Making oral comprehension interventions TIDieR: A narrative synthesis of interventions improving comprehension in children from 1 to 5 years with language difficulties.

BACKGROUND: Oral comprehension difficulties are prevalent in preschool children with language difficulties and are frequently the target of speech and language therapy (SLT) intervention. To support the implementation of research to practice, there is a need to identify effective interventions for this population and to describe their components. To date, reviews of oral comprehension intervention have not used inclusion criteria aligned with common clinical practice, particularly in the United Kingdom. No studies have previously used the Template for Intervention Description and Replication (TIDieR) checklist to describe developmental SLT interventions. AIMS: To identify intervention studies effective for oral comprehension in preschool children with language difficulties, using the UK definition of 'preschool' as children under 5 years; to describe the components of these interventions. METHOD: This followed two phases: (1) an International Prospective Register of Systematic Reviews registered search, which identified 20 systematic reviews; and (2) an exploration of individual studies within these reviews. Seventeen individual studies described effective intervention for children from 1 to 5 years old with language difficulties. Data were extracted from each study against headings from the TIDieR checklist. Findings were analysed and reported using narrative synthesis. MAIN CONTRIBUTION: A wide variety of rationales, techniques, procedures, settings and intensities were associated with effective intervention. The TIDieR checklist highlighted components that were unreported or under-described. CONCLUSIONS: Studies show that intervention can be effective for improving oral comprehension in preschool children with language difficulties. Analysis of intervention components has relevance to clinical practice and research, and highlights the importance of naturally occurring interactions, cross-over between oral comprehension and expressive language and the variety in delivery models and dosage. WHAT THIS PAPER ADDS: What is already known on this subject There is a reported lack of research into interventions developing oral comprehension in children with language difficulties. Intervention checklists such as the Template for Intervention Description and Replication are valuable tools for understanding interventions and supporting the application of research to practice, but none have been used to describe interventions for children with language difficulties. What this study adds There is evidence that intervention developing oral comprehension in preschool children (using UK definition, those under 5 years) with language difficulties can be effective. Analysing intervention components reveals key points for consideration by clinicians. What are the clinical implications of this work? Intervention components identified by this study support the implementation of research to practice by highlighting particular areas for consideration by clinicians. For researchers, gaps in reporting demonstrate the need to describe all aspects of intervention to support replication and implementation.

Searching for active ingredients in rehabilitation: applying the taxonomy of behaviour change techniques to a conversation therapy for aphasia.

PURPOSE: A taxonomy of behaviour change techniques has been developed to help specify the active ingredients of behaviour change interventions. Its potential for rehabilitation research is significant, however, reliable use among allied health professionals has not yet been explored. This article describes the content of a conversation therapy for post-stroke aphasia using the taxonomy and investigates inter-rater reliability among Speech and Language Therapists. METHODS AND MATERIALS: Two Speech and Language Therapists undertook the same half day, self-led training programme in the behaviour change technique taxonomy and independently coded all materials in the "Better Conversations with Aphasia" programme. Inter-rater reliability was evaluated using the kappa coefficient and percentage agreement. Reliably agreed techniques were categorised according to the speaker and type of behaviour they targeted. RESULTS: Sixteen behaviour change techniques were reliably agreed to be present. Inter-rater reliability was moderate (K = 0.465), and in line with satisfactory percentage agreement (79.8%). More techniques were used to target the adoption of new behaviours (15) than the termination of old ones (3). People with aphasia received fewer behaviour change techniques (10) than their communication partners (16). CONCLUSIONS: Describing the content of conversation therapy with the taxonomy of behaviour change techniques offers clinically useful insights with potential to enhance both research and practice. The intervention is shown to target different types of behaviour in different ways, and offer different speaker groups different content. Non-psychologist users of the taxonomy may encounter challenges working with unfamiliar concepts and terminology, which may impact on reliable use.IMPLICATIONS FOR REHABILITATIONIn order to change communicative behaviours within conversation, feedback should focus not only on performance but also on the immediate social and emotional consequences of a behaviour.This study adds to the evidence that unhelpful conversational behaviours can be reduced by providing speakers with information about any unwanted consequences, and then agreeing on a supportive behaviour to use instead.People with aphasia should be offered the same range of behaviour change techniques as their communication partners.

Understanding differing outcomes from semantic and phonological interventions with children with word-finding difficulties: A group and case series study.

Developmental Language Disorder occurs in up to 10% of children and many of these children have difficulty retrieving words in their receptive vocabulary. Such word-finding difficulties (WFD) can impact social development and educational outcomes. This research aims to develop the evidence-base for supporting children with WFD and inform the design and analysis of intervention studies. We included 20 children (age 6 to 8) with WFD each of whom participated in two interventions one targeting semantic attributes and the other phonological attributes of target words. The interventions, employing word-webs, were carefully constructed to facilitate direct comparison of outcome which was analysed at both group and case-series level. The study used a robust crossover design with pre-intervention baseline, between-intervention wash-out and post-intervention follow-up testing. We incorporated: matching of item sets on individual performance at baseline, independent randomisation of order of intervention and items to condition, blinding of assessor, evaluation of fidelity and control items. The interventions were clinically feasible, with weekly sessions over six weeks. Intervention improved children's word-finding abilities with statistically significant change only during treatment phases of the study and not over baseline, wash-out or follow-up phases. For the group the semantic intervention resulted in a gain of almost twice as many items as the phonological intervention, a significant difference. However, children differed in their response to intervention. Importantly, case-series analysis revealed outcomes predictable on the basis of children's theoretically driven language profiles. Taking account of individual profiles in determining choice of intervention would enable more children to benefit. The study provides new evidence to inform and refine clinical practice with this population. Future studies should be designed such that results can be analysed at both group and case series levels to extend theoretical understanding and optimise use of appropriate interventions.

Computational modeling of interventions for developmental disorders.

We evaluate the potential of connectionist models of developmental disorders to offer insights into the efficacy of interventions. Based on a range of computational simulation results, we assess factors that influence the effectiveness of interventions for reading, language, and other cognitive developmental disorders. The analysis provides a level of mechanistic detail that is generally lacking in behavioral approaches to intervention. We review an extended program of modeling work in four sections. In the first, we consider long-term outcomes and the possibility of compensated outcomes and resolution of early delays. In the second section, we address methods to remediate atypical development in a single network. In the third section, we address interventions to encourage compensation via alternative pathways. In the final section, we consider the key issue of individual differences in response to intervention. Together with advances in understanding the neural basis of developmental disorders and neural responses to training, formal computational approaches can spur theoretical progress to narrow the gap between the theory and practice of intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effectiveness of a small-group vocabulary intervention programme: evidence from a regression discontinuity design.

BACKGROUND: Children's vocabulary knowledge is closely related to other measures of language development and to literacy skills and educational attainment. AIM: To use a regression discontinuity design (RDD) to evaluate the effectiveness of a small-group vocabulary intervention programme for children with poor vocabulary knowledge. METHODS & PROCEDURES: The vocabulary knowledge of children (N = 199) aged 6-9 years was assessed in six classes. Based on scores at the initial assessment, children with low vocabulary scores for their age were assigned to an intervention group (43 children), with the remaining 156 children assigned to a control group. Children in the intervention group received two to three small-group weekly teaching sessions over a 10-week period. All children were retested post-intervention on the same measures of vocabulary knowledge. OUTCOMES & RESULTS: The intervention group showed significant improvements in their knowledge of the meanings of the taught words at post-test (an additional 3.95 words learned [95% confidence interval (CI) = 2.70-5.20] compared with the control group; d = 1.20), but the effects did not generalize to untaught words. CONCLUSIONS & IMPLICATIONS: A small-group vocabulary intervention programme is effective for teaching word meanings to 6-9-year-old children with poor vocabulary skills. This study provides further evidence that the RDD is an effective method for evaluating educational interventions.

Intervention for children with word-finding difficulties: a parallel group randomised control trial.

PURPOSE: The study investigated the outcome of a word-web intervention for children diagnosed with word-finding difficulties (WFDs). METHOD: Twenty children age 6-8 years with WFDs confirmed by a discrepancy between comprehension and production on the Test of Word Finding-2, were randomly assigned to intervention (n = 11) and waiting control (n = 9) groups. The intervention group had six sessions of intervention which used word-webs and targeted children's meta-cognitive awareness and word-retrieval. RESULT: On the treated experimental set (n = 25 items) the intervention group gained on average four times as many items as the waiting control group (d = 2.30). There were also gains on personally chosen items for the intervention group. There was little change on untreated items for either group. CONCLUSION: The study is the first randomised control trial to demonstrate an effect of word-finding therapy with children with language difficulties in mainstream school. The improvement in word-finding for treated items was obtained following a clinically realistic intervention in terms of approach, intensity and duration.

Delivering communication strategy training for people with aphasia: what is current clinical practice?

BACKGROUND: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. AIMS: To investigate UK SLTs' current CST practices. METHODS & PROCEDURES: Thirty-seven UK SLTs completed an online questionnaire, eight of whom attended a follow-up focus group. A clinical consistency scale was applied to the questionnaire data and tasks that were most consistently used were explored in the focus group and analyzed using a primarily deductive thematic data analysis approach. OUTCOMES & RESULTS: Three key CST findings arose: (1) the rarity with which SLTs focus equally and explicitly on both communication partners' strategies; (2) SLTs' differing understandings of CST terminologies and concepts and underuse of formal assessment; and (3) the absence of video feedback. CONCLUSION & IMPLICATIONS: This study's survey findings suggest that conversation partners not only receive half the amount of CST given to people with aphasia but also play a more passive learning role when they are present. This is an interesting point to consider when the current evidence base contains stronger evidence for the effectiveness of conversation partner CST over other CST approaches, it being described as an effective method that may be maintained over time.

Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods.

BACKGROUND: Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change. AIMS: To identify mechanisms of change within a conversation therapy for people with aphasia and their partners. Using qualitative methods, the study draws on behaviour change theory to understand how and why participants make changes in conversation during and after therapy. METHODS & PROCEDURES: Data were derived from 16 participants (eight people with aphasia; eight conversation partners) who were recruited to the Better Conversations with Aphasia research project and took part in an eight session conversation therapy programme. The dataset consists of in-therapy discussions and post-therapy interviews, which are analysed using Framework Analysis. OUTCOMES & RESULTS: Seven mechanisms of conversational behaviour change are identified and linked to theory. These show how therapy can activate changes to speakers' skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use. CONCLUSIONS & IMPLICATIONS: These clinically relevant findings offer guidance about the processes involved in producing behavioural change via conversation therapy. A distinction is made between the process involved in motivating change and that involved in embedding change. Differences are also noted between the process engaged in reducing unhelpful behaviour and that supporting new uses of compensatory strategies. Findings are expected to have benefits for those seeking to replicate therapy's core processes both in clinical practice and in future research.

Conversation Therapy with People with Aphasia and Conversation Partners using Video Feedback: A Group and Case Series Investigation of Changes in Interaction.

Conversation therapies employing video for feedback and to facilitate outcome measurement are increasingly used with people with post-stroke aphasia and their conversation partners; however the evidence base for change in everyday interaction remains limited. We investigated the effect of Better Conversations with Aphasia (BCA), an intervention that is freely available online at https://extend.ucl.ac.uk/. Eight people with chronic agrammatic aphasia, and their regular conversation partners participated in the tailored 8 week program involving significant video feedback. We explored changes in: (i) conversation facilitators (such as multi-modal turns by people with aphasia); and (ii) conversation barriers (such as use of test questions by conversation partners). The outcome of intervention was evaluated directly by measuring change in video-recorded everyday conversations. The study employed a pre-post design with multiple 5 minute samples of conversation before and after intervention, scored by trained raters blind to the point of data collection. Group level analysis showed no significant increase in conversation facilitators. There was, however, a significant reduction in the number of conversation barriers. The case series data revealed variability in conversation behaviors across occasions for the same dyad and between different dyads. Specifically, post-intervention there was a significant increase in facilitator behaviors for two dyads, a decrease for one and no significant change for five dyads. There was a significant decrease in barrier behaviors for five dyads and no significant change for three dyads. The reduction in barrier behaviors was considerable; on average change from over eight to fewer than three barrier behaviors in 5 minutes of conversation. The pre-post design has the limitation of no comparison group. However, change occurs in targeted conversational behaviors and in people with chronic aphasia and their partners. The findings suggest change can occur after eight therapy sessions and have implications for clinical practice. A reduction in barrier behaviors may be easier to obtain, although the controlled case series results demonstrate a significant increase in conversation facilitators is also possible. The rehabilitation tool is available online and video technology was central to delivering intervention and evaluating change.

How 'some garlic' becomes 'a garlic' or 'some onion': Mass and count processing in aphasia.

This paper informs our understanding of the representation and processing of mass and count nouns through an investigation of the underlying causes of mass/count specific impairments in in two people with aphasia, DEH and GEC. The factors influencing the production of mass and count nouns and noun phrases was comprehensively assessed. The results showed that GEC's impairment affected mass noun naming, resulting in the production of semantic paraphasias and no responses. In contrast, DEH frequently substituted mass determiners with count determiners leading to ungrammatical noun phrases. In comparison to younger control group, a control group of older adults showed similar difficulties to DEH with mass noun phrases, although less severe, indicating effects of cognitive ageing on lexical and semantic processing. DEH and the elderly controls' results replicate and support previous findings regarding the lexical-syntactic representation of mass/count information. GEC's difficulties extend these findings by providing additional evidence for a semantic component in the representation of countability (e.g., a semantic feature/concept COUNTABLE for count nouns, UNCOUNTABLE for mass nouns) which contributes to mass and count noun selection. GEC's mass noun difficulties are suggested to result from weaker connection strength between noun lemmas and mass concepts compared to count concepts as a result of the overall lower frequency distribution of mass nouns.

Conversation focused aphasia therapy: investigating the adoption of strategies by people with agrammatism.

Background: A recent review of interaction (or conversation)-focused therapy highlighted the potential of programmes targeting the person with aphasia (PWA) directly. However, it noted the key limitations of current work in this field to be a reliance on single case analyses and qualitative evidence of change, a situation that is not unusual when a complex behavioural intervention is in the early stages of development and evaluation. Aims: This article aims to evaluate an intervention that targeted a PWA and their conversation partner (CP), a dyad, as equals in a novel conversation therapy for agrammatic aphasia, using both quantitative and qualitative evidence of change. The intervention aimed to increase the insight of a dyad into facilitator and barrier conversation behaviours, to increase the understanding of the effect of agrammatism on communication, and to support each speaker to choose three strategies to work on in therapy to increase mutual understanding and enhance conversation. Methods & Procedures: Quantitative and qualitative methods are used to analyse multiple pre-therapy and follow up assessments of conversation for two dyads. Outcomes & Results: Results show that one person with severe and chronic agrammatic aphasia was able to select and practise strategies that led to qualitative and quantitative changes in his post-therapy conversations. The other PWA showed a numerical increase in one of his three strategies post therapy, but no significant quantitative change. Although both CPs significantly reduced barrier behaviours in their post-therapy conversations, neither showed a significant increase in the strategies they chose to work on. For one CP, there was qualitative evidence of the use of different turn types. Conclusions: Individually tailored input from a speech and language therapist can assist some people with chronic agrammatism to develop conversational strategies that enhance communication. Outcomes are influenced by the severity and extent of language deficits affecting, for example, single word writing. In terms of behaviour change for CPs, it appears that it may be easier to reduce barrier behaviours rather than to increase the use of facilitatory strategies. The results have implications for collaborative goal setting with clients undergoing conversation therapy.

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.

From "some butter" to "a butter": an investigation of mass and count representation and processing.

This paper investigates the representation of mass and count nouns at the lexical-syntactic level, an issue that has not been addressed to date in psycholinguistic theories. A single case study is reported of a man with aphasia, R.A.P., who showed a countability specific deficit that affected processing of mass noun grammar. R.A.P. frequently substituted mass noun determiners (e.g., some, much) with count noun determiners (e.g., a, many). Experimental investigations determined that R.A.P. had a modality-neutral lexical-syntactic impairment. Furthermore, a series of novel experiments revealed that R.A.P.'s processing of mass noun determiners varied depending on how mass nouns were depicted (single vs. multiple depictions) and how congruent these were with the conceptual-semantic information of target determiners (e.g., "some" corresponds to multiple but not single concepts). R.A.P.'s determiner difficulties emerged only when mass nouns and determiners were number incongruent. The results of this research clearly indicate that nouns are lexical-syntactically specified for countability, but that the derivation of countability can additionally be influenced by conceptual-semantics.

Syntactic versus lexical therapy for anomia in acquired aphasia: differential effects on narrative and conversation.

BACKGROUND: Previous studies of therapy for acquired anomia have treated nouns in isolation. The effect on nouns in connected speech remains unclear. In a recent study in 2012, we used a novel noun syntax therapy and found an increase in the number of determiner plus noun constructions in narrative after therapy. AIMS: Two aims arose from the previous study: to identify the critical ingredient in the noun syntax therapy,specifically whether this is lexical production, or the syntactic context; and to extend the analysis of the effects beyond narrative into conversation. METHODS & PROCEDURES: We compared the effects of lexical therapy with those of noun syntax therapy in one individual with aphasia, in a sequential intervention design. We analysed the effects on conversation and on narrative. OUTCOMES & RESULTS: There was improved picture naming of treated words after both therapies. Lexical therapy had no impact on narrative and conversation, whereas noun syntax therapy led to more noun production, primarily in the context of determiner plus noun combinations. CONCLUSIONS & IMPLICATIONS: The results support the claim that greater impact on narrative and conversation can be achieved for some people with aphasia by treating nouns in syntactic contexts.

Extended turn construction and test question sequences in the conversations of three speakers with agrammatic aphasia.

The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers with agrammatism construct turns from sequences of nouns, adjectives, discourse markers and conjunctions, packaged by a distinct pattern of prosody. This article presents examples of turn construction methods deployed by three people with agrammatism as they take an extended turn, in order to recount a past event, initiate a discussion or have a disagreement. This is followed by examples of sequences occurring in the talk of two of these speakers that result in different, and more limited, turn construction opportunities, namely "test" questions asked in order to initiate a new topic of talk, despite the conversation partner knowing the answer. The contrast between extended turns and test question sequences illustrates the effect of interactional context on aphasic turn construction practices, and the potential of less than optimal sequences to mask turn construction skills. It is suggested that the interactional motivation for test question sequences in these data are to invite people with aphasia to contribute to conversation, rather than to practise saying words in an attempt to improve language skills. The idea that test question sequences may have their origins in early attempts to deal with acute aphasia, and the potential for conversation partnerships to become "stuck" in such interactional patterns after they may have outlived their usefulness, are discussed with a view to clinical implications.

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.

Conversation therapy for agrammatism: exploring the therapeutic process of engagement and learning by a person with aphasia.

BACKGROUND & AIMS: A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment which closely mirrors that of expected use, and that cognitive flexibility may be a better predictor of response to therapy than severity of language impairment. This study reports results for a single case, one of a case series evaluation of a programme of conversation training for agrammatism that directly involves a person with aphasia (PWA) as well as their communication partner. It explores how a PWA is able to engage with and learn from the therapy, and whether this leads to qualitative change in post-therapy conversation behaviours. METHODS & PROCEDURES: A 55-year-old man with chronic agrammatism and his wife took part in eight weekly sessions of conversation therapy, adapted from Supporting Partners of People With Aphasia in Relationships and Conversation (SPPARC). Language and conversation were assessed before and after therapy, and the couple's views on conversation and disability were elicited. Conversation analysis was used to analyse: (1) pre-therapy conversation patterns, (2) how the PWA engaged and learned during therapy and the forms of facilitation that aided this process, and (3) qualitative change in post-therapy conversation behaviour. OUTCOMES & RESULTS: After therapy, the PWA showed increased insight and acceptance of the use of strategies such as writing and drawing in the face of conversational difficulty. However, use was prompted by his wife and was rarely spontaneous. CONCLUSIONS & IMPLICATIONS: This single case study suggests that conversation training based around an experiential learning process is able to engage a PWA directly in learning about the effects of aphasia on conversation. Key facilitators were self-study via video and experience of practising conversation whilst receiving online feedback from a speech and language therapist. However, increased insight did not automatically change conversation behaviour. Although he better understood the effects of his aphasia on conversations with his wife, learning stopped short of the ultimate goal of the conversation training programme; the spontaneous use of strategies worked on in therapy when faced with conversation breakdown. One explanation may be that limited cognitive flexibility lead to problems with switching from one strategy to another.

"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.

Enhancing communication through gesture and naming therapy.

PURPOSE: In this study, the authors investigated whether gesture, naming, and strategic treatment improved the communication skills of 14 people with severe aphasia. METHOD: All participants received 15 hr of gesture and naming treatment (reported in a companion article [Marshall et al., 2012]). Half the group received a further 15 hr of strategic therapy, whereas the remaining 7 participants received no further input. The effects of therapy on communication were assessed with 2 novel measures. These measures required each participant to convey simple messages and narratives to his or her communication partner. In both assessments, a subset of the stimuli featured items that had been targets in gesture or naming treatment. RESULTS: Performance on the communication measures was stable over 2 baseline assessments but improved after gesture and naming treatment. Those participants who received additional strategic therapy made further gains on the message but not on the narrative task. Communication gains were not specific to the stimuli featuring trained items. CONCLUSIONS: This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear-cut but did have an impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills rather than the use of trained gestures and/or words.

Gesture and naming therapy for people with severe aphasia: a group study.

PURPOSE: In this study, the authors (a) investigated whether a group of people with severe aphasia could learn a vocabulary of pantomime gestures through therapy and (b) compared their learning of gestures with their learning of words. The authors also examined whether gesture therapy cued word production and whether naming therapy cued gestures. METHOD: Fourteen people with severe aphasia received 15 hr of gesture and naming treatments. Evaluations comprised repeated measures of gesture and word production, comparing treated and untreated items. RESULTS: Baseline measures were stable but improved significantly following therapy. Across the group, improvements in naming were greater than improvements in gesture. This trend was evident in most individuals' results, although 3 participants made better progress in gesture. Gains were item specific, and there was no evidence of cross-modality cueing. Items that received gesture therapy did not improve in naming, and items that received naming therapy did not improve in gesture. CONCLUSIONS: Results show that people with severe aphasia can respond to gesture and naming therapies. Given the unequal gains, naming may be a more productive therapy target than gesture for many (although not all) individuals with severe aphasia. The communicative benefits of therapy were not examined but are addressed in a follow-up article.