Phonomotor treatment

for anomia

Diane L. Kendall, PhD

Associate Professor, Department of Speech and Hearing Sciences

Research Scientist, VAMC Puget Sound

TODAY

• Describe study

• Treatment

• Results

• Future

• Veterans Affairs (VA) grant

• 2010-2013

• $850,000

• Provide treatment to 30 individuals

– aphasia and anomia

• Currently,

– Data collection finished!!!!!

– November 2012

• Analysis of ALL data

– Finish June 2013

TODAY

• Describe study

• Treatment

• Results

• Future

Participants • N=28

• Chronic aphasia

(>6mos)

• Left CVA

• 18 right-handed, 2

left-handed

• 18 Monolingual

English

• 2 Bilingual (English dominant

language since childhood)

• Included: – Aphasia

– Word retrieval deficits

– Impaired phonologic processing

• Excluded – Significant (severe) speech

apraxia

– Depression

– Degenerative disease

– Chronic medical illness

N=28 Age

(years)

Education Months

post

stroke

onset

AVE 56 16 47

Range 26-78 12-23 10-211

Western Aphasia

Battery (WAB-AQ) (out of 100)

Boston

Naming Test

(BNT) (spontaneous correct out

of 60)

Standardized Assessment

of Phonology in Aphasia

(SAPA) (raw score out of 151)

AVE 79/100 36/60 96/151

General language test

Western Aphasia

Battery (WAB-AQ) (out of 100)

Boston

Naming Test

(BNT) (spontaneous correct out

of 60)

Standardized Assessment

of Phonology in Aphasia

(SAPA) (raw score out of 151)

AVE 79/100 36/60 96/151

Western Aphasia

Battery (WAB-AQ) (out of 100)

Boston

Naming Test

(BNT) (spontaneous correct out

of 60)

Standardized Assessment

of Phonology in Aphasia

(SAPA) (raw score out of 151)

AVE 79/100 36/60 96/151

Test of ‘sounds”

Immediate treatment

Immediately post treatment

Testing

Pre-treatment

Testing

Treatment

Phase

3-month post treatment testing

1-week 1-week 1-week 6-weeks

Delayed treatment

Immediately post treatment testing

Pre-treatment

Testing

Usual care

control phase

3-months post treatment testing

1-week 1-week 1-week 6-weeks

Treatment

Phase

6-weeks

Post usual care testing

1-week

N=14

N=14

1-year post testing

1-week

1-week

1-year post testing

TODAY

• Describe study

• Treatment

• Results

• Future

TWO PHASES OF TREATMENT

1) Phonemes in Isolation

2) Phoneme Sequences

1-, 2- and 3-syllables

How can you tell if

treatment works?

Research

Questions

Measures

1. Acquire (learn) Phonology

Naming pictures

2. Does what you learn

in therapy generalize

to something else??

Naming pictures

Conversation

3. What about at 3

months and 1 year?

Phonology

Naming pictures

Conversation

TODAY

• Describe study

• Treatment

• Results

• Future

Research aim

Outcome measure

Acquisition (pre- vs imm post-)

N=20

3-mo (pre- vs 3 mo)

N=16

1-yr (pre- vs 1-yr

N=8

Learn

Trained nouns P=.000 Pre 64% (SD 26) Post 82% (SD 17)

P=.000 Pre 66% (SD 25) Post 79% (SD 22)

P=.016 Pre 70% (SD 18) Post 86% (SD 7)

Generalize to

phonology

Standardized Assessment of Phonology in Aphasia

P= .000 Pre 97 (25)

Post 106 (24)

P=.000 Pre 97 (25)

Post 106 (26)

P=.010 Pre 100 (23) Post 115 (15)

Generalize to

words not seen in therapy

Untrained nouns P=.001

Pre 64% (SD 25) Post 70% (SD 25)

P=.033 Pre 66% (SD 25) Post 71% (SD 26)

P=.033 Pre 68% (SD 20) Post 81% (SD 19)

Nouns

0

10

20

30

40

50

60

70

80

90

100

Pre n=20 Imm n=20 3 mo n=16 1 year n=8 Pre n=20 Imm n=20 3 mo n=16 1 year n=8

Real words Trained Real words Untrained

* *

*

* *

*

Perc

ent

accu

racy

Conversation n=3

• VIDEO

• Productivity (# of clauses, # verbal units, # words): – 2 of 3 more verbal output following therapy

– twice the number of clauses, more verbal units, and more words when compared with before

treatment output.

• Grammar (% grammatical clauses): – 0 of 3

• Relevance (% of clauses containing new information, relevance of

response to each prompt): – 2 of 3 improved

• Efficiency (self corrections, interjections, irrelevant words): – there was no change in the overall efficiency

Discussion

• Results support our hypothesis

word

“flower”

Idea!

sounds

F + L + OW + R

TODAY

• Describe study

• Treatment

• Results

• Future

New Grant

N=40 Phonomotor

treatment

N=40 Traditional treatment

(standard of care)

VS.

Acknowledgements • YOU!!!!!

• VA RR&D Merit Review Grant #C6572R

• UW Aphasia Lab – Liz Brookshire, MA

– Megan Oelke, MA

– JoAnn Silkes, PhD

– Irene Minkina, BS

– Lauren Bislick, MA

– Rebecca Pompon, PhC