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Transcript of School of Medicine | School of Medicine - Treatment of ...Treatment of Anomia: Semantic Feature...
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Treatment of Anomia: Semantic Feature Analysis Versus Phonological Component Analysis
Brenna Baltau, B.S. & Abbie Olszewski, Ph.D., CCC-SLP 1664 N Virginia St, Reno, NV 89557
University of Nevada, Reno
• Adults with aphasia can have anomia, which is difficulty retrieving words. Anomia can impact everyday communica9on and rela9onships for adults with aphasia.
• SLPs provide seman9c feature analysis (SFA) therapy to individuals with anomia to improve their word finding difficul9es. It is a technique that focuses on the meaning-‐based proper9es of nouns, where people with aphasia describe each feature of a word in a systema9c way by answering a set of ques9ons (Boyle, 2004).
• Another therapy is phone9c components analysis (PCA), which is a word-‐finding treatment that helps the person with aphasia learn to analyze the sounds in words (Bose, 2013).
• It is unclear if SFA or PCA will improve word finding abili9es for adults with anomia.
Introduc)on
Using the PICO (Purpose, Interven9on, Comparison, Outcome) framework from Gillam and Gillam (2008), the following ques9on was developed: Is phonological components analysis (I) more successful in increasing word finding abili)es
(O) in adults with anomia (P) when compared to seman)c feature analysis (C)?
Clinical Scenario
Methodology Search terms: seman&c feature analysis, SFA, individual therapy or treatment or interven&on, anomia, stroke, aphasia, anomic aphasia, phonological components analysis, PCA, phonological treatment Electronic databases: PubMed, ERIC, Web of Science, Academic Premier, PsycINFO Appraisal: Ten research ar9cles were appraised for internal validity. A 10-‐point CATE form was used for experimental studies and a 10-‐point CASM form was used for systema9c review.
CATE Form: Compelling (8 -‐ 10), Sugges9ve (4 -‐ 7), Equivocal (0 -‐ 3) CASM Form: Compelling (8 -‐10), Sugges9ve (4 -‐ 7), Equivocal (0 -‐ 3)
Discussion
Purpose
• Brooke is a 53 year old woman with Broca’s aphasia and anomia. Brooke has never received speech therapy before. She would like to return to work.
• Brenna is a speech-‐language pathologist graduate student at University of Nevada, Reno. She currently sees Brooke two 9mes per week for one hour sessions. This semester, Brenna is using seman9c feature analysis therapy approach to increase word finding abili9es twice a week throughout one hour sessions.
• Brenna is curious if phonological component analysis would yield be^er word finding abili9es for Brooke than seman9c feature analysis.
Authors (Date) Research Design
Appraisal
Purpose Par)cipants (Age, TPS, E)ology, Diagnosis)
Dependent Variables Results
Bose (2013) Experimental Single Subject Design CATE: Sugges9ve
Inves9gate the effec9veness of a phonological naming therapy on picture naming abili9es in individuals with jargon aphasia.
N = 1 Age: 77 years Time post-‐stroke (TPS): 4 years E)ology: L CVA Diagnosis: NR
30 item probes list used to measure the occurrence of: formal, seman)c, mixed, neologisms and miscellaneous errors
Results showed significant improvements in the par9cipants ability to name the treated items. These improvements were maintained.
DeLong, Nessler, Wright, & Wambaugh (2015) Experimental Mul9ple-‐baseline across-‐subjects-‐design study CATE: Compelling
To systema9cally examine outcomes associated with SFA.
N = 5 Age: 30 -‐ 65 years TPS: 11 -‐ 384 mos. E)ology: L CVA, L MCA Diagnosis: Wernicke’s, Broca’s, Anomic, Global, and Conduc9on aphasias
Confronta9on Naming Probes used to measure: produc)on of seman)c informa)on
4 out of 5 par9cipants demonstrated large effects for produc)on of seman)c informa)on post-‐treatment and at follow-‐up. Findings were mixed for generaliza9on.
Leonard, Rochon, & Laird (2008) Experimental Single Subject Design CATE: Compelling
To document the effec9veness of PCA treatment for the remedia9on of naming deficits in aphasia.
N = 10 Age: 50 -‐ 73 years TPS: NR E)ology: L CVA Diagnosis: Broca’s aphasia, Wernicke’s aphasia, Mixed nonfluent aphasia, and Anomic aphasia
Philadelphia Naming Test (PNT) used to measure: PCA at post-‐treatment and generaliza9on
7 of 10 par9cipants demonstrated small to medium effects for using PCA. Results for post-‐treatment and generaliza9on measures were similar for each par9cipant.
Maddy, Capilouto, & McComas (2014) Non-‐experimental Systema9c Review CASM: Compelling
To examine the effec9veness of seman9c feature analysis as an interven9on to improve naming abili9es for persons with aphasia.
N = 11 Inclusion Criteria:
Age: 24 – 85 years TPS: 4 -‐ 187 mo E)ology: L CVA, TBI, CVA Diagnosis: Broca’s aphasia and Wernicke’s aphasia
Confronta)onal naming
3 out of the 6 studies that showed sta9s9cal significance demonstrated medium to large effects for confronta)onal naming abili9es post-‐treatment. Addi9onally, highly effec9ve PND was observed for 6 out of 7 studies that demonstrated significant results. This suggested that SFA is a promising interven9on approach for individuals with anomia.
Van Hees, Angwin, McMahon, & Copland (2013) Experimental Single Subject Design CATE: Sugges9ve
To inves9gate the rela9ve effects of SFA and PCA therapy for naming in a group of people with aphasia.
N = 8 Age: 41 -‐ 69 years TPS: 17 -‐ 170 mos. E)ology: Single L CVA Diagnosis: NR
Naming accuracy at post-‐treatment and follow-‐up
Naming Accuracy • PCA: 7 out of 8 par9cipants improved naming accuracy from
baseline (Wilcoxon, p < .05, d = 3.93 -‐ 9.45) to post-‐treatment tes9ng. 6 of those 7 par9cipants maintained improvements
(Wilcoxon, p < .05, d = 5.00 -‐ 5.67). • SFA: 4 out of 8 par9cipant improved naming accuracy from
baseline (Wilcoxon, p < .05, d = 4.93 -‐ 6.93) to post-‐treatment tes9ng. 3 of those 4 par9cipants maintained improvements
(Wilcoxon, p < .05, d = 4.14 -‐ 8.66).
Cohen’s d 6.35 – 18.48 Medium to large effect size PND 91.67% -‐ 100% Highly effec9ve
External evidence: Both SFA (DeLong et al., 2015; Maddy et al., 2014) and PCA (Bose, 2013; Leonard et al., 2008; van Hees et al., 2013) demonstrated improvements in word finding abili9es in individuals with aphasia and anomia. When SFA and PCA were compared, Internal evidence in rela)on to the client: Brooke was informed of the results of SFA and PCA. She prefers to try both of the approaches because she thinks they would provide her with more strategies for her word finding difficul9es. Internal evidence in rela)on to the clinician: these approaches allows my client more access to features of a word in an effort to be able I would feel comfortable implemen9ng both PCA and SFA into therapy. Using to increase her word finding abili9es. E3BP Decision: Based on the external evidence, internal evidence to clinical prac9ces and evidence internal to my client, we decided to implement both PCA and SFA to improve Brooke’s word finding abili9es. Brooke will a^end therapy 2 9mes per week. In three months, word finding abili9es will be evaluated using the Boston Naming Test to determine if a combined approach improved Brookes’ word finding abili9es.
Post-‐treatment Follow-‐up P1 d = 3.59 d = 2.68 P2 d = 11.49 d = 3.47 P3 d = 15.47 d = 14.52 P4 d = 17.36 d = 8.98 P5 Omi^ed Omi^ed
Formal Not Significant (p = .81)
Seman)c Not Significant (p > .05)
Mixed Not Significant (p > .05)
Neologisms Significant (p = .03)
Miscellaneous Significant (p = .07)
Post-‐treatment Effects P1 d = 7.20
p > .01 Medium effect Not significant
P2 d = 2.65 p < .01
Small effect Significant
P3 d = 8.70 p < .01
Medium effect Significant
P4 d = 2.80 p < .01
Small effect Significant
P5 d = 3.00 p > .01
Small effect Not significant
P6 d = 3.47 p > .01
Small effect Not significant
P7 d = 6.80 p > .01
Small effect Not significant
References Bose, A. (2013). Phonological therapy in jargon aphasia: Effects on naming and neologisms. Interna&onal Journal of Language & Communica&on Disorders, 48(5), 582-‐592. doi: 10.111/1460-‐6984.12038. DeLong, C., Nessler, C., Wright, S., & Wambaugh, J. Seman9c feature analysis: Further examina9on of outcomes. American Journal of Speech -‐ Language Pathology, 24, 864-‐879. doi: 10.1044/2015_AJSLP-‐14-‐0155 Leonard, C., Rochon, E., & Laird, L. (2008). Trea9ng naming impairments in aphasia: Findings from a phonological components analysis treatment. Aphasiology, 22(9), 923-‐947. doi: 10.1080/02687030701831474. Maddy, K. M., Capilouto, G. J., & McComas, K. L. (2014). The effec9veness of seman9c feature analysis: An evidence-‐based systema9c review. Annals of Physical and Rehabilita&on Medicine, 57, 254-‐267. doi: 10.1016/j.rehab.2014.03.002. Van Hees, S., Angwin, A., McMahon, K., & Copland, D. (2013). A comparison of seman9c feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. Neuropsychological Rehabilita&on, 23(1), 102-‐132. doi: 10.1080/09602011.2012.726201.