A MetaAnalysis of WordFinding Therapies

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A Meta-Analysis of Word-Finding Therapies Bruce
Wisenburn, Ph.D, Department of Speech Pathology
Audiology SUNY Fredonia 2007 Annual
Convention of the American-Speech-Language-Hearing
Association, Boston, MA
NOTE This poster has been corrected from the
original presentation at ASHA. Upon further
review, the study by Seron et al. (1979) was
eliminated as the therapy description was vague.
Categorization of therapies has been adjusted
slightly. Small changes in effect sizes were seen
from the original findings. The only change to
the conclusion is that mixed therapy was slightly
more effective for trained sets than phonological
therapy. I have included the complete therapy
list with codings, which was not shown at ASHA.
Please contact me at bruce.wisenburn_at_fredonia.edu
for questions/comments.
Introduction A meta-analysis is an objective
method of synthesizing primary research
experiments to answer basic research questions
(Robey Dalebout, 1998). The question of
effectiveness for aphasia therapy has been
evaluated in previous meta-analyses (Berndt,
Mitchum Haendiges, 1996 Robey, 1998). These
meta-analyses have focused on therapy for a wide
range of communication disorders due to aphasia,
such as agrammatism, comprehension deficits, and
simple verbal production deficits. The
specific question for this study is the
therapeutic effectiveness for word-finding
deficits due to aphasia. Although numerous
literature reviews exist (e.g., Nickels, 2002
Nickels Best, 1996a Nickels Best, 1996b
Raymer, 2005), no systematic meta-analysis
specifically for word-finding deficits has been
published. This study focuses specifically on
research related to the effectiveness of therapy
for word-finding deficits. Method For this
study, research studies were gathered that
related to the efficacy of aphasia therapy. The
search for these studies included the use of
numerous search engines (such as Pub Med,
PsychInfo, Psych Articles, and Ebsco-Host). From
the hundreds of studies found, 26 studies were
deemed appropriate for this project. The analyzed
studies are marked in the reference list. Some
single studies had numerous effect sizes,
depending on different therapy or word sets. A
common formula for calculating effect size (d)
(Glass, McGaw Smith, 1981) was used in this
study d (Mpost tx Mpre tx) / SDpost tx
An unbiased effect size was calculated to
account for research studies with small sample
sizes (Hedges and Olkin, 1985, pp
302-304) Unbiased d (1 (3/((4total n)
9))) d
Follow-up measures Some studies used follow-up
tests at approximately one, two, or three months
post-therapy Time post-tx unbiased d SD effect
sizes studies Immediate post 1.01 1.22 57 25 1
month post 3.89 1.25 3 1 2 months
post 1.07 0.72 10 3 3 months post 0.48 0.33 4 3
Aphasia type and severity A few studies
looked at therapy for fluent or nonfluent
aphasias, and for mild or moderate
cases Aphasia type unbiased d SD effect
sizes studies Fluent 1.13 1.37 3 3 Nonfluent 1.
19 0.78 20 4 Severity unbiased d SD effect
sizes studies Mild 2.43 0.86 2 1 Moderate 1.49
1.65 24 6 Months post-onset, median The
median amounts of time post onset (measured in
months) were compared Months PO unbiased
d SD effect sizes studies 12 0.23 0.32 7 3 13-18 1.50 1.13 14 4 19-24 3.07
2.00 8 3 25-36 1.41 1.28 4 2 37-48 0.74 0.67 9
3 49 0.60 0.57 17 5
Treatment type within unseen, unrelated word
sets The effect size for therapy types within
unseen, unrelated word sets was also
investigated Treatment unbiased d SD effect
sizes studies No therapy 0.05 0.00 1
1 Semantic 0.52 0.81 11 7 Phonological 0.25 0.38
4 4 Functional 0.40 0.18 2 1 Mixed 0.16 0.20 6 4
Conclusion The results of this meta-analysis
suggest that word-finding therapy is effective.
Mixed and phonological-based treatment methods
appear to be the most successful for trained
sets, while semantic therapy offers the best
chance of generalization to untrained words.
Although these gains diminished to some extent by
three months, some lasting effects could be seen.
Another important finding is that studies showed
that substantial gains could be made even after a
considerable time post-injury, and for both
fluent and nonfluent aphasia. Acknowledgements
The author would like to thank Dr. Kate Mahoney
for her statistical consultation throughout this
research. I would also like to thank the diligent
work of student members of the Evidence-Based
Practice Project to support this research.
Members include Jessica Brocki, Justin Carr,
Katie Catania, Jennifer Dechert, Elizabeth Derx,
Shannon DeSantis, Erin Fenar, Rachel Garguilo,
Amy Gibson, Cody Goodwin, Sarah Hunt, Keri
Jakubowski, Helen Johnson, Lindsay Johnson,
Melissa Kron, Melanie Lescynski, Meaghan Linehan,
Delaney Lowery, Elizabeth Murphy, Shannon
OLeary, Laurie Pollinger, Pam Prentice, Amy
Pugh, Jennifer Rosney, Lindsey Taylor, Kim
Uminski, Elizabeth Wilger, Sarah Williams,
Lindsay Zoldos, Alycia Zwahlen, and Christie
Zyhowski. References References marked with
an asterisk indicate studies included in the
meta-analysis. Bastiaanse, R., Hurkmans, J.,
Links, P. (2006). The training of verb production
in Brocas Aphasia A multiple-baseline
across-behaviours study. Aphasiology, 20.
298311. Beeson, P. Egnor, H. (2006).
Combining treatment for written and spoken
naming. Journal of International
Neuropsychological Society, 12, 816-827. Berndt,
R.S., Mitchum, C.C., Haendiges, A.N. (1996).
Comprehension of reversible sentences in
agrammatism a meta-analysis. Cognition, 58,
289308. Deloche, G., Dordain, M., Kremin, H.
(1993). Rehabilitation of confrontation naming in
aphasia Relations between oral and written
modalities. Aphasiology, 7, 201-216. Doesborgh,
S., Van de Sandt-Koudstaal, M., Dippel, D.,
Harskamp, F., Koudstaal, P., Visch-Brink, E.
(2004). Cues on request the efficacy of
Multicue, a computer program for wordfinding.
Aphasiology, 18(3), 213--222. Drew, R. L.
Thompson, C. K. (1999). Model-based semantic
treatment for naming deficits in aphasia. Journal
of Speech, Language, and Hearing Research, 42,
972--989. Edwards, S. and Tucker, K. (2006) Verb
retrieval in fluent aphasia A clinical study.
Aphasiology, 20, 644--657 Fink, R. B., Schwartz,
M. F., Sobel, P.R., Myers, J. (1997). Effects
of Multilevel Training on verb Retrieval Is more
always better? Brain and Language,
41. Fridriksson, J., Morrow-Odom, L., Moser, D.,
Fridriksson, A., Baylis, G. (2006). Neural
recruitment associated with anomia treatment in
aphasia. NeuroImage, 32, 14031412. Glass, G.,
McGaw, B., Smith, M.L. (1981). Meta-analysis in
social research. Beverly Hills, CA Sage. Hedges,
L., Olkin, I. (1985). Statistical methods for
meta-analysis. Orlando, FL Academic Press.
Helm-Estabrooks, Emery, P., Albert, M.
(1987). Treatment of Aphasic Perseveration (TAP)
program A new approach to Aphasia therapy.
Archives of Neurology, 44, 12531255. Herbert,
R., Best, W., Hickin, J., Howard, D., Osborne,
F. (2003). Combining lexical and interactional
approaches to therapy for word finding deficits
in aphasia. Aphasiology, 17, 11631186. Hickin,
J., Best, W., Herbert, R., Howard, D., Osborne,
F. (2002). Phonological therapy for word-finding
difficulties A re-evaluation. Aphasiology, 16,
981-999. Hinckley, J. J. Carr, T. (2005).
Comparing the outcomes of intensive and
non-intensive context-based aphasia treatment.
Aphasiology, 19. 965974. Hinckley, J. J.
Craig, H. K. (1998). Influence of rate of
treatment on the naming abilities of adults with
chronic aphasia. Aphasiology, 12,
989-1006. Kiran, S., Thompson, C. K. (2003).
The role of semantic complexity in treatment of
naming deficits Training semantic categories in
fluent aphasia by controlling exemplar
typicality. Journal of Speech, Language,
Hearing Research, 46, 773-787. Laganaro,
M., Di Pietro, M., Schnider, A. (2003).
Computerised treatment of anomia in chronic and
acute aphasia An exploratory study. Aphasiology,
17, 709721. Mackenzie, C. (1991). An aphasia
group intensive efficacy study. British Journal
of Disorders of Communication, 26,
275291. Miceli, G., Amitrano, A., Capasso, T.,
Caramazza, A. (1996). The treatment of anomia
resulting from output lexical damage Analysis of
two cases. Brain and Language, 52,
150--174. Nadeau, S. Kendall, D. (2006).
Significance and possible mechanisms underlying
generalization in aphasia therapy Semantic
treatment of anomia. Brain and Language, 99.
1213. Nettleton, J., Lesser, R. (1991).
Therapy for naming difficulties in aphasia
application of a cognitive neuropsychological
model. Journal of Neurolinguistics, 6,
139-157. Nickels, L. (2002). Therapy for naming
disorders Revisiting, revising and reviewing.
Aphasiology, 16, 935979. Nickels, L., Best,
W. (1996a). Therapy for naming deficits (part 1)
Principles, puzzles and progress. Aphasiology,
10, 2147. Nickels, L., Best, W. (1996b).
Therapy for naming deficits (part 1) Specifics,
surprises and suggestions. Aphasiology, 10,
109136. Pring, T., Hamilton, A., Macbride, L.
(1993). Generalization of naming after
picture/word matching tasks Only items appearing
in therapy benefit. Aphasiology, 7,
383-394. Raymer, A. (2005). Naming and
word-retrieval problems. In L.L. LaPointe (ed),
Aphasia and related language disorders, 3rd ed.
New York Thieme. Raymer, A. M., Thompson, C.
K., Jacobs, B. Le Grand, H. R. (1993).
Phonological treatment of naming deficits in
aphasia model based generalization analysis.
Aphasiology, 7, 27-53. Raymer, A. M. Kohen, F.
(2006). Word retrieval treatment in
aphasiaeffects of sentence context. Journal of
Rehabilitation Research Development, 43.
367378. Raymer, A. M., Kohen, F., Saffell,
D. (2006). Computerised training for impairments
of word comprehension and retrieval in aphasia.
Aphasiology, 20, 257268. Robey, R. (1998). A
Meta-Analysis of Clinical Outcomes in the
Treatment of Aphasia. Journal of Speech-Language
Hearing Research, 41, 172187. Robey, R.,
Dalebout, S. (1998). A Tutorial on Conducting
Meta-Analyses of Clinical Outcome Research.
Journal of Speech-Language Hearing Research, 41,
12271241. Rodriguez, A., Raymer, A., Gonzalez
Rothi, L. (2006). Effects of gestureverbal and
semantic-phonologic treatments for verb retrieval
in aphasia. Aphasiology, 20. 286297. Rudner, L,
Glass, G., Evartt, D, Emery, P. (2002).
Meta-Stat (Version 1.5) Computer software.
College Park, MD ERIC Clearinghouse on
Assessment and Evaluation. Seron, X., Deloche,
G., Bastard, V., Chassin, G., Hermand N.
(1979). Word-finding difficulties and learning
transfer in aphasic patients. Cortex, 15,
149155. Van Mourik, M., Van De
Sandt-Koenderman, W.M.E. (1992). Multicue.
Aphasiology, 6. 179183.
A computer program, Meta-Stat (Rudner, Glass,
Evartt Emery, 2002), allowed for the effect
size to be calculated from means and standard
deviations, t scores and F distributions. Five
moderator variables were evaluated for this
study type of therapy, word set, amount of time
for follow-up, type of aphasia, severity of
aphasia, and time post onset. Results The
weighted effect sizes from these studies ranged
from -3.86 to 48.80. Eight studies that contained
an effect size above 6.0 were considered outliers
and were not analyzed further. A total of 26
studies were analyzed that contained 77 effect
sizes. The mean effect size for word-finding
therapy was 1.19 (SD 1.24). Type of
therapy Therapy was divided into four basic
types semantic, phonologic, functional, and
mixed Treatment unbiased d SD effect
sizes studies No therapy 0.16 0.16 2 2 Semantic 0
.65 1.11 18 8 Phonological 1.43 0.94 17 6 Function
al 0.95 0.60 10 2 Mixed 1.52 1.55 27 10 Word
set The pre-post measurement methods included
trained sets seen and phonologically or
semantically related sets that were exposed
throughout therapy seen and unrelated sets that
were tested repeatedly throughout therapy, but
were never trained and unseen and unrelated sets
that were only used as pre and post-therapy
measures Word set unbiased d SD effect
sizes studies Trained set 1.74 1.42 36 13 Seen/re
lated 1.37 0.27 5 2 Seen/unrelated 1.00 1.09 9 4 U
nseen/unrelated 0.36 0.59 24 16
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• Definitions
• Tx
• 0 no therapy
• semantic therapy
• phonological therapy
• functional therapy
• mixed therapy
• Set
• Trained
• seen, semantically or phonologically related
• seen, unrelated
• unseen, except for baseline and post testing
• Follow-up
• 0 measured immediately at post-tx
• 1 month post tx
• 2 months post tx
• 3 months post tx
• 4 months post tx
• Aphasia type