Rhonda Friedman - US grants

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 cognitive impairments in general, and aphasic symptoms in particular. 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. The project focuses on one particular cognitive deficit, anomia, in attempting to study the relative efficacy of errorless vs. errorful learning in the rehabilitation of cognitive 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. A specific aim of the project is to test the hypothesis that patients with anomia subsequent to stroke 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 will be produced. A second aim is to examine the effects of intact vs. impaired explicit learning on the effects of the errorless/full variable. Both of 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 cue of minimal stimulus power 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, both in writing and orally, and is asked to reproduce 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 will be compared, within-subject, for differences in time to learn the words and degree of retention of the words learned after one month. These results will be correlated with the results of a test of explicit learning. 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 other cognitive deficits, and the potential value of tests of explicit learning in predicting therapy success.

[unreadable] DESCRIPTION (provided by applicant): Acquired disorders of reading (acquired dyslexia) are common in patients with aphasia subsequent to left hemisphere stroke. Even when language functions recover sufficiently to enable the patient to return to work, an unrecovered dyslexia often interferes significantly with job performance. Patients who cannot return to work may be left with little to occupy their time; the ability to read for pleasure could make a significant difference in their quality of life. The purpose of this project is to test a set of therapy programs for the treatment of acquired dyslexia, based upon a cognitive neuropsychological model of reading. A comprehensive and detailed battery of reading and reading-related tests is used to determine the underlying impairment causing the reading deficit in each patient. This proposal focuses on three specific deficits: 1) impaired access to the visual word form from the visual modality (pure dyslexia); 2) impaired orthographic-phonologic connections (phonologic/deep dyslexia); 3) poor lector/affixed word reading in text (phonological text alexia)). A set of experimental treatment programs has been devised for each of these reading deficits. These therapy programs derive in part from cognitive models of reading, in part from differences in general approach to treatment, and in part from the results of previous treatment studies. A set of general external probe tests are administered to all subjects before and after treatment There are additional external probes for each of the three deficit types, consisting of a list of words targeted for improvement but never trained. Measures include both accuracy and speed of reading. Group studies will examine the efficacy of treatments that have been successful in prior single case studies, and in some instances will compare the efficacy of two treatments with each other. Single case studies will be implemented to explore new treatment protocols or variations on old treatment protocols. Treatment programs are evaluated for efficacy by comparing the accuracy and speed of reading the treatment-specific probe words pre- and post-treatment, and examining performance on the general external probes pre- and post-treatment. The results of this project will increase our understanding of reading and its breakdown, leading to more effective methods of teaching reading to both normal and developmentally dyslexic children, in addition to providing a scientific basis for the choice of effective intervention strategies for the treatment of acquired dyslexia.

[unreadable] 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. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Acquired reading disorders (alexias) are common in patients with aphasia subsequent to left hemisphere stroke or head injury. Even when language functions recover sufficiently to enable the patient to return to work, unrecovered alexia often significantly interferes with job performance. Patients who cannot return to work may be left with little to occupy their time;regaining the ability to read would make a significant improvement in their quality of life. An important factor affecting a patient's ability to return to work and sustain a good quality of life is successful therapy. A language therapy is generally considered to be effective if a patient succeeds in performing a set of tasks at a specific criterion level over a number of sessions. Attaining this goal is significant;it demonstrates that learning has occurred, provides the patient with a sense of progress, and advances our understanding of language processing in the brain. However, an essential component of rehabilitation that rarely receives sufficient attention is the patient's ability to maintain the learned skills after therapy is terminated. 1 goal of this project is to examine the effects of training beyond criterion performance upon the maintenance of learned language skills. A second goal is to investigate the functional changes in the brain that occur following successful treatment, and to explore any additional changes that may occur following such extended periods of additional practice. According to neuropsychological models of reading, the success of aphasia treatment in stroke patients is dependent upon the reorganization of the cognitive and neural pathways used to process language;thus, fMRI techniques may be useful in documenting and elucidating how changes in processing may be brought about by aphasia therapy and extended practice. The proposal focuses on treatment of 2 specific deficits: pure alexia and phonologic alexia. However, the principles being examined are general ones, and apply to aphasia therapies in general. Functional brain activation patterns during certain reading tasks will be measured prior to treatment for these alexic disorders, then again following completion of the treatment (as ascertained by the reaching of criterion performance). An 8-week period of extended treatment will then be implemented, followed once again by an fMRI scan. Maintenance of performance will be re-assessed at 6 months. Effects of extended treatment on maintenance will be assessed, and comparisons will be made between scans obtained at the 3 different stages. Results will provide important information regarding the role of extended treatment in long-term success of language therapy, the potential for fMRI scans to predict long-term maintenance, and will lead to important insights into the ways that the brain effects cognitive changes following treatment for alexia. These results will have important implications for the design and implementation of aphasia rehabilitation programs, which should have significant positive effects upon the lives of individuals with alexia and aphasia.

DESCRIPTION (provided by applicant): The goal of this study is to delay the progression of word-finding problems in patients with Alzheimer's Disease (AD). The paradox of attempting to restore that which has begun to decline in AD is that patients with AD - by definition - have impairments in explicit memory, making new learning problematic. The current approach is novel in that it attempts to strengthen connections that have not yet been lost, making them more resistant to loss as the disease progresses. This study capitalizes on the finding that patients with AD continue to read words well into the course of the disease by strengthening the connections between objects and their written names. While the study is specific in its targeting of word-finding problems, a successful outcome would bode well for other studies aimed at prevention, rather than reversal, of declining cognitive functions in dementia. Patients with mild cognitive impairment (MCI) and mild AD whose naming of pictures has just begun to show signs of decline will practice naming pictures in two conditions. In one condition, they will view the pictures and repeat their names; in the other condition they will view the pictures with their written names, then read and transcribe the names. Naming of pictures trained in each of these conditions will be compared, at three time intervals post-training, with naming of pictures tested before the study but never trained. It is predicted that the pairing of the picture with its written name, combined with the motor task of transcribing the name, will result in a greater ability to name the picture at a later date than simple practice viewing the picture and repeating the name. Generalization of this better preserved naming ability to novel exemplars, contexts and tasks, is also predicted. PUBLIC HEALTH RELEVANCE During the early stages of AD, when patients are still living at home and functioning within the normal family setting, one of the greatest challenges to normal living is difficulty communicating caused in part by the inability to access the appropriate words. The successful delay of such word finding problems - the goal of the proposed study - would have significant consequences for the quality of life of patients with early AD, and for their families and caregivers.

DESCRIPTION (provided by applicant): The goal of this study is to remediate word-finding problems in patients with Primary Progressive Aphasia (PPA) and to delay the further progression of word-finding impairment. The current approach is novel in that it contains a prophylaxis component in which we attempt to strengthen neural connections that remain functional, making them more resistant to degradation as the disease progresses. While the study is specific in its targeting of word-finding problems, a successful outcome would bode well for other studies aimed at prevention or reversal of declining cognitive functions in dementia. Patients with PPA whose naming of pictures has just begun to show signs of decline will receive practice with picture naming in two conditions: viewing the picture and repeating the name; and viewing the picture with its written name, plus reading and writing the name. Naming of pictures trained in each of these conditions will be compared, at three time intervals post-training, with naming of pictures tested before the study but never trained. A scene-description task containing trained items will be used to assess generalization. It is predicted that the pairing of the picture with its written name, combined with the motor task of writing the name, will result in a greater ability to name the picture at a later date than simple practice viewing the picture and repeating the name. Generalization to other exemplars and to other task situations is also predicted. In addition, we will image the brains of the patients to determine whether patterns of brain atrophy can be used to predict treatment response.