Treatment for Progressive Impairments of Language

2010 ◽  
Vol 20 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Maya Henry
Keyword(s):  
Behavioral Treatment ◽  
Primary Progressive Aphasia ◽  
Sentence Production ◽  
Lexical Retrieval ◽  
Functional Communication ◽  
Language Performance ◽  
Communication Techniques ◽  
Primary Object ◽  
Behavioral Treatments ◽  
Treatment Research

Abstract Primary progressive aphasia (PPA) is a relatively new diagnostic entity, for which few behavioral treatments have been investigated. Recent work has helped to clarify the nature of distinct PPA variants, including a nonfluent variant (NFV-PPA), a logopenic variant (LV-PPA), and a semantic variant (SV-PPA). This paper reviews treatment research to date in each subtype of PPA, including restitutive, augmentative, and functional approaches. The evidence suggests that restitutive behavioral treatment can result in improved or stabilized language performance within treated domains. Specifically, sentence production and lexical retrieval have been addressed in NFV-PPA, whereas lexical retrieval has been the primary object of treatment in LV and SV-PPA. Use of augmentative communication techniques, as well as implementation of functional communication approaches, also may result in improved communication skills in individuals with PPA. The ideal treatment approach may be one that combines restitutive, augmentative, and functional approaches to treatment, in order to maximize residual cognitive-linguistic skills in patients. Additional research is warranted to determine which modes of treatment are most beneficial in each type of PPA at various stages of severity.

scholarly journals Behavioral and Pharmacological Treatment of Lexical-Semantic Deficits in a Single Patient With Primary Progressive Aphasia

1995 ◽  
Vol 4 (4) ◽  
pp. 76-87 ◽  
Author(s):  
Malcolm R. McNeil ◽  
Steven L. Small ◽  
Robert J. Masterson ◽  
Tepanta R. D. Fossett
Keyword(s):  
Pharmacological Treatment ◽  
Behavioral Treatment ◽  
Primary Progressive Aphasia ◽  
Lexical Retrieval ◽  
Baseline Design ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Lexical Semantic ◽  
Positive Effects ◽  
Extended Practice

In the context of a hybrid multiple-baseline design, this study demonstrated the positive effects of a behavioral + pharmacological (dextroamphetamine) treatment for lexical-semantic deficits in an individual with primary progressive aphasia (PPA). Behavioral treatment entailed application of a cuing hierarchy to predicative adjectives in order to facilitate lexical retrieval. Treatment was effective for both antonym and synonym adjectives, although extended practice was required to achieve criterion. Generalization to nontreated adjectives, verbs, and prepositions was observed, and maintenance was difficult to disambiguate from the progressive nature of the disease. It was proposed that the mechanisms of activation and inhibition were responsible for improved performance. Differential effects between behavioral and behavioral + pharmacological treatment were not observed.

scholarly journals A Systematically Conducted Scoping Review of the Evidence and Fidelity of Treatments for Verb and Sentence Deficits in Aphasia: Sentence Treatments

2021 ◽  
pp. 1-32
Author(s):  
Julie Hickin ◽  
Madeline Cruice ◽  
Lucy Dipper
Keyword(s):  
Outcome Measures ◽  
Argument Structure ◽  
Case Series ◽  
Sentence Production ◽  
Functional Communication ◽  
Case Control Studies ◽  
Level Of Evidence ◽  
Discourse Production ◽  
Treatment Research ◽  
The Impact

Purpose: This review article synthesizes and evaluates the evidence for sentence production treatments in aphasia, systematically charting impairment-based and functional communication outcomes. It reports (a) the level of evidence and fidelity of sentence treatments; (b) the impact of treatment on production of trained and untrained verbs and sentences, functional communication, and discourse; and (c) the potential active ingredients of treatment. Method: The search included studies from January 1980 to June 2019. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to treatment methods used. Results: Thirty-three studies were accepted into the review and predominantly constituted Level 4 evidence (e.g., case control studies and case series). Thirty studies (90%) described treatment in sufficient detail to allow replication, but dosage was poorly reported, and fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were mapping (10 studies: 30%), predicate argument structure treatment (six studies: 18%), and verb network strengthening treatment (five studies: 15%). Production of trained sentences improved for 83% of participants, and improvements generalized to untrained sentences for 59% of participants. Functional communication was rarely assessed, but discourse production improved for 70% of participants. Conclusions: The evidence for sentence treatments is predominantly generated from Level 4 studies. Treatments were effective for the majority of participants regarding trained sentence and discourse production. However, there is inconsistent use of statistical analysis to verify improvements, and diverse outcome measures are used, which makes interpretation of the evidence difficult. The quality of sentence treatment research would be improved by agreeing a core set of outcome measures and extended by ascertaining the views of participants on sentence treatments.

scholarly journals Breakdowns in Informativeness of Naturalistic Speech Production in Primary Progressive Aphasia

2021 ◽  
Vol 11 (2) ◽  
pp. 130
Author(s):  
Jeanne Gallée ◽  
Claire Cordella ◽  
Evelina Fedorenko ◽  
Daisy Hochberg ◽  
Alexandra Touroutoglou ◽  
...  
Keyword(s):  
Primary Progressive Aphasia ◽  
Speech Analysis ◽  
Clinical Settings ◽  
Functional Communication ◽  
Or Efficiency ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Communication Impairment ◽  
Semantic Variant ◽  
Lower Production

“Functional communication” refers to an individual’s ability to communicate effectively in his or her everyday environment, and thus is a paramount skill to monitor and target therapeutically in people with aphasia. However, traditional controlled-paradigm assessments commonly used in both research and clinical settings often fail to adequately capture this ability. In the current study, facets of functional communication were measured from picture-elicited speech samples from 70 individuals with mild primary progressive aphasia (PPA), including the three variants, and 31 age-matched controls. Building upon methods recently used by Berube et al. (2019), we measured the informativeness of speech by quantifying the content of each patient’s description that was relevant to a picture relative to the total amount of speech they produced. Importantly, form-based errors, such as mispronunciations of words, unusual word choices, or grammatical mistakes are not penalized in this approach. We found that the relative informativeness, or efficiency, of speech was preserved in non-fluent variant PPA patients as compared with controls, whereas the logopenic and semantic variant PPA patients produced significantly less informative output. Furthermore, reduced informativeness in the semantic variant is attributable to a lower production of content units and a propensity for self-referential tangents, whereas for the logopenic variant, a lower production of content units and relatively ”empty” speech and false starts contribute to this reduction. These findings demonstrate that functional communication impairment does not uniformly affect all the PPA variants and highlight the utility of naturalistic speech analysis for measuring the breakdown of functional communication in PPA.

Exploring generalisation processes following lexical retrieval intervention in primary progressive aphasia

2016 ◽  
Vol 18 (3) ◽  
pp. 299-314 ◽  
Author(s):  
Ashleigh Beales ◽  
Jade Cartwright ◽  
Anne Whitworth ◽  
Peter K. Panegyres
Keyword(s):  
Primary Progressive Aphasia ◽  
Lexical Retrieval ◽  
Progressive Aphasia ◽  
Primary Progressive

scholarly journals A Window Into Functional Communication: Leveraging Naturalistic Speech Samples in Primary Progressive Aphasia

2021 ◽  
pp. 1-10
Author(s):  
Jeanne Gallée ◽  
Anna Volkmer
Keyword(s):  
Primary Progressive Aphasia ◽  
Functional Communication ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Communication Difficulties ◽  
Treatment Plans ◽  
Strengths And Difficulties ◽  
Disordered Speech ◽  
Everyday Communication ◽  
Diagnose Monitor

Purpose Naturalistic speech samples should be routinely collected in the assessment of individuals with communication difficulties. However, even when these samples are collected, they are often underutilized. We propose that the analysis of naturalistic speech samples can greatly enhance our understanding and evaluation of the functional impact of primary progressive aphasia (PPA) on communication. First, we review the current practices of evaluating PPA. Second, we provide a framework to optimize the collection, analysis, and interpretation of speech samples to accomplish this goal. In particular, we demonstrate how speech samples can be evaluated for measures of informativeness, the presence of atypical patterns of speech, articulatory rate, and pausing, all of which are helpful metrics in characterizing disordered speech. These factors can be leveraged to identify both the strengths and difficulties an individual may face in everyday communication. Conclusion The collection of naturalistic speech in both clinical and naturalistic settings with typical communication partners is highly recommended to best diagnose, monitor, and inform treatment plans for individuals with PPA.

Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease

2021 ◽  
pp. 1-16
Author(s):  
Ashleigh Beales ◽  
Anne Whitworth ◽  
Jade Cartwright ◽  
Peter K. Panegyres ◽  
Robert T. Kane
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Family Members ◽  
Primary Progressive Aphasia ◽  
Lexical Retrieval ◽  
Connected Speech ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Word Classes ◽  
The Impact

Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771

Treatment for Lexical Retrieval Impairments in Primary Progressive Aphasia: A Research Update with Implications for Clinical Practice

2018 ◽  
Vol 39 (03) ◽  
pp. 242-256 ◽  
Author(s):  
Karen Croot
Keyword(s):  
Clinical Practice ◽  
Clinical Decision Making ◽  
Primary Progressive Aphasia ◽  
Clinical Decision ◽  
Lexical Retrieval ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Behavioral Studies ◽  
Long Term Treatment

AbstractLexical retrieval impairments (also known as anomia or word-finding deficits) are an early and prominent symptom in primary progressive aphasia (PPA), causing distress and frustration to individuals with PPA and their communication partners, and prompting research on lexical retrieval treatment. This paper reviews the research on lexical retrieval treatment in PPA from the earliest reports in the 1990s to early 2018 and considers the implications of this research for clinical practice. The number of published studies has increased markedly over the past decade, consisting primarily of behavioral studies, with rapid recent growth in noninvasive brain stimulation studies. Five general treatment techniques were identified in the behavioral studies, described here as standard naming treatment, Look, Listen, Repeat treatment, cueing hierarchies, semantically focused treatments, and lexical retrieval in context. Across techniques, behavioral studies targeting difficult-to-retrieve items typically report immediate gains, and there is evidence these gains can be maintained over months to years by some participants who continue with long-term treatment. There is also evidence that prophylactic treatment supports retrieval of treated items compared with untreated items. There is limited evidence for generalization of treatment to untreated items, suggesting the primary aim of lexical retrieval treatment in this population is to maintain retrieval of a core vocabulary for as long as possible. Language and cognitive assessment and piloting of the intended treatment can inform decisions about treatment selection and participant suitability for long-term lexical retrieval treatment. The paper concludes with some questions to guide clinical decision making about whether to implement or continue with a behavioral lexical retrieval treatment.

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