School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
Int J Lang Commun Disord. 2019 Jan;54(1):123-142. doi: 10.1111/1460-6984.12437. Epub 2018 Nov 26.
Severe word production difficulties remain one of the most challenging clinical symptoms to treat in individuals with jargon aphasia. Clinically, it is important to determine why some individuals with jargon aphasia improve following therapy when others do not. We report a therapy study with AM, an individual with severe neologistic jargon aphasia, and provide a subsequent comparison with previous cases, with the purpose of informing both our theoretical and clinical understanding of jargon aphasia.
To investigate AM's locus of word production deficit and determine the effectiveness of phonological component analysis (PCA) therapy, a phonological cueing therapy, in the re-learning and generalization of naming responses for words. In addition, AM's performance in therapy, linguistic profile and ability to engage with therapy/cues were compared in a retrospective analysis with the background linguistic and therapy data of two other individuals with jargon aphasia (P9 and FF), who responded differentially to PCA. This was undertake to explore possible prognostic indicators of phonological therapy for jargon aphasia.
METHODS & PROCEDURES: A battery of linguistic and neuropsychological tests was used to identify AM's word production deficit. A single-subject multiple probe design across behaviours was employed to evaluate the effects of PCA therapy on the re-learning and generalization of naming responses. In the retrospective analysis of AM, P9 and FF, we compared differences and similarities in performance on various linguistic tasks, the ability to engage in therapy (i.e., ability to generate and use the cues), as well as to retain and maintain cues.
OUTCOMES & RESULTS: AM's locus of deficit was identified in the mapping between semantics and phonology. PCA was found to be effective in improving naming in two of the three treated word lists during the treatment phase; however, these gains were not maintained. Generalization to untreated picture names was not observed. Findings from the retrospective analysis illustrated that oral reading skills, the ability to segment phonological information from words and active engagement with provided cues are likely prerequisites for obtaining robust and long-term gains.
CONCLUSIONS & IMPLICATIONS: We demonstrated that phonological therapy could be beneficial for the remediation of naming abilities at least in the re-learning phase; however, maintenance and generalization of these gains were limited. This research helps to elucidate the considerations and evaluations necessary for the appropriateness of phonological therapy and candidacy of individuals with jargon aphasia for this treatment approach.
严重的单词生成困难仍然是治疗命名性失语症患者最具挑战性的临床症状之一。临床上，重要的是要确定为什么一些命名性失语症患者在治疗后会有所改善，而另一些患者则不会。我们报告了一项针对 AM 的治疗研究，AM 患有严重的新语命名性失语症，并与之前的病例进行了后续比较，旨在为我们对命名性失语症的理论和临床理解提供信息。
探讨 AM 的单词生成缺陷部位，并确定语音成分分析（PCA）疗法——一种语音提示疗法，在重新学习和泛化命名反应方面对单词的有效性。此外，我们还通过回顾性分析，将 AM 在治疗中的表现、语言特征和对治疗/提示的参与能力与另外两名患有命名性失语症的个体（P9 和 FF）的背景语言和治疗数据进行比较，这两名个体对 PCA 的反应不同。这是为了探索命名性失语症语音治疗的可能预后指标。
使用一系列语言和神经心理学测试来确定 AM 的单词生成缺陷。采用跨行为的单个被试多次探针设计来评估 PCA 疗法对重新学习和泛化命名反应的影响。在对 AM、P9 和 FF 的回顾性分析中，我们比较了他们在各种语言任务上的表现、参与治疗（即生成和使用提示的能力）以及保留和维持提示的能力方面的差异和相似之处。
AM 的缺陷部位位于语义和语音之间的映射上。在治疗阶段，PCA 被发现对治疗词表中的两个词列表的命名有显著的改善作用；然而，这些收益并没有持续。未观察到对未经治疗的图片命名的泛化。回顾性分析的结果表明，口语阅读技能、从单词中切分语音信息的能力以及积极参与提供的提示，可能是获得强大且长期收益的前提条件。
我们证明了语音疗法至少在重新学习阶段对命名能力的矫正可能是有益的；然而，这些收益的维持和泛化是有限的。这项研究有助于阐明语音疗法的适当性以及命名性失语症患者接受这种治疗方法的适用性所需的考虑因素和评估。
