How can recovery from acquired language impairment be maximized? This question is central to the focus of every clinician and clinical researcher working with adults with aphasia, alexia, and agraphia. Nearly six decades of treatment research has yielded evidence supporting the efficacy of a wide range of language rehabilitation approaches. Unfortunately, the research efforts have been directed toward treatment approaches in isolation, and few, if any, researchers have considered the full scope and sequence of treatments necessary to maximize language recovery. In our current research, we tackled this issue with respect to the treatment of acquired agraphia, yielding evidence to support a treatment continuum for single-word writing. In the current proposal, we aim to build on the re-trained skills to maximize lexical retrieval in the spoken language modality, and to extend the treatment sequence to text-level reading and written composition. Our approach is novel in its focus on the interactive contribution of semantic, phonological, and orthographic processes. This perspective stems from evidence that literate adults have strongly established links among these three central language components, and the promotion of interactive processing of residual (and re-trained) skills in each domain can advance performance at multiple levels within the language system (sublexical, lexical, and sentence). We will examine a hierarchically structured treatment continuum where gaining mastery at a given level provides the scaffolding for advancing to the next level. A decision tree is proposed to guide the sequence for each individual in an algorithmic fashion. Using a case series approach, we propose to implement treatment with 50 individuals who reflect a diverse range of severity levels and behavioral and lesion profiles. Individual responses to treatment will be evaluated relative to performance on a comprehensive assessment of language before and after critical phases of treatment, allowing us to test the proposed algorithm. Language behavior and treatment outcomes will also be considered relative to the location and extent of brain damage affecting critical cortical networks. This work will advance the understanding of sequential treatment outcomes, and will serve to establish guidelines regarding treatment candidacy across the continuum. Ultimately, this study has the potential to change the way that clinicians plan treatment: shifting from the administration of isolated treatments to a planned sequence of interventions to maximize language recovery.

Public Health Relevance

More than 1 million Americans have persistent acquired language impairment due to brain damage. The rehabilitation of spoken and written language impairments is a high priority for affected individuals, and the quality and efficiency of treatment approaches are critical issues for patients, family members, speech-language pathologists, and third-party payers. The research proposed here has the potential to significantly impact the planning and implementation of behavioral treatment in a manner that maximizes recovery of function.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Cooper, Judith
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University of Arizona
Schools of Arts and Sciences
United States
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DeMarco, Andrew T; Wilson, Stephen M; Rising, Kindle et al. (2018) The neural substrates of improved phonological processing following successful treatment in a case of phonological alexia and agraphia. Neurocase 24:31-40
Beeson, Pélagie M; Rising, Kindle; DeMarco, Andrew T et al. (2018) The nature and treatment of phonological text agraphia. Neuropsychol Rehabil 28:568-588
DeMarco, Andrew T; Wilson, Stephen M; Rising, Kindle et al. (2017) Neural substrates of sublexical processing for spelling. Brain Lang 164:118-128
Henry, Maya L; Wilson, Stephen M; Babiak, Miranda C et al. (2016) Phonological Processing in Primary Progressive Aphasia. J Cogn Neurosci 28:210-22
Patterson, Dianne K; Van Petten, Cyma; Beeson, Pélagie M et al. (2014) Bidirectional iterative parcellation of diffusion weighted imaging data: separating cortical regions connected by the arcuate fasciculus and extreme capsule. Neuroimage 102 Pt 2:704-16
Roberts, Daniel J; Woollams, Anna M; Kim, Esther et al. (2013) Efficient visual object and word recognition relies on high spatial frequency coding in the left posterior fusiform gyrus: evidence from a case-series of patients with ventral occipito-temporal cortex damage. Cereb Cortex 23:2568-80
Beeson, Pélagie M; Higginson, Kristina; Rising, Kindle (2013) Writing treatment for aphasia: a texting approach. J Speech Lang Hear Res 56:945-55
Meinzer, Marcus; Beeson, Pélagie M; Cappa, Stefano et al. (2013) Neuroimaging in aphasia treatment research: consensus and practical guidelines for data analysis. Neuroimage 73:215-24
Wilson, Stephen M; Rising, Kindle; Stib, Matthew T et al. (2013) Dysfunctional visual word form processing in progressive alexia. Brain 136:1260-73
Henry, M L; Rising, K; DeMarco, A T et al. (2013) Examining the value of lexical retrieval treatment in primary progressive aphasia: two positive cases. Brain Lang 127:145-56

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