The benefits of orthographic cueing to naming deficits in aphasia:A case study

Carol Leonarda,b,*, Elizabeth Rochonb, Laura Lairdb

aAudiology and Speech-Language Pathology Program, School of Rehabilitation Sciences, University of Ottawa, CanadabDepartment of Speech-Language Pathology, University of Toronto, Canada

Available online 29 July 2004

Under the influence of serial two-stage models of lexical retrieval

(e.g., Levelt, 1989), treatments for naming deficits in aphasia have been

of two broad types: semantic and phonological. Semantic treatments

focus on highlighting the meaning of the word and phonological

treatments focus on emphasizing the form of the word in the absence

of its meaning. Both semantic and phonological treatments for anomia

have been found to be effective (e.g., Coelho, McHugh, & Boyle, 2000;

Wambaugh, 2003). Recently, another form based treatment for

anomia—orthographic cueing—has proven effective in some instances.

For example, Hickin, Best, Herbert, Howard, and Osborne (2002)

showed that phonological and orthographic treatment improved

naming performance in seven patients, and DeDe, Parris, and Waters

(2003) showed improved naming in one patient with both orthographic

and tactile cues.

We present the case of an individual with anomia who was initially

enrolled in a combined semantic and phonological features analysis

treatment that was then modified to include orthographic cueing.

Method

Subject

M.H. was a 75-year-old, right-handed man, who suffered a single

left hemisphere stroke and was 2 years post-onset at the time of testing.

Results on the BDAE were consistent with the profile of mixed non-

fluent aphasia. Pre-therapy tests identified a significant naming im-

pairment (7% correct on the Philadelphia Naming Test) with relatively

spared repetition (90% correct) and oral reading (93% correct) skills,

but impaired single word comprehension (51% correct).

Design

A multiple-baseline across behaviours design was used. Initially, as

part of a larger study (Rochon & Leonard, in preparation), M.H. was

assigned to a combined semantic and phonological features treatment

condition. To obtain a list of words to be treated and ensure a stable

baseline, M.H. was first shown 105 pictures and asked to name them in

three consecutive sessions. Of the words that were in error in each

session, M.H. was asked to choose the items that he would like to have

treated. Of those words, 30 were chosen and divided into three lists of

10 words each. The three lists were equated as much as possible by

category, frequency, and number of syllables. List 1 words were treated

first while words in Lists 2 and 3 were held in baseline. Treated words

were probed every second session and untreated every third session,

prior to the beginning of treatment. The criterion for moving to

treatment on a subsequent list was 80% correct or a maximum of 15

sessions.

Treatments and results

Combined semantic and phonological

This treatment involved the use of a features analysis chart fol-

lowing the protocol of Coelho et al. (2000). The target picture was

presented in the centre of the chart and M.H. was asked to name it.

Irrespective of his ability to do so, he was asked to identify three se-

mantic features (group, associations, and properties) and two phono-

logical features (rhymes, first sound). If M.H. could not spontaneously

provide a response he was asked to choose one from a list of four. The

examiner wrote the word on the chart. Once all features were gener-

ated, M.H. was asked to name the target again and all features were

reviewed. This treatment proved unsuccessful as M.H. achieved only

20% correct on Lists 1 and 2 and 10% correct on List 3.

Phonological features

Three new treatment lists of 10 items each were constructed

from the list of pictures that M.H. could not name. The protocol

was the same as that used above with the exception that only

phonological features (rhymes, first sound, first sound associates,

final sound, and number of syllables) were targeted. Treatment of

List 1 was unsuccessful, therefore this therapy was terminated and

the orthographic cueing procedure described below was initiated on

List 2.

Orthographic cueing

Despite M.H.’s significant naming impairment, an interesting

component of his linguistic competence was his ability to complete

crossword puzzles. We used this strength in a modification of the

features treatment just described. In this approach, M.H. was required

to write the first letter in the target word. If M.H. could not sponta-

neously provide a response, the examiner wrote the letter. M.H. (or the

examiner) provided successive orthographic cues until he could name

the word or until the word was written in its entirety. This treatment

proved successful as percent correct on items in List 2 increased from

10 to 80 over the course of 14 sessions (see Fig. 1), while performance

on untreated items (Lists 1 and 3) remained virtually unchanged (all at

Brain and Language 91 (2004) 185–186

www.elsevier.com/locate/b&l

* Corresponding author.

E-mail address: cleonard@uottawa.ca (C. Leonard).

0093-934X/$ - see front matter � 2004 Elsevier Inc. All rights reserved.

doi: 10.1016/j.bandl.2004.06.095

0% correct except for the first probe of List 1 items which was at 10%

correct). Treatment on List 3 items was begun, but terminated early

due to time constraints, leaving the results inconclusive.

Follow-up testing 2 weeks post-therapy revealed that the effects of

treatment for List 2 were not maintained (10% correct).

Discussion

The present results highlight the potential benefits of orthographic

cueing to improving naming deficits in aphasia and underscore the

importance of capitalizing on a patient’s strengths when designing

therapy. While these results are encouraging, they are considered

preliminary in the sense that only one list of items and only one

patient were treated. Additionally, the effect proved to be of short

duration and potential contributing factors to this finding must be

considered.

References

Coelho, C. A., McHugh, R. E., & Boyle, M. (2000). Semantic feature

analysis as a treatment for aphasic dysnomia. Aphasiology, 14(2),

133–142.

DeDe, G., Parris, D., & Waters, G. (2003). Teaching self-cues: A

treatment approach for verbal naming. Aphasiology, 17, 465–

480.

Hickin, J., Best, W., Herbert, R., Howard, D., & Osborne (2002).

Phonological therapy for word-finding difficulties: A re-evaluation.

Aphasiology, 16, 981–999.

Levelt, W. J. M. (1989). Speaking: From intention to articulation.

Cambridge, MA: MIT Press.

Rochon, E., & Leonard, C. (in preparation). Treatments for naming

impairments using a features analysis approach.

Wambaugh, J. L. (2003). A comparison of the relative effects of

phonological and semantic cueing treatments. Aphasiology, 17(5),

433–441.

Fig. 1. M.H.’s percent correct naming of treated words.

186 Abstract / Brain and Language 91 (2004) 185–186