Generalization and maintenance in aphasia rehabilitation

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Thesis (Ph.D.)--Georgetown University, 2010.; Includes bibliographical references.; Text (Electronic thesis) in PDF format. Cognitive rehabilitation after stroke or brain injury is often desired by patients but dismissed by doctors and insurance companies. However, it has been shown to be effective, even for patients whose deficits persist for more than one year post-stroke. The following studies investigate two important factors in the rehabilitation of language disorders: generalization and maintenance. Chapter 2 examines the reasons for the success of Multiple Oral Re-reading, a non-invasive, easily administered treatment that has been reported to generalize and is currently in clinical use for two acquired reading disorders (pure alexia and phonological alexia). The treatment consists of reading text aloud multiple times a day. We hypothesized that MOR generalizes because of the repetition of high frequency words in text. We designed text passages to test the hypothesis that participants would show generalization only with untrained text that included a critical mass of the words contained in the passages they re-read in treatment. We further hypothesized that the improvement patterns would differ in the two types of alexia. Contrary to the conclusions of previous studies, our results indicate that generalization effects in MOR are due to the repetition of specific words in text. However, most patients also showed improvement when specific phrases were re-used, indicating that practice of difficult words in context may be crucial to reading improvement. Chapter 3 examines the effect of error-production during treatment on initial learning and long-term maintenance of a behavioral intervention for word-finding (anomia). We compared two versions of the same treatment: an errorful (EF) version in which guessing is encouraged and errors occur frequently and an errorless (EL) version in which supportive cues greatly reduce the chances of making an error. We hypothesized that EL treatment would be associated with better maintenance, especially in patients with memory deficits, but our comparison revealed no advantage to EL. The results suggest that attentional engagement may be more relevant than error-prevention in the rehabilitation of people with aphasia. These two studies contribute to the literature on evidence-based practice in cognitive rehabilitation and have implications for cognitive models of reading and the interaction of memory and language.
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