This is a draft dissertation/thesis proposal.
Anomia is a common symptom of aphasia after stroke. This affects a person’s naming ability, which can have a serious impact on everyday communication and socialization with family, friends and society.
The purpose of this study is to examine the efficacy of semantic feature analysis treatment on functional communication in adults with fluent aphasia due to stroke. This study will also examine if this type of treatment will improve functional communication as perceived by the participants themselves.
A multiple-baseline across-subjects design will be implemented with six participants with fluent aphasia. This study will include baseline, intervention, and follow-up phases. Treatment efficacy will be assessed using measures on confrontation naming and semantic feature generation tasks. The participants will also complete a rating scale independently that will measure self-perception on functional communication. The participants will receive treatment for 10 weeks, with follow-up being 10 weeks after the last session. The duration of the entire study will be 20 weeks.
Keywords: anomia, aphasia, semantic feature analysis
Effects of Semantic Feature Analysis Treatment on Functional Communication in Adults with Fluent Aphasia Resulting from a Stroke
An increasing number of people all over the world suffer from a stroke every year. According to the World Health Organization (2012), one sixth of the entire population will suffer a stroke at some point in their lifetime. Primarily 30% of those people will suffer from a language impairment, aphasia, which causes difficulty communicating in everyday life (Kristensson, Behrns, & Caldhert, 2014). A person with aphasia has lost the ability to express or understand language. A person with aphasia may present with many different communication difficulties; however, a primary symptom of aphasia is anomia. Anomia is simply defined as word finding difficulty (Goodglass & Wingfield, 1997). Difficulty in retrieving words to communicate effectively can have a serious impact on a person due to the inability to participate in day to day activities. A person with aphasia may have a lower quality of life, because he or she is unable to communicate with family, loved ones, or friends. The ability to communicate in everyday life is imperative to a person’s overall well-being. Aphasia results in ‘loss of self’ and has a negative impact on relationships. The overall lower quality of life seen in persons with aphasia may result in isolation (Thompson & Mckeever, 2012).
There will always be some degree of anomia seen in aphasic patients; therefore, increased naming ability and reduced word-finding difficulties are among the primary goals of intervention (Kristensson et al., 2014). Therapy to increase word retrieval has been extensively researched and has proven to be effective in patients with aphasia. More specifically, semantic feature analysis has shown greater improvements in overall generalization of trained and untrained items in word retrieval treatment (Wisenburn & Mahoney, 2009). Semantic Feature Analysis is an approach that utilizes techniques to strengthen a person’s impaired semantic network (DeLong, Nessler, Wright, & Wambaugh, 2015). During semantic feature analysis treatment, the patient with aphasia works with the treating clinician in a process to generate relevant features that relate to the target word (Coelho, McHugh, & Boyle, 2000). The patient and clinician work through a process to generate semantic attributes about the specific target word. Semantic attributes consist of the superordinate category of a word (i.e. the word “cat” is a part of the superordinate “animal”), associated words, or physical appearance of the target. The clinician may use elicitation of features by asking questions or sentence completion (Papathanasiou, Coppens, & Potaga, 2013). Making connections between features and meaning of target words may increase a patient’s accurate word retrieval process (Coelho et al., 2000). Current research supports the importance of treating persons with aphasia using semantic feature analysis; however, most research lacks focus on patients with only fluent aphasia. Therefore, it is important that further research study the effects semantic feature analysis treatment has on improving overall communication ability in persons with fluent aphasia.
The immense literature concerning both aphasia patients and semantic feature analysis treatment proves to both researchers and clinicians the importance of this specific treatment approach. Research by Wisenburn and Mahoney (2009) supports a study related to different treatment approaches for word-finding deficits in individuals with aphasia. Throughout their research findings, semantic feature analysis proved to be an important treatment to increase an aphasia patient’s overall communication. In the Kristensson et al. (2014) study, the researchers aimed to further study the findings of Coelho, Boyle, Wambaugh, and Ferguson regarding the use of semantic feature analysis for individuals with aphasia after stroke to confirm the efficacy of this treatment approach. Their findings suggest it is important to further investigate concurrent aphasia symptoms to create appropriate targets during semantic feature analysis treatment. Intervention targeting naming and everyday life communication is important, so further investigation is needed on what type of patient semantic feature analysis treatment is beneficial (Kristensson et al., 2014). The purpose of the DeLong et al. study was to observe outcomes associated with semantic feature analysis in patients with aphasia and further expand knowledge on generalization. Their findings suggest that implementing the technique to improve a patient’s semantic map by way of semantic feature analysis, does increase a person’s overall communication level (DeLong et al., 2015). Semantic feature analysis is a well-known intervention for anomia in patients with aphasia and a number of studies such as, (Wambaugh, Mauszycki, Cameron, Wright, & Nessler, 2013) and (Nadeau & Kendall, 2006), have proved an increase in overall communication.
The ability to communicate in everyday life is vital to a person’s overall well-being; therefore, it is important to further research treatment approaches that will allow a person to gain access into communicating effectively. The present study aims to further investigate the impact Semantic Feature Analysis can have on an aphasia patient’s ability to communicate in everyday life through communication with partners, and the overall functional communication of an aphasia patient. Throughout the study, patients with aphasia will be treated using Semantic Feature Analysis and overall communication will be measured. This study will examine if intensive Semantic Feature Analysis treatment truly does improve overall functional communication in aphasia patients.
The participants of this study will be recruited by consulting speech language pathologists and primary care physicians at St. David’s Rehabilitation Hospital in Austin, Texas. A consent form will be sent to the qualified participants, which will provide an explanation of the study and what the expected outcomes will be. The consent form will be documented appropriately and kept in the participant’s folder throughout the study. The participants of this study will include six native speakers of English, both male and female, in the age range of 46 to 82 years old. The participants will be assessed by the clinician to determine eligibility according to the inclusion criteria. The inclusion criteria of this study will include: each participant be at least six-months post left-sided stroke, have a fluent aphasia with mild to moderate anomia, sufficient auditory comprehension in order to be able to understand the instructions that will be given in this study, no other illnesses or injury, no visual or articulatory difficulties that will prevent participation, good physical and psychological status in order to complete the study, and a high school diploma. The clinician will administer the Western Aphasia Battery – Revised (WAB; Kertesz, 2006) and the Porch Index of Communicative Ability (PICA; Porch, 2001) in order to determine type and severity of aphasia.
The treatment materials that will be needed during this study will include three picture stimulus sets that will be obtained from the Object and Action Naming Battery (Druks & Masterson, 2000). The materials needed for data collection and measurement during this study will include both standardized and non-standardized measures. The standardized assessments will include the Western Aphasia Battery (WAB; Kertesz, 2006), Porch Index of Communicative Ability (PICA; Porch, 2001), and the Communicative Activities of Daily Living- 2nd edition (CADL; Holland, 1980). These assessments will be administered at baseline and at follow-up in order to determine changes in severity of aphasia and communication skills after treatment. The Communication Outcome After Stroke scale (COAST scale; Long, Hesketh, Paszek, Booth, & Bowen, 2008) will be included in this study as an observer measure and each participant will rate their own functional communication following treatment. These multiple measures will be included in order to increase validity and reliability.
This study will be a multiple-baseline across-subjects design. Each participant will be assessed separately with the focus being on individual progress following the treatment. Baseline measures using the mentioned standardized assessments will be taken for each participant during the first session. The intervention phase will be 10 weeks long and include the implementation of semantic feature analysis treatment. Follow-up measures will be taken 10 weeks after. The total duration of the study will be 20 weeks.
Treatment Setting. This study will be conducted at the Texas State University Speech-Language-Hearing Clinic in San Marcos, Texas. Treatment sessions will take place in a quiet, private therapy room. At the beginning of the study, each participant will choose the time and days therapy will be conducted to ensure that he or she will function at the highest level of alertness. All participants will be in a safe environment and no potential risks will impose on their overall wellbeing.
Treatment Process. Each participant will receive semantic feature analysis treatment three times per week for one hour. Each session will be carried out in two steps: a confrontation naming task and semantic feature generation task. First, each participant will be presented with three picture stimulus sets that will contain 10 items each. Each picture set will include two categories of living and nonliving items. The clinician will prompt the participant to simply name the picture item. Secondly, the clinician will provide the same picture stimuli and prompt the participant to provide more information about each picture. The clinician will prompt the participant to think about the picture and say as much as he or she can about it. The clinician will use open-ended questions or sentence completion prompts to elicit features when the participant provides an incorrect response. The clinician will transcribe and audio-record each response during both tasks each session. Each participant will receive the same set of instructions for both tasks to ensure consistency during intervention. Each participant will receive the same type of feedback regarding correct responses and general motivators, such as, “you’re working hard” to encourage the participant to finish the study.
Throughout this study, data will be collected at baseline, once a week during the intervention phase and at follow-up 10 weeks after the intervention. Data will be collected at baseline to determine the severity of aphasia and level of functional communication using the Western Aphasia Battery (WAB; Kertesz, 2006), Porch Index of Communicative Ability (PICA; Porch, 2001), the Communicative Activities of Daily Living- 2nd edition (CADL; Holland, 1980), and the Communication Outcome After Stroke scale (COAST scale; Long et al., 2008). During the intervention stage, data will be collected on the participant’s accuracy during the confrontation naming and semantic generation tasks every week. The participants will also complete the COAST scale again at the end of the intervention phase. At follow-up 10 weeks after the study, data will be taken on all measurements used throughout the entire study. The treating clinicians, participants and significant others of this study will have access to the results that will be obtained. However, the results will not be published. See Table 1 for an overview of the data collection process.
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