ACQ Vol 13 No1 2011

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ACQ Volume 13, Number 1 2011 39
There is limited evidence for other interventions. For
example, there is no evidence for an impairment-directed
intervention that targets apraxia of speech in this population,
and predominantly anecdotal evidence for the success of
activity/participation-directed interventions.
Collaborative decision-making and goal-setting with client
and significant communication partner(s) is necessary.
Collaborative decision making is required when deciding
whether to proceed with an impairment-directed or an
activity/participation-directed intervention and about
You read over the summary of cases reviewed by Croot
et al. (2009) and the abstracts of the additional articles, to
identify individuals similar to your current client. The findings
are provided in Table 3.
You notice some things in common across these studies,
with the controlled impairment-directed interventions
producing a treatment effect in all cases but almost no
generalisation. Furthermore treatment gains are not
well maintained once therapy ceases. The activity and
participation-directed interventions are reported to be
successful in helping the participant achieve desired social
and communicative goals, but these reports are case
descriptions not controlled studies. You select the article by
Jokel and colleagues as appropriately similar to the potential
new referral and critically appraise the study following
the EBP guidelines
specialties/ebp_sp_path/resources.html (Table 4).
As the paper reports a single case design you also evaluate
the methodology of the paper using a scale for rating Single
Case Experimental Designs (SCED; Tate et al., 2008). The
method received 8/10 points for clear identification of target
behaviours, overall design (multiple baselines across behaviours),
establishing a stable pre-treatment baseline, sampling during
treatment, providing raw data in a graph, use of statistics,
replication across two individuals, and testing of
generalisation. The 2/10 points that were not awarded were
for independence of assessors and inter-rater reliability.
However, given the nature of the outcome measures (naming
accuracy) you feel this is not too great a problem.
Clinical bottom line
Having surveyed the literature you return to your clinical
question and determine the clinical bottom line:
There is Level IV evidence for the efficacy of word retrieval
interventions for treated items in progressive aphasia and
semantic dementia. Some of these were studies that rated
highly on the Tate et al. (2008) SCED scale, indicating
methodological adequacy for single case designs. Hence,
these provide some basis for clinical decision-making in your
service, taking into account the similarity of presenting clients
to participants described in the published studies. However,
there are no randomised control trials and almost no
replications of the same treatment with different individuals
that would indicate the generality of the results for any
intervention, thus at this point in time, every intervention
would need to be considered experimental.
Table 3. Overview of cases similar to your current client
Authors Case description Intervention
Cartwright & Elliot F, 65 years, F, 59 years, and F, 66 years with increasingly nonfluent Group program with aphasia-friendly TV viewing to
(2009) speech, with social disinhibition, pronounced anomia and promote discourse comprehension and production
agrammatic output respectively
Cress & King (1999) M, 60 years & F, 59 years with 6-7 year histories of nonfluent AAC: communication boards, books and file cards
speech
Jokel et al. (2009) F, 58 years, 3-4 year history of nonfluent aphasia, slow and Cued naming treatment to improve retrieval of nouns
anomic speech
McNeil et al. (1995) M, 61 years, lawyer with 9 month history or anomia, mild spastic Hierarchical cueing of synonyms and antonyms to
dysarthria, and mild aphasia improve retrieval of adjectives
Pattee et al. (2006) F, 57, primary progressive aphasia with apraxia of speech Text-to-speech and American sign language
Rogers et al. (2000) M, 71 years, 2-year history of anomia, AOS and telegraphic speech Principles of proactive intervention, AAC
Schneider et al. F, 62 years, nonfluent aphasia (anomia, slow, agrammatic speech, Gestural combined with verbal forms to promote use
(1996) pronunciation errors) of nouns, verbs and tense markers
Note. F = female, M = male
Table 4. Critically appraised article
Article title Relearning lost vocabulary in nonfluent progressive
aphasia with MossTalk Words®
Citation Jokel, R., Cupit, J., Rochon, E., & Leonard, C. (2009).
Relearning lost vocabulary in nonfluent progressive aphasia
with MossTalk Words®. Aphasiology, 23(2), 175-191.
Design Case series pretest posttest
Level of NHMRC: IV
evidence Tate et al. (2008): 8/10
Participants 2 people with nonfluent progressive aphasia, one slow
and anomic, the other hesitant and anomic
Experimental Cued naming of 3 lists of 14–15 words, 1 hour 2–3
group times per week for 4 weeks (participant 1) and 12
weeks (participant 2) using MossTalk Words®, a
computer-based therapy with a large array of words
with pictures and cues including high frequency items.
Results Improvement on all 3 treated lists by both participants,
maintained at 1 month with no practice but not at 6
months. No generalisation to a 180-item picture
naming test but improved syntactic production at 1
month but not 6 months post treatment.
Summary Two individuals with anomia in the context of nonfluent
progressive aphasia improved word retrieval for treated
items that did not generalise to untreated items but
improved syntax in a sentence production task.
Clinical Word retrieval can be improved with treatment in
bottom line nonfluent progressive aphasia, but improvement is
likely to be restricted to treated items and may not be
maintained when therapy activities cease.