Naming facilitation therapy: How many words can be treated this way?

Background: Anomia, a word-finding deficit, is the most common reported feature of aphasia and can result in deprived communication which may impact social relationships, well-being and quality of life (Kagan 1998). Facilitation therapy is one a strategy which has been demonstrated to help patients retrieve difficult to access information by strengthening the link between the semantic representations (i.e. meanings) and phonological representations (i.e. sounds) (Edmunson and McIntosh 1995; Nickels 2002a). There is a distinct lack of research into how many words can be treated however, and with an average of only 47 words being typically treated (Snell et al 2010).Emerging evidence has suggested that larger set sizes may be tolerated (Kelly and Franklin 2012). This is an exciting prospect given the limited functional gains a small set size offers. If larger sets of words can be treated this would suggest greater opportunity to improve quality of life and increase social participation for people suffering from this restrictive symptom of aphasia. Aims: The purpose of this study was to investigate if the treatment of a large set of words can still result in significant improvements in word-finding abilities. Specifically, the following questions were posed: (1) Can the treatment of a large set of 500 items, through naming facilitation therapy, still result in a significant improvement in naming accuracy? (2) Is the facilitation effect through a priming mechanism, restoring the connection between meaning and word, or is it a case of re-learning? Methods: This paper describes a case series of five participants with anomia. All participants were initially assessed to determine if their language and communication impairments and cognitive status met the criteria required to participate in the treatment phase of the study. Participant’s received twice-weekly therapy sessions for five consecutive weeks in their own home. 100 items were treated per week. Participants were told the name in the presence of a picture which they had to then repeat. Each item received a total of four repetitions. Treated and untreated sets were retested after the five-week block of therapy. This paper will report on the group results and the results of two participants, POD and JMCC. Results: Group and case level analysis revealed gains in naming abilities. At group level, raw scores revealed gains in naming accuracy on treated items. No statistically significant difference was found however between the gains made in treated and control sets. On an individual case level, both POD and JMCC made statistically significant improvements on their treated items, with no significant improvements on control items. No statistically significant differences in improvements between sets were found which indicated that there was no recency or primacy effect in the results. Conclusions: This study suggests that people with aphasia can tolerate large set sizes. The study also indicates that improvements were item-specific with no generalization to untreated words. It also established that there was no primacy or recency effect. This would indicate that the facilitation effect is a priming mechanism and would suggest that there is no obvious upper limit to the number of words that can be improved since it is not a method of re-learning.