توانبخشی زبان پریشی: آیا تعمیم نام پریشی درمان اتفاق می افتد و آن قابل پیش بینی است؟ مطالعه موردی سری

Introduction The majority of adults with acquired aphasia have anomia which can respond to rehabilitation with cues. However, the literature and clinical consensus suggest change is usually limited to treated items. We investigated the effect of an experimentally controlled intervention using progressive cues in the rehabilitation of noun retrieval/production in 16 participants with chronic aphasia. Method Participants were sub-divided relative to the group according to performance on semantic tasks (spoken/written word to picture matching) and phonological output processing (presence/absence of word length effect and proportion of phonological errors in picture naming) in order to investigate outcome in relation to language profile. Cueing therapy took place weekly for 8 weeks. Results Intervention resulted in significant improvement on naming treated items for 15/16 participants, with stable performance on control tasks. Change occurred at the point of intervention and not during pre-therapy assessments. We predicted particular patterns of generalisation which were upheld. Only participants classified as having relatively less of a semantic difficulty and more of a phonological output deficit demonstrated generalisation to untreated items. Outcome did not relate to traditional aphasia classification. Conclusion A cueing hierarchy can improve word retrieval/production for adults with aphasia. In some cases generalisation to untreated items also occurs. The study demonstrates that the results of behavioural testing can be used to guide predictions of recovery with intervention.

The majority of people with aphasia have difficulty in finding or producing words and this can be a significant cause of breakdown in conversation (e.g., Perkins et al., 1999). There is a large and growing body of evidence demonstrating that intervention can help improve word retrieval or word production (see Nickels, 2002 for a review). However, the majority of interventions result in change primarily on treated items (e.g., Abel et al., 2005; Fillingham et al., 2006; Laganaro et al., 2003; Wisenburn and Mahoney, 2009). Given these fairly consistent findings a key question of both clinical and theoretical importance arises: what pattern(/s) of strengths and difficulties leads to generalisation to untreated items? The answer to this question may inform clinical practice and our understanding of how intervention is altering word retrieval/production.