Learning Paradigms in Aphasia Rehabilitation

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DESCRIPTION (provided by applicant): The long-term objective of this research project is to improve our ability to design effective treatment strategies for the remediation of aphasic symptoms. The project examines a specific design variable that has application to many kinds of cognitive rehabilitation programs - the extent to which the patient makes errors when attempting to produce the correct response during training. It focuses on one particular cognitive deficit, anomia, in attempting to study the relative efficacy of errorless vs. errorful learning in the rehabilitation of language deficits. Anomia, an impairment in the retrieval of words, is the most common deficit resulting from a left hemisphere stroke. This deficit can have grave consequences upon one's ability to communicate effectively and can interfere with work, social function, and everyday life. One goal of the project is to test the hypothesis that patients with anomia are more likely to improve their ability to retrieve words following a therapy that allows for few or no errors during training compared with a commonly used therapy that guarantees that errors are produced. A second aim is to examine the effects of deficits in explicit memory and in attention/executive control on the errodess/ful variable. These hypotheses derive from the literature on errorless vs. errorful learning that has been applied to patients with memory deficits. Patients with anomia will participate in a therapy program in which two different sets of words are trained under different conditions. In the errorful condition, the patient first attempts to name a picture without any external cues. If an incorrect response is produced, a minimal stimulus cue is provided. If another incorrect response is given, a more powerful cue is added, etc. until the patient produces the correct word. In the errorless condition, the patient views a picture and is given its name and asked to repeat it. Pieces of the word are then removed bit by bit, and the patient names the item after each successive piece is removed. The conditions are compared, within-subject, for differences in time to learn the words and degree of retention of the words after one month and six months. These results will be correlated with the results of tests of explicit and implicit memory, and attention. The overall results will provide the basis for future studies of the importance of the errorless/ful variable in the design of cognitive rehabilitation of language deficits, and the potential value of tests of explicit memory in predicting therapy success.