Phonomotor treatment for anomia Today I am going to talk about a treatment program that we have been systematically developing for about 10 years now. Diane L. Kendall, PhD Associate Professor, Department of Speech and Hearing Sciences Research Scientist, VAMC Puget Sound

TODAY Describe study Treatment Results Future

Veterans Affairs (VA) grant 2010-2013 $850,000 Provide treatment to 30 individuals aphasia and anomia

Currently, Analysis of ALL data Data collection finished!!!!! November 2012 Analysis of ALL data Finish June 2013

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Participants Included: Excluded N=28 Aphasia Word retrieval deficits Impaired phonologic processing Excluded Significant (severe) speech apraxia Depression Degenerative disease Chronic medical illness N=28 Chronic aphasia (>6mos) Left CVA 18 right-handed, 2 left-handed 18 Monolingual English 2 Bilingual (English dominant language since childhood)

N=28 Age (years) Education Months post stroke onset AVE 56 16 47 Range 26-78 12-23 10-211

General language test AVE 79/100 36/60 96/151 Western Aphasia Battery (WAB-AQ) (out of 100) Boston Naming Test (BNT) (spontaneous correct out of 60) Standardized Assessment of Phonology in Aphasia (SAPA) (raw score out of 151) AVE 79/100 36/60 96/151 General language test

AVE 79/100 36/60 96/151 Western Aphasia Battery Boston Naming Test (WAB-AQ) (out of 100) Boston Naming Test (BNT) (spontaneous correct out of 60) Standardized Assessment of Phonology in Aphasia (SAPA) (raw score out of 151) AVE 79/100 36/60 96/151

Test of ‘sounds” AVE 79/100 36/60 96/151 Western Aphasia Battery (WAB-AQ) (out of 100) Boston Naming Test (BNT) (spontaneous correct out of 60) Standardized Assessment of Phonology in Aphasia (SAPA) (raw score out of 151) AVE 79/100 36/60 96/151 Test of ‘sounds”

Post usual care testing Immediate treatment Immediately post treatment Testing Pre- treatment Treatment Phase 3-month post treatment testing 1-week 6-weeks 3-months Delayed treatment Immediately post treatment testing Usual care control phase 3-months post treatment testing Post usual care testing 1-year post testing N=14 1-year 1-week 1-year post testing N=14 1-year 1-week

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TWO PHASES OF TREATMENT Phonemes in Isolation Phoneme Sequences 1-, 2- and 3-syllables ** Phonemes in Isolation Train up individual phonemes using acoustic, articulatory, tactile-kinesthetic, orthographic tasks Phoneme Sequences *** Aim to build up phonological sequence knowledge across domains through the cultivation of phonological awareness tasks, *** development of an incipient phonological neighborhood by enabling engagement of various permutations and combinations of phonological sequences so that upon termination of treatment, through continued use improved lexical growth is expected

How can you tell if treatment works?

Research Questions Measures Acquire (learn) Phonology Naming pictures Does what you learn in therapy generalize to something else?? Conversation What about at 3 months and 1 year?

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Generalize to phonology Generalize to words not seen in therapy Research aim Outcome measure Acquisition (pre- vs imm post-) N=20 3-mo (pre- vs 3 mo) N=16 1-yr (pre- vs 1-yr N=8 Learn Trained nouns P=.000 Pre 64% (SD 26) Post 82% (SD 17) Pre 66% (SD 25) Post 79% (SD 22) P=.016 Pre 70% (SD 18) Post 86% (SD 7) Generalize to phonology Standardized Assessment of Phonology in Aphasia P= .000 Pre 97 (25) Post 106 (24) Post 106 (26) P=.010 Pre 100 (23) Post 115 (15) Generalize to words not seen in therapy Untrained nouns P=.001 Pre 64% (SD 25) Post 70% (SD 25) P=.033 Post 71% (SD 26) Pre 68% (SD 20) Post 81% (SD 19)

Nouns * * * * * * Percent accuracy

Conversation n=3 VIDEO Productivity (# of clauses, # verbal units, # words): 2 of 3 more verbal output following therapy twice the number of clauses, more verbal units, and more words when compared with before treatment output. Grammar (% grammatical clauses): 0 of 3 Relevance (% of clauses containing new information, relevance of response to each prompt): 2 of 3 improved Efficiency (self corrections, interjections, irrelevant words): there was no change in the overall efficiency

Discussion Results support our hypothesis Your treatment primarily focuses on training up phonemes and phonological sequence knowledge, thereby enhancing the probability that a semantic representation will sufficiently engage a phonological (sequence) representation to enable word production. Your training of real words sought to further enhance phonological sequence knowledge acquisition by simultaneously engaging phonemes in particular real word sequences, thereby enhancing the connectivity underlying these sequences through Hebbian mechanisms. Because there are many regularities in phonological sequence knowledge, there is great capacity for generalization to untrained sequences. Because all our words use the same phoneme sequence building blocks, training up phonological sequence knowledge has the potential for enabling naming of all concepts. On the other hand, because word meaning and word sound are substantially orthogonal, training up lexical semantic connections has essentially no capacity for generalizing -- there are almost no regularities in the connectivity between the substrate for concept representations and the substrate for phonological sequence representations. Your engagement of lexical semantic representations in your treatment program was not intended to strengthen these connections (which would have no generalizing effect) -- it was only a heuristic to get one more handle on phonological sequence knowledge acquisition.

Idea! “flower” word sounds F + L + OW + R

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Traditional treatment New Grant N=40 Traditional treatment (standard of care) N=40 Phonomotor treatment VS.

Acknowledgements YOU!!!!! VA RR&D Merit Review Grant #C6572R UW Aphasia Lab Liz Brookshire, MA Megan Oelke, MA JoAnn Silkes, PhD Irene Minkina, BS Lauren Bislick, MA Rebecca Pompon, PhC