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
