Asynchronous, online spaced-repetition training alleviates word-finding difficulties in aphasia

Word-finding difficulties for naming everyday objects are often prevalent in aphasia. Traditionally, treating these difficulties has involved repeated drilling of troublesome items with a therapist. Spaced repetition schedules can improve the efficiency of such training. However, spaced repetition in a therapy environment can be both difficult to implement and time-consuming. The current study evaluated the potential utility of automated, asynchronous, online spaced repetition training for the treatment of word-finding difficulties in individuals with aphasia. Twenty-one participants completed a two-week training study, completing approximately 60 minutes per day of asynchronous online drilling. The training items were identified using a pretest, and word-finding difficulties were evaluated both at the end of training (i.e., a post-test) and four weeks later (i.e., a retention test). The trained items were separated into three different spaced-repetition schedules: (1) Short-spacing; (2) Long-spacing; and (3) Adaptive-spacing. At the retention-test, all trained items outperformed non-trained items in terms of accuracy and reaction time. Further, preliminary evidence suggested a potential reaction time advantage for the adaptive-spacing condition. Overall, online, asynchronous spaced repetition training appears to be effective in treating word-finding difficulties in aphasia. Further research will be required to determine if different spaced repetition schedules can be leveraged to enhance this effect.

Using a combined working memory - Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study

INTRODUCTION

The purpose of the study was to pilot a working memory (WM) - and modified Semantic Feature Analysis (SFA) approach to treat word finding deficits in a group of people with aphasia (PwA). Two research questions were posed: 1. Will the group of PwA be able to complete the WM tasks used in the approach? 2. Will the approach improve naming performance in PwA?

METHOD

Three individuals with mild - moderate aphasia participated in this singlesubject multiple baseline treatment design. Pre-treatment assessments of language, and pre- to post-treatment assessments of WM abilities were carried out. The treatment protocol incorporated WM and linguistic tasks in order to improve naming accuracy across two treatment lists. Probes were carried out prior to treatment on each list, and at one-month following completion of treatment. Two outcome measures were obtained: Percent accuracy in completing the WM steps, and treatment effect sizes (Beeson & Robey, 2006). Additionally, modified t-tests (Crawford & Garthwaite, 2012; Crawford & Howell, 1998), were calculated in which post-treatment WM measures were compared against neurotypical control groups to detect any improvements in WM functions.

RESULTS

All three participants completed the WM steps with a high degree of accuracy. A range of small to large ESs were obtained for all three participants across the two treated lists, while no meaningful ESs were obtained for the control (untreated) list. All three participants demonstrated improved scores across most of the WM measures with significant improvements noted on certain WM assessments.

CONCLUSIONS

The findings revealed that the WM - SFA approach can be used successfully in individuals with mild - moderate aphasia. The proposed approach holds promise as feasible intervention designed to remediate anomia in PwA.

Treatment-induced neuroplasticity after anomia therapy in post-stroke aphasia: A systematic review of neuroimaging studies

We systematically reviewed the literature on neural changes following anomia treatment post-stroke. We conducted electronic searches of CINAHL, Cochrane Trials, Embase, Ovid MEDLINE, MEDLINE-in-Process and PsycINFO databases; two independent raters assessed all abstracts and full texts. Accepted studies reported original data on adults with post-stroke aphasia, who received behavioural treatment for anomia, and magnetic resonance brain imaging (MRI) pre- and post-treatment. Search results yielded 2481 citations; 33 studies were accepted. Most studies employed functional MRI and the quality of reporting neuroimaging methodology was variable, particularly for pre-processing steps and statistical analyses. The most methodologically robust data were synthesized, focusing on pre- versus post-treatment contrasts. Studies more commonly reported increases (versus decreases) in activation following naming therapy, primarily in the left supramarginal gyrus, and left/bilateral precunei. Our findings highlight the methodological heterogeneity across MRI studies, and the paucity of robust evidence demonstrating direct links between brain and behaviour in anomia rehabilitation.

The eyes speak when the mouth cannot: Using eye movements to interpret omissions in primary progressive aphasia

Though it may seem simple, object naming is a complex multistage process that can be impaired by lesions at various sites of the language network. Individuals with neurodegenerative disorders of language, known as primary progressive aphasias (PPA), have difficulty with naming objects, and instead frequently say "I don't know" or fail to give a vocal response at all, known as an omission. Whereas other types of naming errors (paraphasias) give clues as to which aspects of the language network have been compromised, the mechanisms underlying omissions remain largely unknown. In this study, we used a novel eye tracking approach to probe the cognitive mechanisms of omissions in the logopenic and semantic variants of PPA (PPA-L and PPA-S). For each participant, we identified pictures of common objects (e.g., animals, tools) that they could name aloud correctly, as well as pictures that elicited an omission. In a separate word-to-picture matching task, those pictures appeared as targets embedded among an array with 15 foils. Participants were given a verbal cue and tasked with pointing to the target, while eye movements were monitored. On trials with correctly-named targets, controls and both PPA groups ceased visual search soon after foveating the target. On omission trials, however, the PPA-S group failed to stop searching, and went on to view many foils "post-target". As further indication of impaired word knowledge, gaze of the PPA-S group was subject to excessive "taxonomic capture", such that they spent less time viewing the target and more time viewing related foils on omission trials. In contrast, viewing behavior of the PPA-L group was similar to controls on both correctly-named and omission trials. These results indicate that the mechanisms of omission in PPA differ by variant. In PPA-S, anterior temporal lobe degeneration causes taxonomic blurring, such that words from the same category can no longer be reliably distinguished. In PPA-L, word knowledge remains relatively intact, and omissions instead appear to be caused by downstream factors (e.g., lexical access, phonological encoding). These findings demonstrate that when words fail, eye movements can be particularly informative.

Treatment-induced neural reorganization in aphasia is language-domain specific: Evidence from a large-scale fMRI study

Studies investigating the effects of language intervention on the re-organization of language networks in chronic aphasia have resulted in mixed findings, likely related to-among other factors-the language function targeted during treatment. The present study investigated the effects of the type of treatment provided on neural reorganization. Seventy individuals with chronic stroke-induced aphasia, recruited from three research laboratories and meeting criteria for agrammatism, anomia or dysgraphia were assigned to either treatment (N = 51) or control (N = 19) groups. Participants in the treatment group received 12-weeks of language intervention targeting sentence comprehension/production, naming, or spelling. At baseline and post-testing, all participants performed an fMRI story comprehension task, with blocks of auditorily-presented stories alternated with blocks of reversed speech. Participants in the treatment, but not control, group significantly improved in the treated language domain. FMRI region-of-interest (ROI) analyses, conducted within regions that were either active (or homologous to active) regions in a group of 22 healthy participants on the story comprehension task, revealed a significant increase in activation from pre-to post-treatment in right-hemisphere homologues of these regions for participants in the sentence and spelling, but not naming, treatment groups, not predicted by left-hemisphere lesion size. For the sentence (but not the spelling) treatment group, activation changes within right-hemisphere homologues of language regions were positively associated with changes in measures of verb and sentence comprehension. These findings support previous research pointing to recruitment of right hemisphere tissue as a viable route for language recovery and suggest that sentence-level treatment may promote greater neuroplasticity on naturalistic, language comprehension tasks, compared to word-level treatment.

Baseline structural imaging correlates of treatment outcomes in semantic variant primary progressive aphasia

Semantic variant primary progressive aphasia (svPPA) is a neurodegenerative disorder characterized by a loss of semantic knowledge in the context of anterior temporal lobe atrophy (left > right). Core features of svPPA include anomia and single-word comprehension impairment. Despite growing evidence supporting treatment for anomia in svPPA, there is a paucity of research investigating neural mechanisms supporting treatment-induced gains and generalization to untrained items. In the current study, we examined the relation between the structural integrity of brain parenchyma (tissue inclusive of gray and white matter) at pre-treatment and treatment outcomes for trained and untrained items in a group of 19 individuals with svPPA who completed lexical retrieval treatment. Two structural neuroimaging approaches were used: an exploratory, whole-brain, voxel-wise approach and an a priori region of interest (ROI) approach. Based on previous research, bilateral temporal (inferior, middle, and superior temporal gyri), parietal (supramarginal and angular gyri), frontal (inferior and middle frontal gyri) and medial temporal (hippocampus and parahippocampal gyri) ROIs were selected from the Automated Anatomical Labeling (AAL) atlas. Analyses revealed improved naming of trained items and generalization to untrained items following treatment, providing converging evidence that individuals with svPPA can benefit from treatment for anomia. Better post-treatment naming accuracy was associated with the structural integrity of inferior parietal cortex and the hippocampus. Specifically, improved naming of trained items was related to the left supramarginal (phonological processing) and angular gyri (phonological and semantic processing), and improved naming of trained and untrained items was related to the left hippocampus (episodic, context-based memory). Future research should examine treatment outcomes in relation to pre-treatment functional and structural connectivity as well as changes in network dynamics following speech-language intervention to further elucidate the neural mechanisms underlying treatment response in svPPA and related disorders.

Applying adaptive distributed practice to self-managed computer-based anomia treatment: A single-case experimental design

INTRODUCTION

There is a pressing need to improve computer-based treatments for aphasia to increase access to long-term effective evidence-based interventions. The current single case design incorporated two learning principles, adaptive distributed practice and stimuli variability, to promote acquisition, retention, and generalization of words in a self-managed computer-based anomia treatment.

METHODS

Two participants with post-stroke aphasia completed a 12-week adaptive distributed practice naming intervention in a single-case experimental design. Stimuli variability was manipulated in three experimental conditions: high exemplar variability, low exemplar variability, and verbal description prompt balanced across 120 trained words. Outcomes were assessed at 1-week, 1-month, and 3-months post-treatment. Statistical comparisons and effect sizes measured in the number of words acquired, generalized, and retained were estimated using Bayesian generalized mixed-effect models.

RESULTS

Participants showed large and robust acquisition, generalization, and retention effects. Out of 120 trained words, participant 1 acquired ∼77 words (trained picture exemplars) and ∼63 generalization words (untrained picture exemplars of treated words). Similarly, participant 2 acquired ∼57 trained words and ∼48 generalization words. There was no reliable change in untrained control words for either participant. Stimuli variability did not show practically meaningful effects.

CONCLUSIONS

These case studies suggest that adaptive distributed practice is an effective method for re-training more words than typically targeted in anomia treatment research (∼47 words on average per Snell et al., 2010). Generalization across experimental conditions provided evidence for improved lexical access beyond what could be attributed to simple stimulus-response mapping. These effects were obtained using free, open-source flashcard software in a clinically feasible, asynchronous format, thereby minimizing clinical implementation barriers. Larger-scale clinical trials are required to replicate and extend these effects.

Language learning in aphasia: A narrative review and critical analysis of the literature with implications for language therapy

People with aphasia (PWA) present with language deficits including word retrieval difficulties after brain damage. Language learning is an essential life-long human capacity that may support treatment-induced language recovery after brain insult. This prospect has motivated a growing interest in the study of language learning in PWA during the last few decades. Here, we critically review the current literature on language learning ability in aphasia. The existing studies in this area indicate that (i) language learning can remain functional in some PWA, (ii) inter-individual variability in learning performance is large in PWA, (iii) language processing, short-term memory and lesion site are associated with learning ability, (iv) preliminary evidence suggests a relationship between learning ability and treatment outcomes in this population. Based on the reviewed evidence, we propose a potential account for the interplay between language and memory/learning systems to explain spared/impaired language learning and its relationship to language therapy in PWA. Finally, we indicate potential avenues for future research that may promote more cross-talk between cognitive neuroscience and aphasia rehabilitation.

Naming vs. non-naming treatment in aphasia in a group setting-A randomized controlled trial

INTRODUCTION

Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting.

METHODS

In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication.

RESULTS

Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group.

CONCLUSIONS

Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.

12-item version of Boston Naming Test: usefulness in the diagnosis of primary progressive aphasia, frontotemporal dementia, and Alzheimer's disease

The 12-item version of the Boston Naming Test (BNT) was adapted to Argentina for the detection of dementia due to Alzheimer's disease (AD), with scores similar to the original 60-item version (sensitivity and specificity of 85 and 94%, respectively) without demographic influence (age and educational level). To date, no publications on the use of abbreviated BNT in other degenerative pathologies with language impairment have been reported.

Reversible anomia and cerebral venous thrombosis: a case report and review of the literature

Background

Cerebral venous thrombosis is a rare form of venous stroke with diverse clinical manifestations. Word-finding difficulty (anomia) is rarely reported in patients with cerebral venous thrombosis.

Case presentation

We report a 30-year-old right-handed Ethiopian female patient, who presented with global headache associated with a new onset word-finding difficulty of 2 weeks duration. The headache was not responsive to over-the-counter medications. She reported blurring of vision and nausea. Two months previously, she gave birth to a dead fetus. On neurological assessment, the patient was fully conscious and oriented, with a Glasgow coma score of 15/15, and cranial nerves, motor, and sensory examinations were unremarkable. Examination of fundus showed grade 2 papilledema bilaterally. Language assessment showed normal fluency, compression, naming, reading, and repetition. Naming was assessed using a 60 second word generating test, which indicated anomia. Brain magnetic resonance imaging showed left temporoparietal ischemia, magnetic resonance venography showed thrombosis of the left transverse, sigmoid sinus, and corresponding cortical veins. She was started on warfarin 5 mg daily for 6 months and showed significant resolution of symptoms, including the anomia.

Conclusion

The present case describes a young female patient with reversible anomia as a complication of cerebral venous thrombosis. The case also highlights the importance of timely diagnosis and treatment of cerebral venous thrombosis for a benign prognosis.

Intellectual awareness of naming abilities in people with chronic post-stroke aphasia

Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.

NUVA: A Naming Utterance Verifier for Aphasia Treatment

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NUVA automatically assesses online word naming attempts in aphasia therapy.

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Significantly more accurate and faster than leading commercial speech recognition.

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Accuracies between 83.6% and 93.6% validate use in clinical research.

Anomia (word-finding difficulties) is the hallmark of aphasia, an acquired language disorder most commonly caused by stroke. Assessment of speech performance using picture naming tasks is a key method for both diagnosis and monitoring of responses to treatment interventions by people with aphasia (PWA). Currently, this assessment is conducted manually by speech and language therapists (SLT). Surprisingly, despite advancements in automatic speech recognition (ASR) and artificial intelligence with technologies like deep learning, research on developing automated systems for this task has been scarce. Here we present NUVA, an utterance verification system incorporating a deep learning element that classifies 'correct' versus' incorrect' naming attempts from aphasic stroke patients. When tested on eight native British-English speaking PWA the system's performance accuracy ranged between 83.6% to 93.6%, with a 10-fold cross-validation mean of 89.5%. This performance was not only significantly better than a baseline created for this study using one of the leading commercially available ASRs (Google speech-to-text service) but also comparable in some instances with two independent SLT ratings for the same dataset.

Effects of semantic variables on word production in aphasia

Words differ in the complexity of their semantic representations and their relationships to other words and these differences can be operationalised as a variety of semantic variables. The research presented here investigates how word production in aphasia is influenced by six feature-based semantic variables (number of near semantic neighbours, semantic similarity, number of semantic features, typicality, intercorrelational density, and distinctiveness). Previous research has reported inconsistent findings for some of the semantic variables, while others have not been previously studied in aphasia. Spoken picture naming data from a large group of individuals with aphasia with mixed spoken word production impairments (n = 175) and a sub-group who produced few phonological errors (n = 60) was analysed. We examined effects of the semantic variables on overall naming accuracy and on the occurrence of different error types (semantic errors overall, coordinate errors, omissions), while controlling for other psycholinguistic variables using generalised linear mixed effects models and Bayesian correlations. Across analyses, number of semantic features was the most important predictor with a facilitatory main effect on naming accuracy in the sub-group analysis. Number of semantic features, along with typicality and semantic similarity, also predicted error types and in some analyses these effects depended on the integrity of semantic processing. Effects of the semantic variables and their theoretical explanations and implications are discussed in light of previous research and models of word production.

TDQ-30-A New Color Picture-Naming Test for the Diagnostic of Mild Anomia: Validation and Normative Data in Quebec French Adults and Elderly

OBJECTIVE

A reduction in lexical access is observed in normal aging and a few studies also showed that this ability is affected in individuals with subjective cognitive decline. Lexical access is also affected very early in mild cognitive impairment as well as in major neurocognitive disorders. The detection of word-finding difficulties in the earliest stages of pathological aging is particularly difficult because symptoms are often subtle or mild. Therefore, mild anomia is underdiagnosed, mainly due to the lack of sensitivity of naming tests. In this article, we present the TDQ-30, a new picture-naming test designed to detect mild word-finding deficits in adults and elderly people.

METHOD

The article comprises three studies aiming at the development of the test (Study 1), the establishment of its validity and reliability (Study 2), and finally, the production of normative data for French-speaking adults and elderly people from Quebec (Study 3).

RESULTS

The results showed that the TDQ-30 has good convergent validity. Also, the TDQ-30 distinguished the performance of healthy controls from those of participants with mild cognitive impairment, Alzheimer's disease, and post-stroke aphasia. This suggests good discriminant validity. Finally, this study provides normative data computed from a study sample composed of 227 participants aged 50 years and over.

CONCLUSIONS

The TDQ-30 has the potential to become a valuable picture-naming test for the diagnosis of mild anomia associated with pathological aging.

Mechanisms underlying anomia treatment outcomes

Treatments for anomia have demonstrated short- and long-term efficacy. However, individual outcomes can be variable, and evidence for treatment generalization is limited. We investigated whether treatment-related measures of access to- and learning of language, namely, a) responsiveness to cues, and b) during-treatment improvements in naming, are good predictors of treatment outcomes. In addition, we investigated mechanisms underlying treatment generalization. Ten adults with chronic, post-stroke aphasia received a phonological treatment for anomia three times a week for five weeks. Naming accuracy of treated and untreated words was assessed pre- and post-treatment and at four- and eight-week follow-ups. Generalization to an untrained naming task, which involved analyses of naming accuracy and speech errors, was also assessed; speech errors were analyzed according to the Interactive Activation (IA) model of word retrieval. Group analyses indicate significant improvements in naming treated compared to untreated words, at all timepoints after therapy. Additional analyses showed significant long-term improvements in naming untreated words. Initial responsiveness to cueing and early improvement emerged as significant predictors of overall pre- to post-treatment improvements in naming treated words; naming improvements made early-on in treatment were also predictive of improvements in naming of the untreated words at follow-up. Furthermore, our study is the first to demonstrate that generalization after a phonological treatment for anomia may be driven by a strengthening of lexical-phonological connections. This study provides novel insights regarding mechanisms driving anomia treatment outcomes. Understanding such mechanisms is critical to improving existing assessment practices, optimizing treatment selection and building treatment protocols that are more likely to generalize.

Eyetracking during picture naming predicts future vocabulary dropout in progressive anomia

The dynamic and unpredictable nature of expressive vocabulary dropout in progressive anomia presents a challenge for language intervention. We evaluated whether eye gaze patterns during naming could predict anomia for the same items in the near future. We tracked naming accuracy and gaze patterns as patients with semantic (n = 7) or logopenic (n = 2) variants of Primary Progressive Aphasia or amnestic Alzheimer's Disease (n = 1), named photographs of people and objects. Patients were tested three or more times spaced roughly evenly over an average duration of 19.1 months. Target words named accurately at baseline were retrospectively coded as either known (i.e., consistently named) or vulnerable (i.e., inaccurately or inconsistently named) based on naming accuracy over the study interval. We extracted gaze data corresponding to successful naming attempts and implemented logistic mixed effects models to determine whether common gaze measures could predict each word's naming status as known or vulnerable. More visual fixations and greater visual fixation dispersion predicted later anomia. These findings suggest that eye tracking may yield a biomarker of the robustness of particular target words to future expressive vocabulary dropout. We discuss the potential utility of this finding for optimizing treatment for progressive anomia.

An Exploration of the Impact of Group Treatment for Aphasia on Connected Speech

OBJECTIVE

Group treatment enables people with aphasia to practise communication skills outside the typical clinician-patient dyad. While there is evidence that this treatment format can improve participation in everyday communication, there is little evidence it impacts linguistic abilities. This project aimed to investigate the effects of 'typical' group treatment on the communication skills of people with aphasia with a focus on word retrieval in discourse.

METHODS

Three people with aphasia took part in a 6-week group therapy programme. Each week focused on a different topic, and three topics also received a home programme targeting word retrieval. The six treated topics were compared with two control topics, with regard to language production in connected speech. Semistructured interviews were collected twice prior to treatment and twice following the treatment and analysed using (a) word counts; (b) the profile of word errors and retrieval in speech; (c) a measure of propositional idea density, and (d) perceptual discourse ratings.

RESULTS

Two participants showed no significant improvements; one participant showed significant improvement on discourse ratings.

CONCLUSIONS

This study provides limited support for group treatment, leading to improved communication as measured by semistructured interviews, even when supplemented with a home programme. We suggest that either group treatment, as implemented here, was not an effective approach for improving communication for our participants and/or that outcome measurement was limited by difficulty assessing changes in connected speech.

Correlates of anomia in non-semantic variants of primary progressive aphasia converge over time

To track neural correlates of naming performance with disease progression, we estimated key areas affected in nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) primary progressive aphasia variants over time and changes in naming correlates over time. Twenty-nine non-semantic PPA participants (17 nfvPPA and 12 lvPPA) were selected based upon current diagnostic criteria and PiB-PET status and conducted a confrontation-naming task and a structural MRI. Linear mixed-effect models implemented in FreeSurfer were used for tracking cortical thickness and epicenters of atrophy over time. Using averaged cortical thickness of epicenters and naming performance as variables of interest, two sets of multivariate analyses were conducted to compare atrophy progression and naming correlates across groups. While all PPA participants demonstrated naming deterioration and progressive cortical thinning in the left temporal lobe and the left inferior frontal gyrus, the lvPPA cohort showed greater naming deterioration and thinning in the left posterior inferior parietal cortex over time than it did the nfvPPA cohort. The multivariate analyses confirmed a widespread cortical thinning in lvPPA over time, but a more rapid thinning in the right superior frontal gyrus of nfvPPA participants. Impaired naming correlated with common cortical regions in both groups. These regions included the left anterior superior temporal gyrus and the posterior middle temporal gyrus, which was primarily affected in lvPPA. Non-semantic PPA variants initially present with separate epicenters of atrophy and different spatial-temporal patterns of neurodegeneration over time, but the common involvement in key cortical regions of the left temporal lobe accounts for naming deterioration in both groups.

Self-reported inner speech relates to phonological retrieval ability in people with aphasia

Many individuals with aphasia report the ability to say words in their heads despite spoken naming difficulty. Here, we examined individual differences in the experience of inner speech (IS) in participants with aphasia to test the hypotheses that self-reported IS reflects intact phonological retrieval and that articulatory output processing is not essential to IS. Participants (N = 53) reported their ability to name items correctly internally during a silent picture-naming task. We compared this measure of self-reported IS to spoken picture naming and a battery of tasks measuring the underlying processes required for naming (i.e., phonological retrieval and output processing). Results from three separate analyses of these measures indicate that self-reported IS relates to phonological retrieval and that speech output processes are not a necessary component of IS. We suggest that self-reported IS may be a clinically valuable measure that could assist in clinical decision-making regarding anomia diagnosis and treatment.

The left temporal pole is a convergence region mediating the relation between names and semantic knowledge for unique entities: Further evidence from a "recognition-from-name" study in neurological patients

Prior research has implicated the left temporal pole (LTP) as a critical region for naming semantically unique items, including famous faces, landmarks, and musical melodies. Most studies have used a confrontation naming paradigm, where a participant is presented with a stimulus and asked to retrieve its name. We have proposed previously that the LTP functions as a two-way, bidirectional convergence region brokering between conceptual knowledge and proper names for unique entities. Under this hypothesis, damage to the LTP should result in a "two way" impairment: (1) defective proper name retrieval when presented with a unique stimulus (as shown in prior work); and (2) defective concept retrieval when presented with a proper name. Here, we directly tested the second prediction using a "recognition-from-name" paradigm. Participants were patients with LTP damage, brain-damaged comparisons with damage outside the LTP, and healthy comparisons. Participants were presented with names of famous persons (e.g., "Marilyn Monroe"), landmarks (e.g., "Leaning Tower of Pisa"), or melodies (e.g., "Rudolph the Red-Nosed Reindeer") and were asked to provide conceptual knowledge about each. We found that individuals with damage to the LTP were significantly impaired at conceptual knowledge retrieval when given names of famous people and landmarks (but this finding did not hold for melodies). This outcome supports the theory that the LTP is a bidirectional convergence region for proper naming, but suggests that melody retrieval may rely on processes different from those supported by the LTP.

[18F]THK-5351 PET imaging in early-stage semantic variant primary progressive aphasia: a report of two cases and a literature review

Background

Semantic variant primary progressive aphasia (svPPA) is a subtype of primary progressive aphasia characterized by two-way anomia and disturbance in word comprehension, with focal atrophy in the left temporal lobe. [¹⁸F]THK-5351 was originally developed to trace tau protein. However, it has recently been suggested that [¹⁸F]THK-5351 binds to monoamine oxidase B in astrocytes, which reflects gliosis. Herein, the authors present two cases involving patients with early-stage svPPA who underwent [¹⁸F]THK-5351 positron emission tomography (PET) imaging, and examined whether [¹⁸F]THK-5351 PET imaging is more sensitive to neurodegenerative lesions than conventional imaging modalities such as magnetic resonance imaging (MRI) and cerebral blood flow (CBF)-single photon emission computed tomography (SPECT).

Case presentation

Two patients, 64- and 79-year-old men, without notable medical or family history, exhibited disturbances in word comprehension and mild anomia with fluent speech and spared repetition. In both cases, surface dyslexia was observed but prosopagnosia was absent. Although mild depression was detected in 1 of the 2 patients, no behavioral disorders were present in either case. In both cases, MRI revealed atrophy in the anterior and inferior portions of the left temporal lobe. Technetium-99-ethyl cysteinate dimer ([^99mTc]ECD) SPECT revealed hypoperfusion in the left temporal lobe. Alzheimer’s disease was ruled out by [¹¹C]Pittsburgh Compound-B (PiB) PET scan. Both patients fulfilled the diagnostic criteria for svPPA. Because of mild language deficits and lack of right temporal atrophy, they were considered to be at an early stage of the disease. In both cases, [¹⁸F]THK-5351 retention was observed in bilateral temporal lobes, predominantly on the left side. Comparison of different imaging modalities suggested that [¹⁸F]THK-5351 was more sensitive in detecting neurodegenerative change in the right temporal lobe than MRI and [^99mTc]ECD SPECT.

Conclusions

[¹⁸F]THK-5351 retention was clearly demonstrated at an early stage of svPPA. Results of the present study suggest that [¹⁸F]THK-5351 PET imaging may facilitate very early diagnosis of the disease.

Electronic supplementary material

The online version of this article (10.1186/s12883-018-1115-3) contains supplementary material, which is available to authorized users.

[Collation of word retrieval disorders in patients with Alzheimer's dementia]

BACKGROUND

One of the first symptoms of Alzheimer's disease (AD) is word retrieval deficits. A systematic evaluation of word retrieval deficits can have an important predictive value for developing Alzheimer's disease.

OBJECTIVE

Is the test for finding word retrieval deficits (word finding = WoFi) able to detect deficits in word retrieval and does it correlate with other dementia tests?

METHODS

A word retrieval test called WoFi was developed. It is an instrument that tests word retrieval deficits based on 50 questions. A maximum of 100 points can be scored.

RESULTS

The control group scored significantly better than the AD group. Using a cut-off score of 84 points WoFi could discriminate controls from subjects with a sensitivity of 95% and a specificity of 92%.

CONCLUSION

The use of WoFi was able to test for word retrieval deficits. Application required less than 15 min and test instructions are very simple. This instrument might be useful in telehealth.

How distributed processing produces false negatives in voxel-based lesion-deficit analyses

In this study, we hypothesized that if the same deficit can be caused by damage to one or another part of a distributed neural system, then voxel-based analyses might miss critical lesion sites because preservation of each site will not be consistently associated with preserved function. The first part of our investigation used voxel-based multiple regression analyses of data from 359 right-handed stroke survivors to identify brain regions where lesion load is associated with picture naming abilities after factoring out variance related to object recognition, semantics and speech articulation so as to focus on deficits arising at the word retrieval level. A highly significant lesion-deficit relationship was identified in left temporal and frontal/premotor regions. Post-hoc analyses showed that damage to either of these sites caused the deficit of interest in less than half the affected patients (76/162 = 47%). After excluding all patients with damage to one or both of the identified regions, our second analysis revealed a new region, in the anterior part of the left putamen, which had not been previously detected because many patients had the deficit of interest after temporal or frontal damage that preserved the left putamen. The results illustrate how (i) false negative results arise when the same deficit can be caused by different lesion sites; (ii) some of the missed effects can be unveiled by adopting an iterative approach that systematically excludes patients with lesions to the areas identified in previous analyses, (iii) statistically significant voxel-based lesion-deficit mappings can be driven by a subset of patients; (iv) focal lesions to the identified regions are needed to determine whether the deficit of interest is the consequence of focal damage or much more extensive damage that includes the identified region; and, finally, (v) univariate voxel-based lesion-deficit mappings cannot, in isolation, be used to predict outcome in other patients.

Long-Term maintenance of anomia treatment effects in primary progressive aphasia

This study examined the maintenance of anomia treatment effects in primary progressive aphasia (PPA). Following baseline testing, a phonological treatment and an orthographic treatment were administered over the course of six months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at 1 month, 8 months, and 15 months post-treatment. The change in naming accuracy from baseline to each post-treatment evaluation was calculated within each treatment condition, and within a matched untrained condition. The change in naming accuracy was then compared between the three conditions. The results of these analyses indicate that phonological and orthographic treatments are both effective in the Prophylaxis and Remediation of anomia in all three variants of PPA. For Prophylaxis items, some of the effects of each treatment can persist for as long as 15 months post-treatment. These long-term treatment effects were more robust in the orthographic treatment condition and for participants with the semantic variant of PPA.

Lexical Retrieval or Semantic Knowledge? Which One Causes Naming Errors in Patients with Mild and Moderate Alzheimer's Disease?

Background

The purpose of the study was to analyze naming errors in patients with Alz­heimer's disease in comparison to healthy subjects and determine the underlying cause of naming errors in these patients.

Method

In this study, we included 35 healthy elderly subjects, 23 patients with mild Alzheimer's disease, and 23 with moderate Alzheimer's disease. Forty-five images were used to determine the type of naming errors, and to identify the underlying cause of errors, matching an image with a written word was used.

Results

Patients with Alz­heimer's disease had more naming errors compared with the group of healthy elderly, and patients with moderate Alzheimer's disease showed a slower reaction in matching an image with a written word.

Conclusion

Anomia in the initial phase of Alzheimer's disease is due to problems in lexical retrieval; however, as the disease advances, in addition to lexical retrieval problems, conceptual knowledge causes naming problems.

Transcranial direct current stimulation (tDCS) to improve naming ability in post-stroke aphasia: A critical review

PURPOSE

Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation tool that can be used to influence cortical brain activity to induce measurable behavioral changes. Although there is growing evidence that tDCS combined with behavioural language therapy could boost language recovery in patients with post-stroke aphasia, there is great variability in patient characteristics, treatment protocols, and outcome measures in these studies that poses challenges for analyzing the evidence. The purpose of this study is to critically analyze the methodological rigor of the evidence regarding the use of tDCS for post-stroke anomia.

METHOD

This critical review was conducted by searching four databases (MEDLINE, EMBase, PsycINFO, and CINAHL). Nineteen studies fully met the inclusion criteria. Three critical appraisal tools and Robey and Schultz's (1998) five- phase model for conducting clinical outcome research were adopted to evaluate and analyze the current level of evidence. Methodological issues of the studies were also identified.

RESULTS

The current level of evidence for using tDCS for anomia is at the pre-efficacy level with emerging evidence at the efficacy level. Lack of proper evaluation of carry-over effects in cross-over studies, lack of or unclear randomization, allocation concealment, and incomplete data handling were the main methodological issues that could threaten the validity of the tDCS for anomia studies.

CONCLUSIONS

Several methodological issues have been identified in pre-efficacy studies that pose challenges in determining whether tDCS is a beneficial adjunct to behavioral aphasia therapy. Future studies need to improve the quality of the methods used to investigate the effect of tDCS for anomia.

Inferior parietal transcranial direct current stimulation with training improves cognition in anomic Alzheimer's disease and frontotemporal dementia

Introduction

We evaluated whether transcranial direct current stimulation (tDCS) can improve picture-naming abilities in subjects with anomic Alzheimer or frontotemporal dementias.

Methods

Using a double-blind crossover design, 10 participants were trained on picture naming over a series of 10 sessions with either 30 minutes of anodal (2 mA) tDCS stimulation to the left inferior parieto-temporal region (P3) or sham stimulation. We evaluated performance on a trained picture-naming list, an equivalent untrained list, and additional neuropsychological tasks.

Results

Participants improved significantly more receiving real stimulation rather than sham stimulation (40% vs. 19%, P < .01), lasting at least 2 weeks after stimulation. Furthermore, these participants showed a small increase for untrained picture-naming items and digit span when they received real stimulation but a decrease when sham stimulation was received.

Discussion

tDCS stimulation has promise as a treatment for anomia in demented individuals and the effect can generalize to unstudied items as well as other cognitive abilities.

Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review

BACKGROUND

Technologies are becoming increasingly popular in the treatment of language disorders and offer numerous possibilities, but little is known about their effectiveness and limitations.

AIM

The aim of this systematic review was to investigate the effectiveness of treatments delivered by technology in the management of post-stroke anomia.

METHODS

As a guideline for conducting this review, we used the PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions. We conducted a systematic search of publications in PubMed, PsycInfo and Current Contents. We also consulted Google Scholar. Without any limitations as to publication date, we selected studies designed to assess the effectiveness of an intervention delivered by a technology, namely computer or smart tablet, to specifically improve anomia in post-stroke participants. The main outcomes studied were improvement in naming skills and generalisation to untreated items and daily communication.

RESULTS

We examined 23 studies in this review. To date, computers constitute the most popular technology by far; only a few studies explored the effectiveness of smart tablets. In some studies, technology was used as a therapy tool in a clinical setting, in the presence of the clinician, while in others, therapy with technology was self-administered at home, without the clinician. All studies confirmed the effectiveness of therapy provided by technology to improve naming of trained items. However, generalisation to untrained items is unclear and assessment of generalisation to daily communication is rare.

DISCUSSION

The results of this systematic review confirm that technology is an efficient approach in the management of post-stroke anomia. In future studies, ecological tasks aimed at evaluating therapy's effectiveness with word retrieval in real-life situations should be added since the ultimate goal of improving anomia is to increase the ability to retrieve words more easily in everyday life.

Subjective experience of inner speech in aphasia: Preliminary behavioral relationships and neural correlates

Many individuals with aphasia describe anomia with comments like "I know it but I can't say it." The exact meaning of such phrases is unclear. We hypothesize that at least two discrete experiences exist: the sense of (1) knowing a concept, but failing to find the right word, and (2) saying the correct word internally but not aloud (successful inner speech, sIS). We propose that sIS reflects successful lexical access; subsequent overt anomia indicates post-lexical output deficits. In this pilot study, we probed the subjective experience of anomia in 37 persons with aphasia. Self-reported sIS related to aphasia severity and phonological output deficits. In multivariate lesion-symptom mapping, sIS was associated with dorsal stream lesions, particularly in ventral sensorimotor cortex. These preliminary results suggest that people with aphasia can often provide meaningful insights about their experience of anomia and that reports of sIS relate to specific lesion locations and language deficits.

The neural correlates of anomia in the conversion from mild cognitive impairment to Alzheimer's disease

INTRODUCTION

Language impairment is frequently observed in patients with Alzheimer's disease (AD): in this study, we investigated the extent and distribution of brain atrophy in subjects with conversion from mild cognitive impairment (MCI) to AD with and without naming difficulties.

METHODS

This study was approved by the institutional review board and was HIPAA compliant. All subjects or their legal representatives gave informed consent for participation. Ninety-one subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with (N = 51) and without (N = 40) naming impairment as per the Boston Naming Test (BNT), underwent brain magnetic resonance (MR) imaging 12 months before, at AD diagnosis, and 12 months after. Structural MR images were processed using voxel-based morphometry. Cross-sectional comparisons and mixed ANOVA models for assessing regional gray matter (GM) volume differences were performed.

RESULTS

As from 12 months prior to AD diagnosis, patients with naming difficulties showed distinct areas of greater GM loss in the left fusiform gyrus (Brodmann area 20) than patients without naming difficulties. Differences in the GM atrophy extended to the left hemisphere in the subsequent 12 months.

CONCLUSION

This study provided evidence of distinct patterns and dynamics of brain atrophy in AD patients with naming difficulties when compared to those with intact language, as early as 12 months prior to AD diagnosis and in the subsequent 12 months.

The contrast between cueing and/or observation in therapy for verb retrieval in post-stroke aphasia

BACKGROUND

Studies measuring treatment efficacy for post-stroke verb anomia are scarce. These studies mainly assessed the efficacy of three strategies: semantic, phonological and sensorimotor. Following these previous treatments, the performance of most participants improved on treated verbs, while improvement on untreated stimuli and tasks was inconsistent.

AIMS

This study aimed to measure the effectiveness of a semantic-phonological strategy and a sensorimotor strategy for verb anomia in post-stroke aphasia.

METHODS

A multiple baseline single-subject experimental study was conducted with two participants (9-37 years post-stroke). Four phases were completed: (1) background assessment, (2) baselines, (3) therapy, and (4) follow-up. Three equivalent lists of verbs were created for each participant and two of them were trained with a different strategy: action observation+semantic-phonological cues, action observation alone. The stimuli of the third list (control list) were not treated.

RESULTS

The semantic-phonological cueing strategy led to a significant improvement. No improvement was observed after action observation. No generalization to untreated verbs was found.

CONCLUSIONS

Verb naming can be enhanced by semantic/phonological cueing. In addition, other studies (clinical, neuroimaging, etc.) are needed to document the effect of action observation for the treatment of verb anomia.

LEARNING OUTCOMES

The reader will be able to (1) describe semantic-phonological therapies used in post-stroke verb anomia, (2) describe sensorimotor therapies used in post-stroke verb anomia, and (3) identify factors contributing to the efficacy of therapies to improve action naming in aphasia.

How to constrain and maintain a lexicon for the treatment of progressive semantic naming deficits: Principles of item selection for formal semantic therapy

The progressive degradation of semantic memory is a common feature of many forms of dementia, including Alzheimer's disease and the semantic variant of primary progressive aphasia (svPPA). One of the most functionally debilitating effects of this semantic impairment is the inability to name common people and objects (i.e., anomia). Clinical management of a progressive, semantically based anomia presents extraordinary challenges for neurorehabilitation. Techniques such as errorless learning and spaced-retrieval training show promise for retraining forgotten words. However, we lack complementary detail about what to train (i.e., item selection) and how to flexibly adapt the training to a declining cognitive system. This position paper weighs the relative merits of several treatment rationales (e.g., restore vs. compensate) and advocates for maintenance of known words over reacquisition of forgotten knowledge in the context of semantic treatment paradigms. I propose a system for generating an item pool and outline a set of core principles for training and sustaining a micro-lexicon consisting of approximately 100 words. These principles are informed by lessons learned over the course of a Phase I treatment study targeting language maintenance over a 5-year span in Alzheimer's disease and SvPPA. Finally, I propose a semantic training approach that capitalises on lexical frequency and repeated training on conceptual structure to offset the loss of key vocabulary as disease severity worsens.

Activation of syntax in lexical production in healthy speakers and in aphasia

Theories of spoken word production agree that semantic and phonological representations are activated in spoken word production. There is less agreement concerning the role of syntax. In this study we investigated noun syntax activation in English bare noun naming, using mass and count nouns. Fourteen healthy controls and 13 speakers with aphasia took part. Participants named mass and count nouns, and completed a related noun syntax judgement task. We analysed speakers' noun syntax knowledge when naming accurately, and when making errors in production. Healthy speakers' noun syntax judgement was accurate for words they named correctly, but this did not correlate with naming accuracy. Speakers with aphasia varied in their noun syntax judgement, and this also did not correlate with naming accuracy. Healthy speakers' syntax for semantic errors was less accurate, as was that for speakers with aphasia. For phonological errors half the participants with aphasia could access syntax, half could not, indicating two types of phonological error. Individual differences were found in no responses. Finally, we found no effect of frequency for any of the above. The lack of a relationship between syntax and naming accuracy suggests that syntax is available, but access is not obligatory. This finding supports theories incorporating non-obligatory syntactic processing, which is independent of phonological access. The semantic error data are best explained within such a theory where there is damage to phonological access and hence to independent syntax. For the aphasia group we identify two types of phonological error, one implicating syntax and phonology, and one implicating phonology only, again supporting independent access to these systems. Overall the data support a model within which syntax is independent of phonology, and activation of syntax operates flexibly dependent on task demands and integrity of other processing routines.

Hidden word learning capacity through orthography in aphasia

The ability to learn to use new words is thought to depend on the integrity of the left dorsal temporo-frontal speech processing pathway. We tested this assumption in a chronic aphasic individual (AA) with an extensive left temporal lesion using a new-word learning paradigm. She exhibited severe phonological problems and Magnetic Resonance Imaging (MRI) suggested a complete disconnection of this left-sided white-matter pathway comprising the arcuate fasciculus (AF). Diffusion imaging tractography confirmed the disconnection of the direct segment and the posterior indirect segment of her left AF, essential components of the left dorsal speech processing pathway. Despite her left-hemispheric damage and moderate aphasia, AA learned to name and maintain the novel words in her active vocabulary on par with healthy controls up to 6 months after learning. This exceeds previous demonstrations of word learning ability in aphasia. Interestingly, AA's preserved word learning ability was modality-specific as it was observed exclusively for written words. Functional magnetic resonance imaging (fMRI) revealed that in contrast to normals, AA showed a significantly right-lateralized activation pattern in the temporal and parietal regions when engaged in reading. Moreover, learning of visually presented novel word-picture pairs also activated the right temporal lobe in AA. Both AA and the controls showed increased activation during learning of novel versus familiar word-picture pairs in the hippocampus, an area critical for associative learning. AA's structural and functional imaging results suggest that in a literate person, a right-hemispheric network can provide an effective alternative route for learning of novel active vocabulary. Importantly, AA's previously undetected word learning ability translated directly into therapy, as she could use written input also to successfully re-learn and maintain familiar words that she had lost due to her left hemisphere lesion.

"Penguins don't fly": An investigation into the effect of typicality on picture naming in people with aphasia

BACKGROUND

PREVIOUS RESEARCH HAS HIGHLIGHTED PSYCHOLINGUISTIC VARIABLES INFLUENCING NAMING ABILITY FOR INDIVIDUALS WITH APHASIA, INCLUDING: familiarity, frequency, age of acquisition, imageability, operativity, and length (Nickels & Howard, 1995) and a potential link between typicality and generalisation to untreated items in intervention (Kiran, Sandberg, & Sebastian, 2011). However, the effect of concept typicality (the extent to which an item can be considered a prototype of a category) on naming in aphasia warrants further examination.

AIMS

To investigate first whether typicality can be reliably rated across a range of natural semantic categories and second whether, and if so in which direction, typicality influences naming performance for people with aphasia. To provide quantitative and qualitative information on typicality for a set of stimuli for use in future research.

METHODS & PROCEDURES

Typicality ratings were obtained and the results compared with those in the existing literature. The influence of typicality on picture naming was investigated employing both matched sets (high and low typicality matched for other psycholinguistic variables) and logistic regression analyses for the group and individual participants with aphasia (n = 20).

OUTCOMES & RESULTS

Typicality rating correlated strongly with ratings obtained in previous research (Rosch, 1975: r = .798, N = 35, p < .001; Uyeda & Mandler, 1980: r = .844, N = 47, p < .001). Typicality was a significant predictor of picture naming for the group and some individuals, with generally better performance for typical items. This was demonstrated in both matched sets and regression analyses. However, other psycholinguistic variables proved more strongly related to naming success, particularly age of acquisition.

CONCLUSIONS

Typicality can be rated reliably and should be considered alongside other psycholinguistic variables when investigating word retrieval and intervention in aphasia. Further research is necessary to accurately model the direction of typicality effects found in word retrieval. Finally, the differing nature, size, and internal structure of categories require further exploration when investigating typicality effects.

Aphasia rehabilitation: does generalisation from anomia therapy occur and is it predictable? A case series study

INTRODUCTION

The majority of adults with acquired aphasia have anomia which can respond to rehabilitation with cues. However, the literature and clinical consensus suggest change is usually limited to treated items. We investigated the effect of an experimentally controlled intervention using progressive cues in the rehabilitation of noun retrieval/production in 16 participants with chronic aphasia.

METHOD

Participants were sub-divided relative to the group according to performance on semantic tasks (spoken/written word to picture matching) and phonological output processing (presence/absence of word length effect and proportion of phonological errors in picture naming) in order to investigate outcome in relation to language profile. Cueing therapy took place weekly for 8 weeks.

RESULTS

Intervention resulted in significant improvement on naming treated items for 15/16 participants, with stable performance on control tasks. Change occurred at the point of intervention and not during pre-therapy assessments. We predicted particular patterns of generalisation which were upheld. Only participants classified as having relatively less of a semantic difficulty and more of a phonological output deficit demonstrated generalisation to untreated items. Outcome did not relate to traditional aphasia classification.

CONCLUSION

A cueing hierarchy can improve word retrieval/production for adults with aphasia. In some cases generalisation to untreated items also occurs. The study demonstrates that the results of behavioural testing can be used to guide predictions of recovery with intervention.

Simulated in-home teletreatment for anomia

This pilot study explored the feasibility of in-home teletreatment for patients with post-stroke anomia. Three participants over 65 years of age suffering from post-stroke anomia were treated in this pre/post-intervention case study. They received 12 speech therapy teletreatments (two sessions/week for 6 weeks) aimed at improving confrontation naming skills. Half of the failed items from a set of 120 preselected stimuli were trained during treatment (Block A-trained stimuli) while the other half served as controls (Block B-untrained stimuli). Variables measured were: 1) efficacy of treatment (performance on Block-A vs. Block B Stimuli), and 2) participants’ satisfaction with teletreatment (using a French adaptation of the Telemedicine satisfaction questionnaire). All participants showed a clinically relevant improvement on confrontation naming of trained items and less improvement for untrained items. The researchers also obtained high satisfaction scores on the questionnaire (above 57/60). This pilot study supports the feasibility of speech therapy teletreatments applied to neurological language disorders.

Word-retrieval in two cases of progressive supranuclear palsy

In this paper, we describe the detailed neuropsychological investigation of two cases of progressive supranuclear palsy (PSP) and demonstrate word-finding difficulties associated with pervasive problems in word-retrieval. The pattern of deficits resembles that seen in Parkinson's Disease (PD) but is more severe, even in very mild PSP, and appears less amenable to cue facilitation. Performance on a variety of word-production tasks is compared, and experimental controls for motor effects on performance are included. The role of stimulus cues in speeded word-finding is addressed experimentally, as are central executive influences on task performance. This combines with functional brain-scan data from single photon emission computed tomography (SPECT) which shows reduced frontal perfusion in one of the two cases.