Intervention for Anomic

Aphasia from a Cognitive

Impairment-Based Perspective

Nadine Martin
Philadelphia, PA
 A simple model of word
processing

Semantic
Network

Lexical Network

Input Output
phonological phonological
network network

Auditory Input
Verbal Output
 Hypothesized breakdown in word processing
system is between the semantic and lexical
network.

Semantic
Network Good repetition, good single
word comprehension, impaired
naming.
Semantic
Network

Lexical Network

Lexical Network

Input Output
phonological phonological
network Input network
Output
Auditory Input
phonological phonological
network Verbal Output
network

Auditory Input
Verbal Output
Additional testing
Word comprehension - Philadelphia Comprehension Battery
Word-to-picture Matching
Within category distractor: 14/16
Across category distractor: 16/16
Synonymy Judgments:
Nouns: 11/15
Verbs: 9/15
Sentence Comprehension
Reversible semantic arguments: 53/60
Non-reversible semantic arguments: 57/60
Phonological Processing:
Same-different discrimination (PALPA 1 nonwords): 69/72
Same different discrimination (PALPA 2 words): 70/72

Word Discrimination:
Auditory Lexical Decision (PALPA 5): 71/80
Additional testing
Word Repetition – PALPA 9
High Imageability words: 39/40
Low Imageability words: 33/40

Reading aloud – PALPA 32

Nouns: 12/20
Adjectives: 10/20
Verbs: 9/20
Functors: 4/20

Auditory Short-term Memory:

Repetition span:
Digits: 3
Words: 2
Pointing Span:
Digits: 2
Words: 3
 Treatment Approach 1. Production priming with
increasing intervals between prime and production
 This direct method aims to improve the ability to retrieve and
maintain activation of a word’s semantic and phonological
representations in production by facilitating repeated use of the
pathway between semantics and the output word form. (Martin et al., 2006)
 Priming the production of a single word is accomplished by naming
several different exemplars of a target word:
 For example, for the target word “fire hydrant”, the clinician would
present four pictures of fire hydrants, each in a different style and
subsequently, 4 pictures of other items in the training set.

 In a second stage, pictures in a set (4 in all) would be trained in

random composition (sets of hydrant, latch, airport, factory) as
opposed to blocks of 4 hydrants, 4 latches, 4 airports, etc.
 In each stage, an interval (5 sec) is added between productions of the
name in order to improve ability to maintain activation of that name
for increasing amounts of time.
Step 1: Pictures of the target words are first
presented in a blocked fashion
X

Original
Step 2: Pictures from each set are presented in an
Unblocked Fixed Order

Set A
Step 2: Unblocked Fixed Order

Set B
Step 2: Unblocked Fixed Order

Set C
Step 3: Pictures are presented in an Unblocked
Random Order

Original
 Treatment Approach 2. Development of self-
cueing strategies to facilitate word retrieval
(Nickels, 1992).

 Goal: Develop a functional strategy for WS to retrieve words.

 Identify core words that can be read and retrieved without struggle.
 Develop the ability to produce their initial sounds in response to written
word.
 /k/ for cake
 Establish a link between each cue word and words that begin with that
sound but cannot be retrieved.
 Cake /k/ car, cane, cab etc.
 Use the cue to facilitate retrieval of that word. i.e., WS will learn to use the
cue word that begins with the particular sound that is the same initial
sound as the object he is trying to name.
 Initially, written cue words will be paired with a picture.
 As WS becomes more familiar with written cue words and the initial
sound, the picture cue will be faded out.
Functional Aspects of the
Word cueing strategy
 This aspect of treatment allows WS to
use his ability to read some words to
facilitate his word retrieval.

 It is, in that sense, an adaptive strategy

that attempts to use strengths to
compensate for a disability.
Functional Aspects of the
Priming Treatment
 Target words will be chosen by the client
from a large pool of possible words and
words that he chooses.

 Working directly on word retrieval is

initiated in response to his specific desire
to work on his ability to say the words he
wants to say.
 Outcome measures
 Data analysis. Acquisition, maintenance and
generalization.
 Progress will be measured as proportion of correct
responses on daily administration of test used in
baseline at the beginning of each treatment session.
 McNemar tests of change will be used to determine
overall improvements in naming.
 Additionally, carryover of retrieval skills to extended
speech will be measured by speech samples obtained
before and after treatment (e.g., Cinderella story retell
and picture description task).
 Will look for: increase in expressive vocabulary,
improvements in sentence structure.
 Summary
 Focus of treatment: DIRECT - improvement of most
prominent language deficit: word retrieval difficulty.
 Two approaches:
 One that targets the word retrieval process directly (production
priming with short-term memory stimulation)
 One that enables WS to use his residual reading skills to self-
cue retrieval of words in production.

 WS’s overall well-being is addressed via:

 the content of therapy (words that will be targeted in training)
according to his everyday needs and interests.

 family’s involvement is incorporated into the treatment plan.

 satisfies WS desire to work directly on his naming.

 References
 Martin, N., Fink, R., Renvall, K., & Laine, M. (2006).
Effectiveness of contextual repetition priming. Treatments
for anomia depends on intact access to semantics. Journal
of International Neuropsychological Society, 12, 1-14.

 Nickels, L., (1992). The Autocue? Self-generated phonemic

cues in the treatment of a disorder of reading and naming.
Cognitive Neuropsychology, 9, 155-182.