Focus on the building, not the blocks

Objectives: Difficulty with word finding is a pervasive symptom in aphasia and a common target of treatment. This review explored whether therapy-induced naming gains induce improvements to everyday (naturalistic) communication. Methods: Online databases were searched for naming interventions that also assessed discourse or functional communication, and for studies of therapies that directly treated them. Results: Among the studies that found word production gains following therapy, only about half found that the gains generalized to improved discourse or functional communication. However, discourse and functional communication can be improved by therapies that target them, and often improve word finding as well. Conclusions: Generalization of rehabilitation is complex and difficult to achieve. If the therapeutic goal in aphasia is to improve everyday communication, then intervention research needs to shift focus from “building blocks” like word production to the building of discourse and functional communication.