Phonological and orthographic cueing therapy: A case of generalised improvement

Background: Phonological and orthographic cues can both be effective in the treatment of anomia, and are often used clinically. However, studies using phonological and orthographical cues in aphasia therapy have tended to be equivocal about their benefits, and most demonstrate improvements limited to treated items. Few previous studies investigate change in conversation or in people's own views of their aphasia. Aims: The aim of the study was to investigate the effect of a weekly delivered therapy, using combined phonological and orthographic cues, on word retrieval, connected speech, conversation, and on the participant's own views of his aphasia. Methods Procedures: A person with anomia (TE) is presented as a detailed single-case study. Two baselines, 8 weeks apart, were followed by two 8-week phases of therapy, delivered weekly in a clinical setting. The first phase involved the use of combined phonological and orthographic cues to aid retrieval of a targeted set of words. The second phase encouraged the use of targeted words in connected speech and conversation. TE was reassessed after each phase of therapy and again 2 months later, after a period of no therapy. The study involved controls for improvement due to regular contact but without intervention (the baseline phase) and investigated generalisation to untreated items (treated and untreated sets were used, balanced for performance prior to therapy). Finally non-specific effects of therapy were determined by testing throughout the study on a set of language control tasks (predicted to be unaffected by the therapy). Outcome Results: TE demonstrated significant and enduring improvements in picture naming, which had generalised to untreated items. Significant improvements were also demonstrated in the broader measures of connected speech, aspects of conversation, and his own views of his aphasia, while performance on control tasks remained fairly stable. There was a significant relationship between changes in word finding and changes in TE's views of his communication activity across the course of the study, with a pattern of stability over baseline and change with intervention, particularly the first phase of therapy, i.e., using cues. Conclusions: These findings demonstrate that a combined phonological and orthographic cueing therapy targeting word retrieval can have lasting benefits, not just on targeted items but also on untreated words, connected speech, and the views of the person with aphasia. Furthermore, such improvements can be achieved within a prevalent service delivery model.