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

Trial Summary

What is the purpose of this trial?

Aphasia is a language disorder caused by stroke and other acquired brain injuries that affects over two million people in the United States and which interferes with life participation and quality of life. Anomia (i.e., word- finding difficulty) is a primary frustration for people with aphasia. Picture-based naming treatments for anomia are widely used in aphasia rehabilitation, but current treatment approaches do not address the long-term retention of naming abilities and do not focus on using these naming abilities in daily life. The current research aims to evaluate novel anomia treatment approaches to improve long-term retention and generalization to everyday life. This study is one of two that are part of a larger grant. This record is for sub-study 1, which will adaptively balance effort and accuracy using speeded naming deadlines.

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.

What data supports the effectiveness of the Learning Strategies for Naming in Aphasia treatment?

Research shows that using retrieval practice (actively recalling information) and spacing (spreading out learning sessions) in naming treatments for aphasia can improve naming performance and retention better than repetition or errorless methods. These strategies help people with aphasia remember names more effectively over time. ^{1 2 3 4 5}

Is the Learning Strategies for Naming in Aphasia treatment safe for humans?

The studies reviewed do not report any safety concerns related to the Learning Strategies for Naming in Aphasia treatment, including errorless and errorful learning methods, suggesting it is generally safe for humans. ^{2 4 6 7 8}

How does the Learning Strategies for Naming in Aphasia treatment differ from other treatments for aphasia?

This treatment is unique because it combines different learning strategies, such as errorless learning (where patients are shown pictures and given the correct name) and effortful learning (where patients try to name pictures and receive feedback), to improve naming in aphasia. It focuses on balancing accuracy and effort, which may enhance learning and retention compared to traditional methods that do not integrate these approaches. ^{3 4 6 7 9}

Research Team

William Evans, PhD

Principal Investigator

University of Pittsburgh

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

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]

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 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]

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]

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]

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]

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]

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]

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. England pubmed.ncbi.nlm.nih.gov

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

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

Test-enhanced learning versus errorless learning in aphasia rehabilitation: testing competing psychological principles. [2022]

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

Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients. [2023]

5. Italy pubmed.ncbi.nlm.nih.gov

Retrieval practice and spacing effects in multi-session treatment of naming impairment in aphasia. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Do errors matter? Errorless and errorful learning in anomic picture naming. [2019]

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

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

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

Model-based semantic treatment for naming deficits in aphasia. [2019]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Effects of distributed practice and criterion level on word retrieval in aphasia. [2021]