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Treatment of Anomia: Semantic Feature Analysis Versus Phonological Component Analysis Brenna Baltau, B.S. & Abbie Olszewski, Ph.D., CCC-SLP 1664 N Virginia St, Reno, NV 89557 University of Nevada, Reno • Adults with aphasia can have anomia, which is difficulty retrieving words. Anomia can impact everyday communica9on and rela9onships for adults with aphasia. • SLPs provide seman9c feature analysis (SFA) therapy to individuals with anomia to improve their word finding difficul9es. It is a technique that focuses on the meaningbased proper9es of nouns, where people with aphasia describe each feature of a word in a systema9c way by answering a set of ques9ons (Boyle, 2004). • Another therapy is phone9c components analysis (PCA), which is a wordfinding treatment that helps the person with aphasia learn to analyze the sounds in words (Bose, 2013). • It is unclear if SFA or PCA will improve word finding abili9es for adults with anomia. Introduc)on Using the PICO (Purpose, Interven9on, Comparison, Outcome) framework from Gillam and Gillam (2008), the following ques9on was developed: Is phonological components analysis (I) more successful in increasing word finding abili)es (O) in adults with anomia (P) when compared to seman)c feature analysis (C)? Clinical Scenario Methodology Search terms: seman&c feature analysis, SFA, individual therapy or treatment or interven&on, anomia, stroke, aphasia, anomic aphasia, phonological components analysis, PCA, phonological treatment Electronic databases: PubMed, ERIC, Web of Science, Academic Premier, PsycINFO Appraisal: Ten research ar9cles were appraised for internal validity. A 10point CATE form was used for experimental studies and a 10point CASM form was used for systema9c review. CATE Form: Compelling (8 10), Sugges9ve (4 7), Equivocal (0 3) CASM Form: Compelling (8 10), Sugges9ve (4 7), Equivocal (0 3) Discussion Purpose • Brooke is a 53 year old woman with Broca’s aphasia and anomia. Brooke has never received speech therapy before. She would like to return to work. • Brenna is a speechlanguage pathologist graduate student at University of Nevada, Reno. She currently sees Brooke two 9mes per week for one hour sessions. This semester, Brenna is using seman9c feature analysis therapy approach to increase word finding abili9es twice a week throughout one hour sessions. • Brenna is curious if phonological component analysis would yield be^er word finding abili9es for Brooke than seman9c feature analysis. Authors (Date) Research Design Appraisal Purpose Par)cipants (Age, TPS, E)ology, Diagnosis) Dependent Variables Results Bose (2013) Experimental Single Subject Design CATE: Sugges9ve Inves9gate the effec9veness of a phonological naming therapy on picture naming abili9es in individuals with jargon aphasia. N=1 Age: 77 years Time poststroke (TPS): 4 years E)ology: L CVA Diagnosis: NR 30 item probes list used to measure the occurrence of: formal, seman)c, mixed, neologisms and miscellaneous errors Results showed significant improvements in the par9cipants ability to name the treated items. These improvements were maintained. DeLong, Nessler, Wright, & Wambaugh (2015) Experimental Mul9plebaseline across subjectsdesign study CATE: Compelling To systema9cally examine outcomes associated with SFA. N=5 Age: 30 65 years TPS: 11 384 mos. E)ology: L CVA, L MCA Diagnosis: Wernicke’s, Broca’s, Anomic, Global, and Conduc9on aphasias Confronta9on Naming Probes used to measure: produc)on of seman)c informa)on 4 out of 5 par9cipants demonstrated large effects for produc)on of seman)c informa)on posttreatment and at followup. Findings were mixed for generaliza9on. Leonard, Rochon, & Laird (2008) Experimental Single Subject Design CATE: Compelling To document the effec9veness of PCA treatment for the remedia9on of naming deficits in aphasia. N = 10 Age: 50 73 years TPS: NR E)ology: L CVA Diagnosis: Broca’s aphasia, Wernicke’s aphasia, Mixed nonfluent aphasia, and Anomic aphasia Philadelphia Naming Test (PNT) used to measure: PCA at posttreatment and generaliza9on 7 of 10 par9cipants demonstrated small to medium effects for using PCA. Results for posttreatment and generaliza9on measures were similar for each par9cipant. Maddy, Capilouto, & McComas (2014) Nonexperimental Systema9c Review CASM: Compelling To examine the effec9veness of seman9c feature analysis as an interven9on to improve naming abili9es for persons with aphasia. N = 11 Inclusion Criteria: Age: 24 – 85 years TPS: 4 187 mo E)ology: L CVA, TBI, CVA Diagnosis: Broca’s aphasia and Wernicke’s aphasia Confronta)onal naming 3 out of the 6 studies that showed sta9s9cal significance demonstrated medium to large effects for confronta)onal naming abili9es posttreatment. Addi9onally, highly effec9ve PND was observed for 6 out of 7 studies that demonstrated significant results. This suggested that SFA is a promising interven9on approach for individuals with anomia. Van Hees, Angwin, McMahon, & Copland (2013) Experimental Single Subject Design CATE: Sugges9ve To inves9gate the rela9ve effects of SFA and PCA therapy for naming in a group of people with aphasia. N=8 Age: 41 69 years TPS: 17 170 mos. E)ology: Single L CVA Diagnosis: NR Naming accuracy at post treatment and followup Naming Accuracy • PCA: 7 out of 8 par9cipants improved naming accuracy from baseline (Wilcoxon, p < .05, d = 3.93 9.45) to posttreatment tes9ng. 6 of those 7 par9cipants maintained improvements (Wilcoxon, p < .05, d = 5.00 5.67). • SFA: 4 out of 8 par9cipant improved naming accuracy from baseline (Wilcoxon, p < .05, d = 4.93 6.93) to posttreatment tes9ng. 3 of those 4 par9cipants maintained improvements (Wilcoxon, p < .05, d = 4.14 8.66). Cohen’s d 6.35 – 18.48 Medium to large effect size PND 91.67% 100% Highly effec9ve External evidence: Both SFA (DeLong et al., 2015; Maddy et al., 2014) and PCA (Bose, 2013; Leonard et al., 2008; van Hees et al., 2013) demonstrated improvements in word finding abili9es in individuals with aphasia and anomia. When SFA and PCA were compared, Internal evidence in rela)on to the client: Brooke was informed of the results of SFA and PCA. She prefers to try both of the approaches because she thinks they would provide her with more strategies for her word finding difficul9es. Internal evidence in rela)on to the clinician: these approaches allows my client more access to features of a word in an effort to be able I would feel comfortable implemen9ng both PCA and SFA into therapy. Using to increase her word finding abili9es. E 3 BP Decision: Based on the external evidence, internal evidence to clinical prac9ces and evidence internal to my client, we decided to implement both PCA and SFA to improve Brooke’s word finding abili9es. Brooke will a^end therapy 2 9mes per week. In three months, word finding abili9es will be evaluated using the Boston Naming Test to determine if a combined approach improved Brookes’ word finding abili9es. Posttreatment Followup P1 d = 3.59 d = 2.68 P2 d = 11.49 d = 3.47 P3 d = 15.47 d = 14.52 P4 d = 17.36 d = 8.98 P5 Omi^ed Omi^ed Formal Not Significant (p = .81) Seman)c Not Significant (p > .05) Mixed Not Significant (p > .05) Neologisms Significant (p = .03) Miscellaneous Significant (p = .07) Posttreatment Effects P1 d = 7.20 p > .01 Medium effect Not significant P2 d = 2.65 p < .01 Small effect Significant P3 d = 8.70 p < .01 Medium effect Significant P4 d = 2.80 p < .01 Small effect Significant P5 d = 3.00 p > .01 Small effect Not significant P6 d = 3.47 p > .01 Small effect Not significant P7 d = 6.80 p > .01 Small effect Not significant References Bose, A. (2013). Phonological therapy in jargon aphasia: Effects on naming and neologisms. Interna&onal Journal of Language & Communica&on Disorders, 48(5), 582592. doi: 10.111/14606984.12038. DeLong, C., Nessler, C., Wright, S., & Wambaugh, J. Seman9c feature analysis: Further examina9on of outcomes. American Journal of Speech Language Pathology, 24, 864879. doi: 10.1044/2015_AJSLP140155 Leonard, C., Rochon, E., & Laird, L. (2008). Trea9ng naming impairments in aphasia: Findings from a phonological components analysis treatment. Aphasiology, 22(9), 923947. doi: 10.1080/02687030701831474. Maddy, K. M., Capilouto, G. J., & McComas, K. L. (2014). The effec9veness of seman9c feature analysis: An evidencebased systema9c review. Annals of Physical and Rehabilita&on Medicine, 57, 254267. doi: 10.1016/j.rehab.2014.03.002. Van Hees, S., Angwin, A., McMahon, K., & Copland, D. (2013). A comparison of seman9c feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. Neuropsychological Rehabilita&on, 23(1), 102132. doi: 10.1080/09602011.2012.726201.
