Anomia. Word finding difficulty after stroke. Plan of talk. Prognosis

Transcription

1 Anomia Word finding difficulty after stroke Professor Sue Franklin University of Limerick A third of people who have had a stroke will have impaired communication = Aphasia The most common symptom is a problem finding the word you want to say = Anomia The severity of this problem can vary From no speech at all To a mild problem finding just the right word, similar to everyone s tip of the tongue experiences Most people with anomia will have other aphasic symptoms too. Plan of talk Prognosis for naming ability Different types of naming impairment Examples of therapy for naming impairments Does therapy work? Conclusions Nb I am going to talk about picture naming this predicts how well the person with aphasia will name in there everyday speech Prognosis Very little information on prognosis in aphasia Swinburne, Porter and Howard (2004) developed a battery of tests, the Comprehensive Aphasia Test. They tested 55 people at 1 month, 3 months, 6 months and 12 months post stroke They grouped them at month one depending on whether naming was mild moderate or severe: 1

2 Progress from 1-12 months post onset Cognitive effects? People who at one month are better at memory (= semantic memory + recognition memory) do better at twelve months Effect of memory deficit Naming in fluent aphasia: Well this is mother is away here working her work out o here to get her better but when she s looking, the two boys looking in the other part. One their small tile into her time here. She s working another time because she s getting too. So the two boys work together and one is sneaking around here making his work and his further funnas his time he had Naming in non-fluent aphasia: Cookie jar fall over. Chair water empty ov ov [overflow?] yeah 2

3 Types of anomia a simple model Types of anomia: 1. Lexical meanings words Speech sounds speech semantic lexical phonological Corresponds most closely to our own experience of word finding lapse (but much more severe) PWA knows the meaning of the word they want to say but just can t recall the actual word. Not a problem with indentifying word sounds, because can repeat the words easily. Example of lexical anomia: Linda (Kay & Franklin 1995) Linda had good functional comprehension, although she had difficulty reading magazines. She was non-fluent, tending to use short, simple sentences. She tended to come to a stop before main words, but was helped by being given the first sound of the word. Linda was able to understand words: ADA synonym judgments Patient hears two words and has to decide whether they have the same meaning eg: realm-kingdom gift-donation Correct: 148/160 (normal control range ) Linda was able to repeat words she couldn t name: Hirsh naming screener Picture naming 38/48 Repetition 48/48 Difficulty = infrequent words Linda: 100 picture naming test (Howard and Franklin, 1989) (A fairly easy test of 100 everyday pictures.) 78/100 correct Errors Self-corrected: egg -> hen, egg mermaid -> woman s body, mermaid pig -> cow, pig stool -> I got one in there, stool tent -> outside, tent 3

4 Incorrect arch cotton crook globe hoof hose lamp mayor pepper pyramid rabbit Linda cont: -> ancient, it s very old and it s -> spool -> outside and it s a sheep farmer and it s -> world -> foot, horse s foot -> thing on the top, I got one in my shed -> lampshade -> it s a man and it s quite high up -> vegetable it s green -> in the desert and my husband knows it. -> it s outside and my son has it Types of anomia: 2. Phonological anomia (aka conduction aphasia) PWA has the word they want to say but the wrong sounds are selected (this is different from apraxia where the motor patterns are impaired). Repetition does not help because the speech sounds will still get mixed up. Errors will be producing the wrong sound. Long words will be especially difficult. Phonological Anomia: Caplan, Vanier & Baker (1986) 55 year-old carpenter Perfect comprehension of single words Naming errors Confiture -> /konfre komfi kofe/* Parapluie -> /pæræti/ Telescope -> /telele telestop telescop* Oral reading = repetition = naming Effect of word length in all modalities *example of conduite d approche Types of anomia: 3. Semantic anomia PWA unable to get exact meaning of the word Affects understanding as well as speaking Errors will be related in meaning or no response Will often not know whether they have said correct word or not May affect specific categories of words Eg abstract words, verbs rather than nouns 4

5 Example semantic patient: Howard & Orchard-Lisle (1984) JCU,43 year-old barmaid Spontaneous speech limited to cor blimey, flipping heck, sod it, I understand Naming (WAB) 3/20, 11 more with phonemic cue Impaired auditory comprehension Cued picture naming Correct Semantic error Correct cue 50 7 Miscue 1 32 So if given a picture of a lion and /l/ said lion if given a picture of a lion and /t/ said tiger Inconsistency Whatever the impairment, an important and very difficult feature of anomia is that it is INCONSISTENT. That is, a pwa will be able to say a word one minute and not the next. Therapy for anomia: Lexical anomia Most common type of therapy is facilitation therapy * Some activity is used to prime the word eg: Giving first sound Asking a question about the meaning of the word Pointing to the picture corresponding to the word from a choice of pictures Giving first letter All these tasks increase the liklihood of saying the word on a later occasion (effect has been shown to last at least one year following therapy) *(Howard, Patterson, Franklin, Orchard-Lisle & Morton, 1985) Therapy for anomia: Lexical anomia For those with a lexical anomia, facilitation therapy only works for the words worked on, with no generalisation to untreated words So words chosen for therapy should be functionally useful (Hicken, 1997) There are some therapies which will work for some patients, which do seem to have (modest) generalisation: 5

6 Circumlocution-induced naming (CIN) (Francis, Clark & Humphreys, 2002) Therapy A picture was presented for naming. If MB unable to name, she was required to talk around the topic. Th What is this called? MB Oh I can never get this one Th Tell me about it MB It s you know like you d put it on the wall Th And why would you want to do that? MB Because like you re proud Th What are you proud of? MB Well, like if you ve won something Th That s right. So what is it? MB I don t know Th You ve told me you d hang it on the wall, if you d achieve something just imagine now, you ve done something you re proud of what could you hang on the wall? MB A certificate Does therapy for anomia work? 1. A group study (Howard, Franklin, Morris, Webster & Whitworth, in preparation)* A treatment trial where we compared intensive therapy for 3 months with the same patients having normal therapy (mean 5 sessions total) for three months. 68 people with aphasia 3 days per week treatment group & individual treatment all aspects of aphasia were treated * Funded by Tavistock Trust for Aphasia Group study: outcomes Cat naming: time post-onset Total score Naming 6

7 Does therapy for anomia work? 2. A single case study Although group studies are the accepted form of treatment efficacy study, we find them problematic. To treat a large enough group of pwa, use a heterogenous group and different treatment techniques. In order to look at what treatment works for what aphasic impairments we use single cases, where pwa is their own control Phonological anomia self-monitoring therapy (Franklin, Buerk & Howard (2002) MB was an 83 year old woman who had had a stroke 2 years previously. She had good comprehension of speech, but her own speech was full of nonsense words and phonologically distorted words eg GRAVE -> /gleif/ and conduite d approche Treatment consisted of Phase 1 auditory training (7 sessions) Phase 2 monitoring for sound errors in naming(14 sessions) Design and results of therapy study for MB Two baseline measures were taken for naming before therapy (Nickels Naming Test) Naming was measured once after therapy and then three months later. A written sentence comprehension test (TROG) was used as a control task. Generalisation to other words and tasks This graph demonstrates improvement across a range of tasks, using the Nickels set. Does improvement generalise to other items? Non word reading, phonemes correct: Pre therapy 54% Post therapy 67% Cinderella story, real words: Pre therapy 231 Post therapy 311 7

8 Conclusion Prognosis is determined by initial severity Different types of deficit underly naming problems in aphasia Therapy works, if targeted to the underlying deficit and if sufficiently intensive Therapy can be effective at any time poststroke good rehabilitation is likely to require intervention over a long time period 8