Authors: Waldron H, Whitworth A ,Howard D
Title: Comparing monitoring and production based approaches to the treatment of phonological assembly difficulties in aphasia
Source: Aphasiology 2011 25(10): 1153-1173
Year: 2011
Research Design: Single Case Design

Background: Waldron, Whitworth, and Howard (2011) replicated the auditory and monitoring therapy reported in a single case by Franklin, Buerk, and Howard (2002) with four participants with phonological assembly difficulties. No participant responded in the same way as Franklin et al.'s client MB and, notably, all improvements seen were item-specific, in contrast to MB who had shown generalised improvements in naming, repetition, and reading aloud. Waldron et al. attributed this difference to the combination of underlying impairments in their participants, in particular additional lexical deficits; it remains unknown whether Franklin et al.'s results would be replicated in someone with a more pure phonological assembly difficulty. It is also unknown whether a more direct therapy approach, targeting a reduction in the production of phonological errors, rather than improving monitoring, might also be efficated the auditory aective with this client group. Aims: The current study aimed to compare the effectiveness of the auditory and monitoring therapy reported by Franklin et al. (2002) with a production-focused therapy based on the articulatory kinematic treatment of apraxia of speech (AOS), in a single participant with phonological assembly difficulties. Methods & Procedures: Participant RE received three consecutive therapy phases: Franklin et al.'s auditory therapy, followed by a new production therapy involving a hierarchy of articulatory kinematic cues and the production of minimal contrast pairs, and finally Franklin et al.'s monitoring therapy. As RE's linguistic profile was similar to that of Franklin et al.'s client, it was predicted that he would make similar gains, i.e., generalised improvement in the production of treated and untreated words, following all three therapy types. Outcomes & Results: RE's naming of treated items improved significantly after both the production therapy and the monitoring therapy, but naming of untreated items did not improve and there were no naming improvements following the auditory therapy. Conclusions: Two possible reasons why RE did not respond as predicted are discussed. First, that RE may have had additional lexical retrieval difficulties, in which case therapy could have improved the link between semantics and lexical phonology; and second, that RE may have had additional mild AOS, in which case therapy may have resulted in improved motor planning abilities. Neither of these hypotheses could fully account for all of RE's results. Nonetheless, the production therapy was shown to be an effective alternative approach for clients with phonological assembly difficulties, when a direct focus on speech production is needed.

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