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

TestingTreatment

Phase

3-month post treatment testing

1-week 1-week1-week6-weeks 3-m

onth

s

Delayed treatment

Immediately post treatment testing

Pre-treatment

TestingUsual care

control phase

3-months post treatment testing

1-week 1-week1-week6-weeks

Treatment

Phase

6-weeks

Post usual care testing

1-week 3-m

onth

s

N=14

N=14

1-year post testing

1-week1-ye

ar

1-ye

ar

1-week

1-year post testing

TODAY• Describe study

• Treatment

• Results

• Future

TWO PHASES OF TREATMENT

1) Phonemes in Isolation

2) Phoneme Sequences1-, 2- and 3-syllables

How can you tell if treatment works?

Research Questions

Measures

1. Acquire (learn) PhonologyNaming pictures

2. Does what you learn in therapy generalize to something else??

Naming picturesConversation

3. What about at 3 months and 1 year?

PhonologyNaming pictures

Conversation

TODAY• Describe study

• Treatment

• Results

• Future

Research aim Outcome measureAcquisition

(pre- vs imm post-)N=20

3-mo(pre- vs 3 mo)

N=16

1-yr(pre- vs 1-yr

N=8

LearnTrained nouns P=.000

Pre 64% (SD 26)Post 82% (SD 17)

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

P=.016Pre 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=.000Pre 97 (25)

Post 106 (26)

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

Generalize to words not

seen in therapy

Untrained nouns P=.001Pre 64% (SD 25)Post 70% (SD 25)

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

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

Nouns

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=8Real words Trained Real words Untrained

0

10

20

30

40

50

60

70

80

90

100

* *

*

**

*

Perc

ent a

ccur

acy

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=40Phonomotor

treatment

N=40Traditional 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