INTRODUCTION:Increasingly, studies are demonstrating language and communication improvement after behavioral interventions for primary progressive aphasia (PPA), and the caregiver perspective has been highlighted as critically important to determining treatment success in this population. This is an exploratory study investigating a comprehensive, person-centered intervention promoting everyday communication, functional independence, and quality of life for people with PPA (PwPPA) and their caregivers. METHODS:Four intervention programs were run separately in 6 to 8 week blocks with a total of 14 dyads (PwPPA and caregiver) enrolled. Group sessions lasted 2 hours and included communication strategy training, PPA education from multidisciplinary experts, speech therapy for PwPPA, and a support group for caregivers (blocks 1 and 2). Personalized language exercises were assigned for home practice, using apps or paper-and-pencil tasks. Quantitative and qualitative outcomes were measured before and after each treatment block and included: the Revised Western Aphasia Battery (WAB-R) Aphasia Quotient (AQ) and subtest scores, content information units (CIUs) on the WAB-R picture description task, and qualitative content analysis of semi-structured interviews, gathered from both PwPPA and caregivers. RESULTS:No statistically significant changes were noted in mean WAB-AQ score pre- to post-intervention. Mean CIUs produced on the WAB-R picture description task pre- to post-intervention increased and approached significance (β = 2.7; confidence interval: -0.45, 5.86, p = 0.09). Qualitative findings from PwPPA and caregivers were very positive, and underscored the sense of community, improved language, communication, and well-being, and access to multidisciplinary expertise and resources afforded by the program. DISCUSSION:Further investigation into the most appropriate assessment tools and intervention approaches for PPA is warranted and has the potential to make a significant positive impact on PwPPA and their families. Highlights:We combined quantitative and qualitative measures of efficacy in treating primary progressive aphasia.Language skills were maintained and communication improvement approached significance.Participants noted the benefits of peer support, education, and communication practice.

Background:People with aphasia present with language and communication deficits, most notably in lexical retrieval (naming). Although positive outcomes in naming have been observed following speech-language treatment, many individuals with aphasia continue to face impairments after the acute phase of rehabilitation. Mobile app-based therapies are increasingly being used by speech-language pathologists in the rehabilitation of people with aphasia as an adjunct to or in lieu of traditional in-person therapy approaches. These apps can increase the intensity of treatment and have been shown to result in meaningful outcomes across several domains. Objective:VoiceAdapt is a mobile therapy app addressing naming impairments, designed within a user-centered design framework. The VoiceAdapt app uses two evidence-based lexical retrieval treatments to engage people with aphasia to improve their naming abilities through interaction with the app. The purpose of this study was to conduct a randomized controlled trial to examine the preliminary clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods:A two-arm, waitlist-controlled, crossover group randomized controlled trial was conducted at two sites within Canada. During the intervention phase, participants completed 5 weeks of independent training with the app, which involved naming practice using Semantic Features Analysis and Phonological Components Analysis. The primary outcome measure was naming performance (Boston Naming Test); secondary outcomes included measures of overall language and naming (Western Aphasia Battery-Revised), communication (Communication Effectiveness Index), and quality of life (Stroke and Aphasia Quality of Life Scale-39). Results:A total of 37 people with aphasia in the chronic stages (average 4.6 y postonset of aphasia) participated in this study. Participants used the app for an average of 20 hours over the 5-week intervention phase. Training with VoiceAdapt resulted in an increase of 1.6 points on the Boston Naming Test (Cohen d=0.3). Evidence for improved naming was also observed on trained items, as well as subtests of naming or word-finding on the WAB-R. Training with the app also resulted in a significant increase in participants' perceptions of their communication quality of life (increase of 0.1 points; Cohen d=0.3), but no other measures (WAB-R Aphasia Quotient, Communicative Effectiveness Index) were significant. Conclusions:Individuals with aphasia who used the VoiceAdapt app for 5 weeks to target naming skills demonstrated measurable gains in naming and communication-based quality of life. Notably, these changes were observed in a remotely delivered program, in participants who were in the chronic stages of aphasia. These findings inform the profession on the use of app-based home therapy programs as an accessible, cost-effective option for individuals in the chronic stages of recovery who often have limited options for rehabilitation.

Persons with aphasia (PWA) often have deficits in cognitive domains such as working memory (WM), which are negatively correlated with recovery, and studies have targeted WM deficits in aphasia therapy. To our knowledge, however, no study has examined the efficacy of multi-modal training which includes both WM training and targeted language therapy. This pilot project examined the feasibility and preliminary efficacy of combining WM training and naming therapy to treat post-stroke PWA. Chronic PWA were randomly assigned to either the a) Phonological Components Analysis (PCA) and WM intervention (WMI) condition (i.e., a computerized adaptive dual n-back task), or b) PCA and active control condition (WMC). Participants received face-to-face PCA therapy 3 times/week for 5 weeks, and simultaneously engaged in WM training or the active control condition five times/week, independently at home. Six PWA were enrolled, 3 in each condition. Feasibility metrics were excellent for protocol compliance, retention rate and lack of adverse events. Recruitment was less successful, with insufficient participants for group analyses. Participants in the WMI (but not the WMC) condition demonstrated a clinically significant (i.e., > 5 points) improvement on the Western Aphasia Battery- Aphasia Quotient (WAB-R AQ) and Boston Naming Test after therapy. Given the small sample size, the performance of two individuals, matched on age, education, naming accuracy pre-treatment, WAB-R AQ and WM abilities was compared. Participant WMI-3 demonstrated a notable increase in WM training performance over the course of therapy; WMC-2 was the matched control. After therapy, WMI-3's naming accuracy for the treated words improved from 30 to 90% (compared to 30–50% for WMC-2) with a 7-point WAB-R AQ increase (compared to 3 for WMC-2). Improvements were also found for WMI-3 but not for WMC-2 on ratings of communicative effectiveness, confidence and some conversation parameters in discourse. This feasibility study demonstrated excellent results for most aspects of Co-TrEAT. Recruitment rate, hampered by limited resources, must be addressed in future trials; remotely delivered aphasia therapy may be a possible solution. Although no firm conclusions can be drawn, the case studies suggest that WM training has the potential to improve language and communication outcomes when combined with aphasia therapy.

Introduction: The evidence regarding optimal treatment intensity is mixed, and differing definitions have further confounded existing findings. The primary objective of this study was to compare the efficacy of Phonological Components Analysis (PCA) treatment for anomia delivered at intense and non-intense schedules, using a well-controlled design. The number of teaching episodes and active ingredients of therapy are important considerations when defining intensity. We hypothesized that an active ingredient of PCA is the self-generation of phonological components during therapy sessions. Our secondary aim was to examine whether component generation predicted treatment outcome. Methods: Sixteen adults (M = 52.63 years old, SD = 11.40) with chronic post-stroke aphasia (M = 4.52 years post-onset, SD = 5.55) were randomly assigned to intensive (IT) or standard (ST) PCA treatment conditions. Cumulative treatment intensity in both conditions was equivalent: ST participants received PCA 1 hour/day, 3 days/week for 10 weeks, whereas IT participants received PCA 3 hours/day, 4 days/week for 2.5 weeks. The primary outcome was naming accuracy on a set of treated and (matched) untreated words, measured pre- and post-treatment, and at four- and eight-week follow-ups. Results: IT and ST conditions were similarly efficacious. However, secondary analyses suggest an advantage for the IT condition in naming of the treated words immediately post-treatment, but not at follow-ups. The self-generation of phonological components emerged as a significant positive predictor of naming accuracy for both the treated and untreated words. However, this relationship did not reach significance once baseline anomia severity was accounted for. Conclusions: Although replication in a larger sample is warranted, results suggest that PCA treatment is similarly efficacious when delivered at different intensities. Other factors related to the quality of treatment (i.e., active ingredients such as cue-generation) may play an important role in determining treatment efficacy and must also be considered when comparing treatment intensities.

BackgroundMobile app–based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. ObjectiveVoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. MethodsA multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. ResultsRecruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. ConclusionsThe results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. Trial RegistrationClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364 International Registered Report Identifier (IRRID)DERR1-10.2196/30621

Treatments for anomia have demonstrated short- and long-term efficacy. However, individual outcomes can be variable, and evidence for treatment generalization is limited. We investigated whether treatment-related measures of access to- and learning of language, namely, a) responsiveness to cues, and b) during-treatment improvements in naming, are good predictors of treatment outcomes. In addition, we investigated mechanisms underlying treatment generalization. Ten adults with chronic, post-stroke aphasia received a phonological treatment for anomia three times a week for five weeks. Naming accuracy of treated and untreated words was assessed pre- and post-treatment and at four- and eight-week follow-ups. Generalization to an untrained naming task, which involved analyses of naming accuracy and speech errors, was also assessed; speech errors were analyzed according to the Interactive Activation (IA) model of word retrieval. Group analyses indicate significant improvements in naming treated compared to untreated words, at all timepoints after therapy. Additional analyses showed significant long-term improvements in naming untreated words. Initial responsiveness to cueing and early improvement emerged as significant predictors of overall pre- to post-treatment improvements in naming treated words; naming improvements made early-on in treatment were also predictive of improvements in naming of the untreated words at follow-up. Furthermore, our study is the first to demonstrate that generalization after a phonological treatment for anomia may be driven by a strengthening of lexical-phonological connections. This study provides novel insights regarding mechanisms driving anomia treatment outcomes. Understanding such mechanisms is critical to improving existing assessment practices, optimizing treatment selection and building treatment protocols that are more likely to generalize.

Event Abstract Back to Event Using Photovoice to Document the Experiences of Individuals with Aphasia – A Pilot Project Caroline Auclair1, Marie-Ange Lataille1, Laura Laird2, 3, Roanne Thomas1, Elizabeth Rochon2, 3 and Carol Leonard1, 2* 1 University of Ottawa, School of Rehabilitation Sciences, Canada 2 University of Toronto, Speech-Language Pathology, Canada 3 Toronto Rehabilitation Institute, University Health Network, Canada Background: Presently there are over 100,000 Canadians living with aphasia and this number is expected to increase with the aging population (Dickey et al., 2010). Although the prevalence of this disorder is relatively high, surveys conducted around the world (including Canada, Australia, United States, England) suggest that awareness and understanding of the disorder are limited (Code et al., 2016; 2001). Simmons-Mackie and Kagan (2007) examined the potential impact of aphasia on an individual’s quality of life and suggested that, among other things, social isolation, difficulty participating in leisure activities, and difficulty maintaining employment may result. They suggested that raising the level of awareness of aphasia among the public in the form of sensitivity training and education is important to better the lives of individuals with aphasia. A recent study (Le Dorze et al., 2014) examining the factors affecting participation in activities by individuals with aphasia identified barriers such as limited services post-stroke, communication problems and physical limitations. Factors found to facilitate participation included aphasia community organizations, supportive family members and positive personal characteristics. The purpose of the present investigation was to have a better understanding of the challenges and successes encountered by people living with aphasia. Methods: This project used a participatory action research (PAR) art-based strategy – that of photovoice. Photovoice is described as "...a PAR method by which people create and discuss photographs as a means of catalyzing personal and community change. Using cameras, participants document the reality of their lives" (p. 75, Wang et al., 1998). Participants included 3 English-speaking women (ages, 50, 82, 69 years) and one man (age 69). Participants took photos over a 3-week period addressing the question “What are your communication issues, challenges, and successes in living with aphasia?” At a second session, participants shared information about the meaning of their four most significant photographs (See Figure 1). Data were transcribed and analyzed using a “Constant Comparative” framework (Kruger & Casey, 2009) whereby key themes and quotes were identified and coded according to major concepts. Results: Frustration, discouragement, and isolation were concepts used to describe the challenges of barriers to social participation (“For a moment, I can’t talk at all. I was stuck); and loss of independence and abilities (“You have to wait, depend on people”). Hope, happiness and support were concepts related to the successes of perseverance (“[…] The doctor said, ‘It’s not possible’ and then I said, ‘I try it anyway’”.) and reminiscence (“I trailed her around, my sister. Yes”). Discussion/Conclusion: Aphasia is a communication problem that can be associated with many challenges as well as individual success. Increasing awareness of aphasia in our society may contribute to decreasing barriers to participation by adjusting one’s communication strategies and/or modifying services. Recognizing the amount of perseverance needed in rehabilitation can help better understand the strengths of and efforts expended by people with aphasia who are aiming to improve their quality of life. While aphasia represents many challenges, success may be reflected in the spirit of hope, happiness, and the support of others. Image 1 Acknowledgements We wish to thank the participants and the staff at the Aphasia Centre of Ottawa for their enthusiasm and support of this project. References Code, C., Papathanasiou, I., Rubio-Bruno, S., de la Paz Cabana, M., Villanueva, M.M., Haaland- Johansen, L., Prizl-Jakovac, T., Leko, A., Zemva, N., Patterson, R., Berry, R., Rochon, E., Leonard, C., Robert, A. (2016). International patterns of the public awareness of aphasia. International Journal of Language and Communication Disorders, 51(3), 276-284. Code, C., Simmons-Mackie, N., Armstrong, E., Stiegler, L., Armstrong, J., Bushby, E., Carew-Price, P., Curtis, H., Haynes, P., McLeod, E., Muhleisen, V., Neate, J., Nikolas, A., Rolfe, D., Rubly, C., Simpson, R., Webber, A. (2001). The public awareness of aphasia: An international survey. International Journal of Language and Communication Disorders, 36 (supplement), 1-6. Dickey, L., Kagan, A., Lindsay, P., Fang, J., Rowland, A., & Black, S. (2010). Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Archives of Physical Medicine and Rehabilitation, 91, 196-202. Kruger, R.A., & Casey, M.A. (2009). Focus groups: A practical guide for applied research (4th ed.). California: Sage Publications Le Dorze, G., Salois-Bellerose, É., Alepins, M. Croteau, C., & Hallé, M-C. (2014). A description of the personal and environmental determinants of participation several years post-stroke according to views of people who have aphasia. Aphasiology, 28(4), 421-439. Simmons-Mackie, N., Kagan, A. (2007). Application of the ICF in aphasia. Seminars in Speech and Language, 28(4), 244-253. Wang, C.C., Yi, W.K., Tao, Z.W., & Carovano, K. (1998). Photovoice as a participatory health promotion strategy. Health Promotion International, 13(1), 75-86. Keywords: Aphasia, Communication, Photovoice, Participatory Action Research, public awareness Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018. Presentation Type: poster presentation Topic: not eligible for a student prize Citation: Auclair C, Lataille M, Laird L, Thomas R, Rochon E and Leonard C (2019). Using Photovoice to Document the Experiences of Individuals with Aphasia – A Pilot Project. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00065 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 26 Apr 2018; Published Online: 22 Jan 2019. * Correspondence: Dr. Carol Leonard, University of Ottawa, School of Rehabilitation Sciences, Ottawa, Ontario, Canada, carol.leonard@uottawa.ca Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Caroline Auclair Marie-Ange Lataille Laura Laird Roanne Thomas Elizabeth Rochon Carol Leonard Google Caroline Auclair Marie-Ange Lataille Laura Laird Roanne Thomas Elizabeth Rochon Carol Leonard Google Scholar Caroline Auclair Marie-Ange Lataille Laura Laird Roanne Thomas Elizabeth Rochon Carol Leonard PubMed Caroline Auclair Marie-Ange Lataille Laura Laird Roanne Thomas Elizabeth Rochon Carol Leonard Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Despite the growing evidence regarding the importance of intensity and dose in aphasia therapy, few well-controlled studies contrasting the effects of intensive and non-intensive treatment have been conducted to date. Phonological components analysis (PCA) treatment for anomia has been associated with improvements in some patients with chronic aphasia; however, the effect of treatment intensity has not yet been studied with PCA. Thus, the aim of the present study was to identify the effect of intensity on neural processing associated with word retrieval abilities after PCA treatment. We used functional magnetic resonance imaging to examine therapy-induced changes in activation during an overt naming task in two patients who suffered from a stroke in the left middle cerebral artery territory. P1 received intensive PCA treatment whereas P2 received the standard, non-intensive, PCA treatment. Behavioral results indicate that both standard and intensive conditions yielded improved naming performance with treated nouns, but the changes were only significant for the patient who received the intensive treatment. The improvements were found to be long lasting as both patients maintained improved naming at 2-months follow-ups. The associated neuroimaging data indicate that the two treatment conditions were associated with different neural activation changes. The patient who received the standard PCA showed significant increase in activation with treatment in the right anterior cingulate, as well as extensive areas in bilateral posterior and lateral cortices. By contrast, the patient who received intensive PCA showed more decreases in activation following the treatment. Unexpectedly, this patient showed subcortical increase in activation, specifically in the right caudate nucleus. We speculate that the recruitment of the caudate nucleus and the anterior cingulate in these patients reflects the need to suppress errors to improve naming. Thus, both short-term intensive and standard, non-intensive, PCA treatment can improve word retrieval in chronic aphasia, but neuroimaging data suggest that improved naming is associated with different neural activation patterns in the two treatment conditions.

Event Abstract Back to Event Patterns of post-stroke aphasia recovery: treatment, maintenance and generalization Tijana Simic1, 2, 3*, Tali Bitan1, 4, Laura Laird1, Carol Leonard1, 3, 5 and Elizabeth Rochon1, 2, 3 1 University of Toronto, Canada 2 Toronto Rehabilitation Institute, University Health Network, Canada 3 Canadian Partnership for Stroke Recovery, Canada 4 University of Haifa, Israel 5 University of Ottawa, Canada Background Phonological Components Analysis (PCA) is a treatment for anomia (1), one of the most prevalent and frustrating symptoms of aphasia. A phonological analogue to the Semantic Feature Analysis (SFA), PCA is a sound-based naming therapy which requires participants to name a picture stimulus (e.g., bed) and to study five phonological components associated with that stimulus (e.g., rhyme word, first and last sounds, etc). Research supports the efficacy of PCA, demonstrating behavioural (1, 2, 3) and neural (4) changes, when administered in both intense and non-intense doses (5). Evidence for treatment generalization, however, has been limited. Further, individual treatment data show differential patterns of responding over time. The aims of the present study were to a) replicate previous findings demonstrating PCA treatment efficacy and maintenance, b) to examine PCA treatment generalization and c) to characterize patterns of recovery in both treated and untreated words over time (i.e., immediately and at long-term follow-ups). Methods Participants were ten adults (mean age = 55.5, SD= 15) with mild to severe aphasia (mean WAB AQ= 67.8, SD=13.9), post single left-hemisphere stroke (months post-onset mean= 18.1, SD= 20.1). Participants completed three baseline naming assessments; two word lists of 30 words each, one treated and one untreated, were created and matched for frequency, syllable length and semantic category. PCA treatment was administered three days a week for five weeks. Naming accuracy on treated and untreated words was assessed at four timepoints: immediately pre- and post-therapy, and at four- and eight-week follow-ups. Results Results are reported according to the aims outlined above. (a) A linear mixed effects model, (fixed factors: timepoint and condition (i.e., treated/untreated); random factor: subject), revealed main effects of timepoint (F(3,23)=12.540, p=.000) and condition (F(1,49)=52.598, p=.000) and a significant interaction (F(3, 23)=8.793, p=.000). Naming accuracy significantly improved on treated compared to untreated words immediately (p=.000), four- (p=.020) and eight-weeks (p=.036) post-treatment. (b) A linear mixed effects model on untreated words (fixed factor: timepoint; random factor: subject), demonstrated a significant main effect of time (F(3,9)=4.467, p=.037). Untreated words did not improve immediately post-treatment (p=.519) but significantly improved at four- (p=.020) and eight-week (p=.019) follow-ups. (c) Pearson correlations revealed that gains made in naming accuracy on treated words immediately post-therapy were significantly correlated to improvements in untreated words at both four- (r=.756, p =.011) and eight-week (r=.699, p=.024) follow-ups. Maintenance of gains made on treated words at four-weeks was significantly correlated with maintenance of treated words at eight-weeks (r=.805, p=.005). Conclusions These data a) replicate previous findings demonstrating PCA treatment efficacy and maintenance b) provide evidence of PCA treatment generalization, and c) suggest two types of responders to PCA therapy: “generalizers” and “maintainers”. Generalizers show the greatest short-term improvements on treated items, poorer maintenance and greater generalization over time. Conversely, the “maintainers” show long-term maintenance of treated words, with minimal generalization. Findings indicate that, contrary to usual practice, generalization is best measured in the longer term, rather than immediately after treatment, which corroborates theories of learning and memory consolidation (6, 7). References 1. Leonard, C., Rochon, E., & Laird, L. (2008). Treating naming impairments in aphasia: Findings from a phonological components analysis treatment. Aphasiology, 22(9), 923-947. 2. Van Hees, S., Angwin, A., McMahon, K., & Copland, D. (2013). A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. Neuropsychological Rehabilitation, 23(1), 102-132. 3. Leonard, C., Laird, L., Burianová, H., Graham, S., Grady, C., Simic, T., & Rochon, E. (2015). Behavioural and neural changes after a “choice” therapy for naming deficits in aphasia: Preliminary findings. Aphasiology, 29(4), 506-525. 4. Rochon, E., Leonard, C., Burianova, H., Laird, L., Soros, P., Graham, S., & Grady, C. (2010). Neural changes after phonological treatment for anomia: An fMRI study. Brain and Language, 114, 164-179. 5. Rochon, E., Laird, L., Simic, T., Leonard, C. The effect of intensity on a treatment for naming deficits in aphasia. (In preparation). 6. Karni, A. & Korman, M. (2011). When and where in skill memory consolidation: Neuro-behavioral constraints on the acquisition and generation of procedural knowledge. BIO Web of Conferences, ISSN 2117-4458, 1 (47), 1-4. 7. Mosha, N. & Robertson, E.M. (2016). Unstable memories create a high-level representation that enables learning transfer. Current Biology, 26 (1), 100-105. Keywords: Anomia, Aphasia, treatment outcome, Treatment maintenance, Treatment generalization, phonological components analysis Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018. Presentation Type: poster presentation Topic: Eligible for a student award Citation: Simic T, Bitan T, Laird L, Leonard C and Rochon E (2019). Patterns of post-stroke aphasia recovery: treatment, maintenance and generalization. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00101 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 May 2018; Published Online: 22 Jan 2019. * Correspondence: Ms. Tijana Simic, University of Toronto, Toronto, Canada, simictij@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Tijana Simic Tali Bitan Laura Laird Carol Leonard Elizabeth Rochon Google Tijana Simic Tali Bitan Laura Laird Carol Leonard Elizabeth Rochon Google Scholar Tijana Simic Tali Bitan Laura Laird Carol Leonard Elizabeth Rochon PubMed Tijana Simic Tali Bitan Laura Laird Carol Leonard Elizabeth Rochon Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Event Abstract Back to Event The Influence of Phonological Components Analysis Treatment on Lexical Access in Individuals with Aphasia Sophia Mengad1, Ruxandra Mosu1, Laura Laird2, Jean K. Gordon3, Elizabeth Rochon2, 4, 5 and Carol Leonard1, 2, 4* 1 University of Ottawa, Audiology and Speech-Language Pathology Program, Canada 2 University of Toronto, Department of Speech-Language Pathology, Canada 3 University of Iowa, Communication Sciences and Disorders, United States 4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada 5 UHN Toronto Rehabilitation Institute, Canada Background: The Phonological Components Analysis (PCA) treatment for naming deficits in aphasia has been shown by us and others to be efficacious (Leonard et al., 2015; Leonard et al., 2008; van Hees et al, 2013), with associated neural changes (Rochon et al., 2010). This treatment protocol was modeled after the Semantic Features Analysis approach (Boyle & Coelho, 1995) and both capitalize on the presumed bidirectional connections between semantics and phonology during lexical access (Foygel & Dell, 2000). Based on this two-step interactive activation model, the purpose of the present study was to examine the influence of PCA therapy on the strength of both the semantic and phonological connections during lexical access in individuals with aphasia. Methods: The data reported here are part of a larger study investigating the influence of intensity of PCA treatment on naming performance (Rochon et al., in preparation). In that study participants with aphasia were randomly assigned to one of two treatment conditions (intense or standard). They were asked to name pictured items and naming accuracy of treated (n = 30) and untreated (n = 30) words was collected pre- and post-therapy. Two independent raters, blind to treatment condition and pre- post-treatment status coded the responses by error type (e.g., semantic, formal, unrelated, etc.) as per Dell et al. (1997). Point-to-point agreement was 93%. The scored responses, per patient, were entered into a web-based computational model of lexical access (Walker & Hickok, 2015) in order to determine the strength of the phonological and semantic connections pre- and post-therapy. Results: The outcome measure for this analysis, connection weight, was submitted to a 2 x 2 x 2 x 2 mixed ANOVA with 3 repeated measures (treatment status [treated vs untreated]; session [pre vs post]; parameter [semantic vs phonological]; and one between-subjects factor (intensity [intense vs standard]). There were significant main effects of treatment status (treated > untreated), F (1, 12) =12.30, p = .004; session (post > pre), F (1, 12) = 24.92, p < .001; and parameter (phonological > semantic), F (1, 12) =9.78, p = .009. A significant 3-way interaction, treatment status x session x parameter, F (1, 12) =5.35, p = .039, was also found. Post-hoc tests showed that the change in the connection weight pre- and post-treatment was specific to the semantic weights for the treated items only (p < .001; see Figure 1). Discussion: It was found that PCA treatment, a phonologically-based therapy, strengthened the semantic connections during lexical access in individuals with aphasia. This finding is consistent with our previous work (Leonard et al., 2015; Rochon et al., 2010) where it was found, using fMRI, that changes in cortical activation post PCA therapy were associated with a semantic task. These results are consistent with Foygel and Dell’s (2000) interactive activation model of lexical access, which posits a strong interaction between the semantic and phonological levels during naming. Figure 1: Semantic and Phonological Connection Weights Pre- and Post-therapy Figure 1 Acknowledgements This study was supported by a grant from the Heart and Stroke Foundation of Canada. References Boyle, M. & Coelho, C.A., (1995). Application of a Semantic Feature Analysis as a treatment for aphasic disnomia. American Journal of Speech-Language Pathology, 4, 135-138. Dell, G., Schwartz, M.F., Martin, N., Saffran, E.M., Gagnon, D. A. (1997). Lexical access in aphasic and nonaphasic speakers. Psychological Review, 104(4), 801-838. Foygel, D. & Dell, G., (2000). Models of impaired lexical access in speech production. Journal of Memory and Language, 43, 182-216. Leonard, C., Laird, L., Burianova, H., Graham, S., Grady, C., Simic, T., Rochon, E. (2015). Behavioural and neural changes after a “choice” therapy for naming deficits in aphasia: preliminary findings. Aphasiology, 29(4), 506-525. Leonard, C., Rochon, E., Laird, L. (2008). Treating naming impairments in aphasia: Findings from a Phonological Components Analysis treatment. Aphasiology, 22, 923-947. Rochon, E., Laird, L., Simic, T., Leonard, C. (in preparation). The effect of intensity on a treatment for naming deficits in aphasia. Rochon, E., Leonard, C., Burianova, H., Laird, L., Soros, P., Graham, S., Grady, C. (2010). Neural changes after phonological treatment for anomia: an fMRI study. Brain and Language, 114, 164–179. van Hees, S., Angwin, A., McMahon, K., Copland, D. (2013). A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia. Neuropsychological Rehabilitation, 23(1), 102-132. Walker G. & Hickok G. (2015, August 7). Computational Models of Aphasia. Retrieved March 25, 2017, from http://www.cogsci.uci.edu/~alns/webfit Keywords: Aphasia, Anomia, phonologically-based treatment, interactive-activation model, lexical access Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster presentation Topic: Consider for student award Citation: Mengad S, Mosu R, Laird L, Gordon JK, Rochon E and Leonard C (2019). The Influence of Phonological Components Analysis Treatment on Lexical Access in Individuals with Aphasia. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00031 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 25 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: Dr. Carol Leonard, University of Ottawa, Audiology and Speech-Language Pathology Program, Ottawa, Ontario, Canada, carol.leonard@uottawa.ca Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sophia Mengad Ruxandra Mosu Laura Laird Jean K Gordon Elizabeth Rochon Carol Leonard Google Sophia Mengad Ruxandra Mosu Laura Laird Jean K Gordon Elizabeth Rochon Carol Leonard Google Scholar Sophia Mengad Ruxandra Mosu Laura Laird Jean K Gordon Elizabeth Rochon Carol Leonard PubMed Sophia Mengad Ruxandra Mosu Laura Laird Jean K Gordon Elizabeth Rochon Carol Leonard Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Event Abstract Back to Event Executive control and its relationship to aphasia therapy outcomes Tijana Simic1, 2, 3*, Laura Laird4, Devora Goldberg4, Tali Bitan4, 5, Craig Chambers6, Gary Turner7, 8, Carol Leonard3, 4, 9 and Elizabeth Rochon2, 3, 4 1 University of Toronto, Speech-Language Pathology - Rehabilitation Sciences Institute, Canada 2 Toronto Rehabilitation Institute - University Health Network, Canada 3 Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Canada 4 University of Toronto, Speech-Language Pathology Department, Canada 5 University of Haifa, Israel 6 University of Toronto - Mississauga, Canada 7 York University, Canada 8 University of Toronto, Rehabilitation Sciences Institute, Canada 9 University of Ottawa, Canada Although anomia therapy can be highly beneficial (1, 2), even in chronic disease states (3), it remains difficult to predict how individuals with post-stroke aphasia will respond to treatment. Individuals with similar aphasia profiles often respond differently to the same treatment (4), and language impairments measured clinically are not always accurate predictors of communication in real-life settings (5, 6, 7). Some research suggests that executive control (EC) ability may be a good predictor of aphasia therapy success (4, 5, 6). EC is conceptualized as a diverse but related group of cognitive processes, recruited in various combinations to perform goal-oriented behaviors and navigate novel situations (8, 9). Our recent systematic review (10) found better EC performance to be related to greater language improvements following therapy in 10/15 studies. This relationship was observed primarily with: simple and specific EC tasks, naming therapy, and moderate-to-severe aphasia. The review highlighted that EC is poorly defined in aphasia treatment studies; tasks used to assess EC are highly variable and interpreted differently across studies, correlate poorly with one another and are low in validity. The aim of this pre-post single group treatment study was to examine whether specific, operationally defined EC processes measured pre-treatment could be indicative of gains made after administration of the structured Phonological Components Analysis (11, 12) naming therapy. Following well-established EC models (8, 9, 13), the EC processes of interest were: updating working memory (replacing irrelevant information with new, relevant information), shifting (switching between multiple tasks) and inhibition (stopping dominant, automatic responses). We expected positive correlations for accuracy data and negative correlations for reaction time (RT) data (i.e., lower RTs indicate better performance). Participants were treated three times a week for five weeks. Naming accuracy of treated and untreated words was assessed pre, post, four- and eight-weeks after therapy. Naming accuracy (difference scores) and performance on EC tasks were correlated using Kendall’s tau-b nonparametric correlation coefficient. Participants were: eight adults (mean age = 52.5, SD= 14.2, range= 35 – 75) with mild to severe aphasia (mean WAB AQ= 63.6, SD=12.15, range=39.6 – 78.6), post single left-hemisphere stroke (months post-onset mean= 11.0, SD= 3.7, range= 6 – 18). Preliminary findings demonstrate significantly improved naming accuracy on treated words pre- to post-treatment (p= 0.01); this was maintained at four- (p= 0.03) and eight-week (p=0.04) follow-ups. Treatment effect sizes at all time points were large. Correlation coefficients between EC tasks and naming accuracy at the three time points are presented in Table 1. Analyses reveal that for certain processes there is a strengthening of the relationship between EC and language over time. Significant correlations were found between naming accuracy at eight-week follow up and updating and inhibition accuracy (p < 0.05), and inhibition RT (p < 0.01) measured pre-treatment. Though preliminary and based on a small sample, these data suggest that distinguishable EC processes may play an important role in consolidating learned material, and maintaining treatment improvements over time. Analysis of the relationship between untreated words, naming errors, and EC processes is ongoing. Acknowledgements This work was supported by a Heart and Stroke Foundation of Canada grant (#NA7015) and a Heart and Stroke Foundation of Canada - Canadian Partnership for Stroke Recovery trainee award to Tijana Simic. The authors wish to acknowledge the participants and their families as well as our referral sites. References 1.Nickels, L. (2002). Therapy for naming disorders: Revisiting, revising, and reviewing. Aphasiology, 16(10-11), 935-979. 2.Raymer, A. M., Beeson, P., Holland, A., Kendall, D., Maher, L. M., Martin, N., . . . Gonzalez Rothi, L. J. (2008). Translational research in aphasia: From neuroscience to neurorehabilitation. Journal of Speech, Language, and Hearing Research, 51(1), S259-S275. 3.Brady, M. C., Godwin, J., Enderby, P., Kelly, H., & Campbell, P. (2016). Speech and language therapy for aphasia after stroke: An updated systematic review and meta-analyses. Stroke, 47(10), e236–e237. doi:10.1161/STROKEAHA.116.014439 4.Helm-Estabrooks, N. (2002). Cognition and aphasia: A discussion and a study. Journal of Communication Disorders, 35(2), 171-186. 5.Ramsberger, G. (2005). Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach. Aphasiology, 19(10-11), 1066-1073. 6.Fridriksson, J., Nettles, C., Davis, M., Morrow, L., & Montgomery, A. (2006). Functional communication and executive function in aphasia. Clinical Linguistics and Phonetics, 20(6), 401-410. 7.Purdy, M. (2002). Executive function ability in persons with aphasia. Aphasiology, 16(4-6), 549-557. 8.Stuss, D. (2011). Functions of the frontal lobes: relation to executive functions. Journal of the International Neuropsychological Society, 17, 759 – 765. 9.Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49-100. 10.Simic, T., Rochon, E., Greco, E., & Martino, R. (2017). Baseline executive control ability and its relationship to language therapy improvements in post-stroke aphasia: a systematic review. Neuropsychological Rehabilitation, DOI: 10.1080/09602011.2017.1307768 11.Leonard, C., Laird, L., Burianová, H., Graham, S., Grady, C., Simic, T., & Rochon, E. (2015). Behavioural and neural changes after a “choice” therapy for naming deficits in aphasia: Preliminary findings. Aphasiology, 29(4), 506-525. 12.Leonard, C., Rochon, E., & Laird, L. (2008). Treating naming impairments in aphasia: Findings from a phonological components analysis treatment. Aphasiology, 22(9), 923-947. 13.Stuss, D.T. & Alexander, M.P. (2007). Is there a dysexecutive syndrome? Philosophical Transactions of The Royal Society Biological Sciences, 362, 901 – 915. 14.Allen, C. M., Martin, R. C., & Martin, N. (2012). Relations between short-term memory deficits, semantic processing, and executive function. Aphasiology, 26(3–4), 428–461. Keywords: aphasia therapy, executive control, anomia treatment, stroke recovery, Cognitive rehabilitation Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster or oral Topic: Consider for student award Citation: Simic T, Laird L, Goldberg D, Bitan T, Chambers C, Turner G, Leonard C and Rochon E (2019). Executive control and its relationship to aphasia therapy outcomes. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00101 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 May 2017; Published Online: 25 Jan 2019. * Correspondence: Ms. Tijana Simic, University of Toronto, Speech-Language Pathology - Rehabilitation Sciences Institute, Toronto, Canada, simictij@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract Supplemental Data The Authors in Frontiers Tijana Simic Laura Laird Devora Goldberg Tali Bitan Craig Chambers Gary Turner Carol Leonard Elizabeth Rochon Google Tijana Simic Laura Laird Devora Goldberg Tali Bitan Craig Chambers Gary Turner Carol Leonard Elizabeth Rochon Google Scholar Tijana Simic Laura Laird Devora Goldberg Tali Bitan Craig Chambers Gary Turner Carol Leonard Elizabeth Rochon PubMed Tijana Simic Laura Laird Devora Goldberg Tali Bitan Craig Chambers Gary Turner Carol Leonard Elizabeth Rochon Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Purpose:This study aimed to evaluate the usability of delivering the Phonological Components Analysis treatment for anomia (Leonard, Rochon, & Laird, 2008) remotely via the Internet to individuals with chronic poststroke aphasia. A secondary aim was to probe the experiences and satisfaction of clinicians in administering treatment at a distance.Method:Six individuals with mild-moderate aphasia and 2 trained clinicians participated in this usability study. Participants and clinicians underwent approximately 6 hr of treatment under observation by an independent observer. The usability characteristics of effectiveness, efficiency, and satisfaction were assessed.Results:Individuals with aphasia used the Internet-based Phonological Components Analysis therapy successfully, demonstrating independence and very few errors in completing online tasks. Overall, participant satisfaction was high, despite occasional difficulties with technical aspects of the system. Clinicians found the application easy to use but raised concerns about the participant-clinician interaction, perceiving rapport-building and communicating to be more difficult online than face-to-face.Conclusions:It is important to consider usability and the clinician's perspective in developing telepractice applications in speech-language pathology. Future directions include assessing the efficacy of remote treatment and collecting a larger sample of clinician data.

Background: Anomia, difficulty producing words, is a pervasive symptom of many individuals with aphasia. We have developed a treatment for naming deficits—the Phonological Components Analysis (PCA) protocol—that has proven efficacious in improving word-finding abilities for individuals with post-stroke aphasia. Aims: The aim of this investigation is to present preliminary findings exploring the potential influence of choice—that is the active engagement of a participant in therapy—on our PCA treatment. Methods & Procedures: Five individuals with aphasia were treated in one of two conditions—Choice or No Choice. Potential changes in neural activation as a function of the treatment were also investigated. Two individuals (one from each condition) underwent functional MRI (fMRI) pre- and post-therapy. Outcomes & Results: All the individuals demonstrated a significant treatment effect immediately post-treatment and at a 4-week follow-up and four of the five participants at an 8-week follow-up. Three also demonstrated generalisation to untrained items. Unfortunately, no clear-cut patterns emerged to allow us to make claims about the influence of choice, per se, on the behavioural manifestations of improved naming. Interestingly, the participant from the Choice condition showed neural activation changes post-treatment in frontal and parietal regions that were not evident for the participant in the No Choice condition. Moreover, these changes were accompanied by a larger treatment effect for that individual and generalisation to a novel naming task. Conclusion: The efficacy of PCA treatment for naming deficits is further supported. In addition, the neuroimaging data suggest the possibility that active engagement of an individual in his/her therapy (in this case choosing phonological attributes of a target word) may exercise executive functions important for success in treating anomia. Also, continued exploration of task factors that may promote even better treatment effects using this protocol is warranted, as is continued investigation of the neural underpinnings associated with treatment effects.

Functional magnetic resonance imaging (fMRI) was used to investigate the neural processing characteristics associated with word retrieval abilities after a phonologically-based treatment for anomia in two stroke patients with aphasia. Neural activity associated with a phonological and a semantic task was compared before and after treatment with fMRI. In addition to the two patients who received treatment, two patients with aphasia who did not receive treatment and 10 healthy controls were also scanned twice. In the two patients who received treatment, both of whose naming improved after treatment, results showed that activation patterns changed after treatment on the semantic task in areas that would have been expected (e.g., left hemisphere frontal and temporal areas). For one control patient, there were no significant changes in brain activation at the second scan; a second control patient showed changes in brain activation at the second scan, on the semantic task, however, these changes were not accompanied with improved performance in naming. In addition, there appeared to be bilateral, or even more right than left hemisphere brain areas activated in this patient than in the treated patients. The healthy control group showed no changes in activation at the second scan. These findings are discussed with reference to the literature on the neural underpinnings of recovery after treatment for anomia in aphasia.

Background: Standardised language tests are the most commonly used assessment tool of aphasia by Speech-Language Pathologists (Katz et al., 2000), yet they are limited in their ability to provide information regarding a person's ability to communicate in daily life. Social validation is a less commonly used type of assessment, but one that may provide additional information regarding language and communication abilities, based on the perceptions of persons not directly involved in the treatment. Despite its potential, there remain questions regarding its optimal use. Aims: The goals of this study were to examine the usefulness of social validation in measuring communicative change after aphasia treatment, and to investigate the potential influence of rater characteristics on raters' perceptions. Methods Procedures: Narratives were elicited before and after naming treatment from 11 participants with aphasia: 7 participants were treated, 4 of whom improved and 3 of whom did not; 4 participants did not receive treatment. Three groups of 10 raters (speech-language pathologists, older and younger naive adults) evaluated the narratives, and their ratings of the pre- and post-treatment narratives were analysed for perceived improvement. Outcomes Results: Results indicated that all three groups of raters observed improvement in the two treated groups of participants with aphasia, but not in the untreated group of participants with aphasia. Conclusions: Raters' perceptions of narratives (i.e., social validation) provide a useful measure of change after aphasia treatment, which can easily be used to supplement objective language measures. Additionally, factors such as the rater's experience with aphasia or life experience do not appear to have an important influence on rater perceptions.