Dosage and Predictors of Naming Treatment Response in Aphasia
Condition: Aphasia; Stroke
MeSH terms: Aphasia
Study type: Interventional

Summary: 
      This study examines aphasia treatment response among Veterans and non-Veterans living with
      aphasia. It seeks to identify cognitive and neural factors which are predictive of positive
      response to treatment targeting naming impairments in aphasia. It also examines the
      dose-response relationship for naming treatment. More broadly, it seeks to determine who
      aphasia therapy works best for, and how much aphasia therapy is sufficient to achieve
      positive treatment response.
    

Detailed description: 
      Language and communicative impairments following stroke (aphasia) affect more than 30% of
      stroke survivors, with an incidence of over 180,000 new cases annually. The consequences of
      aphasia are far reaching and can affect psychosocial adjustment, family role participation,
      vocational opportunities, and the ability to function independently in society. Recent
      estimates suggest that VHA outpatient clinics see 2000 new cases of aphasia each year,
      meaning that approximately 20,000 enrolled VHA patients and 100,000 United States Veterans
      are currently living with the condition. In response to this need, the VA Pittsburgh
      Healthcare System Geriatric Research, Education, and Clinical Center (GRECC) initiated the
      Program for Intensive Residential Aphasia Treatment and Education (PIRATE) in January 2009.
      PIRATE is a clinical demonstration project that provides approximately 100 hours of
      cognitive-linguistically oriented aphasia treatment to community dwelling Veterans over a
      4-week period. PIRATE currently serves 18 Veterans per year in bi-monthly sessions. Resource
      limitations associated with PIRATE and aphasia treatment in general require that treatments
      be offered in the most cost-effective doses to those Veterans most likely to benefit from
      them.

      This treatment-effectiveness research study addresses these issues by examining the
      dose-response relationship for semantically-oriented naming treatment, and identifying
      cognitive, psycholinguistic and neuroanatomical predictors of treatment success. Study
      participants (n=60, over a 4-year period) will be recruited nationwide from Veterans enrolled
      in PIRATE. They will have their naming performance measured prior to PIRATE entry, during
      each week of treatment, and at program exit/follow-up. A battery of cognitive measures and
      structural magnetic resonance images of their brains will also be collected prior to
      treatment. Participants' performance on trained and untrained lexical items and a
      standardized measure of naming performance will be compared across time intervals to specify
      the therapy amounts for which maximum treatment benefits are achieved. Their treatment
      outcomes will also be correlated with specific cognitive test scores and the location and
      extent of their brain lesions to identify cognitive and neurological markers predictive of
      positive treatment response. Treatment response will also be compared across participants
      with different psycholinguistic profiles, to determine which groups of patients show greatest
      benefit from semantically-oriented naming treatment.

      This study should provide answers to two interlocking questions: for whom is aphasia therapy
      most effective, and how much of it is needed to optimize treatment outcomes. These answers
      have the potential to set transformative new standards for how aphasia treatment is delivered
      within VHA and to stroke survivors with aphasia more broadly.
    

Intervention name(s): Naming therapy
Intervention type(s): Behavioral
Intervention description(s): Participants will receive behavioral therapy which is designed to stimulate semantic (meaning) representations which are required for successful naming (word production). Therapy will be administered for 4 weeks on an intensive schedule (5 days a week, approximately 4.5 hours per day).
Other intervention name(s): Semantic feature analysis
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Aphasia; Language Therapy; Acquired Language Disorders; Semantics; Stroke