Intention Treatment for Aphasia

Overseen By Laura Britan Lang, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Severe apraxia, Dysarthria, Depression, others

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

Compensation: Varies

Number of Visits: 5

Duration: 3-12 weeks

32 Participants Needed

Trial Summary

What is the purpose of this trial?

Every year approximately 15,000 Veterans are hospitalized for stroke, and up to 40% of those Veterans will experience stroke-related language impairment (i.e., aphasia). Stroke-induced aphasia results in increased healthcare costs and decreased quality of life. As the population of Veterans continues to age, there will be an increasing number for Veterans living with the aphasia and its consequences. Those Veterans deserve to receive aphasia treatment designed to facilitate the best possible outcomes. In the proposed study, the investigators will investigate optimal treatment intensity and predictors of treatment response for a novel word retrieval treatment. The knowledge the investigators gain will have direct implications for the selecting the right treatment approach for the right Veteran.

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 Intention Treatment for Anomia in treating aphasia?

Research shows that the Intention Treatment for Anomia can help people with moderate to severe word-finding difficulties improve their ability to name pictures. This treatment seems to work better than another method focused on attention, especially for those with moderate to severe issues, by enhancing the brain's ability to retrieve words. ^{1 2 3 4 5}

Is Intention Treatment for Aphasia safe for humans?

The available research does not provide specific safety data for Intention Treatment for Aphasia, but it does not report any adverse effects, suggesting it may be generally safe for humans. ^{1 2 3 6 7}

How does the Intention Treatment for Anomia differ from other treatments for aphasia?

The Intention Treatment for Anomia is unique because it involves initiating word retrieval with a complex left-hand movement to engage the right frontal lobe, which is different from other treatments that focus on phoneme or semantic-based approaches. This method aims to enhance language production by shifting activity to the right hemisphere, which is particularly beneficial for patients with nonfluent aphasia who have difficulty initiating speech. ^{1 3 4 5 6}

Research Team

Amy D. Rodriguez, PhD

Principal Investigator

Atlanta VA Medical and Rehab Center, Decatur, GA

Eligibility Criteria

This trial is for Veterans who primarily speak English, have aphasia with difficulty finding words after a stroke in the left side of the brain, and can follow two-step commands. It's not for those with implanted medical devices or metal in their bodies, severe speech muscle control issues, or major depression.

Inclusion Criteria

I struggle to find the right words when speaking.

I can understand and follow two-step commands.

English as primary language

Exclusion Criteria

I don't have metal implants, devices, or severe fear of tight spaces.

I have severe difficulty speaking clearly.

I have been diagnosed with severe depression.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Standardized assessments and MRI scans are conducted to establish cognitive, language, and neural baselines

1 week

1 visit (in-person)

Treatment

Participants receive Intention Treatment (INT) with either massed or distributed practice

3-12 weeks

Multiple visits (in-person)

Follow-up

Participants are monitored for maintenance and generalization of treatment gains

6 months

4 visits (in-person)

Treatment Details

Interventions

• Intention Treatment for Anomia

Trial Overview The study tests a new word retrieval treatment for aphasia following a stroke. Researchers aim to find out how intense this therapy should be and what factors predict success in improving language skills among Veterans.

Participant Groups

Group I: Distributed Intention Treatment (distributed-INT) Active Control 1 Intervention

Participants will receive 30 hours of Intention Treatment (INT) over 12 weeks.

Group II: Massed Intention Treatment (massed-INT) Active Control 1 Intervention

Participants will receive 30 hours of Intention Treatment (INT) over 3 weeks.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

In a study involving 23 chronic nonfluent aphasia patients, a novel picture-naming treatment focusing on intention (using complex left-hand movements) led to greater improvements in word-finding abilities compared to an attention-focused treatment.

Patients with moderate to severe impairments showed significant gains in picture naming, and nearly all who improved also generalized their skills to untrained items, indicating the effectiveness of the intention-based approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of naming in nonfluent aphasia through manipulation of intention and attention: a phase 1 comparison of two novel treatments. Crosson, B., Fabrizio, KS., Singletary, F., et al.[2022]

A study involving 10 adults with chronic post-stroke aphasia showed that phonological treatment for anomia led to significant improvements in naming accuracy for both treated and untreated words, with benefits observed at multiple follow-up points.

The research identified that early responsiveness to treatment cues and initial improvements in naming were strong predictors of overall treatment success, suggesting that strengthening lexical-phonological connections may facilitate generalization of treatment effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mechanisms underlying anomia treatment outcomes. Simic, T., Chambers, C., Bitan, T., et al.[2021]

In a study of 26 participants with aphasia undergoing a 6-week phonomotor treatment program, characteristics like aphasia severity and error profile were linked to improvements in confrontation naming and discourse abilities, but no single characteristic consistently predicted long-term benefits three months after treatment.

The variability in treatment responses suggests that factors beyond age, severity, and error profile may play a role in how individuals with aphasia respond to phonomotor therapy, indicating a need for further research into these influences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of Linguistic and Nonlinguistic Variables on Generalization and Maintenance Following Phonomotor Treatment for Aphasia. Pompon, RH., Bislick, L., Elliott, K., et al.[2022]

In a study of 57 individuals with aphasia, both Phonomotor Therapy (PMT) and Semantic Feature Analysis (SFA) showed initial improvements in discourse production, but only PMT led to significant long-term gains three months after treatment.

The results suggest that while both treatments can be effective, PMT may provide more lasting benefits for improving functional communication in daily situations compared to SFA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Phonomotor Therapy and Semantic Feature Analysis on Discourse Production. Silkes, JP., Fergadiotis, G., Graue, K., et al.[2021]

In a study involving two patients with nonfluent aphasia after a stroke, an intention treatment successfully shifted language production mechanisms from the damaged left hemisphere to the right hemisphere in one patient, as shown by fMRI results.

The first patient improved only with the intention treatment, while the second patient improved with both intention and attention treatments, suggesting that the integrity of the basal ganglia may influence the ability to reorganize language functions after a stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia. Crosson, B., Moore, AB., Gopinath, K., et al.[2022]

Intention gesture treatment (IGT) showed immediate benefits for verbal word retrieval in two participants with aphasia, but did not help with untrained words.

Pantomime gesture treatment (PGT) improved both verbal production for two participants and gesture production for three participants, with one participant showing carryover effects to untrained words.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of intention and pantomime gesture treatment for noun retrieval in people with aphasia. Ferguson, NF., Evans, K., Raymer, AM.[2022]

A study found a significant gap between the treatment dosage used in research studies for aphasia interventions and what is typically provided in outpatient clinical settings, with research showing a median of 20 hours of treatment compared to only 7.5 hours in practice.

This dosage gap may reduce the effectiveness of aphasia treatments when applied in real-world settings, suggesting a need for future research to focus on aligning clinical practices with evidence-based dosages to improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is There a Research-Practice Dosage Gap in Aphasia Rehabilitation? Cavanaugh, R., Kravetz, C., Jarold, L., et al.[2022]

References

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

Treatment of naming in nonfluent aphasia through manipulation of intention and attention: a phase 1 comparison of two novel treatments. [2022]

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

Mechanisms underlying anomia treatment outcomes. [2021]

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

Influence of Linguistic and Nonlinguistic Variables on Generalization and Maintenance Following Phonomotor Treatment for Aphasia. [2022]

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

Effects of Phonomotor Therapy and Semantic Feature Analysis on Discourse Production. [2021]

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

Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia. [2022]

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

A comparison of intention and pantomime gesture treatment for noun retrieval in people with aphasia. [2022]

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

Is There a Research-Practice Dosage Gap in Aphasia Rehabilitation? [2022]