The Relationship Between Aphasia Therapy and Cognitive Strengths

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Answer

There is a growing empirical literature regarding how aphasia symptoms and outcomes may be related to cognitive strengths and weaknesses, including the integrity of memory skills (e.g., Murray, 2004). To date, however, there has only been limited investigation of how this relationship between language and memory abilities in individuals with aphasia might be exploited during treatment. Initial findings suggest that further research should be pursued given that at least some patients respond positively to memory treatments (e.g., Mayer & Murray, 2003) or language treatments that incorporate memory remediation procedures (e.g., Stark, 2005). Examples of these treatments protocols are described in the following paragraphs.

Mayer and Murray (2003) compared the effects of a reading and a working memory treatment on the reading skills of a patient with mild chronic aphasia and concomitant attention, and working and long-term memory deficits. The reading treatment was a modified version of Multiple Oral Reading (MOR) treatment (see Beeson & Insalaco, 1998 for a description of this reading protocol); MOR was modified in that not only did the patient have to practice reading aloud passages, after reading each passage he had to answer five comprehension questions. The working memory treatment required the patient to read sets of sentences and then say if each sentence was grammatical as well as provide the semantic category to which the last words of each sentence belonged. Both treatments evoked improvements in the patient's reading, particularly in terms of reading rate. These findings indicated that the working memory approach appeared to be as helpful as the more traditional, linguistic approach.

Francis and colleagues (2003) provided a case report of a patient with chronic, mild aphasia in whom short and long-term aspects of auditory-verbal memory were compromised and interfering with her ability to comprehend spoken sentences. She completed a sentence repetition treatment designed to improve her auditory working memory and subsequently, auditory comprehension difficulties. Treatment primarily consisted of sentence repetition tasks in which the patient's husband read aloud a sentence and she then repeated the sentence. Across the treatment sessions, the difficulty of the sentence repetition task was increased in terms of sentence length and semantic complexity. Post-treatment testing revealed improvements on memory span, long-term verbal memory, and auditory comprehension tasks.

More recently, researchers have begun to fuse memory treatments with more traditional aphasia remediation protocols. For example, Fridriksson and colleagues (2005; Morrow & Fridriksson, 2006) explored the effects of providing anomia treatment within the context of spaced retrieval procedures. In spaced retrieval, the patient is trained to recall information over progressively longer intervals (see Murray and Clark, 2006 for a description). Fridriksson and colleagues found that patients with mild to moderate fluent aphasia demonstrated better acquisition and maintenance of items trained via spaced retrieval compared to those trained via solely a traditional cueing hierarchy.

Collectively, the results of these and other recent investigations suggest that at least some patients with aphasia will benefit from direct treatment of their memory impairments, combining memory treatments with language protocols, or both. Further research is needed to identify and refine additional memory treatment procedures and to delineate which patients will respond best to these treatment approaches.

References Cited

Beeson, P., & Insalaco, D. (1998). Acquired alexia: Lessons from successful treatment. Journal of the International Neuropsychological Society, 4, 621-635.

Francis, D. R., Clark, N., & Humphreys, G. W. (2003). The treatment of an auditory working memory deficit and the implications for sentence comprehension abilities in mild receptive aphasia. Aphasiology, 17, 723-750.

Mayer, J. F., & Murray, L. L. (2002). Approaches to the treatment of alexia in chronic aphasia. Aphasiology, 16, 727-744.

Morrow, K. L., & Fridriksson, J. (2006). Comparing fixed- and randomized-interval spaced retrieval in anomia treatment. Journal of Communication Disorders, 39, 2-11.

Murray, L. L. (2004). Cognitive treatments for aphasia: Should we and can we help attention and working memory problems? Medical Journal of Speech-Language Pathology, 12, xxi-xxxviii.

Murray, L. L., & Clark, H. M. (2006). Neurogenic disorders of language: Theory driven clinical practice. Clifton Park, NY: Thomson Delmar Learning.

Stark, J. (2005). Analysing the language therapy process: The implicit role of learning and memory. Aphasiology, 19 (10/11), 1074-1089.

Laura Murray, Ph.D., CCC/SLP, is an associate professor in the Department of Speech and Hearing Sciences and Programs in Cognitive Science and Neuroscience at Indiana University. Her contributions include approximately 40 research articles, a textbook, and over 80 invited and refereed conference presentations in the fields of aphasia, right hemisphere disorders, dementia, traumatic brain injury, and normal aging. Dr. Murray's research primarily focuses on examining how deficits in cognitive processes such as attention interact with the language skills of adults with acquired neurogenic communication disorders and on developing treatments to remediate these disorders.