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      A controlled study of changes in conversation following aphasia therapy for anomia

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          Abstract

          This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [ 1] and Best et al. [ 2]). In each study, therapy involved cueing with the aim of improving retrieval of a set of nouns. Naming of the experimental items was assessed twice prior to therapy and again immediately afterwards. There was a significant change in word finding, as measured by picture naming, for the group and for 11 of the 13 participants. At the same time points, we collected conversations between the person with aphasia and a regular conversational partner. We analysed these using Profile of Word Errors and Retrieval in Speech (Herbert et al. [ 3]) and investigated a set of conversational variables predicted to change with therapy. Unsurprisingly, the conversation data is not straightforward. There is no significant change on the conversation measures for the group but some changes for individuals. We predicted change in word retrieval after therapy would relate to change in everyday conversations and tested this by correlating the change (post-therapy minus mean pre-therapy) in picture naming with the change in conversation variables. There was a significant positive relationship between the change in picture naming and change in some conversation measures including the number of nouns produced in 5 min of conversation ( r = 0.50, p < 0.05, one-tailed) and the number of nouns produced per substantive turn ( r = 0.55, p < 0.05, one-tailed). The findings suggest changes in word finding following therapy for aphasia can be reflected in changes in conversation. The clinical implications of the complex results are explored.

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          Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the Single-Case Experimental Design (SCED) Scale.

          Rating scales that assess methodological quality of clinical trials provide a means to critically appraise the literature. Scales are currently available to rate randomised and non-randomised controlled trials, but there are none that assess single-subject designs. The Single-Case Experimental Design (SCED) Scale was developed for this purpose and evaluated for reliability. Six clinical researchers who were trained and experienced in rating methodological quality of clinical trials developed the scale and participated in reliability studies. The SCED Scale is an 11-item rating scale for single-subject designs, of which 10 items are used to assess methodological quality and use of statistical analysis. The scale was developed and refined over a 3-year period. Content validity was addressed by identifying items to reduce the main sources of bias in single-case methodology as stipulated by authorities in the field, which were empirically tested against 85 published reports. Inter-rater reliability was assessed using a random sample of 20/312 single-subject reports archived in the Psychological Database of Brain Impairment Treatment Efficacy (PsycBITE). Inter-rater reliability for the total score was excellent, both for individual raters (overall ICC = 0.84; 95% confidence interval 0.73-0.92) and for consensus ratings between pairs of raters (overall ICC = 0.88; 95% confidence interval 0.78-0.95). Item reliability was fair to excellent for consensus ratings between pairs of raters (range k = 0.48 to 1.00). The results were replicated with two independent novice raters who were trained in the use of the scale (ICC = 0.88, 95% confidence interval 0.73-0.95). The SCED Scale thus provides a brief and valid evaluation of methodological quality of single-subject designs, with the total score demonstrating excellent inter-rater reliability using both individual and consensus ratings. Items from the scale can also be used as a checklist in the design, reporting and critical appraisal of single-subject designs, thereby assisting to improve standards of single-case methodology.
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            A five-phase model for clinical-outcome research.

            Through a variety of approaches, speech-language pathologists and audiologists have produced strong evidence that treatments are generally potent. However, we have largely ignored the accepted standards for clinical-outcome testing used throughout the broader research community (e.g., by other clinical disciplines, federal regulators, and third-party payers). Several clinical professions recognize a comprehensive model for organizing and scaffolding the many forms of clinical-outcome research. An adaptation of this five-phase model of clinical-outcome research is examined as a means for structuring forms of clinical research throughout audiology and speech-language pathology. Within the organizing structure, relationships become apparent between types and grades of scientific evidence and the processes underpinning evidence-based practice which ultimately lead to decisions on the status of intervention protocols. Readers will be able to distinguish the phases of clinical-outcome research in a comprehensive model. Readers will be able to identify relationships between the structure of the model and broadly recognized concepts associated with the terms 'efficacy' and 'effectiveness.' Readers will be able to identify indicators of quality for controlled clinical trials.
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              Improved vocabulary production after naming therapy in aphasia: can gains in picture naming generalize to connected speech?

              Naming accuracy for nouns and verbs in aphasia can vary across different elicitation contexts, for example, simple picture naming, composite picture description, narratives, and conversation. For some people with aphasia, naming may be more accurate to simple pictures as opposed to naming in spontaneous, connected speech; for others, the opposite pattern may be evident. These differences have, in some instances, been related to word class (for example, noun or verb) as well as aphasia subtype. Given that the aim of picture-naming therapies is to improve word-finding in general, these differences in naming accuracy across contexts may have important implications for the potential functional benefits of picture-naming therapies.
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                Author and article information

                Journal
                Disabil Rehabil
                Disabil Rehabil
                DRE
                Disability and Rehabilitation
                Informa Healthcare
                0963-8288
                1464-5165
                March 2011
                11 December 2010
                : 33
                : 3
                : 229-242
                Affiliations
                1 Division of Psychology and Language Sciences, University College London, London, UK
                2 Department of Speech and Lanaguge Therapy, Amersham Hospital, Buckinghamshire, UK
                3 Department of Human Communication Sciences, Sheffield University, Sheffield, UK
                4 Department of Language and Communication Science, City University, London, UK
                5 School of Education, Communication and Language Sciences, University of Newcastle upon Tyne, UK
                Author notes
                Correspondence: Wendy Best, Division of Psychology and Language Sciences, University College London, London, UK. Tel: +44-0207-679-4257. Fax: +44-0207-679-4238. E-mail: w.best@ 123456ucl.ac.uk
                Article
                10.3109/09638288.2010.534230
                3956489
                21128833
                79ad7c9e-74a3-4ae8-8b7f-6de39de7b9b7
                © 2011 Informa UK, Ltd.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

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                Categories
                Research Paper

                Health & Social care
                aphasia,therapy,conversation,anomia,cues,word finding
                Health & Social care
                aphasia, therapy, conversation, anomia, cues, word finding

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