Some persons with aphasia exhibit a selective verb deficit, which results in a reduced ability to produce verbs in most contexts. A functional level (Bock & Levelt, 1994) impairment may result in impaired sentence production because the verb serves as the semantic-syntactic interface of a sentence. This interface is related to a verb’s relationship with its arguments/thematics. Arguments fill the syntactic slots of subject and object, and those same words serve as thematic roles by referring to who does what to whom. The current study investigates the effect of Verb Network Strengthening Treatment (VNeST) on sentence production using a single subject experimental design across subjects in 4 participants, 2 with nonfluent aphasia and 2 with fluent aphasia. Participants received semantic treatment aimed at re-strengthening the connections between a verb (e.g., measure) and related thematic pairs that refer to the doer and receiver of the action (e.g., carpenter/lumber, chef/sugar). The ability to produce thematic role pairs for trained verbs was tested during treatment while generalization to the ability to produce sentences containing a subject, verb, and object in a picture description task with trained verbs (e.g., The carpenter is measuring the stairs.) and semantically related untrained verbs (e.g., The nurse is weighing the baby.) was monitored. In addition, pre- and post-treatment single word retrieval of verbs (The Northwestern Verb Production Battery (NVPB) (Thompson, 2002)) and nouns (The Boston Naming Test (Goodglass & Kaplan, 1983)) was examined as well as sentence production abilities in unrelated picture description (NVPB) and constrained connected speech tasks. All participants met treatment criteria and exhibited generalization to sentence production with sentences containing trained and semantically related untrained verbs. Participants 1, 2, and 3 exhibited improvements on all pre- and post-treatment measures, including connected speech. Participant 4 exhibited gains on multiple measures but did not show improvement in connected speech. These findings indicate that treatment aimed at strengthening the verb network results in improved word retrieval in naming and sentence production across multiple tasks. Theoretical and clinical implications regarding the impact of using VNeST on rehabilitation of sentence production deficits in aphasia are discussed. / text

An interactive activation model for picture naming was used to guide treatment of a semantic-level deficit in 4 individuals with aphasia and severe picture-naming problems. Participants exhibited a profile consistent with Broca's aphasia with severe naming deficits, part of which was attributable to a semantic impairment based on testing of the lexical system. A semantic-based treatment was used to train naming of nouns in two semantic categories using a single-participant multiple baseline across behaviors and participants. Additional treatment, which included orthographic and phonological information about target words, then was applied. Treatment responses and error patterns demonstrated that semantic treatment resulted in improved naming of both trained and untrained items for 2 of 4 participants. Two participants did not show improved naming until treatment emphasizing the phonological form of the word was provided. This study demonstrates the utility of using an interactive activation model to plan treatment based on levels of disruption in the lexical processing system.

This study investigated the influence of semantic complexity treatment in individuals with fluent aphasia on discourse performance. Semantic treatment is an effective way to improve semantically based word retrieval problems in aphasia. Treatment focused on the semantic application of the Complexity Account of Treatment Efficacy (CATE) (Thompson, Shapiro, Kiran, & Sobecks, 2003) promotes training of complex items resulting in generalization to less complex, untrained items. In addition, research has shown that the personal relevance of treatment material can increase treatment efficacy. This study investigated the effect of semantic treatment of atypical personally relevant items among individuals with aphasia on discourse performance. Two treatment phases were applied to examine the influence of personally relevant and non-relevant treatment material on discourse performance. In addition, generalization from trained atypical items to untrained typical items was investigated. Methods and procedures were partially replicated from Kiran, Sandberg, & Sebastian (2011) examining semantic complexity within goal-derived (ad hoc) categories. Three participants with fluent aphasia were trained on three semantic tasks including category sorting, semantic feature generation/selection, and Yes/No feature questions. A generative naming task was used for probe data collection every second session. Stimuli consisted of atypical items only. The hypothesis that semantic complexity training of personally relevant items from ad hoc categories will produce greater generalization to associated, untrained items than training of non-relevant items and consequently increase discourse performance was not supported. The findings revealed a failure to replicate the magnitude and type of improvements previously reported for the typicality effect in generative naming. Clinical significance was found for personally relevant and non-relevant discourse performance. However, no consistent pattern was found within and across participants. In addition, effect size for generalization from trained atypical to untrained typical items was not significant. Limitations of this study lead to future directions to further specify participation selection, such as cognitive abilities, procedural changes, and the inclusion of discourse performance as an outcome measure. Overall, the results of this study provide weak support for replicating semantic treatment of atypical exemplars in ad-hoc categories and hence demonstrate the critical role of replication across labs to identify key issues in the candidacy, procedures, and outcome measurement of any developing treatment.

Music-based interventions (MBI) may facilitate communication outcomes for people with aphasia (PWA; Cheever et al., 2018; Magee et al., 2017). There are few theory-based, protocolized MBIs for PWA. This study developed a transdisciplinary, theory-based, highly structured improvised singing protocol, the Music enhanced Verb Network Strengthening Treatment (MeVNeST), that is designed to enhance the Verb Network Strengthening Treatment (VNeST) (Edmond, 2016). The feasibility and the preliminary outcomes of MeVNeST were evaluated. The study involved three stages: 1) protocol development; 2) protocol testing; 3) microanalysis. In Stage 1 Standard VNeST procedures were adapted to incorporate music components based on the theoretical premises for music and language in the brain, theories of musical expectation (Lerdahl & Krumhansl, 2007), and two frameworks for music-based intervention protocol development (Robb et al., 2011; Hanson-Abromeit, 2015). The outcome was a preliminary MeVNeST protocol. In Stage 2, two phases were implemented to evaluate the effects of MeVNeST compared with VNeST, and the effect of MeVNeST alone on word retrieval and sentence production. Effect sizes were calculated for probe scores. One participant who received seven weeks of MeVNeST showed improvements in the sentence production score for the VNeST probes of the trained verbs (d=3.22). No changes were observed on the Boston Naming Test, the Verb Naming Test, and the Western Aphasia Battery and the adjective control task. Other participants did not achieve significant changes in word retrieval and sentence production. This indicates the increased duration of MeVNeST in Phase 2 was necessary to produce the desired outcomes. In stage 3, the microanalysis results revealed that patterns of music interaction, called Patterns of Musical Influence (PMI), underpinned how the key musical components in the therapists’ improvised music influenced participants’ improvised singing. Musical strategies named Structuring Strategies and Cueing Strategies clarified the therapists’ musical strategies to facilitate participants’ performance of language tasks that were difficult. The MeVNeST protocol was revised based on the findings. This study suggests that MeVNeST is a feasible treatment approach that warrants further research. Future research is needed to test the MeVNeST protocol with a larger sample, and to optimize the capacity of improvised music to support the structured language task and escalate the generative process in the training of the semantic network. / Music Therapy