Speech-Language Therapy for Aphasia

(TERRA Trial)

Recruiting at 2 trial locations

Overseen By Kelli Powell, B.S.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of South Carolina

Disqualifiers: Neurological disease, Severe speech issues, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

Duration: 6 weeks

100 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Speech-Language Therapy for Aphasia?

Research shows that phonologically-focused therapy, like Phonological Components Analysis (PCA), can significantly improve naming abilities in people with aphasia, with many maintaining improvements over time. Additionally, phonological treatments may be particularly beneficial for individuals with more severe impairments and apraxia of speech, while semantic treatments might be more effective for those with milder impairments and fluent speech. ^{1 2 3 4 5}

Is speech-language therapy for aphasia safe for humans?

The research does not report any safety concerns for speech-language therapy methods like Phonological Cueing Treatment (PCT) and Semantic Feature Analysis (SFA) in people with aphasia, suggesting these treatments are generally safe for humans. ^{1 3 4 5 6}

How does the Speech-Language Therapy for Aphasia treatment differ from other treatments?

This treatment is unique because it combines phonologically-focused tasks, which help with sound retrieval, and semantically-focused tasks, which aid in understanding word meanings, to improve naming abilities in people with aphasia. It is tailored to individual needs, with phonological tasks benefiting those with severe impairments and apraxia of speech, while semantic tasks are more effective for those with milder impairments and fluent speech. ^{2 3 6 7 8}

What is the purpose of this trial?

Speech-language therapy is generally found to be helpful in the rehabilitation of aphasia. However, not all patients with aphasia have access to adequate treatment to maximize their recovery. The goal of this project is to compare the efficacy of telerehabilitation or Aphasia Remote Therapy (ART) to the more traditional In-Clinic Therapy (I-CT).

Research Team

Julius Fridriksson, Ph.D

Principal Investigator

University of South Carolina

Eligibility Criteria

This trial is for English-speaking adults aged 21-80 who've had a left hemisphere stroke at least a year ago and can consent to treatment. They must be MRI compatible without metal implants or claustrophobia, and have no history of other brain diseases or severe speech/comprehension impairments.

Inclusion Criteria

I am between 21 and 80 years old.

Participants must be magnetic resonance imaging (MRI) compatible (e.g., no metal implants, not claustrophobic) on a 3-Tesla (3T) scanner.

I can give my own consent or appoint someone to do it for me.

Exclusion Criteria

I have no history of brain injuries or neurological diseases.

I have not had a stroke affecting both sides of my brain or in the cerebellum or brainstem.

I can speak and understand well enough to participate in therapy.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 3 weeks of daily semantically-focused treatment and 3 weeks of daily phonologically-focused treatment, either remotely or in-clinic

6 weeks

Daily sessions (remote or in-person)

Follow-up

Participants are monitored for changes in speech production and quality of life after treatment

6 months

Follow-up assessments at 6 months

Treatment Details

Interventions

• Phonologically-focused therapy tasks
• Semantically-focused therapy tasks

Trial Overview The TERRA study compares two types of speech-language therapy for aphasia after a stroke: one delivered remotely (ART) and the other in-clinic (I-CT). It aims to see if telerehabilitation is as effective as traditional methods.

Participant Groups

Group I: Aphasia Remote Therapy (ART) Experimental Treatment 2 Interventions

All participants in this group will receive 3 weeks of daily semantically-focused treatment (semantic feature analysis, semantic barrier task and verb network strengthening therapy) and 3 weeks of daily phonologically-focused treatment (phonological components analysis, phonological production task, phonological judgment task). Participants will be randomized to order of treatment. All treatment will be done remotely with a speech-language pathologist through an online platform using therapy applications. Participants will be provided with teletherapy kits (including an Internet hotspot if needed) to complete the therapy tasks.

Group II: In-Clinic Therapy (I-CT) Active Control 2 Interventions

All participants in this group will receive 3 weeks of daily semantically-focused treatment (semantic feature analysis, semantic barrier task and verb network strengthening therapy) and 3 weeks of daily phonologically-focused treatment (phonological components analysis, phonological production task, phonological judgment task). Participants will be randomized to order of treatment. All treatment will be done in person with a speech-language pathologist at the UofSC Aphasia Lab.

Who Is Running the Clinical Trial?

University of South Carolina

Lead Sponsor

Trials

233

Recruited

122,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Medical University of South Carolina

Collaborator

Trials

994

Recruited

7,408,000+

Findings from Research

In a study of eight individuals with aphasia, phonologically-based treatment (Phonological Components Analysis, PCA) led to significant improvements in naming accuracy for seven participants, with most maintaining these gains at follow-up.

Semantic therapy (Semantic Feature Analysis, SFA) was less effective, particularly for those with semantic deficits, highlighting the importance of matching treatment approaches to individual word retrieval breakdowns for optimal outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. van Hees, S., Angwin, A., McMahon, K., et al.[2022]

In a study of 104 individuals with chronic post-stroke aphasia, semantically focused treatment was found to be more effective than phonologically focused treatment for improving naming performance, regardless of treatment order.

Participants with milder speech impairments and fluent speech were more likely to respond positively to semantic treatment, while those with more severe impairments and apraxia of speech benefited more from phonological treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individualized response to semantic versus phonological aphasia therapies in stroke. Kristinsson, S., Basilakos, A., Elm, J., et al.[2022]

In a study involving three chronic aphasia speakers, Phonological Cueing Treatment (PCT) and Semantic Cueing Treatment (SCT) were tested for their effectiveness in improving action naming, with positive results for some participants.

Action naming improved for Speaker 1 (who received SCT) and Speaker 3 (who received both treatments), indicating that these cueing treatments can be beneficial for certain individuals with aphasia, though results may vary depending on the type of treatment and the grammatical category of the words.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of two lexical retrieval cueing treatments on action naming in aphasia. Wambaugh, JL., Doyle, PJ., Martinez, AL., et al.[2009]

The study used a single-participant design with four participants to compare the effects of Semantic Feature Analysis (SFA) and Phonological Components Analysis (PCA) therapies on naming outcomes in individuals with aphasia.

Results showed that the effectiveness of each therapy varied among participants, influenced by factors like the severity of their naming difficulties (anomia) and the order in which treatments were given, suggesting that personalized approaches are crucial for effective intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A case series comparison of semantically focused vs. phonologically focused cued naming treatment in aphasia. Neumann, Y.[2018]

The study demonstrated that a working memory and modified Semantic Feature Analysis approach was successfully completed by all three participants with mild to moderate aphasia, indicating its feasibility for this population.

Participants showed significant improvements in naming performance and working memory abilities after treatment, suggesting that this approach may effectively help remediate word finding deficits in individuals with aphasia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using a combined working memory - Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study. Hashimoto, N.[2023]

Semantic Feature Analysis (SFA) has been shown to improve naming abilities in 81.82% of participants with aphasia, based on a review of 21 studies involving 55 individuals.

The studies reviewed demonstrated a small treatment effect, indicating that while SFA is beneficial, further research is needed to better understand its efficacy and how well improvements generalize to everyday communication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Systematic Review of Semantic Feature Analysis Therapy Studies for Aphasia. Efstratiadou, EA., Papathanasiou, I., Holland, R., et al.[2019]

In a study involving 10 individuals with aphasia, phonological cues were found to be more effective than semantic cues for improving picture naming accuracy, particularly for items with low visual complexity.

The results suggest that phonological cues aid in the initial categorization of pictures rather than directly mapping to phonological processes, which has important implications for developing more effective rehabilitation therapies for naming impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia. Meteyard, L., Bose, A.[2019]

Semantic feature analysis is an effective intervention for improving naming abilities in individuals with aphasia, as shown by a review of 11 studies that utilized single subject research designs.

While most participants showed a small effect size using Cohen's d, a large treatment effect was observed when calculating the percent of non-overlapping data, indicating significant improvements in confrontational naming for many individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of semantic feature analysis: an evidence-based systematic review. Maddy, KM., Capilouto, GJ., McComas, KL.[2018]

References

1. England pubmed.ncbi.nlm.nih.gov

A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Individualized response to semantic versus phonological aphasia therapies in stroke. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Effects of two lexical retrieval cueing treatments on action naming in aphasia. [2009]

4. England pubmed.ncbi.nlm.nih.gov

A case series comparison of semantically focused vs. phonologically focused cued naming treatment in aphasia. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Using a combined working memory - Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

A Systematic Review of Semantic Feature Analysis Therapy Studies for Aphasia. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia. [2019]

8. Netherlands pubmed.ncbi.nlm.nih.gov

The effectiveness of semantic feature analysis: an evidence-based systematic review. [2018]