Word-Retrieval Treatment for Aphasia: Semantic Feature Analysis

• Sponsor: US Department of Veterans Affairs (U.S. Fed)
• Overall Status: Completed
• CT.gov ID: NCT00125242
• Collaborator: (none)
• Enrollment: 110
• Location: 1
• Arms: 2
• Duration (Months): 93
• Patients Per Site Per Month: 1.2

Study Details

Study Description

Brief Summary

The purpose of this investigation is to further develop and test a treatment for word-finding problems in aphasia. The treatment is designed to strengthen meaning associations within categories of words (e.g., animals, tools, fruits). The treatment is also designed to be used as a search strategy in instances of word-finding difficulty. The study was devised to evaluate the extent to which treatment increases the ability to recall trained, as well as untrained, words.

Condition or Disease	Intervention/Treatment	Phase
Aphasia; Language Disorders; Speech Disorders	Behavioral: Semantic Feature Analysis (SFA)Training	N/A

Detailed Description

The purpose of the proposed research is to examine the effects of a semantically-oriented treatment on word retrieval in persons with aphasia. The planned investigations are designed to further the development of semantic feature training so that it may serve as not only a mechanism for improving disrupted lexical semantic processing, but also as a compensatory strategy during word retrieval failures. The proposed research will also address the issue of exemplar typicality (Kiran & Thompson, 2003) by examining the effects of training typical versus atypical exemplars of various categories with individuals with different types of aphasia. A series of 24 single subject experimental designs will be conducted in the context of a group design to address the following experimental questions:

• Will training atypical examples of living and artifact noun categories using semantic feature training result in a significantly different outcome* than training typical examples of living and artifact noun categories?

• Will training of one category of nouns using semantic feature training result in improved retrieval of untrained categories of nouns?

• Will effects of semantic feature training vary across aphasia types?

• Will semantic feature training result in increased production of content during discourse?

• Will generalization to untrained typical examples vary across generalization lists that are repeatedly exposed and those that are limited in exposure? (i.e., Does repeated exposure appear to contribute to generalization?)

• Outcome measure will reflect acquisition, response generalization within category, and response generalization across category effects of treatment.

Study Design

• Study Type: Interventional
• Actual Enrollment: 110 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Word-Retrieval for Aphasia: Facilitation of Generalization
• Study Start Date: Jul 1, 2005
• Actual Primary Completion Date: Feb 1, 2009
• Actual Study Completion Date: Apr 1, 2013

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Semantic Feature Analysis (SFA) Word retrieval treatment for aphasia.	Behavioral: Semantic Feature Analysis (SFA)Training; SFA entails having the speech-language pathologist (SLP) guide the participant through generation of pertinent semantic features for pictured treatment items (e.g., category membership, physical description, location of item in context, personal associations, action associated with item). For some participants, treatment items were grouped according to typicality of category membership (e.g,, a robin-typical bird and penguin-atypical bird). Training of atypical items may stimulate a broader semantic activation of the category and thus, may promote greater generalization. Treatment was applied sequentially to sets of items in the context of single-subject, multiple baseline designs. In this way, replication of treatment effects could be evaluated within and across participants. Treatment was administered by certified SLPs three times per week until prescribed accuracy levels were met during nontreatment probes or a maximum number of treatment sessions was completed.
No Intervention: Participants for Stimuli Development Non-brain-injured participants provided data for development of treatment stimuli.

Outcome Measures

Primary Outcome Measures

1. Word Retrieval Accuracy [End of treatment and at 6 weeks post treatment]

   Accuracy of naming of pictured treated and untreated items was assessed in probes conducted separate from treatment. Probes were conducted repeatedly throughout the study, from baseline (prior to treatment) to follow-up (6 weeks following treatment). All naming responses were scored using a 0-10 scale reflecting promptness and presence of errors; scores of 8-10 received an "accuate" score and scores of 0-7 received an "inaccurate" score. A percentage accuracy score was calculated for each experimental set of items for every probe session. Baseline probe scores were compared to end of treatment and follow-up probe scores to obtain individual effect sizes for each experimental list of items for each participant (i.e., several effect sizes were calculated for each participant). All effect sizes were utlized to obtain an average effect size for each participant; these averages were then utlized to obtain a group average.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 21 Years to 80 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• Diagnosis of Wernicke's, Broca's, or Conduction aphasia with significant word-retrieval deficits

• At least 6 months post-onset of single, left-hemisphere stroke

• Minimum of high-school education

• Visual and auditory acuity sufficient for experimental tasks

• Nonverbal intelligence within normal limits

Exclusion Criteria:

• Diagnosed mental illness other than depression

• Neurological condition other than that which resulted in aphasia

• History of alcohol or substance abuse

• Non-native English speaker

• Premorbid history of speech/language disorder

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	VA Salt Lake City Health Care System, Salt Lake City	Salt Lake City	Utah	United States	84148

Sponsors and Collaborators

• US Department of Veterans Affairs

Investigators

• Principal Investigator: Julie L. Wambaugh, PhD, VA Salt Lake City Health Care System, Salt Lake City

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: US Department of Veterans Affairs
• ClinicalTrials.gov Identifier: NCT00125242
• Other Study ID Numbers: C3826-R
• First Posted: Jul 29, 2005
• Last Update Posted: Dec 24, 2014
• Last Verified: Dec 1, 2014

• Keywords provided by US Department of Veterans Affairs: Aphasia; Language therapy; Rehabilitation of speech and language disorders; Speech-language pathology
• Additional relevant MeSH terms: Aphasia; Language Disorders; Speech Disorders; Disease

Study Results

Participant Flow

Arm/Group Title	Non Treatment Stimuli Development Participants	SFA Treatment Participants
Arm/Group Description	Non-brain-injured participants who were enrolled for the purpose of stimuli development	Stroke survivors who received experimental therapy
Period Title: Overall Study
STARTED	94	16
COMPLETED	87	14
NOT COMPLETED	7	2

Baseline Characteristics

Arm/Group Title	SFA Treatment Participants	Non Treatment Stimuli Development Participants	Total
Arm/Group Description	Semantic Feature Analysis (SFA) is a word-retrieval treatment for aphasia. SFA entails having the speech-language pathologist (SLP) guide the participant through generation of pertinent semantic features for pictured treatment items (e.g., category membership, physical description, location of item in context, personal associations, associated actions). For some participants, treatment items were grouped by typicality of category membership (e.g, robin-typical bird and penguin-atypical bird). Training of atypical items may stimulate a broader semantic activation of the category and thus, may promote greater generalization. Treatment was applied sequentially to sets of items in single-subject, multiple baseline designs. Thus, replication of treatment effects could be evaluated within and across participants. Treatment was administered by SLPs three times per week until prescribed accuracy levels were met during probes or a maximum number of treatment sessions was completed.	Participants for stimuli development provided normative data for stimuli development. e.g., Treatment items were grouped according to typicality of category membership (apple - typical fruit; coconut - atypical fruit). These participants provided the reponses that served as the basis for classifying/organizing stimuli. Because data from this group were used only for the purposes of stimuli development, no findings are reported for this group. See Cameron, R.M., Wambaugh, J.L., & Mauszycki, S. (2008). Effects of age, gender and education on semantic fluency for living and artifact categories. Aphasiology, 22(7/8), 790-801, doi: 10.1080/02687030701818018 for related findings.	Total of all reporting groups
Overall Participants	16	94	110
Age, Customized (participants) [Number]
21-80 Years	16 100%	94 100%	110 100%
Sex: Female, Male (Count of Participants)
Female	4 25%	47 50%	51 46.4%
Male	12 75%	47 50%	59 53.6%

Outcome Measures

1. Primary Outcome

Title	Word Retrieval Accuracy
Description	Accuracy of naming of pictured treated and untreated items was assessed in probes conducted separate from treatment. Probes were conducted repeatedly throughout the study, from baseline (prior to treatment) to follow-up (6 weeks following treatment). All naming responses were scored using a 0-10 scale reflecting promptness and presence of errors; scores of 8-10 received an "accuate" score and scores of 0-7 received an "inaccurate" score. A percentage accuracy score was calculated for each experimental set of items for every probe session. Baseline probe scores were compared to end of treatment and follow-up probe scores to obtain individual effect sizes for each experimental list of items for each participant (i.e., several effect sizes were calculated for each participant). All effect sizes were utlized to obtain an average effect size for each participant; these averages were then utlized to obtain a group average.
Time Frame	End of treatment and at 6 weeks post treatment

Outcome Measure Data

Analysis Population Description

SFA Treatment Participants were stroke-survivors with chronic aphasia who had significant word retrieval difficulties. Non Treatment Stimuli Development Participants were only enrolled in the study to provide data for the development of treatment stimuli. As such, they were not assessed for the outcome measure.

Arm/Group Title	SFA Treatment Participants
Arm/Group Description	Stroke survivors received Semantic Feature Analysis for the treatment of word-retrieval deficits. Each SFA treatment participant received word-retrieval therapy applied sequentially to experimental lists of items. Effect sizes were calculated for each participant for each list. An average effect size was calculated for each participant and an overall average was determined for all participants as a group.
Measure Participants	13
Measure participant effect sizes	68
Mean (Standard Deviation) [d-index (effect size)]	7.15 (3.1)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	SFA Treatment Participants
	Comments	Effect sizes were calculated - this is a comparison of perfomance in baseline (repeated measurements prior to treatment) relative to peformance following treatment
	Type of Statistical Test	Superiority or Other
	Comments
Statistical Test of Hypothesis	p-Value
	Comments
	Method
	Comments
Method of Estimation	Estimation Parameter	effect size
	Estimated Value	7.15
	Confidence Interval	(2-Sided) %; to
	Parameter Dispersion	Type: Standard Deviation; Value: 3.1
	Estimation Comments	the reported effect size is a d-index value

Adverse Events

Time Frame	3 years
Arm/Group Title	SFA Treatment Participants		NonTreatment Stimuli Development Participants
Arm/Group Description	Stroke-survivors who received Semantic Feature Analysis therapy for aphasic word-retrieval deficits Semantic Feature Training: The treatment is designed to stimulate the semantic feature network so that it may serve as not only a mechanism for improving disrupted lexical semantic processing, but also as a compensatory strategy during word retrieval failures.		Non-brain-injured participants who were utilized to develop treatment stimuli.
All Cause Mortality
	SFA Treatment Participants		NonTreatment Stimuli Development Participants
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	SFA Treatment Participants		NonTreatment Stimuli Development Participants
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/16 (0%)		0/94 (0%)
Other (Not Including Serious) Adverse Events
	SFA Treatment Participants		NonTreatment Stimuli Development Participants
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/16 (0%)		0/94 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.