A Comparison of Semantic Feature Analysis and Phonological Components Analysis For The Treatment of Naming Impairments in Aphasia

Neuropsychological Rehabilitation
An International Journal
ISSN: 0960-2011 (Print) 1464-0694 (Online) Journal homepage: http://www.tandfonline.com/loi/pnrh20
A comparison of semantic feature analysis

and phonological components analysis for the
treatment of naming impairments in aphasia
Sophia van Hees , Anthony Angwin , Katie McMahon & David Copland
To cite this article: Sophia van Hees , Anthony Angwin , Katie McMahon & David Copland
(2013) A comparison of semantic feature analysis and phonological components analysis for
the treatment of naming impairments in aphasia, Neuropsychological Rehabilitation, 23:1,
102-132, DOI: 10.1080/09602011.2012.726201
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NEUROPSYCHOLOGICAL REHABILITATION, 2013
Vol. 23, No. 1, 102– 132, http://dx.doi.org/10.1080/09602011.2012.726201
A comparison of semantic feature analysis and

phonological components analysis for the treatment of
naming impairments in aphasia
Sophia van Hees1,2, Anthony Angwin2, Katie McMahon3,

and David Copland1,2,4
Downloaded by [190.246.180.6] at 06:25 26 September 2015
1
Centre for Clinical Research, University of Queensland, Brisbane, Australia
2
School of Health and Rehabilitation Sciences, University of Queensland,
Brisbane, Australia
3
Centre for Advanced Imaging, University of Queensland, Brisbane,
Australia
4
Clinical Centre for Research Excellence in Aphasia Rehabilitation,
University of Queensland, Brisbane, Australia
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 treat-
ment 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 ses-
sions; 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 base-
line 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 par-
ticipants maintaining improvements at follow-up. Four of the eight participants
Correspondence should be addressed to Sophia van Hees, University of Queensland, Centre

for Clinical Research, Level 3 Building 71/918, Royal Brisbane and Women’s Hospital,
Herston QLD 4029, Australia. E-mail: s.vanhees@uq.edu.au
We would like to acknowledge the University of Queensland’s Aphasia Registry for the
recruitment of participants with aphasia, Charlene Pearson for assistance with data collection,
and Associate Professor Greig de Zubicaray for assistance with editing the manuscript.
# 2013 Taylor & Francis

NAMING TREATMENT IN APHASIA 103
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.
Keywords: Anomia; Stroke; Aphasia; Rehabilitation.

INTRODUCTION
Naming impairments are one of the most common and pervasive language
difficulties in people with aphasia and are therefore a major focus of
therapy in the rehabilitation of language post-stroke (Goodglass & Wingfield,
1997). Although models of word production differ in terms of the degree of
modularity and interactivity between different processing stages, it is well
established that naming requires processing at the level of word meaning or
semantics, that connects to the word form or phonology (e.g., Dell, Schwartz,
Martin, Saffran, & Gagnon, 1997; Goldrick, 2006; Levelt, 1999). People with
aphasia may be impaired in one or both of these processing stages, or the con-
nections between them, leading to difficulty naming. Thus, therapy for
naming impairments typically employs semantic and/or phonological tasks
in order to target these major cognitive components involved in word
production.
Impaired naming due to semantic deficits may be the result of impaired
semantic representations, or difficulty accessing semantic representations
(Laine & Martin, 2006). Thus, the rationale underlying semantically-based
therapy is that it improves naming by strengthening semantic representations,
or by priming weak semantic representations, in order to facilitate word
retrieval (Collins & Loftus, 1975; Maher & Raymer, 2004) . Semantically-
based therapy tasks that have been shown to improve naming in people
with aphasia include spoken and written word–picture matching (e.g.,
Davis & Pring, 1991), semantic feature verification (e.g., Kiran & Thompson,
2003) as well as contextual priming (e.g., Martin, Fink, & Laine, 2004;
Renvall, Laine, & Martin, 2007). Improved naming following therapy
employing such tasks may be the result of improved processing at the level
of the semantic system itself. However, as the word form is also often pro-
vided, improvements may not be purely due to changes in semantic proces-
sing (Kiran & Bassetto, 2008).
In contrast, impaired naming due to deficits in post-semantic/phonological
processing may be the result of impaired access to the phonological output
104 VAN HEES, ANGWIN, McMAHON, AND COPLAND
lexicon, or in the lexical representations themselves (Laine & Martin, 2006).

Thus, phonologically-based therapy aims to strengthen representations at the
level of the word form (Maher & Raymer, 2004), or strengthen the connec-
tions from the semantic system to the word form (Laine & Martin, 2006).
Phonologically-based therapy tasks that have been shown to improve
naming in people with aphasia include the use of cueing hierarchies and rep-
etition (e.g., Raymer, Thompson, Jacobs, & Le Grand, 1993) as well as tasks
such as syllable judgements, initial phoneme discrimination, and rhyme jud-
gement (e.g., Franklin, Buerk, & Howard, 2002; Robson, Marshall, Pring, &
Chiat, 1998). Improved naming following the use of such tasks may be the
result of improved processing at the level of the phonological form.
However, as the corresponding semantic representation becomes activated
during word production, and most phonological treatments occur in the pres-
ence of a picture, improvements may also be the result of strengthening the
mapping between semantics and phonology (Howard, Hickin, Redmond,
Clark, & Best, 2006).
Studies investigating semantic and phonological therapy for naming
impairments have produced varied results. Nettleton and Lesser (1991) com-
pared therapy targeting the impaired process (model appropriate therapy)
with therapy targeting a relatively spared process (model inappropriate
therapy) in six people with aphasia. Two participants with semantic impair-
ments received semantic therapy, and two participants with impairments in
the phonological output lexicon received phonological therapy. The semantic
therapy involved word–picture matching, categorisation tasks, and yes/no
judgements about categorical and attributive information. Thus, the word
form was not overtly produced by the participants during the semantic
therapy tasks. In contrast, the phonological therapy involved repetition,
rhyme judgement, and naming with phonemic cueing. Both participants
who received phonological therapy and one participant who received seman-
tic therapy significantly improved in naming of treated items following the
therapy, with no generalisation to untreated items. An additional two partici-
pants with phonological assembly impairments received the semantic therapy
and showed no improvement, which may suggest that therapy targeting the
impaired process was more beneficial. However, it was not determined
whether the phonological therapy tasks could improve naming in the partici-
pants with semantic impairment, or whether the semantic therapy tasks could
improve naming in the participants with impairments in the phonological
output lexicon. Additionally, one of the participants with semantic impair-
ment did not significantly improve following the semantic therapy.
In a larger study conducted by Doesborgh et al. (2004) semantic (BOX)
therapy was compared with phonological (FIKS) therapy in a randomised
controlled trial with 58 participants with aphasia. The semantic BOX
treatment consisted of tasks involving semantic decisions, whereas the
phonological FIKS treatment involved tasks focusing on sound structure. No

significant differences were reported for performance on semantic and phono-
logical tasks pre-treatment in either group. Using the Amsterdam-Nijmegen
Everyday Language Test (ANELT; Blomert, 1992), an assessment of
verbal communicative ability based on informational content within everyday
language scenarios, no difference in improvement post-treatment was found
in either the group receiving semantically-based or those receiving phonolo-
gically-based therapy. However, the semantic treatment group showed sig-
nificant improvement on semantic tasks post-treatment (written word
synonym judgement and relatedness judgements) and no significant improve-
ment on phonological tasks post-treatment (nonword repetition and auditory
lexical decision). The phonological treatment group showed the opposite
results, with significant improvements only for the phonological tasks.

Such results suggest that although both treatment approaches resulted in
improved functional communication, they may have targeted different under-
lying mechanisms of processing.
A limitation of the above studies is that participants did not receive both
semantic and phonological treatment, precluding within subject comparisons.
This is of particular importance in people with aphasia due to the heterogen-
eity of language symptoms and variable responses to different treatment
tasks, which pose a significant challenge for between-group treatment
studies. In an early study conducted by Howard, Patterson, and Franklin
(1985), 12 participants with aphasia received both semantic and phonological
therapy consisting of word–picture matching and semantic verification tasks
for the semantic therapy, and repetition, phonemic cueing and rhyme judge-
ment tasks for the phonological therapy. Significant improvements were
observed following both treatment types for 8 of the 12 participants,
despite variations in locus of breakdown in word retrieval. Davis and Pring
(1991) examined the effect of naming therapy involving written word to
picture matching compared to repetition of picture names in seven partici-
pants with different loci of impairments. Significant improvements were
found for both treatments, which were maintained six months post-therapy.
Such results suggest that the difference between semantic and phonological
therapy tasks may be overstated, and that both approaches may be beneficial
for people with different loci of impairments. In contrast, a study conducted
by Drew and Thompson (1999) reported that only two of four participants
with lexical–semantic impairments improved in naming following semanti-
cally-based therapy. The other two participants only improved once phonolo-
gically-based therapy was added, suggesting that the type of task chosen can
determine treatment outcome.
However, the type of tasks used to compare semantic and phonological
therapy in the above studies varied considerably in terms of format and
task demands. Thus, in addition to the language process targeted, the tasks
may differ with respect to the level of difficulty and the depth of processing
required to perform the task, which may also alter the outcome of the treat-
ment. Hickin, Best, Herbert, Howard, and Osborne (2002) suggest that
semantic therapy tasks are more likely to involve an element of choice,
which may engage a deeper level of processing. For example, picture–
word matching and semantic relatedness judgements require the person to
make a decision, an element often lacking in phonological therapy tasks
such as repetition or phonemic cueing. Such differences in task demands
may account for the greater and/or longer lasting effects of semantic
therapy in previous studies (e.g., Macoir, Routhier, Simard, & Picard,
2012; Marshall, Pound, White-Thomson, & Pring, 1990).
Other studies have compared semantic and phonological cueing tasks,
which were administered in a similar format and required similar response

demands, and may provide a better comparison for treatment outcome. Wam-
baugh (2003) compared therapy involving semantic versus phonological
cueing in a case study of an individual with predominately lexical–semantic
impairments. Although both cueing techniques resulted in improved naming
following therapy, semantic cueing was found to be more effective than pho-
nological cueing. More recently, Lorenz and Ziegler (2009) also compared
therapy involving semantic versus phonological cueing in 10 individuals
with aphasia. Although one participant with a predominantly semantic
impairment only benefited from the semantic cueing therapy, and one partici-
pant with a predominantly post-semantic impairment only benefited from the
phonological cueing therapy, treatment outcome for the other eight partici-
pants did not directly relate to the underlying language deficit. Some partici-
pants with semantic impairments benefited from phonological cueing, some
participants with post-semantic impairments benefited from semantic
cueing, and some participants benefited from both treatments. However,
differences were found in the maintenance of improvement between the
two therapy tasks; phonological cueing resulted in stronger immediate
effects 24 hours post-treatment, whereas semantic cueing was associated
with more stable effects at two weeks post-treatment.
In order to address the above issues the present study compared the effects
of two treatments that target semantics versus phonology although employ a
similar format and response demands. Semantic Feature Analysis (SFA)
involves analysing the features of an object using a matrix of cue words in
order to facilitate the activation of semantic information required for word
retrieval (Boyle & Coelho, 1995; Coelho, McHugh, & Boyle, 2000). This
task is based on the spreading activation theory of semantic processing
(Collins & Loftus, 1975), where activation of the semantic features of a
target word is presumed to increase the probability that the target word will
reach the threshold needed for activation. It has also been suggested that
such a task may increase semantic specificity of the target, and thus aid in
word retrieval (Nickels, 2002). For example, if categorical errors in naming

(e.g., naming an apple as another fruit, such as pear) are due to under-speci-
fied semantic information, where multiple lexical representations in a seman-
tic category are equally activated, increasing the activation of distinctive
semantic features may increase the probability that the target representation
will receive more activation and become selected for further processing.
Modelled on the same structure as SFA, Phonological Components Analysis
(PCA) was developed as a phonologically-based approach to naming treatment,
where the semantic cues in SFA are replaced with cues for phonological features
to facilitate processing at the level of the word form (Leonard, Rochon, & Laird,
2008). The depth of processing used in this therapy task has been suggested to
promote maintenance of treatment effects, an effect that is variable in the litera-
ture concerned with phonological treatment (Hickin et al., 2002).

The aim of the current study was to investigate the relative effects of SFA
and PCA therapy for naming in a group of people with aphasia. As response to
a particular treatment does not always relate to the locus of breakdown in
naming, and given the inherent heterogeneity in aphasic symptoms, a
within subject alternating treatment design was chosen to allow for compari-
sons between the different treatments in the same individual. Both treatments
were administered in similar formats, where only the type of cue was manipu-
lated, making them comparable. Furthermore, both treatments have shown
positive effects previously and were expected to be a similar level of difficulty
(e.g., Boyle, 2004; Boyle & Coelho, 1995; Coelho et al., 2000; Leonard et al.,
2008). If the semantic and phonological treatment tasks target semantic and
phonological processing, respectively, it is predicted that participants with
primarily semantic impairments will show greater benefit from the semanti-
cally-based therapy, and vice versa participants with primarily phonological
impairments will show greater benefit from the phonologically-based therapy.
However, if the treatment tasks are not selectively targeting specific levels of
processing, no difference is expected between participants with different loci
of impairments.
METHODS
Participants
A total of eight people with aphasia (five female), as previously diagnosed by
a speech pathologist and according to performance on the Western Aphasia
Battery (WAB-R; Kertesz, 2007), participated in the study. Participants
ranged in age from 41 to 69 years (mean 56.38; SD 9.15) and were
between 17 and 170 months post single left cerebrovascular accident
(CVA) at the time of the study (mean 52.25; SD 49.84). See Table 1 for
108
VAN HEES, ANGWIN, McMAHON, AND COPLAND
TABLE 1
Demographic information and lesion site for each participant
Participant PS JV LW TW HJ TK TP BA
Age (years) 60 60 41 52 56 48 69 65
Months post-stroke 38 57 170 55 25 17 36 20
Gender F M F F F F M M
Years of education 10 13 14 16 10 11 10 NA
Lesion volume 22.68cm3 39.51cm3 135.69cm3 166.05cm3 46.26cm3 22.74cm3 66.26cm3 42.53cm3
Lesion site MTG IFG (oper) IFG (oper) IFG IFG Putamen Inferior temporal IFG
STG MTG IFG (tri) Mid/superior STG Amygdala MTG STG
SMG STG Mid/superior Frontal SMG Insula STG Insula
Hippocampus Insula Frontal Rolandic oper Rolandic oper Thalamus SMG Rolandic Oper
Caudate Rolandic oper Insula Precentral Caudate Insula Putamen
Putamen Insula STG Insula Hippocampus
Hippocampus Cingulate (mid Heschl’s gyrus Putamen
and anterior) SMG Caudate
Caudate Putamen Thalamus
Precentral Precentral
SMA Postcentral
MTG ¼ middle temporal gyrus; STG ¼ superior temporal gyrus; SMG ¼ supramarginal gyrus; IFG ¼ inferior frontal gyrus; SMA ¼ supplementary
motor area.
demographic details and lesion site information. All participants had English
as a first or primary language prior to stroke, were right handed, and had
normal or corrected-to-normal vision and hearing. None of the participants
had a history of any other neurological disease or disorder, mental illness,
head trauma, alcoholism, cerebral tumour or abscess, or any significant cog-
nitive deficits (e.g., memory, attention). None of the participants had a
reported history of moderate to severe apraxia of speech or dysarthria.
Further, initial observations of each participant at the commencement of
the study indicated that language production was not significantly impacted
by motor speech impairment for any participant.
All subjects gave their informed consent prior to participation in the
study and were assessed using the Mini Mental State Examination (Folstein,
Folstein, & McHugh, 1975), the Glasgow Depression Scale (Feher, Larra-
bee, & Crook, 1992), the Edinburgh Handedness Inventory (Oldfield,
1971), and Pure Tone assessment of hearing. The Western Aphasia
Battery (WAB-R) was conducted to determine overall severity of language
impairment and aphasia classification (Kertesz, 2007). In order to categorise
participants into those with predominantly semantic deficits and those with
predominantly post-semantic deficits, the Pyramids and Palm Trees Test
(Howard & Patterson, 1992), the Boston Naming Test (Kaplan, Goodglass,
& Weintraub, 1983), as well as the Comprehensive Aphasia Test (Swinburn,
Porter, & Howard, 2004) were conducted. A naming battery consisting of
476 items from the International Picture Naming Project Database
(Szekely et al., 2004) was also administered twice within the same week,
and analysed with respect to proportion of semantically and phonologically
related errors.
Participants were categorised as having predominantly semantic impair-
ments if they displayed impaired performance on the Pyramids and Palm
Trees Test, similar impairments in both spoken and written naming, and
the presence of semantic paraphasias in naming, as well as preserved real-
word reading and repetition suggesting intact lexical representations despite
impaired semantics. In contrast, participants were categorised as having pre-
dominantly phonological impairments if they displayed good performance on
the Pyramids and Palm Trees Test, the presence of phonological paraphasias
in naming with little or no benefit of phonemic cueing, as well as impaired
real-word reading and repetition suggesting impaired lexical representations
despite intact semantic processing. Finally, participants were categorised with
primary impairments in accessing lexical representations from semantics if
they displayed good performance on the Pyramids and Palm Trees Test, pre-
served real-word reading and repetition, and benefited from phonemic cueing
during naming suggesting intact lexical representations and semantic proces-
sing, however impaired mapping from semantics to phonology. Using this
criteria, two participants were classified with predominantly semantic
impairments (TP and BA), two participants were classified with predomi-
nantly phonological impairments (PS and HJ), and four participants were
classified with impairments accessing lexical representations from semantics
(JV, LW, TW, and TK). See Table 2 for language assessments results.
Additionally, connected speech was assessed using five different tasks:
request for procedural information (Tell me how you would go about
writing and sending a letter), request for personal information (Tell me
what you usually do on Sundays), narrative sample using a sequence of six
pictures that told a story, picture description using the “man in a tree”
scene (see Nicholas & Brookshire, 1993), as well as a free speech sample
(Can you tell me a story about something important that happened to you
in your life?).
Procedure
Three initial assessment sessions were completed prior to therapy in which all
assessments were administered. Based on error responses from the naming
battery, treatment items were individualised for each participant by selecting
90 items that were not able to be named on at least one out of two naming
attempts. The 90 items were then split into three sets of 30 items and each
set was assigned to either a treatment type (SFA or PCA) or to the untreated
control set. For each participant, the three sets were matched for number of
phonemes, syllables, and characters (Szekely et al., 2004), age of acquisition
(Morrison, Chappell, & Ellis, 1997), Centre for Lexical Information
(CELEX) Frequency (Davis, 2005), imageability (Wilson, 1988), as well
as mean response time and percent name agreement (Szekely et al., 2004)
(p . .05). Additionally, each set was matched for number of correctly
named items at baseline for each individual.
Three therapy sessions were provided per week for four weeks (12 sessions
in total). Each session continued until the full set of 30 items was completed.
Therefore, there was some variation in time spent in therapy depending on
severity of aphasia. For the four participants with milder naming deficits
(JV, LW, TW, and TK), therapy sessions typically ranged from 45 up to 60
minutes. However, for the four participants with more severe naming deficits
(PS, HJ, TP, and BA), therapy sessions typically ranged from 60 minutes up to
90 minutes. Half the sessions involved SFA and the other half involved PCA,
where the type of therapy task was alternated each session and the order of
treatment delivery counterbalanced among participants. After every fourth
session, all treatment items as well as the untreated control set were probed
for naming performance. Additionally, in a follow up session two to three
weeks after the final session, all items were re-assessed to examine mainten-
ance of treatment effects. The BNT and the five tasks comprising the speech
TABLE 2
Language assessment results for each participant
Language Assessment PS JV LW TW HJ TK TP BA
∗ ∗ ∗ ∗ ∗ ∗
BNT (/60) 35 57 44 57 9 40 31 35
P&PT Version 1 (/52) 49 51 52 51 51 50 46∗ 48
P&PT Version 5 (/52) 49 52 50 51 50 48 45∗ 46∗
CAT: Raw T score Raw T score Raw. T score Raw T score Raw T score Raw T score Raw T score Raw T score
Comp/Spoken (/66) 52.5 53∗ 56.5 57 62 62 57.5 58 46 49∗ 61 61 49.5 52∗ 53.5 53∗
Comp/Written (/62) 58 65 58 65 56 62 57 63 40 49∗ 60 68 46 53 56 62
Repetition (/74) 23 44∗ 56 54∗ 66 59∗ 65 58∗ 11 42∗ 61 56∗ 62 56∗ 70 62
Naming 67 61∗ 78 68 74 65 74 65 23 48∗ 69 62∗ 45 53∗ 58 57∗
Reading (/70) 66 64 68 66 68 66 59 58∗ 17 46∗ 65 63 52 55∗ 65 63
NAMING TREATMENT IN APHASIA

Writing (/76) 70 59 76 69 76 69 75 65 56 52∗ 74 64 67 57∗ 67 57∗
Picture Description:
Spoken 26.5 57∗ 36 61 18 26∗ 33.5 60∗ 25 56∗ 18 52∗ 13 50∗ 23 55∗
Written 18 65 36 75 26 70 32 73 15 62∗ NA NA NA NA 14 61∗
WAB-R:
Spontaneous Speech (/20) 17 18 18 15 13 14 12 14
Comprehension (/10) 7.6 9.2 8.8 9.9 6.95 9.85 9.7 9.85
Repetition (/10) 5.4 6.6 9.4 9.4 3.8 8.2 8.6 10
Naming(/10) 8.6 9.9 9.6 8.9 4.9 8.8 6.4 7.6
AQ (/100) 77.2 87.4 91.6 86.4 57.3 81.7 73.4 82.9
Classification Conduction Anomic Anomic Anomic Conduction Anomic Anomic Anomic
Severity Mild- Mild Mild Mild Moderate Mild Moderate Mild
Moderate
111
(Continued)
112
Table 2. Continued.
Language Assessment PS JV LW TW HJ TK TP BA

Naming Battery:
% Correct 72 86 87 95 26 82 46 76
% Incorrect 28 14 13 5 74 18 54 24
% Semantic errors 4 38 29 15 4 19 26 37
% Phonological errors 11 12 8 0 35 4 7 14
% Unrelated/No response 83 36 58 62 60 70 62 51
2 14 5 23 1 7 4 8
% Perceptual errors
Locus of Breakdown Post- Semantics to Semantics to Semantics to Post- Semantics to Semantic Semantic
semantic/ Phonology Phonology Phonology semantic/ Phonology
Phonological Phonological
BNT ¼ Boston Naming Test; P&PT ¼ Pyramids and Palm Trees; CAT ¼ Comprehensive Aphasia Test; WAB-R ¼ Western Aphasia Battery–Revised.
∗
indicates impaired performance.
sample were also re-assessed at follow-up to examine generalisation of treat-

ment to naming and connected speech.
Treatment
Each picture was presented as a black line drawing in the centre of a matrix
displayed on a Dell Latitude E6500 Laptop computer screen using Microsoft
Office PowerPoint (2007). The delivery of the treatment tasks followed the
same procedure as previous studies employing SFA and PCA (e.g., Boyle
& Coelho, 1995; Coelho et al., 2000; Leonard et al., 2008). Firstly, partici-
pants were asked to name the item. Regardless of participants’ ability to
name the item, they were then asked to produce the features of the item
according to each cue word in the matrix. For SFA the cues were: group,
use, action, properties, location, and association (Boyle & Coelho, 1995).
For PCA the cues were: first sound, syllables, last sound, association, and
rhyme (Leonard et al., 2008). As responses were provided, they were typed
into the relevant boxes by the clinician. If a participant was unable to
produce a response, the clinician provided a response both orally and in
written form. After all the features were produced, the participant was
asked to name the item again. Regardless of correct/incorrect response, the
clinician then reviewed all the features of the object and asked the participant
to name the item once more. If the participant was still unable to name the
item, the clinician provided a model that the participant then repeated.
Each session continued until all items from the treatment set were completed.
RESULTS
A weighted Wilcoxon one-sample test was used to identify whether improve-
ment in naming accuracy pre-treatment (baseline measures from the two
attempts of the naming battery and naming probe prior to the first treatment
session) differed significantly from improvement in naming accuracy
immediately post-treatment, or at follow-up assessment. Each item was
scored as either correct (1) or incorrect (0) in the first, second and third base-
line assessments, as well as in the post-treatment assessment (immediately
post-treatment or at follow-up), and was then multiplied by the weightings
2, –1, –4, and 3 for each time point, respectively. Thus, if the sum of
weighted scores centred on zero, improvement due to the treatment did not
differ to improvement during baselines. Once the sum of weighted scores
was calculated for each item, these scores where then analysed using a Wil-
coxon one-sample test for each condition (PCA, SFA, and Untreated items).
Seven out of eight participants (PS, LW, TW, HJ, TK, TP, and BA)
improved significantly in naming accuracy for items treated using PCA com-
pared to baseline scores (p , .05, one-tailed). Furthermore, six of the seven
participants who significantly improved following PCA maintained improve-

ments at 2–3 week follow-up (PS, LW, TW, TK, TP, and BA) (p , .05, one-
tailed). Four out of eight participants (PS, LW, TW, and HJ) improved signifi-
cantly in naming accuracy of items trained using SFA compared to baseline
scores (p , .05, one-tailed). Furthermore, three of the four participants who
Figure 1. Naming accuracy data for each participant: B1-3 ¼ Baseline 1-3 (pre-treatment), P1-P3 ¼
Probe 1-3 (every 4th session during treatment), FU ¼ Follow-up, PCA ¼ items treated using
Phonological Components Analysis, SFA ¼ items treated using Semantic Feature Analysis, UNT
¼ Untreated items. (∗ p , .05 ∗∗ p , .01 ∗∗∗ p , .001).
significantly improved following SFA maintained improvements at 2–3 week

follow-up (PS, TW, and HJ) (p , .05, one-tailed). No significant differences
in naming accuracy were found between baseline scores and post-treatment
scores for untreated items for all participants (p . .05, one-tailed). See
Figure 1 for individual results.
Effect sizes were also calculated for participants who demonstrated treat-
ment effects, using the Busk and Serlin (1992) method. Thresholds of 2.6, 3.9,
and 5.8 were used to determine whether effect sizes were small, medium, or
large, respectively (Beeson & Robey, 2006). Effect sizes ranged from small to
large, and complemented the results of the Wilcoxon Test (see Table 3).
To further investigate generalisation of treatment to untreated items, a
McNemar’s Test was used to examine significant changes in naming accuracy
scores on the BNT administered pre- and post-therapy. Stimulus items on the
BNT that also appeared in a participant’s list of treatment items were removed
from the analysis. Seven of the eight participants showed no significant
changes between pre- and post-treatment on BNT scores (p . .05, one-
tailed). Only one participant, TK, showed a significant improvement on
BNT scores (p ¼ .03, one-tailed) indicating some generalisation to untreated
items for this participant.
In addition to naming accuracy, an analysis of the type of errors made was
also conducted for each participant. Errors were coded as either semantically-
related paraphasias, phonologically-related paraphasias, or no-responses,
using the classification system used in Chenery, Murdoch, and Ingram
(1996). A McNemar’s Test was used to examine significant differences in
the number of each error type made in the final baseline compared to
scores immediately post-treatment as well as at follow-up assessment for
each treatment set. Two participants, JV and TP, showed no significant
TABLE 3
Results from effect size calculations
PCA SFA
Post-Tx Follow-up Post-Tx Follow-up

PS 9.45∗∗∗ 5.67∗∗ 6.43∗∗∗ 5.29∗∗
LW 5.33∗∗ 5.00∗∗ 3.79∗ -
TW 3.93∗∗ 3.71∗ 4.93∗∗ 4.14∗∗
HJ 5.48∗∗ - 6.93∗∗∗ 8.66∗∗∗
TK 2.89∗ 2.62∗ - -
TP 3.27∗ 2.89∗ - -
BA 3.44∗ 2.86∗ - -
Effect size thresholds: .2.6∗ (small), .3.9∗∗ (medium), and .5.8∗∗∗ (large).
changes in any error type at either time point (p . .05, two-tailed). Three par-
ticipants (PS, LW, and TW), showed a significant decrease in no-response
errors for both treatment sets at both time points (p , .05, two-tailed). TK
also showed a significant decrease in no-response errors for items treated
with PCA at both time points, as well as items treated with SFA at follow-
up assessment only (p , .05, two-tailed). HJ showed a significant decrease
in phonologically-related errors for items treated with PCA immediately
post-treatment (p , .05, two-tailed), however this was not maintained at
follow up. In contrast, items treated with SFA showed a significant decrease
in phonologically-related errors at follow-up assessment only (p , .05, two-
tailed). Finally, BA showed a significant decrease in semantically-related
errors only for items treated with PCA at both time points (p , .05, two-
tailed). However, significant changes may only have been possible with indi-
viduals who had more errors pre-treatment, or errors restricted to one type.
Thus, the results of error analysis need to be interpreted with caution.
Speech samples were also analysed pre- and post-therapy using Systematic
Analysis of Language Transcripts software (Miller & Iglesias, 2010). Measures
that were analysed included total number of utterances, mean length of utter-
ance, words per minute, total number of words, number of different words,
type token ratio, number of maze words, as well as number of abandoned utter-
ances, omitted words, and word errors. Some changes were identified pre-
versus post-treatment; four participants (PS, HJ, TP, and BA) showed either
increased total number of utterances or mean length of utterances across the
five tasks. However, the other four participants (JV, LW, TW, and TK) did
not show any discernible change. See Appendix 1 for detailed results of the
speech sample analyses for each participant.
DISCUSSION
This study compared a semantically-based and a phonologically-based treat-
ment task for naming impairments in eight people with aphasia, using a within
subject alternating treatment design, keeping differences between task struc-
ture and response demands minimal. It was hypothesised that if the semantic
and phonological treatment tasks targeted semantic and phonological proces-
sing, respectively, that participants with primarily semantic impairments
would show greater benefit from the semantically-based therapy, and, vice
versa, participants with primarily phonological impairments would show
greater benefit from the phonologically-based therapy. However, if the treat-
ment tasks were not selectively targeting specific levels of processing, no
difference was expected between participants with different loci of
impairments.
Seven of the eight participants made significant improvements immedi-

ately post-treatment for items treated with PCA, despite differences in loci
of impairments. Only four participants significantly improved in naming
items treated with SFA. Both participants with primarily semantic impair-
ments did not significantly improve on naming items treated with the seman-
tic task. Changes in the frequency of different error types were also found for
six of the eight participants. Although improvements in naming accuracy for
the untreated set were evident for all eight participants, these did not reach
significance either immediately post-treatment or at follow-up assessment.
Only TK showed a significant difference on the Boston Naming Test post-
treatment, suggesting some generalisation. Additionally, four of the eight par-
ticipants showed improvements in connected speech post-treatment in terms
of an increased number of utterances and/or mean length of utterances.

However, these results were likely to be impacted by severity of aphasia,
where participants with mild anomia may have been more prone to ceiling
effects compared to participants with more severe anomia.
The results of the study do not support the hypothesis that the phonologi-
cally and semantically-based tasks would benefit individuals with predomi-
nantly phonological or semantic impairments, respectively. However, some
differences were found between participants with different loci of impair-
ments, suggesting the two treatments may have been targeting different mech-
anisms of processing. The following discussion will examine the relationship
between each participant’s locus of breakdown in naming and response to
both treatment tasks. Possible mechanisms of treatment effects in terms of
theories of word production will be explored, as well as a discussion of poss-
ible generalisation to connected speech, and finally some limitations of the
current study.
Relationship between locus of breakdown and response to

treatment
One question under debate within the aphasia literature is whether treatment
for language impairments should target the locus of breakdown or focus on a
relatively spared process (e.g., Drew & Thompson, 1999; Howard et al., 1985;
Nettleton & Lesser, 1991). Although this issue is undoubtedly complicated by
other factors such as the type and severity of the impairment, the relationship
between locus of breakdown in naming and response to a particular treatment
task remains an important area of enquiry. Increased knowledge of this
relationship has the potential to inform and optimise individualised targeted
treatment.
Two participants whose pre-treatment assessments indicated impairments
primarily in semantic processing, TP and BA, displayed similar treatment
effects. TP and BA both showed significant improvements in naming
accuracy for items treated with PCA, and both participants maintained signifi-
cant improvements at follow-up for these items. In contrast, improvements in
naming items treated with SFA failed to reach significance. Such results are in
contrast to the notion that treatment should directly target the locus of
breakdown, and provides some evidence that targeting the relatively spared
process may actually be more beneficial in the case of impaired semantic
processing.
These results are in line with previous studies that found phonological
therapy to be beneficial for individuals with semantic impairments. For
example, Raymer et al. (1993) reported improved naming for four participants
with impairments in semantics and lexical access following therapy involving
phonological cueing. Nickels and Best (1996) also reported a case study of a
participant with both semantic and phoneme assembly impairments, where

phonological therapy resulted in improved naming whereas semantic therapy
did not. Additionally, Drew and Thompson (1999) found semantic therapy to
be ineffective for a person with lexical–semantic impairments, where improve-
ments were only found once phonological tasks were added to the therapy.
Thus, the results of TP and BA provide further evidence that phonological
tasks can improve naming in individuals with semantic impairments.
However, the PCA treatment may not have directly targeted phonological pro-
cessing for these individuals. It is also possible that the task strengthened the
mappings between semantics and phonology, particularly as the task involved
picture stimuli, which should activate semantic processing.
Two participants whose pre-treatment assessments indicated impairments
primarily in post-semantic processing (PS and HJ) showed significant
improvements for both treatment sets immediately post-treatment. Previous
studies have found both phonological and semantically-based treatments to
be beneficial for individuals with post-semantic impairments (e.g., Howard
et al., 1985; Lorenz & Ziegler, 2009). However, differences were found in
terms of maintenance of treatment. PS maintained significant improvements
for both treatment sets at follow-up assessment, whereas only the SFA items
remained significant for HJ. Interestingly, HJ was more accurate at naming
SFA items at follow-up than immediately post-treatment. Such results
suggest that although PCA and SFA treatments may both be beneficial for
individuals with post-semantic impairments, SFA may be more beneficial
in terms of maintenance of treatment effects in some individuals.
The remaining four participants whose pre-treatment assessments
indicated impairments primarily in the mapping between semantics and
phonology (JV, TK, LW, and TW) showed variable results. JV did not
show significant improvements for either treatment set; TK only showed
significant improvements for items treated with PCA; LW showed signifi-
cant improvements for both treatment sets, however only maintaining
significant improvements for items treated with PCA; and finally TW
showed significant improvements for both treatment sets that were both
maintained at follow-up.
However, all four participants with primary impairments in accessing pho-
nology from semantics also had only mild naming deficits. As such, naming
accuracy at baseline testing was relatively high. Therefore, the absence of
treatment effects may also reflect ceiling effects for these participants. For
example, for TK the lack of a significant treatment effect for items treated
with SFA may be due to higher accuracy at baseline for this set compared
to the PCA treatment set. Similarly, JV had the highest accuracy scores
pre-treatment and failed to show significant effects for either treatment.
Overall, some differences in the results are evident in terms of locus of
breakdown and treatment effects. Participants with primarily semantic
impairments showed greater effects for items treated with PCA, whereas par-
ticipants with primarily post-semantic impairments benefited from both treat-
ments, with greater maintenance of items treated with SFA. Participants with
difficulty mapping semantic information onto the word form showed variable
results, although these results were likely to be affected by ceiling effects. In
the following section, we address the possible mechanisms of these results
with respect to theories of word production.
Possible mechanisms of treatment effects

SFA and PCA tasks were chosen to target primarily semantic and phonologi-
cal processing, respectively. However, both tasks included attempted naming,
which would be expected to involve both semantic and phonological proces-
sing (Dell et al., 1997; Levelt, 1999). Thus, although the focus of SFA was to
strengthen semantic representations related to a target item, or increase the
semantic specificity of the target, production of the word form during the
task would also engage processing at the level of phonology. Similarly,
although the PCA task involved phonological analysis of the target item in
order to strengthen word form representations or access to the word form,
the presentation of a picture and production of the target word is likely to
engage semantic processing. Given the above considerations (presence of
both semantics and phonology in both treatments), it is also possible that
both treatments could strengthen the mapping between semantics and phonol-
ogy. However, as treatment outcome differed across the two treatments for
some participants, this suggests that the treatments may have targeted differ-
ent mechanisms of processing.
For example, TP and BA were both identified with predominantly semantic
impairments as their locus of breakdown in naming. They both showed sig-
nificant improvements in naming accuracy for items treated with PCA,
whereas improvements in items treated with SFA did not reach significance.
The absence of a significant effect for items treated with SFA for TP and BA
may relate to increased competition between lexical items (e.g., Damian &
Als, 2005; Damian, Vigliocco, & Levelt, 2001). For example, Howard,
Nickels, Coltheart, and Cole-Virtue (2006) found that naming categori-
cally-related items cumulatively inhibits naming in healthy participants.
Thus, as the SFA task requires the participant to produce words
semantically related to the target, the activation of semantically-related con-
cepts within an impaired semantic system may have caused increased acti-
vation and competition of semantically-related words in the phonological
output lexicon.
One possible explanation for the significant improvements found for items
treated with PCA for TP and BA is that the task bypassed the impaired seman-
tic system. Kremin (1986) suggests that in the presence of semantic deficits,
accurate naming can be achieved via a direct non-semantic route from the
“pictogen” to the “output logogen system”. However, such a direct route
remains controversial, and others view semantic processing as a necessary
step in object naming (e.g., Levelt, Roelofs, & Meyer, 1999). An alternative
explanation is that activation of the word form may have aided word retrieval
in the presence of insufficient semantic information (Wingfield, Goodglass, &
Smith, 1990). Such an account of TP and BA’s results is in line with interac-
tive models of word production, as opposed to more discrete stage models, as
activation of word form information may feedback and support impaired or
underspecified semantic processing (e.g., Dell, 1985; Dell et al., 1997; Gold-
rick, 2006). Some evidence to support this interpretation can be found in the
analysis of the types of errors made. BA showed a significant decrease in
semantically-related errors only for items treated with PCA, suggesting that
focusing on the word form may have improved semantic specificity for
these items.
It is also possible that the type of treatment tasks used in this study allowed
for the development of a conscious strategy to self-cue naming. For example,
during partial access to the word form in the presence of reduced activation
from semantics, self-cueing phonological features of a target word may
support word retrieval. Anecdotally, TP would say or tap the number of syl-
lables of a target word when experiencing word-finding difficulty during
testing sessions and often mimed the initial letter in the air. Such actions
suggest that TP was using components of the PCA task as a strategy during
attempted naming. Similarly, self-cueing of semantic features may increase
activation to the impaired word form, an approach similar to circumlocu-
tion-induced naming (Francis, Clark, & Humphreys, 2002). If participants
did in fact develop a strategy from the treatment tasks, it would be expected
that improvements would generalise to naming untreated items, which was
not the case. However, it is still possible that self-cueing did contribute to
treatment outcome, but only for priming items that were trained using this
procedure.
Participants PS and HJ were identified with predominantly post-semantic

impairments, both lexical and post-lexical. Although they both also
showed significant improvements for items treated with PCA immediately
post-treatment, the task may have targeted a different mechanism in the pres-
ence of post-semantic deficits. For example, the task may have decreased the
threshold required to retrieve the word forms in the phonological output
lexicon (Laine & Martin, 2006).
Although the PCA task may have targeted the same mechanism for both PS
and HJ, the lack of maintenance for HJ suggests that the PCA task may not
have been effective in strengthening the link between semantics and the
word form for this participant. It has been suggested that many phonologi-
cally-based treatment tasks may only have short-lasting effects as they
focus on the final stage of word production rather than driving access to
word forms from semantics (Francis et al., 2002; McNeil et al., 1997). The
analysis of HJ’s errors supports this view, as a significant decrease in phono-
logically-related errors was found for items treated with PCA immediately
post-treatment. However, this was not maintained at follow-up assessment,
suggesting that in this individual the PCA task did not strengthen the connec-
tion between semantics and the word form, resulting in only short-term
improvements.
However, other studies have reported cases of treatment outcome being
well maintained following phonological therapy (e.g., Greenwood, Grassly,
Hickin, & Best, 2010; Hickin et al., 2002; Miceli, Amitrano, Capasso, & Car-
amazza, 1996) suggesting that phonologically-based therapy can produce
lasting results for certain individuals. One difference between PS and HJ
that may explain the discrepancy between their results was the severity of
their impairments. HJ’s anomia was more severe than PS, suggesting that
the PCA treatment may not lead to maintenance of treatment outcome in
the presence of more severe impairments.
In contrast, both PS and HJ showed significant improvements and mainten-
ance of items treated with SFA, which may reflect more effective semantic
processing to drive retrieval of the word form in the phonological output
lexicon for these participants. Specifically, the SFA task may have decreased
the threshold required for word retrieval (Collins & Loftus, 1975), or
increased the semantic specificity of the target to facilitate word retrieval in
the phonological output lexicon (Nickels, 2002). Alternatively, the SFA
task may have strengthened the mappings between semantics and phonology
(Howard et al., 2006). The analysis of HJ’s errors found a significant decrease
in phonologically-related errors for items treated with SFA only at follow-up
assessment, suggesting that focusing on the semantic drive for word retrieval
may have strengthened the connection between semantics and the word form,
producing longer-lasting effects for this participant. In contrast, PS only
showed a significant decrease in “no response” errors for both treatment
sets at both time points. However, it is difficult to determine the cause of “no
response” errors. For example, a lack of response may suggest that no lexical
item has been sufficiently activated. Alternatively, an erroneous item may
have been activated; however, the person was able to self-monitor the error
before production. Thus, such results prevent any conclusions being made
regarding the mechanism underlying this improvement.
Of the remaining four participants only TW showed significant improve-
ments for both treatment sets, which were also maintained at follow-up
assessment. As TW’s locus of breakdown was identified as impaired access
to phonology from semantics, treatment effects may have stemmed from
either improved semantic processing/semantic specificity reducing the
threshold required for word retrieval, improved phonological processing
facilitating access to the phonological output lexicon, or a combination of

the two. In contrast, LW improved significantly for both treatment sets,
however, only PCA items remained significant at follow-up, and TK only
showed significant improvements for items treated with PCA. As both LW
and TK were also identified with deficits primarily in access to phonology
from semantics, such results provide some evidence that tasks focusing on
the word form may be more beneficial for individuals with deficits in the con-
nections between semantics and phonology. However, these four participants
may have been subject to ceiling effects on either or both of the treatment sets.
Thus, no strong conclusions can be made regarding the mechanisms of treat-
ment effects for these participants. Additionally, in the analysis of error types,
only “no-response” errors showed a significant reduction post-treatment.
Thus, as discussed above for PS, no further conclusions regarding the mech-
anisms of treatment response can be made based on these results.
Generalisation to connected speech

Another method of examining treatment outcome is to investigate its effect on
connected speech. Four participants (PS, HJ, TP, and BA) showed either
increased total number of utterances or mean length of utterances (MLU)
across five different elicitation tasks. However, the other four participants
(JV, LW, TW, and TK) did not show any discernible change. Although the
ultimate goal of therapy tasks that aim to improve word retrieval is to transfer
this improvement into everyday speech, the measurement of such outcomes
remains problematic. This difficulty stems from the inherent shortcomings
of quantifying changes over time across individuals with different language
impairments. For example, a decrease in MLU for a person with fluent
aphasia can be interpreted very differently from a person with non-fluent
aphasia (Armstrong, 2000). Additionally, results are likely to vary depending
on the type of elicitation technique and the method of analysis used. Thus, the
results of connected speech analyses must be interpreted with caution.
One factor to consider is the type of elicitation techniques used. Differ-

ences in quantitative measures of discourse are likely to differ depending
on whether picture descriptions are used, compared to interactive, as well
as monologic speech (Armstrong, 2000). Although picture descriptions are
often short and very controlled, they do provide structure to the speech
sample and may be more sensitive to identifying changes across time. In con-
trast, interactive or monologic speech is likely to be more naturalistic;
however, greater variability between elicitations may cause difficulty in
measuring changes over time. It is also possible that the semantic and phono-
logical strategies learned during treatment for picture naming may have
assisted with tasks involving picture descriptions, where they could apply
the same strategies to picture content, but not so to the other forms of dis-
course. In a comparison across tasks, the personal narrative sample was the
least consistent measure within participants, when compared to picture
descriptions and more structured procedural or personal requests. In addition
to variability due to lack of task structure, this type of elicitation task may also
have been affected by factors such as participant motivation and fatigue and
thus may not provide an accurate description of the participant’s ability.
Another important consideration in the interpretation of connected speech
is the method of analysis. Boyle’s (2004) study attempted to measure
improvements in discourse production following SFA therapy in two partici-
pants with aphasia using Nicholas and Brookshire’s (1993) analysis of correct
information units (CIUs). One participant increased in CIUs per minute, with
no change in mean CIUs or percent CIUs, whereas the other participant
increased in mean CIUs, with no change in CIUs per minute or percent
CIUs. Such results are difficult to interpret, as the relevance of individual
words within a certain time period does not necessarily reflect the overall effi-
ciency of the message (Armstrong, 2000).
The current study employed a different technique to investigate changes in
speech samples post-treatment, by measuring changes at the utterance level
(total number of utterances and mean length of utterance), the word level
(words per minute, total number of words, number of different words, and
the type token ratio), as well as errors (word errors, number of maze
words, omitted words, and number of abandoned utterances). The results of
this analysis differed between measures within participants, as well as
across participants. However, some consistent changes were identified pre-
versus post-treatment for four participants (PS, HJ, TP, and BA) who
showed either increased total number of utterances or mean length of utter-
ances across the five tasks. That is, if MLU did not increase in one task, a
change was seen in the total number of utterances for that task, suggesting
increased total output for these participants.
The other four participants (JV, LW, TW, and TK) did not show any dis-
cernible change, suggesting that the treatment may either have had no benefit
in terms of transfer to connected speech, or that the measures used to quantify

this change were not sensitive enough. However, the impact of severity of
anomia may also explain the lack of change in connected speech samples
for these four participants. Where improved naming accuracy was
accompanied by increased number or length of utterances in the four partici-
pants with more severe anomia, more subtle changes in the four participants
with mild anomia may not have been able to be identified.
In addition to its effect on connected speech analyses, severity of anomia
also limited the ability to compare treatment effects between participants.
Differences in the effort required to complete the therapy tasks for partici-
pants with mild anomia relative to those with moderate anomia, and thus
differences in time spent in therapy, are also likely to have affected the
results. It is possible that the differences in effort and time in therapy may
have contributed to the lack of treatment effects found in the four participants
with milder anomia, which in turn impacts on the ability to compare treatment
effects with participants with more severe anomia.
Another limitation of the current study was that both treatments were
received concurrently. Although no significant generalisation was found in
the untreated control set, it is possible that either treatment had some effect
on the other, or that treatment effects were due to a combination of the treat-
ments provided. However, participants who showed a selective improvement
for one treatment argue against this possibility. Additionally, although the
group of participants provided a range of impairments to explore the relation-
ship between locus of breakdown in naming and response to the different
treatment tasks, other factors such as the site and extent of brain lesion,
and time post-onset of aphasia, may have also impacted on the results of
the study. Thus, data from a larger cohort of participants with aphasia
would be required before any generalisations can be made.
Summary and conclusions

The relationship between individuals’ locus of breakdown in word retrieval
and their response to either semantically-based or phonologically-based treat-
ment tasks in aphasia is unclear; some individuals can show benefit from both
approaches, whereas others can show a selective benefit for one approach
over the other. The current study found that both participants with semantic
impairments only showed significant improvements for items treated
with the phonologically-based task, whereas participants with primarily
post-semantic impairments benefited from both treatments, with greater
maintenance of items treated with the semantically-based task. Participants
with difficulty mapping semantic information onto the word form showed
more variable results, although this may have been influenced by the rela-
tively mild naming impairments in these participants creating ceiling
effects. For the phonologically-based task, activation of word form infor-

mation may have fed back and supported impaired or underspecified semantic
processing, or decreased the threshold required to retrieve word forms in the
presence of post-semantic impairments. In contrast, the semantically-based
task may have improved semantic processing leading to improved word
retrieval, or strengthened the mapping between semantics and phonology.
Where previous studies have compared tasks that may have differed in
more ways than just the cognitive process targeted, the current study com-
pared tasks that were presented in a similar format and that required
similar response demands. Additionally, due to the heterogeneity of language
impairments and response to different treatment tasks in people with aphasia,
an alternating treatment design was employed in order to compare different
treatments within the same individual. However, in order to support and

generalise these findings, data from a larger group of participants would be
required. Further research in this area may have implications for current
clinical practice, as increased understanding of the relationship between an
individual’s locus of breakdown in word retrieval and their response to a par-
ticular treatment approach has the potential to optimise targeted individual
treatment for people with aphasia.
REFERENCES
Armstrong, E. (2000). Aphasic discourse analysis: The story so far. Aphasiology, 14(9),
875–892.
Beeson, P. M., & Robey, R. R. (2006). Evaluating single-subject treatment research: Lessons
learned from the aphasia literature. Neuropsychology Review, 16(4), 161–169.
Blomert, L. (1992). The Amsterdam-Nijmegen Everyday Language Test (ANELT). In N. von
Steinbuchel, D. Y. van Cramon, & E. Poppel (Eds.), Neuropsychological rehabilitation
(pp. 121–127). Berlin: Springer-Verlag.
Boyle, M. (2004). Semantic feature analysis treatment for anomia in two fluent aphasia syn-
dromes. American Journal of Speech-Language Pathology, 13, 236–249.
Boyle, M., & Coelho, C. A. (1995). Application of semantic feature analysis as a treatment for
aphasic dysnomia. American Journal of Speech – Language Pathology, 4(4), 94–98.
Busk, P. M., & Serlin, R. (1992). Meta-analysis for single case research. In T. R. Kratochwill &
J. R. Levin (Eds.), Single-case research design and analysis: New directions for psychology
and education. Hillsdale, NJ: Lawrence Erlbaum Associates.
Chenery, H. J., Murdoch, B. E., & Ingram, J. C. L. (1996). An investigation of confrontation
naming performance in Alzheimer’s dementia as a function of disease severity. Aphasiol-
ogy, 10, 423–441.
Coelho, C. A., McHugh, R. E., & Boyle, M. (2000). Semantic feature analysis as a treatment for
aphasic dysnomia: A replication. Aphasiology, 14, 133–142.
Collins, A. M., & Loftus, E. F. (1975). A spreading-activation theory of semantic processing.
Psychological Review, 82, 407–428.
Damian, M. F., & Als, L. C. (2005). Long-lasting semantic context effects in the spoken
production of object names. Journal of Experimental Psychology: Learning Memory and
Cognition, 31, 1372–1384.
Damian, M. F., Vigliocco, G., & Levelt, W. J. M. (2001). Effects of semantic context in the
naming of pictures and words. Cognition, 81, B77–B86.
Davis, C. J. (2005). N-watch: A program for deriving neighborhood size and other psycholin-
guistic statistics. Behavior Research Methods, 37, 65–70.
Davis, A., & Pring, T. (1991). Therapy for word-finding deficits: More on the effects of seman-
tic and phonological approaches to treatment with dysphasic patients. Neuropsychological
Rehabilitation, 1, 135–145.
Dell, G. S. (1985). Positive feedback in hierarchical connectionist models: Applications to
language production. Cognitive Science, 9, 3–23.
Dell, G. S., Schwartz, M. F., Martin, N., Saffran, E. M., & Gagnon, D. A. (1997). Lexical access
in aphasic and nonaphasic speakers. Psychological Review, 104, 801–838.
Doesborgh, S. J., Van De Sandt-Koenderman, M. W., Dippel, D. W., Van Harskamp, F., Koud-
staal, P. J., & Visch-Brink, E. G. (2004). Effects of semantic treatment on verbal communi-
cation and linguistic processing in aphasia after stroke: A randomized controlled trial.
Stroke, 35, 141–146.

Drew, R. L., & Thompson, C. K. (1999). Model-based semantic treatment for naming deficits in
aphasia. Journal of Speech, Language, and Hearing Research, 42, 972–989.
Feher, E. P., Larrabee, G. J., & Crook, T. H. (1992). Factors attenuating the validity of the
Geriatric Depression Scale in a dementia population. Journal of the American Geriatrics
Society, 40, 906–909.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). ‘Mini mental state’. A practical method
for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research,
12, 189–198.
Francis, D. R., Clark, N., & Humphreys, G. W. (2002). Circumlocution-induced naming (CIN):
A treatment for effecting generalisation in anomia? Aphasiology, 16, 243–259.
Franklin, S., Buerk, F., & Howard, D. (2002). Generalised improvement in speech production
for a subject with reproduction conduction aphasia. Aphasiology, 16, 1087–1114.
Goldrick, M. (2006). Limited interaction in speech production: Chronometric, speech error, and
neuropsychological evidence. Language and Cognitive Processes, 21, 817–855.
Goodglass, H., & Wingfield, A. (1997). Anomia: Neuroanatomical and cognitive correlates.
San Diego, CA: Academic Press.
Greenwood, A., Grassly, J., Hickin, J., & Best, W. (2010). Phonological and orthographic
cueing therapy: A case of generalised improvement. Aphasiology, 24, 991–1016.
Hickin, J., Best, W., Herbert, R., Howard, D., & Osborne, F. (2002). Phonological therapy for
word-finding difficulties: A re-evaluation. Aphasiology, 16, 981–999.
Howard, D., Hickin, J., Redmond, T., Clark, P., & Best, W. (2006). Re-visiting “semantic facili-
tation” of word retrieval for people with aphasia: Facilitation yes but semantic no. Cortex,
42, 946–962.
Howard, D., Nickels, L., Coltheart, M., & Cole-Virtue, J. (2006). Cumulative semantic inhi-
bition in picture naming: Experimental and computational studies. Cognition, 100, 464–482.
Howard, D., & Patterson, K. (1992). The Pyramids and Palm Trees Test: A test of semantic
access from words and pictures. Bury St Edmunds, Suffolk: Thames Valley Test Company.
Howard, D., Patterson, K., & Franklin, S. (1985). Treatment of word retrieval deficits in
aphasia. A comparison of two therapy methods. Brain, 108, 817–829.
Kaplan, E., Goodglass, H., & Weintraub, S. (1983). Boston Naming Test. Philadelphia, PA: Lea
and Febiger.
Kertesz, A. (2007). The Western Aphasia Battery. San Antonio, TX: PsychCorp.
Kiran, S., & Bassetto, G. (2008). Evaluating the effectiveness of semantic-based treatment for
naming deficits in aphasia: What works? Seminars in Speech and Language, 29, 71–82.
Kiran, S., & Thompson, C. K. (2003). The role of semantic complexity in treatment of naming
deficits: Training semantic categories in fluent aphasia by controlling exemplar typicality.
Journal of Speech, Language, and Hearing Research, 46, 608–622.
Kremin, H. (1986). Spared naming without comprehension. Journal of Neurolinguistics, 2,
131–150.
Laine, M., & Martin, N. (2006). Anomia: Theoretical and clinical aspects. New York: Psychol-
ogy Press.
Leonard, C., Rochon, E., & Laird, L. (2008). Treating naming impairments in aphasia: Findings
from a phonological components analysis treatment. Aphasiology, 22, 923–947.
Levelt, W. J. M. (1999). Models of word production. Trends in Cognitive Sciences, 3, 223–232.
Levelt, W. J. M., Roelofs, A., & Meyer, A. S. (1999). A theory of lexical access in speech pro-
duction. Behavioral and Brain Sciences, 22, 1–75.
Lorenz, A., & Ziegler, W. (2009). Semantic vs. word-form specific techniques in anomia treat-
ment: A multiple single-case study. Journal of Neurolinguistics, 22, 515–537.
Macoir, J., Routhier, S., Simard, A., & Picard, J. (2012). Maintenance and generalization effects
of semantic and phonological treatments of anomia: A case study. Communication Dis-
orders Quarterly, 33, 119–128.
Maher, L. M., & Raymer, A. M. (2004). Management of anomia. Topics in Stroke Rehabilita-
tion, 11, 10–21.
Marshall, J., Pound, C., White-Thomson, M., & Pring, T. (1990). The use of picture/word
matching tasks to assist word retrieval in aphasic patients. Aphasiology, 4, 167–184.
Martin, N., Fink, R., & Laine, M. (2004). Treatment of word retrieval deficits with contextual
priming. Aphasiology, 18, 457–471.
McNeil, M. R., Doyle, P. J., Spencer, K. A., Jackson Goda, A., Flores, D., & Small, S. L. (1997).
A double-blind, placebo-controlled study of pharmacological and behavioural treatment of
lexical-semantic deficits in aphasia. Aphasiology, 11, 385–400.
Miceli, G., Amitrano, A., Capasso, R., & Caramazza, A. (1996). The treatment of anomia result-
ing from output lexical damage: Analysis of two cases. Brain and Language, 52, 150–174.
Miller, J., & Iglesias, A. (2010). Systematic Analysis of Language Transcripts (SALT) Research
Version 2010 [Computer Software]: SALT Software, LLC.
Morrison, C. M., Chappell, T. D., & Ellis, A. W. (1997). Age of acquisition norms for a large set
of object names and their relation to adult estimates and other variables. Quarterly Journal
of Experimental Psychology Section A: Human Experimental Psychology, 50, 528–559.
Nettleton, J., & Lesser, R. (1991). Therapy for naming difficulties in aphasia: Application of a
cognitive neuropsychological model. Journal of Neurolinguistics, 6, 139–157.
Nicholas, L. E., & Brookshire, R. H. (1993). A system for quantifying the informativeness and
efficiency of the connected speech of adults with aphasia. Journal of Speech and Hearing
Research, 36, 338–350.
Nickels, L. (2002). Therapy for naming disorders: Revisiting, revising, and reviewing.
Aphasiology, 16, 935–979.
Nickels, L., & Best, W. (1996). Therapy for naming disorders (Part II): Specifics, surprises and
suggestions. Aphasiology, 10, 109–136.
Oldfield, R. (1971). The assessment and analysis of handedness: The Edinburgh inventory.
Neuropsychologia, 9, 97–113.
Raymer, A. M., Thompson, C. K., Jacobs, B., & Le Grand, H. R. (1993). Phonological treatment
of naming deficits in aphasia: Model-based generalization analysis. Aphasiology, 7, 27–53.
Renvall, K., Laine, M., & Martin, N. (2007). Treatment of anomia with contextual priming:
Exploration of a modified procedure with additional semantic and phonological tasks.
Aphasiology, 21, 499–527.
Robson, J., Marshall, J., Pring, T., & Chiat, S. (1998). Phonological naming therapy in jargon
aphasia: Positive but paradoxical effects. Journal of the International Neuropsychological
Society, 4, 675–686.
Swinburn, K., Porter, G., & Howard, D. (2004). Comprehensive Aphasia Test. New York: Psy-
chology Press.
Szekely, A., Jacobsen, T., D’Amico, S., Devescovi, A., Andonova, E., Herron, D., . . . Bates, E.
(2004). A new on-line resource for psycholinguistic studies. Journal of Memory and
Language, 51, 247–250.
Wambaugh, J. L. (2003). A comparison of the relative effects of phonologic and semantic
cueing treatments. Aphasiology, 17, 433–441.
Wilson, M. (1988). MRC psycholinguistics database: Machine-useable dictionary, version 2.0.
Behavior Research Methods Instruments & Computers, 20, 6–10.
Wingfield, A., Goodglass, H., & Smith, K. L. (1990). Effects of word-onset cuing on picture
naming in aphasia: A reconsideration. Brain and Language, 39, 373–390.
Manuscript received April 2012

Revised manuscript received August 2012
First published online October 2012
APPENDIX 1
Results from speech sample analyses for each participant pre and post-treatment
Procedural Personal Sequence Picture Description Personal Narrative

PRE POST PRE POST PRE POST PRE POST PRE POST
PS
Total utterances 5 11 6 8 7 14 10 9 28 14
Time (min) 0.6 1.53 0.62 0.67 3.52 2.2 2.25 2.85 3.4 2.27
Words/min 70 66.52 68.11 97.5 21.04 62.73 43.11 53.33 86.47 70.15
MLU (words) 8.6 8.27 7.17 7 9.57 7.93 8.1 13.75 10.15 11.38
Different words n 26 43 26 30 44 68 51 57 116 80
Total words n 43 91 43 56 67 111 81 110 274 148
Type token ratio 0.6 0.47 0.6 0.54 0.66 0.61 0.63 0.52 0.42 0.54
Maze words n 0 8 0 10 8 29 8 16 8 4
Maze words % 0 8 0 15 11 21 9 13 3 3

Abandoned utterances 0 0 0 0 0 0 0 1 1 1
Omitted words n 2 3 0 2 1 3 1 1 2 1
Word-level errors 1 2 1 1 1 9 0 6 4 4
JV
Time (min) 0.22 0.33 2.05 1.13 0.98 0.73 1.23 1.02 4.42 2.67
Words/min 106.15 84 53.17 60.88 58.98 60 60 73.77 64.08 62.25
MLU (words) 4.6 4.6 6.62 6.6 7.17 8.8 7.88 13.4 7.14 9.41
Total words n 23 23 86 66 43 44 63 67 264 160
Type token ratio 0.7 0.83 0.7 0.64 0.77 0.73 0.71 0.66 0.47 0.72
Maze words n 0 0 13 3 3 1 12 8 12 6
Maze words % 0 0 13 4 7 2 16 11 4 4
Omitted words n 3 5 0 2 2 0 1 3 4 0
129
(Continued)
130
Table A1. Continued.

LW
Time (min) 0.97 1.53 2.07 1.28 3.12 2.35 3.43 1.75 4.02 5.43
Words/min 56.9 56.74 36.29 30.39 35.29 37.87 31.46 28.57 27.39 30.18
MLU (words) 7.13 8.11 9.25 5.29 10.5 11.13 12.14 13.67 9.89 8.59
Total words n 57 73 74 37 105 89 85 41 89 146
Type token ratio 0.54 0.56 0.49 0.65 0.53 0.58 0.4 0.68 0.6 0.47
Maze words n 0 15 1 2 2 2 10 1 16 12
Maze words % 0 17 1 5 2 2 11 2 15 8
Omitted words n 0 0 0 0 1 0 0 0 2 0
TW
Time (min) 0.53 1.08 1.18 0.87 0.65 0.9 2 1.17 2.42 3.35
Words/min 52.5 49.85 51.55 43.85 32.31 37.78 36 37.71 31.45 35.82
MLU (words) 7 6.11 11.2 6.33 3.5 6 6.88 10 8.75 7.8
Total words n 28 55 56 38 21 30 55 40 70 78
Type token ratio 0.82 0.65 0.73 0.74 0.9 0.73 0.71 0.7 0.69 0.77
Maze words n 0 0 5 0 0 4 7 1 6 5
Maze words % 0 0 8 0 0 12 11 2 8 6
Omitted words n 0 2 0 2 0 1 2 0 0 1
HJ
Time (min) 1.08 1.27 0.87 1.37 1.28 1.65 1.63 2.32 2 4.18
Words/min 62.77 71.84 79.62 65.12 85.71 84.85 56.33 66.04 62 66.93
MLU (words) 8 10.33 13 8.25 8.33 14.29 7.75 8.25 7.86 13
Total words n 40 31 26 66 50 100 31 66 55 169
Type token ratio 0.63 0.77 0.77 0.67 0.7 0.55 0.81 0.5 0.62 0.51
Maze words n 5 7 3 15 8 37 6 22 15 30
Maze words % 11 18 10 19 14 27 16 25 21 15
Omitted words n 0 0 0 0 0 1 3 0 0 1
TK
Time (min) 0.67 0.52 1.1 0.65 0.68 0.53 0.65 0.88 2.6 1.02
Words/min 97.5 81.29 100 100 83.41 116.25 86.15 83.77 70.38 92.46

MLU (words) 7.88 6.5 11 6.89 5.22 8 7.86 8.38 8.06 8.7
Total words n 63 39 110 62 47 56 55 67 137 87
Type token ratio 0.57 0.54 0.6 0.63 0.74 0.77 0.64 0.69 0.57 0.61
Maze words n 3 3 1 3 10 7 6 8 15 7
Maze words % 5 7 1 5 18 11 10 11 10 7
Omitted words n 0 2 2 1 3 1 0 4 0 2
TP
Time (min) 1.67 0.57 0.85 1.05 1.1 1.58 0.63 0.98 1.07 3.82
Words/min 35.4 82.94 56.47 64.76 68.18 42.32 69.47 74.24 55.31 63.93
MLU (words) 8.67 6.83 12.5 10.5 7.83 4.86 8 9.4 10 10.83
131
(Continued)
132
Table A1. Continued.

Total words n 26 41 25 63 47 34 24 47 40 130
Type token ratio 0.77 0.71 0.8 0.67 0.74 0.76 0.88 0.64 0.68 0.48
Maze words n 14 3 0 10 16 6 6 1 20 51
Maze words % 35 7 0 14 25 15 20 2 33 28
Omitted words n 1 1 0 0 0 0 0 0 1 0
BA
Time (min) 0.2 0.6 0.42 1.63 0.27 0.52 0.47 0.47 1.58 2.7
Words/min 160 141.67 115.2 132.86 142.5 114.19 154.29 126.43 138.95 133.33
MLU (words) 6.75 8.56 6.86 10.39 6.33 5.18 7.1 8.14 12.75 10.63
Total words n 27 77 48 187 38 57 71 57 153 340
Type token ratio 0.81 0.53 0.75 0.45 0.71 0.58 0.65 0.68 0.43 0.44
Maze words n 5 8 0 10 0 2 1 2 33 22
Maze words % 16 9 0 5 0 3 1 3 18 6
Omitted words n 0 0 1 0 0 0 0 1 1 0

A Comparison of Semantic Feature Analysis and Phonological Components Analysis For The Treatment of Naming Impairments in Aphasia

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Neuropsychological Rehabilitation

ISSN: 0960-2011 (Print) 1464-0694 (Online) Journal homepage: http://www.tandfonline.com/loi/pnrh20

A comparison of semantic feature analysis

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Download by: [190.246.180.6] Date: 26 September 2015, At: 06:25

A comparison of semantic feature analysis and

Sophia van Hees1,2, Anthony Angwin2, Katie McMahon3,

Therapy for naming impairments post-stroke typically involves semantic and/

Correspondence should be addressed to Sophia van Hees, University of Queensland, Centre

# 2013 Taylor & Francis

Keywords: Anomia; Stroke; Aphasia; Rehabilitation.

lexicon, or in the lexical representations themselves (Laine & Martin, 2006).

phonological FIKS treatment involved tasks focusing on sound structure. No

results, with significant improvements only for the phonological tasks.

which were administered in a similar format and required similar response

word retrieval (Nickels, 2002). For example, if categorical errors in naming

ture concerned with phonological treatment (Hickin et al., 2002).

Language assessment results for each participant

NAMING TREATMENT IN APHASIA

VAN HEES, ANGWIN, McMAHON, AND COPLAND

sample were also re-assessed at follow-up to examine generalisation of treat-

participants who significantly improved following PCA maintained improve-

significantly improved following SFA maintained improvements at 2–3 week

Post-Tx Follow-up Post-Tx Follow-up

Seven of the eight participants made significant improvements immedi-

of an increased number of utterances and/or mean length of utterances.

Relationship between locus of breakdown and response to

participant with both semantic and phoneme assembly impairments, where

Possible mechanisms of treatment effects

Participants PS and HJ were identified with predominantly post-semantic

facilitating access to the phonological output lexicon, or a combination of

Generalisation to connected speech

One factor to consider is the type of elicitation techniques used. Differ-

in terms of transfer to connected speech, or that the measures used to quantify

Summary and conclusions

effects. For the phonologically-based task, activation of word form infor-

treatments within the same individual. However, in order to support and

Stroke, 35, 141–146.

Manuscript received April 2012

Procedural Personal Sequence Picture Description Personal Narrative

NAMING TREATMENT IN APHASIA

Procedural Personal Sequence Picture Description Personal Narrative

VAN HEES, ANGWIN, McMAHON, AND COPLAND

NAMING TREATMENT IN APHASIA

VAN HEES, ANGWIN, McMAHON, AND COPLAND

Procedural Personal Sequence Picture Description Personal Narrative

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