Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors.

The aim of this study was to determine whether it was possible to predict therapy gain from participants' performance on background tests of language and cognitive ability. To do this, we amalgamated the assessment and therapy results from 33 people with aphasia following cerebral vascular accident (CVA), all of whom had received the same anomia therapy (based on progressive phonemic and orthographic cueing). Previous studies with smaller numbers of participants had found a possible relationship between anomia therapy performance and some language and cognitive assessments. Because this study had access to a larger data set than previous studies, we were able to replicate the previous findings and also to verify two overarching factors which were predictive of therapy gain: a cognitive factor and a phonological factor. The status of these two domains was able to predict both immediate and longer-term therapy gain. Pre-treatment naming ability also predicted gain after the anomia therapy. When combined, both cognitive and language (naming or phonological) skills were found to be independent predictors of therapy outcome.

The treatment of anomia using errorless learning.

In the contemporary literature, errorless learning is thought to have benefits over more traditional trial-and-error methods. The most prominent investigations of errorless learning are those designed for rehabilitation of severe memory impairments, including numerous demonstrations of effective amelioration of word-finding difficulties (Baddeley & Wilson, 1994; Clare, Wilson, Breen, & Hodges, 1999; Clare et al., 2000; Evans et al., 2000). Despite this, there are very few reports on the application of purely errorless learning to people with aphasia (Fillingham, Hodgson, Sage, & Lambon Ralph, 2003). The aim of this study was to compare directly the efficacy of errorless and errorful learning in a case series of 11 aphasic people with pronounced word-finding difficulties. Previous studies of errorless learning and, more recently, studies of rehabilitation have suggested that cognition is an important factor for determining outcome (Helm-Estabrooks, 2002; Robertson & Murre, 1999). Therefore, a thorough language and neuropsychological assessment battery was completed with each participant. Naming therapy was carried out to contrast errorless and errorful therapy in a case series analysis. Errorless learning proved to be as effective as the more traditional, errorful approach in the majority of cases in terms of both immediate improvement and at follow up assessment. Without exception, the patients preferred the errorless learning therapy. Strikingly, it was found that language skill did not predict therapy outcome. Participants who responded better overall, had better recognition memory, executive/problem solving skills and monitoring ability. This replicates recent findings that frontal executive skills are crucial for rehabilitation (Robertson & Murre, 1999). Also, participants who did better at errorful treatment were those with the best working and recall memory, and attention. It is probable that these factors are essential cognitive components for providing effective monitoring and feedback systems to a more general learning mechanism.

Treatment of anomia using errorless versus errorful learning: are frontal executive skills and feedback important?

BACKGROUND: Studies from the amnesia literature suggest that errorless learning can produce superior results to errorful learning. However, it was found in a previous investigation by the present authors that errorless and errorful therapy produced equivalent results for patients with aphasic word-finding difficulties. A study in the academic literature of phoneme discrimination learning found that errorful learning produced equivalent results to errorless learning when feedback was given. In the authors' previous study, feedback was available to the participants in the errorful therapy. It is possible, therefore, that this feedback may have improved the results from errorless learning -- thereby reducing an underlying difference between the two techniques. Generally, feedback is thought to aid learning, however, there is little information in the speech therapy literature about this factor. AIMS: The present investigation was conducted as a follow-up to authors' original study to compare errorless and errorful therapy for the amelioration of aphasic word-finding difficulties. The second aim was to replicate key findings from the original study: namely, that recognition memory, executive/problem-solving skills and monitoring ability predict immediate and long-term naming improvements but not the participants' remaining language ability. METHODS & PROCEDURES: Seven of the original 11 participants took part in a multiple baseline, crossover, case series design. OUTCOMES & RESULTS: The previous results were replicated: errorless and errorful therapy produced equivalent results immediately post-therapy and at follow-up. There was no effect of omitting feedback - the participants learnt equally well without therapist's feedback about whether or not their response was correct. In addition, executive/problem-solving skills and monitoring ability again predicted immediate naming improvements not language ability. CONCLUSIONS: The findings support the view that cognitive abilities and in particular executive function are important contributors to rehabilitation.

The application of errorless learning to aphasic disorders: A review of theory and practice.

Recently, there has been great interest in errorless learning as a new intervention technique. This may be because there are data from both basic neuroscience and clinical application that suggest it is superior to more traditional trial and error methods. In the contemporary literature the most prominent investigations of errorless learning are those designed for rehabilitation of memory impairments. These studies include numerous demonstrations of effective amelioration of word finding difficulties using errorless intervention. The aphasic literature contains no examples of purely errorless learning methods, however, some studies have successfully treated anomia using error reducing techniques. This suggests that errorless learning could be advantageous for treating aphasic disorders, in particular anomia. To explore this idea, we discuss previous research and review two current theories of errorless learning. We provide our own framework for thinking about errorless and errorful learning. In addition, a review of the anomia treatment literature (from 1985 to the present) is presented and conclusions drawn on the methods of treating the word finding difficulties of patients with aphasia.