Learning Strategies for Naming in Aphasia

Overseen By Alyssa Kelly, M.A., CCC-SLP

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: University of Pittsburgh

Disqualifiers: Neurological disease, Language comprehension, Drug/alcohol dependence, Mood/behavioral disorders

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

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 50

Duration: 10 months

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to find better ways to help people with aphasia, a language disorder often caused by a stroke, improve their word-finding abilities and use these skills more effectively in daily life. Participants will try three different treatment methods—Accuracy-maximized condition, Effort-accuracy balanced condition, and Effort-maximized condition—that focus on balancing effort and accuracy when naming pictures, to determine which method best retains these skills long-term. Individuals who have lived with aphasia for more than six months due to a stroke and struggle to recall words in everyday situations may find this trial suitable. As a Phase 2 trial, this research focuses on measuring the treatment's effectiveness in an initial, smaller group, offering participants a chance to contribute to important advancements in aphasia treatment.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that the treatments being tested for aphasia are generally safe. Studies have not found any safety issues with the Learning Strategies for Naming in Aphasia treatments. These treatments include different approaches: one focused on accuracy, one balancing effort and accuracy, and one focused on effort. This suggests that the treatments are well-tolerated and not linked to negative side effects. Participants in previous studies did not experience any harmful effects from these naming strategies, supporting the idea that the treatments are safe to try in clinical settings. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about this trial because it explores innovative approaches to improving naming abilities in people with aphasia. Unlike traditional speech therapy that often focuses on repetitive practice, this trial employs varied strategies: accuracy-maximized, effort-accuracy balanced, and effort-maximized conditions. Each approach targets different aspects of learning, potentially offering insights into which strategy or combination is most effective for enhancing communication skills in aphasia patients. By understanding these mechanisms, the trial could lead to more personalized and effective treatment plans for individuals struggling with language recovery.

What evidence suggests that this trial's treatments could be effective for aphasia?

Research has shown that different methods can help people with aphasia, a condition affecting language skills after a brain injury, improve their ability to name things. In this trial, participants will experience various treatment conditions. The accuracy-focused approach, known as the accuracy-maximized condition, uses techniques like retrieval practice to enhance memory and naming accuracy. The effort-accuracy balanced condition aims to improve learning by making tasks challenging yet achievable, leading to better memory and everyday language use. Finally, the effort-intensive approach, referred to as the effort-maximized condition, involves extensive practice to boost naming skills. These treatments aim for not only short-term improvements but also long-lasting benefits that enhance daily communication. ^{1 3 4 6 7}

Who Is on the Research Team?

William Evans, PhD

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for people who have had a stroke at least 6 months ago, resulting in chronic aphasia, which is difficulty with language and naming things. They must struggle on certain parts of a language test but can't have severe comprehension issues or other neurological diseases, unmanaged substance dependence, or serious mood disorders.

Inclusion Criteria

I have had difficulty speaking for over 6 months due to a stroke.

You have trouble with at least two out of eight parts of the Comprehensive Aphasia Test.

Exclusion Criteria

I have a severe mood or behavioral disorder that needs special mental health care.

I have a history of a progressive neurological condition.

You have problems with drugs or alcohol that are not being treated.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Assessment

Comprehensive initial battery of standardized assessments characterizing aphasia severity and overall language profile

2 sessions

2 visits (in-person)

Treatment

Participants receive 8 sessions of treatment per condition over 4 weeks, with a total of 24 treatment sessions

10 months

24 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment with probes administered at baseline and 1 week, 3 months, and 6 months post-treatment

6 months

24 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Accuracy-maximized condition
• Effort-accuracy balanced condition
• Effort-maximized condition

Trial Overview The study tests three ways to help people with aphasia improve their ability to name pictures and use these skills in daily life. It compares treatments that focus on maximum effort, balance between effort and accuracy, and maximum accuracy using speeded naming tasks.

How Is the Trial Designed?

Group I: Effort-maximized, then effort-accuracy balanced, then accuracy-maximized Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group II: Effort-maximized, then accuracy-maximized, then effort-accuracy balanced Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group III: Effort-accuracy balanced, then effort-maximized, then accuracy maximized Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group IV: Effort-accuracy balanced, then accuracy-maximized, then effort-maximized Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group V: Accuracy-maximized, then effort-maximized, then effort-accuracy balanced Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group VI: Accuracy-maximized, then effort-accuracy balanced, then effort-maximized Experimental Treatment 3 Interventions

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

University of Massachusetts, Amherst

Collaborator

Trials

83

Recruited

3,474,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Published Research Related to This Trial

In a study over 8 weeks involving anomic patients, both errorless learning and errorful learning with feedback significantly improved picture naming abilities, while errorful learning without feedback showed no improvement.

The findings suggest that providing correct feedback is crucial for learning in anomic patients, and that allowing errors during the learning process may not be beneficial, challenging the assumption that retrieval attempts are necessary for effective rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do errors matter? Errorless and errorful learning in anomic picture naming. McKissock, S., Ward, J.[2019]

A study comparing two rehabilitation strategies for naming impairment in individuals with acquired language disorders found that retrieval practice led to better long-term retention of object names compared to errorless learning, despite the latter showing superior immediate performance.

The results suggest that prioritizing retrieval practice in treatment can enhance the retention of learned names over time, which has important implications for clinical practices in language rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Test-enhanced learning versus errorless learning in aphasia rehabilitation: testing competing psychological principles. Middleton, EL., Schwartz, MF., Rawson, KA., et al.[2022]

Retrieval practice significantly improves naming performance in people with aphasia compared to traditional repetition training, with benefits observed even one month after treatment.

Spacing training sessions (intervening trials) enhances learning outcomes more effectively than massing them together, indicating that both retrieval practice and spacing are important for effective speech-language therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Retrieval practice and spacing effects in multi-session treatment of naming impairment in aphasia. Middleton, EL., Rawson, KA., Verkuilen, J.[2021]

Language rehabilitation can effectively improve naming impairments in individuals with aphasia, but challenges exist in applying research findings to diverse clinical populations due to the homogeneity of study samples.

Clinicians can adapt evidence-based interventions using theoretical frameworks like errorless learning and retrieval practice, ensuring that essential treatment components remain intact to facilitate effective outcomes for individual clients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Theory-driven treatment modifications: A discussion on meeting the linguistic, cognitive, and psychosocial needs of individual clients with aphasia. Nunn, K., Vallila-Rohter, S.[2023]

In a case-series study involving four participants with aphasia, a modified decreasing cue method led to significant improvements in naming accuracy for treated nouns and verbs, indicating its efficacy in therapy.

Participants showed different progress trajectories, with some able to take on new items consistently while others reached a saturation point, suggesting that individual baseline language and cognitive skills may influence therapy outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Decreasing cues for a dynamic list of noun and verb naming targets: a case-series aphasia therapy study. Conroy, P., Scowcroft, J.[2016]

A semantic-based treatment for picture naming was effective for 2 out of 4 individuals with Broca's aphasia, leading to improved naming of both trained and untrained nouns.

For the other 2 participants, improvements in naming only occurred after additional treatment focused on phonological information, highlighting the importance of tailoring therapy to individual needs in lexical processing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Model-based semantic treatment for naming deficits in aphasia. Drew, RL., Thompson, CK.[2019]

In a study involving 9 individuals with chronic aphasia, increasing the number of correct word retrievals per session improved naming performance, suggesting that more practice can enhance word retrieval efficiency.

Distributing practice across multiple sessions (spaced practice) led to better long-term retention of naming skills compared to massed practice within a single session, indicating that spacing is beneficial for learning in aphasia treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of distributed practice and criterion level on word retrieval in aphasia. Schuchard, J., Rawson, KA., Middleton, EL.[2021]

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]

This systematic review analyzed 19 studies on three learning-based approaches (errorless learning, errorful learning, and retrieval practice) for improving naming in aphasia, highlighting the importance of understanding mechanisms of action (MoAs) to enhance treatment effectiveness.

Key proposed MoAs included Hebbian learning and effortful retrieval, but significant knowledge gaps remain regarding which specific ingredients influence these mechanisms and how individual patient characteristics affect treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients. Nunn, K., Vallila-Rohter, S., Middleton, EL.[2023]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05653440

Balancing Effortful and Errorless Learning in Naming ... The current research aims to evaluate novel anomia treatment approaches to improve long-term retention and generalization to everyday life.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10023178/

Errorless, Errorful, and Retrieval Practice for Naming ... Likewise, in a group study of 10 people with aphasia, RP was more effective than ELess at improving performance on items that elicited naming errors ...

3. centerwatch.com centerwatch.com/clinical-trials/listings/NCT05653440/balancing-effortful-and-errorless-learning-in-naming-treatment-for-aphasia?state=PA&city=Pittsburgh,%20Pa%2015213

Balancing Effortful and Errorless Learning in Naming ... The current research aims to evaluate novel anomia treatment approaches to improve long-term retention and generalization to everyday life.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5268500/

The impact of dose on naming accuracy with persons with ... Previous studies have shown that individuals who receive more intensive treatment improve to a greater degree than those who receive less intensive aphasia ...

5. withpower.com withpower.com/trial/phase-stroke-1-2023-d3700

Learning Strategies for Naming in Aphasia In a case-series study involving four participants with aphasia, a modified decreasing cue method led to significant improvements in naming accuracy for treated ...

6. trialx.com trialx.com/clinical-trials/listings/217867/balancing-effortful-and-errorless-learning-in-naming-treatment-for-aphasia/

Balancing Effortful and Errorless Learning in Naming ... Picture-based naming treatments for anomia are widely used in aphasia rehabilitation, but current treatment approaches do not address the long- ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT07179458

Study Details | NCT07179458 | Criterion-learning Naming ... The overarching goal of this project is to develop and test early efficacy, efficiency, and the tolerability of a lexical treatment for aphasia in multiple- ...