Circumlocution-induced naming (CIN): A treatment for effecting generalisation in anomia?

Abstract

Background: Many studies of clients with 'pure' anomia (i.e. word finding difficulties in the absence of semantic impairment) have found a lack of generalization to the naming of items that are not treated in therapy. One explanation for this result is that the phonological output lexicon consists of discrete entries which are not as interconnective as those in the semantic system (Miceli, Amatrano, Capasso, and Caramazza 1996). However, more recent studies suggest that therapy which requires more explicit and unaided access on the part of the client might indeed effect generalization (McNeil, Small, Masterton, and Fossett, 1995; Spencer, Doyle, McNeil, Wambaugh, Park, and Carroll, 2000). Aims: The main aim of our study was to investigate whether requiring a client to name pictures with minimal help (i.e. cueing, repetition) from therapists would result in generalization. Methods & Procedures: We used a single case design, employing multiple baselines across behaviours to control for possible spontaneous recovery. The participant was MB, a 79 year old client who was anomic subsequent to a stroke. Therapy sessions required MB to name a set of pictures. Instead of cues, she was required to describe and 'talk around' each picture for as long as it took until the name came to her. We termed this therapy 'Circumlocutioninduced naming' (CIN). Nonparametric statistical analysis was performed on pre and post test results. Outcomes & Results: Therapy resulted in improvement to untreated as well as to treated words, and there was also a qualitative change in error patterns on untreated words (namely fewer unrelated errors and more semantic errors). Performance on unrelated control tasks did not improve. Conclusions: Our results suggest that CIN may effect a generalized improvement on the phonological output lexicon. We hypothesize that the therapy 'exercises' the impaired link between semantics and phonology to a greater degree than do other methods (e.g. phonemic cueing, repetition). This suggests that clients with moderate to mild anomia might benefit from therapy that requires them to take a more active and independent part in accessing words. We discuss some difficulties in the interpretation of our results, including the possible existence of spontaneous recovery, and the issue of exactly what our therapy targeted.