|Year : 2020 | Volume
| Issue : 2 | Page : 101-106
Effectiveness of speech and language therapy and spontaneous recovery in anomic aphasia
Department of Audiology and Speech and Language Pathology, JSS Institute of Speech and Hearing, Dharwad, Karnataka, India
|Date of Submission||12-Aug-2020|
|Date of Decision||19-Dec-2020|
|Date of Acceptance||15-Jan-2021|
|Date of Web Publication||3-Feb-2021|
Mrs. K Sandhya
Department of Audiology and Speech and Language Pathology, JSS Institute of Speech and Hearing, Dharwad, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Anomia is a problem with naming objects. Anomic aphasia, also called as anomia or amnesic aphasia, is characterised by word-finding difficulties in the absence of major syntactic impairment.
Objectives: To determine the effectiveness of therapy techniques in recovery of language abilities in a patient with anomic aphasia.
Materials and Methods: Prospective study of a patient diagnosed with anomic aphasia secondary to ischaemic stroke, whose response and progress was followed from the time of presentation, along the course of therapy with techniques including semantic feature analysis (SFA) and phonological component analysis (PCA), and scored according to the guidelines of Manual for Adult Non-Fluent Aphasia Therapy in Kannada (MANAT-K).
Results: Significant improvement was noted in the patient's naming skills, with an increase in almost 20% in the score in confrontation naming, responsive naming, and word fluency, post-therapy, as compared to pre-therapy.
Conclusion: Although there is contribution of spontaneous recovery in the betterment of a person with aphasia, timely planned therapy brings about a marked improvement in the patient's language abilities.
Keywords: Anomic aphasia, phonological component analysis, semantic feature analysis, spontaneous recovery, treatment efficacy
|How to cite this article:|
Sandhya K. Effectiveness of speech and language therapy and spontaneous recovery in anomic aphasia. J Cerebrovasc Sci 2020;8:101-6
|How to cite this URL:|
Sandhya K. Effectiveness of speech and language therapy and spontaneous recovery in anomic aphasia. J Cerebrovasc Sci [serial online] 2020 [cited 2021 Sep 17];8:101-6. Available from: http://www.jcvs.com/text.asp?2020/8/2/101/308624
| Introduction|| |
Anomia refers to occurrences of word-finding difficulty which occur during the conversational discourse. It is a frequent instance in individuals having left hemisphere brain damage and aphasia. Anomic aphasia can be a difficulty in retrieving exact nouns, often intended words, but sometimes verbs, during sentence generation. Although the grammatical features of the sentence remain intact, word retrieval difficulty persists that leads to insertion of filler words, long pauses or choice of wrong words (paraphasias). This is mainly observed in conversation or other word retrieval activities, most frequently in tasks demanding individuals to name pictures.
Treatment for anomic aphasia is explained by advances in understanding the nature of neurobiology of recovery and learning. The multidimensionality of cortical reorganisation and modifiability may be seen in the neuroplasticity, which produces clinical recovery, which is experiential in response to stimulation. Studies on plasticity reveal the functional importance of the 'use it or lose it' principle and show that beneficial neural and behavioural changes can be effected via intense and repetitive practice. A number of patients with aphasia exhibit certain amount of recovery of naming in the initial days to weeks following to stroke; 30%–40% persevere with enduring naming impairments.
Targeted speech therapy can lead to considerable naming improvement in some individuals with anomia following dominant hemisphere stroke. Speech and language therapy, assisted by the spontaneous recovery, will help in a better prognosis of individuals with anomic aphasia. Treatment on cueing has also been studied, in the treatment of object names, and action names., Positive treatment effects were noticed in the study for both phonological cueing treatment and a semantic cueing treatment.
Therapy techniques such as semantic feature analysis (SFA) and phonological component analysis (PCA) are evidenced to be effective patients with anomic aphasia. Patients demonstrated a drastic progress in some aspects of discourse production associated with the confrontation naming while using the SFA treatment plan. Therapy plans such as PCA help in strengthening the activation within the lexical systems, which, in turn, will assist the naming ability. The rationale for early intervention in aphasia is also based on these neuroplasticity principles such that therapy capitalises on spontaneous recovery in the immediate post-stroke period.
| Case Report|| |
A 46 year old male patient approached JSS Institute of Speech and Hearing, Dharwad 10 days after a stroke, with complaints of difficulty in finding words when speaking. He was a right-handed native Kannada speaker who was working as an engineer. He had stroke and was immediately admitted to the hospital. The patient had difficulty in expressing after the attack. There was no history of memory loss or any other neurological disorder at the time of stroke. The patient had a negative history for other neurological conditions, mental illness and alcohol/substance abuse according to self-report.
A detailed speech and language evaluation was carried out. The patient reported a drastic improvement in his expression on the period of a week. Informal assessment of the patient's vital findings and general physical health were tested. The patient was assessed with the first part of the Western Aphasia Battery-Kannada. Medical history was noted to correlate with symptoms present in the patient. A brain magnetic resonance imaging (MRI) was suggestive of multifocal acute infarcts in the left parieto-temporal lobe and the head of the caudate nucleus.
Speech and language therapy
After baseline testing was concluded, the patient underwent a period of speech therapy intended at improving naming performance. Therapy was performed 3 days in a week. The patient attended a total of 12 sessions. The clinician conducted anomia treatment using semantic and phonemic cueing hierarchies. The individuals's preferences and needs in day to day in day to day communication and in working place, coping mechanisms, life circumstances and associated behavioural, sensory, medical and psychological issues were considered while making treatment decisions. Stimuli and scoring pattern were designed based on the guidelines of Manual for Adult Non-Fluent Aphasia Therapy in Kannada (MANAT-K). The five major domains of the MANAT-K contain five domains, namely functional communication, repetition, comprehension and expression, naming and reading and writing. Systematic and regular scoring pattern of MANAT was followed for documenting the responses of each session. To make the sessions interesting, stimuli from trial version of Tactus therapy were used. Each session was audio/video-recorded and transcribed orthographically. After the conclusion of treatment, the patient was re-evaluated with Western Aphasia battery-K. The post-testing replicated the pre-treatment assessments and was also scored by a speech language pathologist.
Techniques such as SFA, PCA and semantic mapping were used with semantic and phonemic cueing hierarchy. SFA is a kind of semantic training, in which the patient is asked to provide different features for each word being trained [Figure 1]. This treatment is based on spreading activation models of the semantic system and has been shown to be effective in both individual and group treatment. SFA can be used to direct the patient in identifying important semantic features of the target word. This approach is thought to help activate the semantic network that surrounds the target word to aid in its retrieval. In the course of identifying features of the target item, non-targeted and semantically linked words may benefit in terms of retrieval because they share features that are being accessed or retrained. Tactus therapy android app [Figure 2] is developed based on the principal of SFA.
Semantic mapping technique also emphasises on semantic priming which takes place in processing of information to a concept. It explains how one concept may be connected to the relational links. Each node is activated when a search in memory is initiated between a concept and its links. This spreads to adjacent links beginning with the node linked to the first node, then the nodes linked to the next and so on [Figure 3]. The magnitude of activation is observed in nearby concepts, which is attributed to the distance between nodes and input concept or the relative link between them and the input or the both. This activation spread helps in focusing on the information that is relevant to the input. It has been reported that the farther the node activation, the slower the reaction time when compared with closer or nearer functions or nodes.
Phonological component analysis is a treatment for word finding that helps a person with aphasia to be trained to analyse the sounds in words. Lendrem et al. have published on the PCA treatment on aphasic individuals. PCA is proven to be useful in strengthening activations within the lexical systems with the potential results of longer standing effects [Figure 4].
| Results|| |
In depth speech and language evaluation reported naming impairment, inconsistent pointing to named objects and pictures, usage of vague and non-specific words instead of specific words which resulted in empty speech, phonemic and verbal paraphasias, circumlocutions and perseverations. Reading and writing were reported to be unimpaired. Due to naming difficulties, he exhibited problems in the construction of coherent narratives. During the case history, he was able to express his needs in complex sentences during the time of assessment. assessment of the patient's vital findings and general physical examination were normal. According to WAB-K results, his spontaneous speech, auditory comprehension and repetition skills were unaffected where his naming was mildly affected.
After the evaluation, the patient was subjected to speech language therapy. Since the start of therapy, significant linguistic changes were observed. Each session was recorded and transcribed orthographically. Based on scoring, percentage of each stimulus was calculated. [Table 1] shows depiction of score sheet for one sample item based on MANAT-K. For the treatment activities for confrontation naming, responsive naming and word fluency were selected. Marked improvement was observed in all the categories. AB design was used to study the effectiveness of intervention by comparing pre- and post-therapy effects. The first session scores were considered as the baseline (A) and the final outcome after evaluating each session was considered as B. [Graph 1] illustrates pre- and post-therapy comparison of confrontation naming. [Graph 2] shows scores of responsive naming across the sessions. [Graph 3] displays responses of word fluency across the sessions. [Graph 4] provides information on pre -and post-comparison collective comparison of naming tasks. As there is a change in B from A in AB design, it is considered to be effective.
|Table 1: Depiction of score sheet for one sample item based on manual for adult non-fluent aphasia therapy-in Kannada|
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After the treatment, the patient was subjected to post-therapy evaluation. Post-therapy scores of WAB-K show noted improvement in his naming skill [Table 2].
|Table 2: Comparison of pre- and post-western aphasia battery-R test scores|
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| Discussion|| |
Improvement in naming within a short span of time can be the result of spontaneous recovery associated with structured therapy using evidence-based therapy techniques. the current study supports earliert reports which suggest that maximum recovery happens in the first 3 months after the attack of stroke and the stage of language abilities in the initial months seems to depend exclusively on the severity of the aphasia. Hence, interpretation of the results cannot be done only based on therapy. Simultaneously, using effective therapy techniques may have attributed in speedy recovery of PWA. Semantically based treatment for the retrieval of lexical impairment has been revealed to get positive outcomes in individuals with progressive as well as stroke-induced aphasia due to focal lesions. In a study by Paradis, a patient who was a 57-year-old male who was diagnosed as having Broca's aphasia secondary to a left frontoparietal ischemic infarction was benefitted to a large extent by SFA in improving confrontation naming. Evidence from research have concluded that application of principles governing brain organisation and reorganisation may add on to the development and usage of more meaningful therapy goals. For example, performance on a confrontation naming task may facilitate person's skill to convey communicative intentions to listeners as a result of the adaptive property of the brain. In a study by and Lincoln to document the effectiveness of PCA for the treatment of naming deficits in aphasia in which 7 out of 10 individuals demonstrated distinguished treatment effects. Treating with phonological component analysis was found to be constructive in strengthening activations in the lexical system with the potential outcome of longer lasting effects.
Bilingual aphasic patients demonstrate various patterns of language recovery such as parallel, differential and selective. As the patient attended language therapy for a restricted duration, his language abilities in bilingualism and recovery pattern in bilingualism could not be assessed. This holds as a limitation of the study. A trend has emerged which depicts that comprehension (listening and reading) can improve in untreated language whereas the expressive modalities (speaking and writing) progress only in the treated language. However, this remains unanswered in this study.
| Conclusion|| |
Factors such as literacy, intelligence, type of aphasia, patient's motivation and regularity in therapy attributed to spontaneous recovery with timely therapy, which resulted in faster and better recovery.
Effective and timely therapy and meticulous planning will showcase an evident improvement in the condition of such disorders. Furthermore, proper documentation and recording of the therapy sessions will help in accurately assessing the prognosis and make the necessary changes to the plan if needed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]