The aim of this research is to translate a theory of the cognitive relationship between verbal short-term memory (STM) and word processing impairments in aphasia to treatment approaches for language impairment in aphasia. Aphasia is typically viewed as a language disorder and yet it is invariably accompanied by a reduction in verbal STM capacity. Based on our research of word processing and verbal STM impairments in aphasia, we have proposed that the co-occurrence of these impairments is due to a disruption of cognitive processes that support both abilities: maintenance of activated semantic and phonological representations of words, hereafter the 'activation-maintenance hypothesis' (Martin and Saffran, 1997~ Martin, 2008). We will test this hypothesis in the context of a treatment approach that aims to improve word processing and verbal STM abilities. Recently, the importance of treatment research as a critical testing ground for theories of language processing has been emphasized (Nickels et al., 2010). Although we have demonstrated associations between impairments of word processing and reduced verbal STM capacity, the activation-maintenance hypothesis presumes a causal association between maintenance of activated semantic and phonological representations and the integrity of both word processing and verbal STM. Direct treatment to improve the ability to maintain activation of word representations will serve as a stronger test of this hypothesis. First, we will establish empirical support for the hypothesis that impairment to short-term maintenance of activated semantic and phonological representations of words impairs language and verbal STM abilities in aphasia and that direct treatment of this deficit will improve both abilities (Specific Aim 1). This support will be obtaind in a short-term facilitation study and two treatment studies that use repetition of verbal stimuli under conditions that increase memory load. We also predict that increasing memory load in language training tasks will improve performance on the training task (repetition) as well as other language tasks that share processing pathways with repetition. Second, we will compare effects of this treatment under two administration conditions, high and low intensity (Specific aim 2). Recent evidence suggests that language treatments are more effective when administered on more intense schedules (Bhogal et al., 2003), but more evidence is needed from studies that directly compare high and low intensity schedules of treatment. Finally, we will investigate neural regions associated with semantic STM and phonological STM using voxel-based lesion- symptom mapping (Bates et al., 2003) (Specific Aim 3). Following recent functional MRI studies (e.g., Shivde and Thompson-Schill, 2004), we predict that reduced semantic STM will be associated with inferior frontal parietal lesions and reduced phonological STM with lesions in the left superior parietal region. This project represents a unique attempt to apply more recent processing theories of aphasia to treatment of the disorder. The outcomes will have important implications for aphasia rehabilitation research.

Public Health Relevance

Approximately one million people in the United States have aphasia, a language impairment most often resulting from a stroke (National Aphasia Association, www.aphasia.org). Recent research has demonstrated that impairments to other cognitive abilities such as verbal short-term memory nearly always accompany the language impairment in aphasia. This indicates a need to develop treatment approaches that target both language and nonlinguistic cognitive abilities that support language function.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Research Project (R01)
Project #
5R01DC013196-05
Application #
9429083
Study Section
Language and Communication Study Section (LCOM)
Program Officer
Cooper, Judith
Project Start
2014-03-20
Project End
2019-02-28
Budget Start
2018-03-01
Budget End
2019-02-28
Support Year
5
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Temple University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
057123192
City
Philadelphia
State
PA
Country
United States
Zip Code
19122
McCarthy, Laura Mary; Kalinyak-Fliszar, Michelene; Kohen, Francine et al. (2017) Effects of semantic context on access to words of low imageability in deep-phonological dysphasia: a treatment case study. Aphasiology 31:542-562
Minkina, Irene; Rosenberg, Samantha; Kalinyak-Fliszar, Michelene et al. (2017) Short-Term Memory and Aphasia: From Theory to Treatment. Semin Speech Lang 38:17-28
Peñaloza, Claudia; Mirman, Daniel; Cardona, Pedro et al. (2017) Cross-situational word learning in aphasia. Cortex 93:12-27
Peñaloza, Claudia; Mirman, Daniel; Tuomiranta, Leena et al. (2016) Novel word acquisition in aphasia: Facing the word-referent ambiguity of natural language learning contexts. Cortex 79:14-31
Martin, Nadine; Kalinyak-Fliszar, Michelene (2015) The case for single-case studies in treatment research-comments on Howard, Best and Nickels ""Optimising the design of intervention studies: critiques and ways forward"". Aphasiology 29:570-574
Peñaloza, Claudia; Benetello, Annalisa; Tuomiranta, Leena et al. (2015) Speech segmentation in aphasia. Aphasiology 29:724-743
Kalinyak-Fliszar, Michelene; Martin, Nadine; Keshner, Emily et al. (2015) Using Virtual Technology to Promote Functional Communication in Aphasia: Preliminary Evidence From Interactive Dialogues With Human and Virtual Clinicians. Am J Speech Lang Pathol 24:S974-89