A mixed method investigation into the impact of activation therapy with and without word finding for people with aphasia




Journal Title

Journal ISSN



Volume Title


De Montfort University


Thesis or dissertation

Peer reviewed


Background Information Impairment based therapy studies for people with aphasia indicate that therapy which involves word finding practice can help people with aphasia find words. Research has also suggested that the impact of therapy can generalise to other words not used in therapy and that it can have a positive impact on communication skills and feelings of wellbeing. This research project introduces a novel word finding therapy. Activation therapy was designed for people with all types of aphasia, even those who have difficulty representing their own views or cannot express their thoughts at all. There is very little evidence base to support a word finding therapy that does not involve overt word finding practice and this limited support is based on the results of three separate therapy studies and its beneficial impact on the word finding skills of five people with aphasia. This therapy trial compared the impact of activation therapy with and without word finding to see if its impact was contingent on the opportunity to practise word finding out loud. It was also designed to evaluate two additional therapy outcomes; the impact of activation therapy on sentence grammar and its impact on the experience of living with aphasia. Methodology This research was designed to conform to therapy trial standards as far as practicable. Seven people with aphasia and their therapy trial partners volunteered to participate in this study. All participants had suffered a left sided cerebrovascular stroke and were at least nineteen months post onset of their aphasia. Participants were diverse in terms of aphasia severity, type of aphasia, age, and pre stroke occupation, however they were all united in their need to receive more aphasia therapy than they had been offered. ttps were related to participants in different ways and were either spouses, partners, parents or the offspring of the seven participants with aphasia. The research design was informed by aphasia therapy trial precedents and followed an “a b a c a” design. Participants were provided with three pre therapy assessment sessions, six activation therapy with or without word finding sessions, three mid therapy assessment sessions, a further six sessions of activation therapy with or without word finding, and finally three post therapy assessments. Random allocation to counterbalanced pathways, verification of stable baselines, and three types of control tasks were used to address possible threats to the integrity of the crossover research design. Participants completed three 260 word finding assessments in each assessment phase. Participants and their therapy trial partners were also interviewed during each assessment phase. Assessments of sentence comprehension and non-verbal problem solving were conducted during pre and post therapy assessment phases and were used as two of the control measures from which the impact of activation therapy could be inferred. Initial word finding assessments were used to identify words which had caused word finding difficulties. For each participant, the words that they had found difficult to say were allocated to one of three equivalent word finding sets, activation therapy with word finding set, activation therapy without word finding set and a control group set. During activation therapy sessions participants listened to the therapist describing each word. Descriptions included at least eight relevant pieces of information about the word. Its appearance, function, most obvious feature, location, category membership, co-ordinates, closely related objects, synonyms, antonyms, subtypes, parts, use in collocations, use in idioms, use in frequent sentences and idiosyncratic associations. Participants were then asked to identify the object that had just been described from an array of five pictures that contained the target picture and four of its coordinates. The only difference between the two activation therapy techniques was that activation therapy with word finding sessions included participants practising saying the word that had just been described and participants were provided with the opportunity to practise saying the word eleven times before listening to the description of the next therapy item. Results Statistical analysis of group results suggested that activation therapy improved the word finding skills of the seven participants with aphasia. A lack of comparable improvement in control tasks suggested that improved word finding skills could be attributed to activation therapy rather than other possible factors such as improved attention, executive functioning, therapeutic alliance or other non-specific effects of attending Speech and Language Therapy sessions. There was however, no statistical difference between the impact of activation therapy with word finding and activation therapy without word finding, suggesting that spoken word finding practice was not an essential part of successful word finding therapy. Grammatical analysis of word, phrase and sentence level output elicited during therapy experience interviews identified only one indicator of the generalisation activation therapy to everyday speech. All seven participants used longer noun phrases after twelve weeks of aphasia therapy. Finally, thematic analysis therapy experience interviews with participants and their therapy trial partners suggested that activation therapy had resulted in positive perceptions of changes in language use and participants’ relationships with themselves, their close others and their interactions with people in the wider community, the other others. Triangulation and integration of these findings suggested that activation therapy may have altered the accessibility of nouns and noun syntax which was apparent in word finding assessments and spontaneous language use. Discussion This small scale therapy trial supports the implementation of aphasia therapy for people who are not happy living with their aphasia. Three complementary evaluation methods identified the meaningful impact of activation therapy in improved word finding in assessments, improved noun phrase structure, and enhanced wellbeing, a triangulation and integration of converging evidence. In this therapy trial, changes in word finding skills could not be attributed to overt word finding practice. The need to practise words is a notion that has guided aphasia therapy research and has framed the way that outcomes have been measured in this field. It has also dictated the type of participant that can take part in research and by implication has affected which type of person with aphasia can be provided with intervention that is evidence based. The equal impact of activation therapy with and without word finding on the words analysed in this therapy trial can be explained by both prominent models of single word processing, interactive and modular. Analysis of meaning word finding difficulties and generalisation to words not targeted in therapy aligned more closely to the interactive models of conceptualisation of single word processing. Neither model adequately explained the overuse of plural markers and relative lack of sound processing difficulties experienced by the seven participants in the study. It is hoped that the findings of this small scale therapy study may contribute to future discussions about the nature of word finding with and without aphasia. It is also hoped that it this study will contribute to the evidence base that supports the implementation of aphasia therapy for those who live with language difficulties.





Research Institute