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OUTLINE

 1. Highlights
 2. Abstract
 3. Keywords
 4. 1. Introduction
 5. 2. Methods
 6. 3. Discussion
 7. Acknowledgments
 8. Appendix A. Supplementary material
 9. References

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CITED BY (65)




FIGURES (5)

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TABLES (4)

 1. Table 1
 2. Table 2
 3. Table 3
 4. Table 4




EXTRAS (1)

 1. Supplementary data 1




BRAIN AND LANGUAGE

Volume 127, Issue 2, November 2013, Pages 145-156



EXAMINING THE VALUE OF LEXICAL RETRIEVAL TREATMENT IN PRIMARY PROGRESSIVE
APHASIA: TWO POSITIVE CASES

Author links open overlay
panelM.L.HenryabK.RisingcA.T.DeMarcocB.L.MilleraM.L.Gorno-TempiniaP.M.Beesonc
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HIGHLIGHTS



•

Two individuals with progressive aphasia underwent a novel treatment for naming.

•

Participants had differing language profiles and levels of aphasia severity.

•

One participant with logopenic and one with semantic variant PPA participated.

•

Treatment was unique in its focus on training self-cueing strategies for naming.

•

Each individual benefited and showed maintenance and generalization of gains.




ABSTRACT

Individuals with primary progressive aphasia (PPA) suffer a gradual decline in
communication ability as a result of neurodegenerative disease. Language
treatment shows promise as a means of addressing these difficulties but much
remains to be learned with regard to the potential value of treatment across
variants and stages of the disorder. We present two cases, one with semantic
variant of PPA and the other with logopenic PPA, each of whom underwent
treatment that was unique in its focus on training self-cueing strategies to
engage residual language skills. Despite differing language profiles and levels
of aphasia severity, each individual benefited from treatment and showed
maintenance of gains as well as generalization to untrained lexical items. These
cases highlight the potential for treatment to capitalize on spared cognitive
and neural systems in individuals with PPA, improving current language function
as well as potentially preserving targeted skills in the face of disease
progression.

 * Previous article in issue
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KEYWORDS

Primary progressive aphasia
Rehabilitation
Treatment
Naming
Lexical retrieval
Logopenic variant
Semantic dementia
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CITED BY (65)


 * TYPES OF MOTOR SPEECH IMPAIRMENTS ASSOCIATED WITH NEUROLOGIC DISEASES
   
   2022, Handbook of Clinical Neurology
   Show abstract
   
   Speech disturbances are common consequences of acquired brain injury or
   neurodegenerative impairment. Although sudden difficulties with speech may
   signal acute pathologic conditions such as cerebrovascular accidents,
   determining the etiology of insidious disruptions in communication can be
   less straightforward. The identification of motor speech impairment,
   independent of difficulties with language, can be useful for diagnosis since
   there are subtle, albeit distinct, patterns of speech production impairments
   associated with different neurologic conditions. Furthermore, the
   identification of impairments specific to speech production can help
   elucidate the suspected pathologic mechanisms or even the neuroanatomic
   structures compromised. During a routine clinical evaluation, early warning
   signs of motor speech impairment may go undetected if a clinician is
   unaccustomed to examining motor speech or is unaware of its manifestations.
   Accordingly, this chapter provides clinicians with a concise yet thorough
   guide for the practical assessment and differential diagnosis of motor speech
   disorders (MSDs)—apraxia of speech and dysarthrias. This chapter is divided
   into neurologic conditions associated with disorders of speech
   planning/programming, execution, and articulatory control. The underlying
   mechanisms associated with these impairments are presented both from a
   clinical perspective as well as through a scientific discussion of recent
   research in the field on MSDs.


 * BEHAVIORAL INTERVENTIONS FOR PRIMARY PROGRESSIVE APHASIA
   
   2022, Handbook of Clinical Neurology
   Show abstract
   
   Primary progressive aphasia (PPA) is a neurodegenerative syndrome
   characterized by a gradual loss of communication ability. Due to the
   centrality of communication deficits, speech-language pathologists play a
   prominent role in the provision of care for individuals with PPA. In this
   chapter, we outline a person-centered approach to the management of PPA that
   aims to preserve independence for as long as possible while anticipating
   future decline in communication and other domains. A growing evidence base
   supports the utility of speech-language treatment approaches in PPA,
   including restitutive, compensatory, and communication partner-focused
   techniques. Restitutive interventions aim to rebuild lost communication
   skills, such as naming or fluent speech production. Compensatory approaches
   include training with high- and low-tech augmentative and alternative
   communication systems that provide complementary means of communication
   beyond speech. Communication partner interventions focus on education and
   strategy training in order to equip conversation partners as skilled
   communication facilitators. Throughout intervention, clinicians should aim to
   provide treatment that impacts functional communication and promotes social
   engagement. Given the documented benefits of speech-language intervention in
   PPA, we are optimistic that such treatment will become the standard of care
   and that additional research will continue to improve the quality and
   accessibility of behavioral interventions.


 * NONINVASIVE BRAIN STIMULATION TO AUGMENT LANGUAGE THERAPY FOR PRIMARY
   PROGRESSIVE APHASIA
   
   2022, Handbook of Clinical Neurology
   Show abstract
   
   Primary progressive aphasia (PPA) is a debilitating disorder characterized by
   the gradual loss of language functioning resulting from neurodegenerative
   diseases including frontotemporal lobar degeneration or Alzheimer's disease
   pathology. There is a dearth of research investigating language therapy in
   PPA. Unlike individuals with poststroke aphasia, language skills are expected
   to decline over time, so the goal of treatment is often to preserve existing
   language functioning. There has been an increasing interest in using
   non-invasive brain stimulation including transcranial magnetic stimulation
   (TMS) and transcranial direct current stimulation (tDCS) to augment
   traditional behavioral therapy in PPA. Research is promising and suggests
   neuromodulation can lead to generalization and maintenance of treatment
   effects for a longer period compared to behavioral therapy alone. Emerging
   research is also beginning to identify predictors of treatment response. Yet
   there is still much to learn regarding how neuromodulation factors (e.g.,
   type of stimulation, stimulation intensity), participant factors (e.g.,
   demographics, extent and location of atrophy), and treatment factors (e.g.,
   type of language therapy, and dosage) will interact to predict treatment
   response. We are moving toward a promising future where individuals with PPA
   will benefit from individualized therapy protocols pairing traditional
   language therapy with neuromodulation.


 * IS WORD LEARNING ENOUGH? IMPROVED VERB PHRASE PRODUCTION FOLLOWING CUEING OF
   VERBS AND NOUNS IN PRIMARY PROGRESSIVE APHASIA
   
   2021, Cortex
   Show abstract
   
   There is little evidence that, for people with aphasia, successful outcomes
   following lexical retrieval treatment generalise beyond single word retrieval
   to sentence production or daily communication. This study aimed to develop
   greater understanding of the mechanisms of generalisation. We employed a
   cueing task to simulate the effects of lexical retrieval treatment. A single
   noun or verb was provided and the effect on production of a corresponding
   verb phrase examined. Sixteen individuals with primary progressive aphasia
   (PPA) were asked to produce verb phrases to describe action pictures
   accompanied by i) a verb cue where a spoken and written verb was also
   presented with the picture; ii) a noun cue where a spoken and written noun
   was presented with the picture; iii) a no cue condition where only the
   picture was presented. Across the case series, both verb and noun cueing
   improved verb phrase production relative to no cue, with verb cueing being
   most effective. At the level of the single case, thirteen individuals showed
   significantly increased production of verb phrases with verb cueing, and
   seven individuals with noun cueing. In addition, seven individuals showed
   significantly greater benefit from verb cueing compared to noun cueing, and
   none showed the reverse. This suggests that improvements in verb phrase
   production may also be achievable following treatment-induced improvements in
   lexical retrieval. Greater benefit from verb cues than noun cues raises
   important theoretical issues regarding sentence construction and clinical
   issues around the most effective treatment techniques for people with
   aphasia.


 * COGNITIVE AND LANGUAGE PERFORMANCE PREDICTS EFFECTS OF SPELLING INTERVENTION
   AND TDCS IN PRIMARY PROGRESSIVE APHASIA
   
   2020, Cortex
   Show abstract
   
   Predictors of treatment effects allow individual tailoring of treatment
   characteristics, thereby saving resources and optimizing outcomes. Electrical
   stimulation coupled with language intervention has shown promising results in
   improving language performance in individuals with Primary Progressive
   Aphasia (PPA). The current study aimed to identify language and cognitive
   variables associated with response to therapy consisting of language
   intervention combined with transcranial direct current stimulation (tDCS).
   Forty individuals with PPA received written naming/spelling intervention
   combined with anodal tDCS or Sham, using a between-subjects, randomized
   design, with intervention delivered over a period of 3 weeks. Participants
   were assessed using a battery of neuropsychological tests before and after
   each phase. We measured letter accuracy during spelling of trained and
   untrained words, before, immediately after, 2 weeks, and 2 months after
   therapy. We used step-wise regression methods to identify variables amongst
   the neuropsychological measures and experimental factors that were
   significantly associated with therapy outcomes at each time-point. For
   trained words, improvement was related to pre-therapy scores, in RAVLT (5
   trials sum), pseudoword spelling, object naming, digit span backward, spatial
   span backward and years post symptom onset. Regarding generalization to
   untrained words, improvement in spelling was associated with pseudoword
   spelling, RAVLT proactive interference, RAVLT immediate recall.
   Generalization effects were larger under tDCS compared to Sham at the 2-month
   post training measurement. We conclude that, for trained words, patients who
   improve the most are those who retain for longer language skills such as
   sublexical spelling processes (phoneme-to-grapheme correspondences) and word
   retrieval, and other cognitive functions such as executive functions and
   working memory, and those who have a better learning capacity. Generalization
   to untrained words occurs through improvement in knowledge of
   phoneme-to-grapheme correspondences. Furthermore, tDCS enhances the
   generalizability and duration of therapy effects.


 * EFFECTIVENESS OF LANGUAGE TRAINING AND NON-INVASIVE BRAIN STIMULATION ON ORAL
   AND WRITTEN NAMING PERFORMANCE IN PRIMARY PROGRESSIVE APHASIA: A
   META-ANALYSIS AND SYSTEMATIC REVIEW
   
   2020, Neuroscience and Biobehavioral Reviews
   Citation Excerpt :
   
   Some treatment investigations have also included a pre-treatment vs.
   post-treatment qualitative error analyses, in order to investigate the
   qualitative effects of the specific language treatment applied (Beales et
   al., 2016; Dressel et al., 2010; Henry et al., 2013; Hoffman et al., 2015).
   In one such analysis, Henry et al. (2013) investigated treatment-induced
   changes in naming errors following a lexical retrieval treatment in two PPA
   patients (L/phvPPA and svPPA) reporting an increase of errors with correct
   semantic information in both participants. In particular, the authors found a
   decrease in the number of no response, in the number of circumlocutions with
   no meaningful semantic information and in the occurrence of phonological
   paraphasias/partial phonological information, along with an increase in
   response attempts with meaningful semantic information, and a decrease in the
   number of “I don’t know” responses in the participant with Lv/phvPPA, while
   responses including a single unit of correct semantic information increased
   in the patient with svPPA.
   
   Show abstract
   
   The aim of this systematic review and meta-analysis is to examine the
   efficacy of language training, alone or in combination with non-invasive
   brain stimulation techniques, designed to improve oral and written naming
   abilities in Primary Progressive Aphasia (PPA), and to investigate whether
   gains can be maintained over time and generalize to untrained items. An
   electronic database search was conducted up to 31st of May 2019. Forty-three
   articles on language training alone and seven articles on the combined
   treatment fitted the inclusion criteria for the systematic review. Results
   indicated that language training, alone or in combination with transcranial
   direct current stimulation (tDCS), improves oral naming accuracy for trained
   items in patients with PPA, with a long-term maintenance of the gain over
   time. Only language training combined with tDCS improves oral naming accuracy
   for untrained items. Considering written naming abilities, language training
   combined with tDCS improves performance for both trained and untrained items,
   immediately after training and at follow-up.

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Copyright © 2013 Elsevier Inc. All rights reserved.


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