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Patterns of post-stroke aphasia recovery: treatment, maintenance and generalization

Tijana Simic1, 2, 3*, Tali Bitan1, 4, Laura Laird1, Carol Leonard1, 3, 5 and Elizabeth Rochon1, 2, 3
  • 1 University of Toronto, Canada
  • 2 Toronto Rehabilitation Institute, University Health Network, Canada
  • 3 Canadian Partnership for Stroke Recovery, Canada
  • 4 University of Haifa, Israel
  • 5 University of Ottawa, Canada

Background Phonological Components Analysis (PCA) is a treatment for anomia (1), one of the most prevalent and frustrating symptoms of aphasia. A phonological analogue to the Semantic Feature Analysis (SFA), PCA is a sound-based naming therapy which requires participants to name a picture stimulus (e.g., bed) and to study five phonological components associated with that stimulus (e.g., rhyme word, first and last sounds, etc). Research supports the efficacy of PCA, demonstrating behavioural (1, 2, 3) and neural (4) changes, when administered in both intense and non-intense doses (5). Evidence for treatment generalization, however, has been limited. Further, individual treatment data show differential patterns of responding over time. The aims of the present study were to a) replicate previous findings demonstrating PCA treatment efficacy and maintenance, b) to examine PCA treatment generalization and c) to characterize patterns of recovery in both treated and untreated words over time (i.e., immediately and at long-term follow-ups). Methods Participants were ten adults (mean age = 55.5, SD= 15) with mild to severe aphasia (mean WAB AQ= 67.8, SD=13.9), post single left-hemisphere stroke (months post-onset mean= 18.1, SD= 20.1). Participants completed three baseline naming assessments; two word lists of 30 words each, one treated and one untreated, were created and matched for frequency, syllable length and semantic category. PCA treatment was administered three days a week for five weeks. Naming accuracy on treated and untreated words was assessed at four timepoints: immediately pre- and post-therapy, and at four- and eight-week follow-ups. Results Results are reported according to the aims outlined above. (a) A linear mixed effects model, (fixed factors: timepoint and condition (i.e., treated/untreated); random factor: subject), revealed main effects of timepoint (F(3,23)=12.540, p=.000) and condition (F(1,49)=52.598, p=.000) and a significant interaction (F(3, 23)=8.793, p=.000). Naming accuracy significantly improved on treated compared to untreated words immediately (p=.000), four- (p=.020) and eight-weeks (p=.036) post-treatment. (b) A linear mixed effects model on untreated words (fixed factor: timepoint; random factor: subject), demonstrated a significant main effect of time (F(3,9)=4.467, p=.037). Untreated words did not improve immediately post-treatment (p=.519) but significantly improved at four- (p=.020) and eight-week (p=.019) follow-ups. (c) Pearson correlations revealed that gains made in naming accuracy on treated words immediately post-therapy were significantly correlated to improvements in untreated words at both four- (r=.756, p =.011) and eight-week (r=.699, p=.024) follow-ups. Maintenance of gains made on treated words at four-weeks was significantly correlated with maintenance of treated words at eight-weeks (r=.805, p=.005). Conclusions These data a) replicate previous findings demonstrating PCA treatment efficacy and maintenance b) provide evidence of PCA treatment generalization, and c) suggest two types of responders to PCA therapy: “generalizers” and “maintainers”. Generalizers show the greatest short-term improvements on treated items, poorer maintenance and greater generalization over time. Conversely, the “maintainers” show long-term maintenance of treated words, with minimal generalization. Findings indicate that, contrary to usual practice, generalization is best measured in the longer term, rather than immediately after treatment, which corroborates theories of learning and memory consolidation (6, 7).

References

1. Leonard, C., Rochon, E., & Laird, L. (2008). Treating naming impairments in aphasia: Findings from a phonological components analysis treatment. Aphasiology, 22(9), 923-947.

2. Van Hees, S., Angwin, A., McMahon, K., & Copland, D. (2013). A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. Neuropsychological Rehabilitation, 23(1), 102-132.

3. Leonard, C., Laird, L., Burianová, H., Graham, S., Grady, C., Simic, T., & Rochon, E. (2015). Behavioural and neural changes after a “choice” therapy for naming deficits in aphasia: Preliminary findings. Aphasiology, 29(4), 506-525.

4. Rochon, E., Leonard, C., Burianova, H., Laird, L., Soros, P., Graham, S., & Grady, C. (2010). Neural changes after phonological treatment for anomia: An fMRI study. Brain and Language, 114, 164-179.

5. Rochon, E., Laird, L., Simic, T., Leonard, C. The effect of intensity on a treatment for naming deficits in aphasia. (In preparation).

6. Karni, A. & Korman, M. (2011). When and where in skill memory consolidation: Neuro-behavioral constraints on the acquisition and generation of procedural knowledge. BIO Web of Conferences, ISSN 2117-4458, 1 (47), 1-4.

7. Mosha, N. & Robertson, E.M. (2016). Unstable memories create a high-level representation that enables learning transfer. Current Biology, 26 (1), 100-105.

Keywords: Anomia, Aphasia, treatment outcome, Treatment maintenance, Treatment generalization, phonological components analysis

Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.

Presentation Type: poster presentation

Topic: Eligible for a student award

Citation: Simic T, Bitan T, Laird L, Leonard C and Rochon E (2019). Patterns of post-stroke aphasia recovery: treatment, maintenance and generalization. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00101

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Received: 01 May 2018; Published Online: 22 Jan 2019.

* Correspondence: Ms. Tijana Simic, University of Toronto, Toronto, Canada, simictij@gmail.com