Discourse treatment for word retrieval impairment in aphasia: The story so far

Abstract

Background: Impairment-focused aphasia treatment has an ultimate goal of improving language production in connected speech and communication in daily life. Although impairment-based treatment has typically been carried out in words or sentences, investigations have begun to explore the efficacy of treatment during discourse production. Focusing treatment on an impaired linguistic process during discourse production is a complex and challenging endeavour.

Aims: This paper aims to review investigations of discourse treatment for word retrieval impairment in aphasia in order to identify and discuss variables that emerge as being important considerations in clinical practice and continued research.

Main Contribution: Seven investigations that applied treatments during structured discourse production to improve word retrieval in participants with aphasia were reviewed. Treatment methods used in the investigations included phonologic and orthographic cues, semantic feature analysis, contingency-based cueing hierarchies, and repeated conversational engagement. The discourse contexts used for treatment were structured conversations or structured narrative discourse. All investigations reported positive outcomes for improved word retrieval abilities. Although treated vocabulary items did not improve in all cases, improvements in general processes of word retrieval were reported. Focusing treatment on the linguistic process of word retrieval resulted in changes to discourse macrostructure, at least in terms of the informativeness of the discourse. When attitudes and perceptions of the participants with aphasia or of naïve judges were assessed, the outcomes were generally favourable. One investigation provided evidence that treatment in structured discourse was related to improved word retrieval in real-life conversations.

Conclusions: There are several promising discourse treatment approaches for word retrieval impairments in aphasia. Systematic analysis of changes in the macrolinguistic processes of discourse, in real-life conversations, and in the attitudes and perceptions of participants with aphasia and others in future discourse treatment studies would enhance our insights about their efficacy.

Keywords:

• Aphasia
• Aphasia treatment
• Discourse treatment
• Word retrieval impairment

Notes

¹Herbert and colleagues (2003) reported that they also assessed microlinguistic changes in the Cinderella narrative and in real-life conversations, but they did not report the results in their paper.