should not alter aspects of treatment that are necessary to produce change within the treatment target. The current discussion paper uses errorless learning, errorful learning, and retrieval practice for naming in aphasia to model how treatment theories can guide clinicians in making theory-informed modifications to interventions. First, we briefly describe the learning mechanisms hypothesized to underlie errorless learning, errorful learning, and retrieval practice. Next, we identify ways clinicians can provide targeted supports to optimize learning for individual clients. The paper ends with a reflection on how well-defined treatment theories can facilitate the generation of practice-based evidence and clinically relevant decision making.
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.
Effects of distributed practice and criterion level on word retrieval in aphasia. [2021]This study examined how the distribution and amount of practice affect word retrieval in aphasia as well as how such factors relate to the efficiency of learning. The central hypothesis was that factors that enhance the learning of new knowledge also enhance persistent access to existing, but inconsistently available, word representations. The study evaluated the impact of learning principles on word retrieval by manipulating the timing and amount of retrievals for items presented for naming. Nine people with chronic aphasia with naming impairment completed the experiment. Training materials involved proper noun entities assigned to six conditions formed by crossing a 2-level factor of spacing of sessions, i.e., intersession interval (1 day versus 7 days between sessions) with a 3-level factor of number of correct retrievals per item per session, i.e., criterion level (Criterion-1, Criterion-2, and Criterion-4). Each intersession interval condition comprised three training sessions and a one-month retention test. Increasing the criterion level enhanced naming performance after short (1 day, 7 days) and long (one month) retention intervals, but these advantages came at the cost of many additional training trials. In most cases, later naming success was superior when the same number of correct retrievals of an item was distributed across multiple sessions rather than administered within one session. The substantial advantages for across-session spacing were gained at little cost in terms of additional training trials. At one-month retention, naming accuracy was numerically but not significantly higher in the 7-day versus 1-day intersession interval condition. Implications for theories of lexical access and naming treatment in aphasia are discussed.