ACQ Vol 13 No1 2011

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 speech, with social disinhibition, pronounced anomia and

Group program with aphasia-friendly TV viewing to promote discourse comprehension and production

(2009)

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

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 http://www.ciap.health.nsw.gov.au/ 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 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. 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. Design Case series pretest posttest Level of evidence NHMRC: IV

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. 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.

Summary

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 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. Clinical

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ACQ Volume 13, Number 1 2011

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