Bridging the gap: Can impairment based therapy for anomia have an impact at the psychosocial level

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Bridging the gap Can impairment based therapy
for anomia have an impact at the psycho-social
level?

• Julie Hickin1, Alison Greenwood2, Jennie Grassly2
  , Wendy Best3
• 1 City University, London
• 2 Wycombe PCT3 University College London

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A Health Service Investigation of the Treatment
of Word-Finding Difficulties in Aphasia Using
Sound and Written CuesApril 2003 September
2005Jointly funded by
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Background

• Studies of therapy with people with aphasia tend
  to use
• impairment based and functional measures of
  outcome.
• the views of participants are not formally
  evaluated.
• In an NHS which is increasingly aiming to be
• evidence-based and patient-centred
• it is imperative that we consider the views of
  the person with aphasia re the impact of therapy
  on their life (RCSLT Clinical Guidelines, 2005)

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This study

• Aimed to explore the outcome of a therapy for
  anomia using a variety of outcome measures
  including
• Picture naming scores (impairment based measure)
• the Communication Disability Profile (CDP
  measure of clients views)

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This study

• Participants
• 6 participants reported on in this study
• more than a year post-stroke
• had word-finding difficulties that formed a
  significant part of their aphasia
• had a range of types and severity of aphasia.
• Design
• two phases of therapy each lasting 8 weeks.
• the first involved the use of spoken and written
  cues to aid word finding in a picture naming
  task.
• the second encouraged the use of targeted words
  in connected speech and conversation

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This study

• Design
• Ax1
• Language assessments
• Ax2
• Cueing therapy
• Ax3
• Connected speech therapy
• Ax4
• Follow-up
• Ax5

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This study

• At each Ax point outcome measures included
• Picture naming score on set of 200 pictures
• The CDP
• CDP (Swinburn with Byng, in preparation)
• offers a means of appraising language disability
  from the perspective of the person with aphasia
• 4 sub-sections focusing on
• (i) activity,
• (ii) participation
• (iii) barriers and facilitators
• (iv) emotional consequences of aphasia.
• We focus on activity section
• E.g. of a question in the activity section
• How easy is it for you to talk under
  pressure?
• The person responds by rating their ability on a
  pictorial visual analogue scale, translated into
  a numerical score.

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The Therapy

• Therapy once a week, for 8 weeks for
  approximately 1 hour
• Phase 1
• combined phonological orthographic cues used to
  treat 100 words in a picture naming task (100
  pictures taken from a set of 200 named at all
  five assessments).
• Phase 2
• Therapy once a week for 8 weeks
• Aimed to encourage use of treated items in
  connected speech

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An example of a single cue

• Participant presented with picture to name
• 2. If unable, cued with spoken and written cue
  /ae/ and A
• 3. If still unable to name cued with /aent/ and
  written ANT
• 4. If still unable presented with spoken and
  written form of whole word anti-biotics and
  ANTI-BIOTICS.

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Results
There was significant change from scores before
the cueing therapy (A1A2) to scores at A3
(Wilcoxon matched samples test, plt0.025,
1-tailed) for all 6 participants
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Results
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Results
(Spearman rank r0.82, df3, plt0.05, 1-tailed).
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Results emotional consequences

• Data on other 3 sections of CDP gathered only at
  A1 and A5
• Section on emotional consequences includes asking
  people to rate their emotions in relation to
  their aphasia
• All 6 participants viewed ease of participation
  as greater at the end than the start of the study
  (Wilcoxon matched pairs test, z-2.3, plt0.025)

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Conclusions

• The study benefited considerably from inclusion
  of the CDP (Swinburn with Byng, in preparation)
• The therapists gained greater insight re the
  impact of aphasia on the daily lives of the
  participants
• This could usefully contribute to the planning of
  therapy and goals.

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Conclusions

• The following results are particularly
  encouraging
• relationship between change in word-finding and
  in CDP activity rating across the intervention
  study
• the increase in ease of participation rating for
  everyone in the study
• This supports therapists clinical intuition
  that impairment based intervention can impact on
  everyday communication and can lead to positive
  changes in how people with aphasia view
  themselves and their ability to participate in
  life.