The purpose of this Merit Review proposal is to continue Phase II development of a phonologic (e.g. sound) based treatment program for word retrieval deficits in aphasia. The most common feature of aphasia is impairment in ability to name objects. The traditional treatment approach to this problem is to train aphasic patients by showing them pictures of objects and asking them to say or repeat the name of that object several times. Controlled studies have shown that this approach may be effective, however generalization is typically limited to just the words trained. The mechanisms underlying generalization are not well understood. Because generalization is so limited with "naming therapies", there currently exists no viable means of training patients on the full corpus of words (perhaps several thousand) they are likely to need in daily life. Two approaches might be taken to solving this problem: (1) develop cost effective means for providing training on several thousand words;and (2) develop alternative training methods, e.g., phonological therapy, that could potentially generalize widely. This systematic line of research focuses on the latter. A Phase I pilot study funded by VA RR&D (PI: Kendall) showed that by applying treatment to the level of the phonologic system (e.g. sounds), reading and spoken word production improved in individuals with aphasia (Kendall et al, 2003). Phase II work (VA RR&D PI: Kendall) extended the Phase I research by 1) comparing the experimental phonologic treatment to a control treatment and 2) refining the experimental treatment in terms of a homogeneous patient population and increasing the frequency and intensity of treatment. Results showed significant treatment and generalization effects in the phonologic treatment group were superior to the semantic group (Kendall et al, 2008). While only preliminary, these results warrant the need for a larger investigation of this approach to the rehabilitation of aphasia. Thus, the purpose of this proposal is to continue Phase II development of a phonologic based treatment program for word retrieval deficits in aphasia. This project involves a longitudinal study to assess treatment and maintenance effects in 30 subjects with left hemisphere lesions and aphasia associated with impaired word retrieval with the goal of completing therapy and 3-month follow-up.
The VA currently cares for approximately 15,000 new stroke cases each year with related VA costs estimated at one billion dollars annually (Department of Veterans Affairs, 1999). One third of these strokes are associated with aphasia. The World Health Organization has deemed stroke a worldwide health problem based upon its high prevalence, associated disability, and the burden it places on the individual, community and society (Janca et al, 2000). The treatment of aphasia is currently unsatisfactory. This proposal seeks to further develop an aphasia treatment that has high potential for improving the daily communicative lives of stroke patients.