Treatment of word retrieval disorders (anomia) in aphasia

1. Is errorless learning a useful concept in the treatment of word retrieval disorders?Lyndsey Nickels, Kate Makin, Belinda McDonaldMelanie Moses & Christine TaylorSpeech Pathology Service, Royal Rehabilitation Centre Sydney & Macquarie Centre for Cognitive Science

2. Treatment of word retrieval disorders (anomia) in aphasia • Word retrieval disorders can be successfully treated. • But no single treatment is successful for every individual. • Do not yet understand the circumstances under which treatments work (who, what, when, why and how) • Our research aims to investigate these issues

3. Errorless learning Hypothesis • Remediation is more effective if errors are prevented - the act of producing an error may strengthen the incorrect association, and make the correct response less likely to occur. • Technique widely & successfully used with people with acquired memory impairments (amnesia) • E.g. Baddeley & Wilson, 1994

4. Errorless learning and anomia treatment • Fillingham et al (2003) “error reducing techniques do have positive effects for patients with word finding difficulties. As yet there is limited information on which to judge whether this technique is significantly advantageous over errorful approaches” (p358). This study: compares an errorful and errorless approach directly using facilitation

5. Facilitation? • The effects of performing a task once on subsequent performance (usually of another task). • Compare effects of two different tasks on word retrieval in individuals with impaired word retrieval - Errorless / error reducing (repetition) vs - Errorful (phonemic cueing)

6. Tasks Errorless Repetition Errorful Phonemic cueing “k” “kangaroo”

7. Method Name 300 pictures until 95 failed (10 second limit) Sort the failed items into 3 (frequency & length) matched sets Errorless Errorful Control 1 week later Facilitation 10 mins later Name all 3 sets of pictures+ 30 easy fillers

8. Participants 15 individuals with aphasia & word production impairments. Age 31-74 9 women, 6 men. 11 Left CVA, 3 TBI, 1 HSE. Time p.o. 6 months – 20years 8 fluent aphasia; 7 non-fluent Majority show comprehension impairments (word-picture matching) All have impaired picture naming

9. Facilitation effect compared to control pictures:Errorless (Repetition) & Errorful (Phonemic cues) * * * * * * * *

10. Facilitation effect compared to control pictures:Errorless (Repetition) & Errorful (Phonemic cues) * * * * * * * *

11. Relative benefitErrorless (repetition) vs Errorful (phonemic cueing) * * * Repetition benefit * Phon cue benefit

12. Relative benefitErrorless (repetition) vs Errorful (phonemic cueing) * * * Repetition benefit * Phon cue benefit

13. Summary • Errorless (repetition) & Errorful (phonemic cueing) tasks significantly facilitate subsequent naming over 10 minutes later. • Errorless (repetition) significantly more beneficial than errorful (phonemic cueing). cf Best et al – no significant difference between repetition & cueing. Conclusion: Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia

14. Conclusion Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia Why might we doubt this simple conclusion? 1) Can we be sure the errorless task was more accurate?

15. How errorless is errorless? Accuracy of the facilitation task. Repetition is more errorless than cueing. (except for JNI)

16. Conclusion Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia Why might we doubt this simple conclusion? • Can we be sure the errorless task was more accurate? • If it is the errorless nature of the task that is important then within a task the more accurate that task the greater the benefit for naming. Is this the case … across people? YES

17. The more errorless, the more benefit? Examine at the correspondence between accuracy of the task (repetition/cueing) and the amount of benefit for naming Order the individuals by facilitation task accuracy and look at whether the naming accuracy shows a parallel increase

18. The more errorless, the more benefit? Examine at the correspondence between accuracy of the task (repetition/cueing) and the amount of benefit for naming

19. The more errorless, the more benefit? Examine at the correspondence between accuracy of the task (repetition/cueing) and the amount of benefit for naming No significant correlation between success of the cue during facilitation and benefit of cueing for subsequent naming In other words: it is not the case that the more accurate the facilitation task the more naming benefits. i.e. errorless is not better than errorful WITHIN a task across individuals

20. Conclusion Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia Why might we doubt this simple conclusion? • Can we be sure the errorless task was more accurate? • If it is the errorless nature of the task that is important then within a task the more accurate that task the greater the benefit for naming. Is this the case … across people? within people across items? YES NO

21. Accuracy within task & within individual across items. • Compared accuracy of items that were accurate in facilitation and those that were not. • Are the items that are accurate repeated/named with a cue more accurately named 10 minutes later? • Repetition: Correctly repeated: 47% correctly named Incorrectly repeated: 23% correctly named • Phonemic Cueing: Correctly named with cue: 62% correctly named Incorrectly named with cue: 18% correctly named

22. Conclusion Errorless tasks are more beneficial than errorful tasks in the treatment of aphasia Why might we doubt this simple conclusion? • Can we be sure the errorless task was more accurate? • If it is the errorless nature of the task that is important then within a task the more accurate that task the greater the benefit for naming. Is this the case … across people? within people across items? YES NO Yes …but

23. Summary of present thinking Errorless learning • An overly simplistic notion…… • CANNOT evaluate using two tasks • More sensible to evaluate within a task. It MAY be the case that items which are more accurate in some therapy tasks that involve output are better named at a later point. ….this is counter to the traditional notion that tasks which are harder and more effortful are more productive.

24. Is errorless learning a useful concept in the treatment of word retrieval disorders? Maybe not!