ADULT LANGUAGE ADULT LANGUAGE EVIDENCE BASED PRACTICE EVIDENCE BASED PRACTICE

GROUPGROUP

Extravaganza2007

Anika Hobbs and Kate SchujGroup Co-Leaders

The GroupThe GroupThe adult group divided into 3 this year – with new terms of reference and new members

We started with a brainstorming session…

Clinical QuestionClinical Question

We asked – “What areas related to your clinical practice do you have a burning desire to find out more about?”

We realised that therapy for word-finding was an area of interest….

The QuestionThe QuestionWe had a brainstorming discussion and came up with:

Is repetition therapy effective in improving lexical access/word finding difficulties (in people with aphasia)?

Search TermsSearch TermsSpeech and language therapyRepetitionAphasiaWord-finding

We searched all the usual suspects (OVID, Medline, PsychInfo, Google Scholar)

CAPping the ArticlesCAPping the Articles

7 possible articles were found

Only 4 actually answered our clinical question and were included in our CAT

Article 1 - Article 1 - Fillingham, Sage and Ralph (2005)

This article examined repetition in the context of errorful versus errorless learningErrorful learning

allows the patient to make mistakes clinician uses a cueing hierarchy to assist correct response

Errorless learning aims to set the patient up to make no errors by providing maximal support prior to attempting a task.

FillinghamFillinghamParticipants:

7 people with aphasia who displayed significant word finding difficulties at 6 months post-stroke

DesignMultiple crossover case series design

Clinical Bottom Line

Overall 5 of the 7 participants showed long term benefits from repetition therapy

FillinghamFillinghamLimitations

Other factors may be influencing participants’ successParticipants’ executive skills may be related to improvementIt’s not possible to dissociate whether for some participants reading rather than repetition might have been the active ingredient to the success of the therapy

FillinghamFillinghamNH&MRC level of evidence:

IV (Evidence obtained from case series, either post-test or pre-test and post-test)

Article 2 – Article 2 – Basso et al, 2001

This article compared multiple cueing strategies:

RepetitionOrthographic cueingReading aloud

BassoBassoParticipants:

30 right handed volunteers and 2 right handed males who had left temporal lobe lesions

DesignABA – single case design

Clinical Bottom LineRepetition therapy did not result in long term improvement in naming for these patients with word finding difficulties

BassoBassoLimitations:

Small number of subjects and no matching between controls and subjects

In addition:Orthographic cueing resulted in long term benefit (>5 weeks) for naming for both subjects

Level of Evidence

NH&MRC IV

Article 3 – Article 3 – Sugushita et al, 1993

This study examined repetition of picture names with provision of orthographic cues on failure

SugushitaSugushitaParticipants:

22 people with aphasia who had a left sided stroke

Design: Modified AB, each group was its own control

Clinical Bottom Line:In this study few people with aphasia benefited from attempted naming followed by repetition for oral naming. The written naming of more individuals was improved by attempted written naming followed by copying.

SugushitaSugushitaLimitations:

There was data for only a small subject group due to exclusions and drop outsThere was a variation in length of time that maintenance was evaluated atStatistics only compared across groups of items, not within a setThere was no control group of untreated items

Level of Evidence – NH&MRC IV

Article 4 – Article 4 – Martin et al, 2004

This study looks at the immediate and short term effects of contextual priming on word retrieval in aphasia.

Martin et al (2004)Martin et al (2004)Participants

11 people with chronic aphasia

Design11 single case studies with pre and post data

Clinical Bottom LineThe data suggests that there is a benefit that lasts at least 5 minutes on naming from repetition, for many (7/11) people with word retrieval impairments

Martin et al (2004)Martin et al (2004)Limitations

Results suggested patterns only, not cause and effectIt was unclear how subjects or picture sets were “constructed” and treatment items “selected”

In additionThere is no evidence that repeating words in the context of other semantically or phonologically similar words increases the benefits. In fact it can temporarily interfere with word retrieval.

Level of evidence – NH&MRC IV

CATCAT

Clinical bottom line:

Repetition therapy improves word finding difficulties for some people with aphasia but not all.

DiscussionDiscussionEffectiveness of repetition therapy depends on the person’s co-occurring impairments, severity and whether impairment is acute or chronic

The method of repetition (ie errorless or errorful) may also have an impact on the effectiveness of repetition therapy

Evidence from the CATs suggests that it is possible to gain some long term benefit (5-12 weeks) from repetition therapy

Further research is needed regarding effectiveness of repetition therapy

Application to Application to practicepractice

Repetition therapy has traditionally been dismissed as not being beneficial

It is difficult to determine who repetition therapy will work for

Some group members incorporated repetition therapy into their practice with varying results, further strengthening the conclusion that it is difficult to determine who “repetition therapy” will work for

Application to Application to practicepractice

It is not clear from the studies we found what the exact impact of personality and learning style has on the responsiveness to, or what the possible outcomes are from repetition therapy

This CAT raised a discussion around whether repetition therapy was actually teaching words or assisting with lexical retrieval – further research needed!

Future DirectionsFuture DirectionsThis CAT has raised more questions related to our clinical practice

The topic for next year is yet to be decided, however it is likely to follow on directly from this year’s CAT

Possible areas include orthographic cueing and word finding, or errorless versus errorful learning

AcknowledgementsAcknowledgementsAll the Adult Language EBP group members for all their hard work, dedication and contributions

Lyndsey Nickels, our academic link whose expertise has been invaluable!

ReferencesReferencesFillingham JK, Sage K, Ralph MAL (2005). Further expolrations and an overview of errorless and errorful therapy for aphasic word-finding difficulties: The number of naming attempts during therapy affects outcome. Aphasiology. 19(7): 597-614

Basso A, Marangola P, Piras F and Galluzi C (2001). Acquisition of new “words” in normal subjects: A suggestion for the treatment of anomia. Brain and Language. 77, 45-49.

Sugushita M, Seki K, Kabe S, Yunoki K (1993). A material-control single-case study of the efficacy of treatment for written and oral naming difficulties, Neuropsychologica. 31(6):559-569.

Martin N, Fink R, Laine M and Ayala J (2004). Immediate and short term effects of contextual priming on word retrieval in aphasia. Aphasiology. 18(10), 867-898.