گسترش استفاده از برنامه توانبخشی نام پریشی اسپانیایی به کمک کامپیوتر (CARP-2) در افراد مبتلا به زبان پریشی

Purpose To extend the use of the Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) for anomia from a single case to a group of 15 people with aphasia. To evaluate whether the treatment is active (Phase 1) for this group (Robey & Schultz, 1998), providing potential explanations as to why. Methods Fifteen participants with chronic aphasia (with a range from moderate to mild anomia) were recruited to 15 weeks of computer-assisted therapy for anomia. A single treatment period with pre- and post-treatment assessments evaluated participants’ ability to name 200 words using the multiple cues provided by the computer. Pre- and post-naming measures of all items examined the effect of treatment. Background linguistic and cognitive skills were measured before and after the therapy to investigate whether the improvements in naming were therapy specific. Results All 15 participants showed significant benefits in their naming skills after the therapy. There were no changes to cognitive and linguistic skills unrelated to anomia. There was evidence of some carry-over effects in naming. Conclusion The Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) for anomia is an active treatment for a range of people who have anomia as part of their aphasia profile. Learning outcomes: By the end of the paper you will be able to answer the CEU questions and consider whether to use computer assisted therapy on a wide range of clients with anomia difficulties.

The case for treatment of naming difficulties is well supported (for summary of these see Laine and Martin, 2006 and Nickels, 2002a). One of the main features of such therapy is the intensity and range of stimulation methods needed (see Howard et al., 1985 and Nickels, 2002a), hence the use of computers to provide and/or supplement face-to-face therapy for anomia. Consequently, in the last decade, there have been a proliferation of studies to examine how and what is the most useful way to use computers in anomia rehabilitation. Adrián, González, and Buiza (2003) set out a list of possible advantages of computer-assisted therapy over face-to-face. These included: mass exposure to items, varied range of multi-sensory tasks to provide the widest possible stimulation, participants able to control their own progress and have precise and on-line feedback about how they are doing, choice of how they carry out the therapy and with whom and a range of positive outcomes, not just in their naming ability but also in other language tasks, self esteem and adjustment to aphasia. Table 1 summarizes previous studies where some of these advantages have been found. Table 1. Summary of studies using computer-assisted therapy to improve anomia from 2000 to 2010. First author and year Participant number Participant type No of items/exercises Range multi-sensory tasks/cues Participant control over program Precise feedback Statistical evidence improvement Evidence of wider improvements Pedersen et al. (2001) 3 CVA 64–184 Multicue Unsupervised Yes Yes Yes Fink et al. (2002) 6 CVA 40 Phonological Partially self-guided Assisted Yes Yes Yes Cuetos (2003) 8 CVA TBI 50–300 Phonological Semantic N/A Yes Yes N/A Mortley, Wade, Davies, & Enderby (2003) 7 CVA 34–52 Multicue Unsupervised Yes Q Yes Adrián et al. (2003) 1 CVA 60 Multicue Assisted Yes Yes Yes Mortley, Wade, & Enderby (2004) 7 CVA 262 Multicue Unsupervised Yes Yes Yes Doesborgh et al. (2004) 18 CVA 320 Multicue Assisted Yes Yes No Laganaro et al. (2006) 8 CVA TBI 144 Multicue Unsupervised Yes Yes No Raymer, Kohen, and Saffell (2006) 5 CVA 60 Multicue Assisted Yes Yes Yes Jokel, Cupit, Rochon, & Leonard (2006) 2 PPA 45 Orthographic Assisted N/A Yes N/A Archibald, Orange, and Jamieson (2009) 8 CVA 99–498 Multicue Unsupervised or Assisted Yes Yes Yes Choe et al. (2007) 4 CVA 75 Multicue Unsupervised and assisted Yes Yes & Q Yes Jokel et al. (2007) 1 SD 90 Errorless Semantic Assisted N/A Yes No Ramsberger and Marie (2007) 4 CVA 40–80 Multicue Unsupervised Yes Yes No Jokel, Cupit, Rochon, & Leonard (2009) 2 NPA 20 Orthographic Phonological Assisted N/A Yes Yes NB: N/A = not available; CVA = cerebral vascular accident; TBI = traumatic brain injury; PPA = primary progressive aphasia; SD = semantic dementia; NPA = non-fluent progressive aphasia; Feedback: includes any picture, spoken word or summary feedback shown; Multicue: more than two cues and exercises provided, Q: No quantitative evidence but evidence of qualitative analysis. Table options From this table, it is clear that computer assisted therapy has been useful for anomia arising from a range of etiologies (CVA, dementia, TBI) and for a wide range of participant numbers (studies varied from 1 to 18 participants). Every study used a large number of items and/or exercises with a wide and varied range of tasks to stimulate both the semantic and phonological information needed to name. Multiple cueing was the most widely used method. There was more variation in whether the computer program is participant-controlled or led by a speech/language pathologist (SLP), dividing equally between assisted and unsupervised learning. Almost all programs provided precise feedback to the participant. Importantly, there was strong statistical support to back up the claims that computer assisted therapy had positive effects on naming. Some studies also reported positive improvements on other areas such as other cognitive and linguistic skills and functional improvement and self-esteem. Given the increased use of these computer-assisted programs, it would be important to conduct research on new programs following Robey and Schultz's (1998) 5-stage model for providing clinical outcome research. These were later modified and further described by Wertz and Katz (2004) specifically for computer-assisted therapy. In brief, those authors proposed a five-phase treatment outcome research model for computer-based interventions in aphasia: Phase 1: The purpose of Phase 1 was to show that the treatment (e.g. a computer-assisted program for anomia) was active in improving the aphasia deficits. Phase 2 refined the ideas explored in Phase 1 by specifying who was more likely to improve from the therapy, to inform clinician training, to reconsider the stimuli (type and number), determine optimal intensity and duration of the treatment and sessions, establish appropriate order of tasks and stimuli and demonstrate validity and reliability of the therapy program (by detecting pre-post improvement). Phase 3 tested the treatment's efficacy under optimal conditions while Phase 4 demonstrated the treatment's effectiveness. Phase 5 examined overall cost-effectiveness of a treatment, assessing outcomes beyond symptom remission and included evaluation of the participant's quality of life and family satisfaction with the rehabilitation. This study aimed to build on the single case study report from Adrián et al. (2003) in order to answer the question of whether the treatment was active (Phase 1). Adrián et al.’s (2003) single case study of a woman with aphasia post CVA (MRP) provided strong evidence that naming could be improved in this specific case using a computer assisted program (CARP-1). The program was based on a ‘drill and practice’ regime of 12 sessions, working with 60 items (40 objects and 20 items) within 5 categories; 2 nonliving things: (furniture and household items), 1 living things (animals), 1 body parts and 1 actions. For each target stimulus, MRP attempted to name the item in the presence of 4 different cues which she selected herself from a choice of semantic, phonological, written and mixed. For example, to name a picture of a tiger [tigre], the semantic cue was: ‘a wild animal, with striped fur’; the phonological cue was the first syllable /ti/; the written cue was the first two graphemes to indicate the first syllable and a line to show second syllable (in this instance, TI_); the mixed cue used a range of ways to stimulate the naming of the word: e.g. superordinate category, visual and contextual features of the word (e.g. scene) and closing sentences prompting familiar expressions. In Spanish, to say something smells bad, one might say ‘huele a tigre’ (it smells like a tiger) so the mixed cue for this example was ‘huele a…’ (it smells like a…). MRP not only improved on the trained items, but also after training was able to self cue such that she could name non-treated items at follow-up. This study was a single case only and what remained unclear was whether her response to the computer therapy was unique or whether this might be expected from all those using such a method for anomia treatment. The current study therefore expanded on this single case pilot by increasing the number of participants who were trained from 1 to 15, with a range of anomia severities. The computer program itself included alterations to improve its appearance and to make the interface more user-friendly. The number of sessions, the number of items and range of stimuli were all increased. The decision to increase all these factors arose from a desire to provide more intense therapy over a longer period (Basso, 2005). The intensity of therapy was not just related to the frequency with which the participants studied items (twice weekly) but also to the increased task complexity (e.g. naming in the presence of different distracters) and the increased number of semantic categories. Laganaro, Di Pietro, and Schnider (2006) found that treatment effects depended more on the number of treated items rather than on the number of repetitions per item. Pedersen, Vinter, and Olsen (2001) suggested that all participants should go through every cue in a hierarchical order and by going through each step/cue in an incremental way, the participant would then be able to improve lexical access following the therapy. Doesborgh et al. (2004) also emphasized the benefits of using multicues in this type of therapy, making use of semantic, phonological and orthographic cues and repetition in combination, rather than in isolation. The overriding aim for the revised program was to provide a larger number of items with a wider range of multicues and a definite hierarchical structure to the tasks so that the full range of participants could be compared on the program.

The results of the naming therapy will be provided, showing the pre-treated scores of the participants with aphasia and their mean, followed by the post treatment measures and their mean. 3.1. Pre-treatment results At baseline, out of a possible 200 items, the group of participants with aphasia correctly named a mean of 70.67 (SD = 44.50) with a range from 8 to 149. The mean correct responses in the control group were 194.27 (SD = 3.53) and a range of 184–198. The inter-groups difference is significant: F(1, 28) = 112.94, p < .001).