An appropriate referral! Word retrieval treatment can benefit individuals with primary progressive aphasia despite disease progression

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Did you know that individuals with primary progressive aphasia (PPA) are less likely to be referred for SLP intervention than individuals with aphasia secondary to stroke? Research suggests that this may be because referring providers—and even treating clinicians—feel pessimistic about prognosis for this neurodegenerative disease. However, Henry et al. (2019) give us a reason to feel optimistic this month!

In this study, participants had mild–moderate logopenic or semantic variant PPA. Read about the three specific PPA variants here. Researchers manipulated treatment technique and dosage to investigate whether SLP intervention can preserve word retrieval skills up to 1 year.

The article gives an informative breakdown of what the clinician/participant actually did in each session. Yes! See Table 2 for the technique. Researchers call their hierarchical method “lexical retrieval treatment.” It combines several techniques you may already know, including semantic feature analysis and orthographic/phonemic cueing. Treatment was repetitive, strategy-focused, and trained specific target words at every session. When creating the targets at the start of treatment, participants generated functional words and used real photos to increase saliency. Researchers included an item if the participant was unable to produce the word in at least two of three attempts during pre-testing.

Now for dosage. Researchers had two groups. One received treatment 1x per week and the other 2x per week. Each session was one hour. The 2x per week folks trained double the number of items and received a “booster” treatment following the three month follow up visit. Importantly, all groups had daily homework for 15 minutes.

Participants named trained items better than at pre-testing in all follow-up sessions up to one year. Untrained items remained better than at pre-testing, but about the same as post-treatment data through six months. Psychosocial measures were favorable for both groups, as well. Keep in mind, this is despite disease progression! Surprisingly, there was no significant difference between the 1x versus 2x per week groups. Researchers suggest that maybe participants relied on strategy use day-to-day, which would have allowed them lots of practice even outside the treatment room. So, keep those referrals coming!

 

Henry, M.L., Hubbard, H.I., Grasso, S.M., Dial, H.R., Beeson, P.M., Miller, B.L., & Gorno-Tempini, M.L. (2019). Treatment for Word Retrieval in Semantic and Logopenic Variants of Primary Progressive Aphasia: Immediate and Long-Term Outcomes. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-L-18-0144

Memory problems have a significant impact on the everyday life of individuals with MS…. and we can help!

...memory for real-life situations is at the heart of what defines an individual as a person in society.
— Ernst, 2019

There has been growing interest in the literature about memory impairments in individuals with multiple sclerosis, with a recent focus on autobiographical memory (i.e., our ability to recall personal life events) and future thinking (i.e., our ability to predict future events). This paper provides an excellent overview on what we know from that research! Here are a few highlights:

  1. “Autobiographical memory and future thinking are frequently and early impaired in individuals with MS…and can have disruptive and pervasive effects in many different aspects of daily functioning” (Ernst, 2019, p. 4).

  2. Individuals with MS are generally aware of these memory problems.

  3. An intervention program aimed at boosting mental visual imagery (MVI) is effective at improving autobiographical memory and future thinking in individuals with relapsing–remitting MS.

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In this paper, the author describes one such rehab program, titled the “MVI program”, which consists of six 2-hour sessions. This program has been previously reported in the literature, and the manual is available upon request from the author.  

The bottom line is this, if you’re not already, SLPs should consider treating autobiographical memory and future thinking in individuals with MS… and therapy aimed at enhancing mental visual imagery appears to be an effective approach!

Ernst, A. (2019). Autobiographical Memory and Future Thinking Impairments in Multiple Sclerosis: Cognitive and Neural Mechanisms, Functional Impact and Rehabilitation. Annals of Physical and Rehabilitation Medicine. doi:10.1016/j.rehab.2019.06.006