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.

A controlled study of changes in conversation following aphasia therapy for anomia.

This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [ 1 ] and Best et al. [ 2 ]). In each study, therapy involved cueing with the aim of improving retrieval of a set of nouns. Naming of the experimental items was assessed twice prior to therapy and again immediately afterwards. There was a significant change in word finding, as measured by picture naming, for the group and for 11 of the 13 participants. At the same time points, we collected conversations between the person with aphasia and a regular conversational partner. We analysed these using Profile of Word Errors and Retrieval in Speech (Herbert et al. [ 3 ]) and investigated a set of conversational variables predicted to change with therapy. Unsurprisingly, the conversation data is not straightforward. There is no significant change on the conversation measures for the group but some changes for individuals. We predicted change in word retrieval after therapy would relate to change in everyday conversations and tested this by correlating the change (post-therapy minus mean pre-therapy) in picture naming with the change in conversation variables. There was a significant positive relationship between the change in picture naming and change in some conversation measures including the number of nouns produced in 5 min of conversation (r = 0.50, p < 0.05, one-tailed) and the number of nouns produced per substantive turn (r = 0.55, p < 0.05, one-tailed). The findings suggest changes in word finding following therapy for aphasia can be reflected in changes in conversation. The clinical implications of the complex results are explored.

Bridging the gap: can impairment-based therapy for anomia have an impact at the psycho-social level?

BACKGROUND: Studies of therapy with people with aphasia tend to use impairment-based and functional measures of outcome. The views of participants are not formally evaluated. Current health and socialcare practice requires intervention to be explicitly client-centred and evidence-based. It is therefore important to investigate the broader effects of speech and language therapy. AIMS: To explore the outcome of a therapy for anomia using the Communication Disability Profile (CDP), focusing particularly on participants' ratings of 'activity'. METHODS & PROCEDURES: Overall eight people with aphasia and their conversation partners participated in the study. There was a range of severity and type of aphasia. Following two baselines (at least 8 weeks apart), there were two phases of therapy for anomia each lasting 8 weeks. This first involved the use of spoken and written cues to aid word finding. The second encouraged the use of targeted words in connected speech and conversation. Eight weeks later, after no further therapy, participants were reassessed. OUTCOMES & RESULTS: Participants' word finding in picture-naming improved significantly, as did their activity ratings. The relationship between the group's word-retrieval scores and CDP activity ratings over the course of the study tended towards significance, although there was considerable variation across individuals. Furthermore, all participants rated participation in activities requiring communication higher at the end than the start of the project. CONCLUSIONS: The findings suggest that therapy which targets word retrieval can have an impact on people with aphasia's views of their communicative activity and life participation. The findings support therapists' clinical insight that impairment-based interventions can effect change beyond scores on language tests.

Traitement homeopathique de la fibromyalgie primaire: a propos de deux essais cliniques en double insu / Homeopathic treatment of primary fibromyalgy: as regards of two clinic essays in double blind

Peu d'essais cliniques en double-insu avec controle par placebo ont ete effectues dans le domaine de la therapeutique homeopathique en rhumatologie. Les differentes methodes employees ont conduit a des resultats varies. Deux approches nouvelles sont decrites ici dans le cadre du traitement de la fibromyalgie primaire. Lors d'un premier essai 24 malades recurent pendant trois mois, selon l'indication, un remede homeopathique choisi parmi trois medicaments: Arnica, Bryonia, Rhus tox. La surveillance mensuelle portait sur les parametres suivants douleur, nombre de points douloureux et sommeil. Un "score d'indication homeopathique" a ete attribue a chaque prescription. Les resultats, analyses par le test "Wilcoxon Rank Sum", ont montre que le traitement actif produisait une amelioration statistiquement significative, mais seulement lorsque son indication etait bien posee. Le deuxieme essai consista en la comparaison de l'effect de Rhus tox. 6 CH a celui d'un placebo sur un groupe de trente patients souffrant de fibromyalgie primaire et choisis sur des criteres symptomatologiques correspondant a l'indication de Rhus tox. L'etude fut conduite selon la methode du double-insu croise contre placebo. L'amelioration par Rhus tox. 6 CH fut significativement plus importante que celle induite par le placebo: ceci, sur les parametres objectifs aussi bien que subjectifs

Efeito de tratamento homeopatico na fibrosite (fibromialgia primaria) / Effect of homeopathic treatment on fibrositis (primary fibromyalgia)

A fibrosite (fibromialgia primaria) e uma condicao controvertida, mas que vem se tornando cada vez mais aceita. E de dificil tratamento. Demonstramos que o remedio homeopatico Rhus toxicodendron C6 foi eficaz para um sub-grupo selecionado de pacientes com fibrosite. A melhora em relacao a sensibilidade, que e o melhor discriminador da fibrosite, foi particularmente perceptivel. A melhora experimentada pelos nossos pacientes enquanto recebiam tratamento ativo foi, no minimo, tao grande quanto o relatado para muitos outros tratamentos que tem sido testados em ensaios de tipo duplo-cego. Somos gratos a Jean Boiron por suas opinioes e encorajamento