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Naming Disorders & potential Therapy

Naming Disorders & potential Therapy

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Published by: Generic_Persona on Feb 14, 2012
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Therapy for naming disorders: Revisiting, revising,and reviewing
Lyndsey Nickels
 Macquarie University, Sydney, Australia
 Background:
Impairments of word retrieval and production are a common and distressingfeature of aphasia, and much clinical time is devoted to attempts at their remediation. Thereare now many research papers devoted to case studies examining treatments for word-retrieval impairments using a wide range of tasks with individuals who have varying levelsof impairment.
 Aims:
This paper aims to continue the selective review of this literature carried out byNickels and Best (1996a). It summarises in table form those published papers since 1980which present single case studies of treatment for word-retrieval impairments and whichsatisfy minimal methodological criteria.
 Main Contribution:
Several main themes are derived from the literature and discussed inmore detail, these include strategic approaches and facilitative or repair approaches toremediation, the contrast between semantic and phonological tasks in therapy, generalisationin therapy tasks and the relationship between impairment, therapy task, and outcome. Furtherdiscussion relates to the relationship between impairment level treatments, and measures of disability and handicap, and between therapy research and therapy practice.
Conclusions:
There are now many research papers devoted to impairments of word retrieval,and there can be no doubt that therapy for word-retrieval impairments can be highlysuccessful, resulting in long-term improvements which can be of great communicativesignificance for the individual with aphasia. However, predicting the precise result of aspecific treatment task with a specific individual with certainty is still not possible. Forclinicians the recommendation is to use analyses of functional impairments to guide thechoice of task, but to ensure that efficacy is tested and not assumed. Furthermore, structuredmulti-modal and multicomponent tasks (e.g., ‘‘semantic’’ or ‘‘phonological’’ cueinghierarchies) may hold the most promise for many individuals. For researchers, there remainsa need to further dissect tasks, impairments, and their interactions across series of singlecases.
#
2002 Psychology Press Ltdhttp://www.tandf.co.uk/journals/pp/02687038.html DOI:10.1080/02687030244000563Address correspondence to: Dr Lyndsey Nickels, Macquarie Centre for Cognitive Science (MACCS),Macquarie University, Sydney, NSW 2109, Australia. Email: lyndsey@maccs.mq.edu.auThanks to all the contributing authors who have worked so hard to comply with my demands, and also to thereviewers of their papers. Thanks to Chris Code for inviting me to compile and edit the volume, and to DeborahMaloney and the production team at Psychology Press for their patience. Wendy Best, Britta Biedermann, RuthFink, Julie Hickin, David Howard, and Stacie Raymer made helpful comments on an earlier version of thispaper. Thanks too to Britta Biedermann who gave invaluable assistance in gathering together the references, andtranslating those not in English. This paper was prepared while the author was supported by an AustralianResearch Council QEII fellowship.APHASIOLOGY, 2002,
16 
(10/11), 935–979
 
Of the symptoms associated with aphasia, none are more pervasive than
anomia
, a difficultyin finding high information words, both in fluent discourse and when called upon to identifyan object of action by name.(Goodglass & Wingfield, 1997, p. 3)
The majority of people with aphasia have some degree of difficulty in retrieving andproducing the words they need to communicate, and this can be reported as one of themost frustrating and distressing aspects of their problems. Clearly then, remediation of impairments of spoken word production is of the utmost importance for the person withaphasia and for those communicating with them.In 1996, Wendy Best and I reviewed (selectively) the literature on the remediation of spoken word production in aphasia (Nickels & Best, 1996a). Our paper focused onresearch addressing the remediation of spoken word retrieval impairments, publishedafter 1980 and that satisfied minimum methodological requirements. This paper willcontinue that review.
1
The papers excluded from this review are those that either presentonly group data, or where pre- and post-testing do not allow clear conclusions to bedrawn (i.e., it is not possible to distinguish effects of treatment from non-specifictreatment effects or spontaneous recovery). Although some papers have been includedthat do not have statistical analysis of results, this has only been the case where thepatterns from visual inspection seem reasonably clear, and adequate baseline testing hasoccurred.Inevitably, there have been more papers published in the last 7 years that fulfil thecriteria than there were in the previous 15!
2
Hence, discussion of each paper individuallyis not possible, rather this paper will discuss general issues pertaining to remediation of word production in aphasia,
3
with illustrative examples being drawn from the literature.The scope of this review will also be somewhat broader, including not only theremediation of spoken word retrieval, but also written word retrieval, and disorders of phonological encoding and semantics (in so far as semantic impairments impact on wordretrieval). Nevertheless this review remains restricted—it focuses on impairment-leveltreatments of spoken word production in aphasia that aim to improve word productionitself. I will not address treatments that aim to use alternative (non-linguistic) means of communication to overcome a word-retrieval/production impairment (e.g., drawing,
1
Although I have attempted to track down as many relevant papers as possible, it is probable that somestudies that meet the criteria for this review have been omitted. The authors of these papers should accept myapologies and I hope will understand that this is no reflection on their work or any bias on my part, but rather thelimitations of keyword searching of electronic databases (which don’t always make life easy when, for example,‘‘anomia’’ is frequently transcribed as ‘‘anemia’’!).
2
Although there are now many published reports of remediation for word retrieval in aphasia, and some areof the highest quality, it is of note that many remain methodologically or analytically weak. Although mostreports incorporate baseline testing, all too often authors claim evidence for treatment effects on the basis of visual inspection of data (rather than statistical analysis), data sets are small, treatment underspecified, and thefunctional impairments of participants poorly described. We can only hope that the increase in quantity of reports will swiftly be followed by an increase in quality.
3
The review also excludes treatments of aphasia as a result of progressive brain diseases (e.g., Alzheimer’sdisease, cortico-basal degeneration). Although a number of studies have now shown positive effects of treatmentwith individuals with these pathologies using similar approaches to the treatment of non-progressive aphasia(e.g., Abrahams & Cramp, 1993), they are excluded here due to the different methodological considerations ininterpretation of the data.
936
NICKELS
 
Hunt, 1999; Sacchet, Byng, Marshall, & Pound, 1999), neither will I address treatmentsthat focus on impairments at an articulatory level (e.g., those treatments focusing onapraxia of speech, for review see Ballard, Granier, & Robin, 2000, and Wambaugh &Doyle, 1994), nor treatments ‘‘beyond the single word’’ (e.g., sentence processing—seeMitchum, Greenwald, & Berndt, 2000, for a review of the issues in this field). In addition,this review will not address rehabilitation primarily focused at reducing levels of handicap/disability where the rehabilitation is not impairment-based (e.g., Lesser &Algar, 1995).
4
Finally, this review will restrict itself to papers published in peer-reviewed journals and books (hence excluding unpublished conference papers, oral paperpresentations, and theses).
APPROACHES TO THE REMEDIATION OF WORD-RETRIEVAL IMPAIRMENTS IN APHASIA
Howard and Hatfield (1987) gave a historical review of approaches to the treatmentof aphasia—these included surgical, pharmacological (e.g., crocodile grease), andbehavioural treatments. However, the vast majority of treatments over the past 100years have been behaviourally based. It is only more recently that pharmacologicalapproaches to the treatment of aphasia have been demonstrated to show some promise,using, for example, amphetamine or piracetam (e.g., Enderby, Broeackx, Hospers,Schildermans, & Deberdt, 1994; Walker-Batson et al., 2001). However, there remainsa general consensus that these treatments are helpful primarily when paired witheffective behavioural language therapy (see Shisler, Baylis, & Frank, 2000, for areview). Hence, it is not the case that there is little point in devoting research effortto evaluating behavioural approaches to the remediation of aphasia because of thepromise of pharmacological approaches; there is little doubt that there will be a rolefor behavioural approaches for many years to come.Behavioural approaches take many forms, and in particular can be divided into thosethat aim to rehabilitate the impaired process(es) and those that attempt to provide analternative mechanism to achieve a goal (such as successful word production) usingprocesses not normally implicated. I shall discuss these latter approaches first.
Strategic, re-organisational, or compensatory approaches
One approach to treatment of word-production/retrieval impairment aims to facilitatenaming by reorganising the processes utilised, such that intact processes are used tocompensate for or support the impaired processes (Howard & Patterson; 1989). Table 1summarises the studies that have set out with the aim of taking this approach (as we willsee aims and results do not always converge).Common to most of these approaches is the use of knowledge of the written form of aword to help retrieve the spoken form. Clearly this approach will be of most benefit to
4
This is not meant to suggest that impairment-based approaches do not have an impact on levels odisability/handicap, far from it, underlying every clinician’s impairment-based treatment is the belief that it willhave an impact on the levels of disability and/or handicap of the individual treated. The evidence for the truth of this statement will be discussed later.
THERAPY FOR NAMING DISORDERS
937

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