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The purpose of this study is to evaluate the effect of Verb Network Strengthening Treatment (VNeST) on the ability to produce sentences and connected speech in persons with aphasia.
Stroke is the leading cause of disability in the United States today, and aphasia, a language disorder that affects production and comprehension of language, remains one of the most devastating aspects of stroke recovery. The most prominent symptom of aphasia is difficulty retrieving words, especially in sentence production and connected speech (e.g., telling a story, having a conversation). The current project examines the effect Verb Network Strengthening Treatment (VNeST), a language therapy, on the ability of persons with moderate aphasia to retrieve words in sentences and connected speech. The primary goals of VNeST are to 1) increase the specificity of nouns and verbs in sentences, 2) maximize improvement to untrained words across a variety of language tasks, and 3) engage and challenge participants with salient and relevant treatment materials and activities. Persons with aphasia who are enrolled in the study will receive VNeST for 10 weeks for 4 hours per week. Treatment tasks involve the retrieval of nouns related to a target verb. For example, for the verb measure, participants would come up with people who measure and what they measure (e.g., carpenter/lumber, chef/sugar). They would then answer questions related to why, where, and when these things might occur (e.g., for carpenter/measure, they might say "to get the right length of board," (why) "at a construction site," (where) and "when building a house" (where)). Cues and assistance are provided to the participants when they are unable to complete any given task. As the participants improve, cues are reduced.
Prior to treatment, testing will be conducted on participants to establish their abilities to retrieve words in the following contexts: 1) naming pictures of objects and actions, 2) sentences, and 3) connected speech.
Participants and a family member or friend (i.e., proxy) will also complete a questionnaire about how the participant is able to communicate in everyday tasks (e.g., indicating yes or no, providing medical information).
During the treatment phase, sentence production abilities on items related to treatment will be examined in order to determine how word retrieval abilities are changing with treatment. After the completion of treatment, all measures examined prior to treatment (including the questionnaire) will be re-examined in order to determine whether improvement was observed. Additionally, participants will complete testing one more time 3 months after the completion of treatment to determine if post-treatment improvements were maintained.
Finally, an analysis of improvement over time across the treatment phase will be examined in order to determine the rate of improvement (or lack of it) over time. All statistical analyses will use group data (i.e., group design), but additional examination of improvements for each participant (i.e., single subject design) will also be conducted. Thus, the overall experimental design is a mix of group and single subject analyses. The findings from this study will help to inform aphasia treatment practices and potentially allow for a larger study with more participants in a clinical trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Verb Network Strengthening Treatment | Experimental | Verb Network Strengthening Treatment (VNeST) tasks involve the retrieval of nouns related to a target verb. For example, for the verb measure, participants would come up with people who measure and what they measure (e.g., carpenter/lumber, chef/sugar). They would then answer questions related to why, where, and when these things might occur (e.g., for carpenter/measure, they might say to get the right length of board, (why) at a construction site, (where) and when building a house (where). Cues and assistance are provided to the participants when they are unable to complete any given task. As the participants improve, cues are reduced. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Verb Network Strengthening Treatment | Behavioral | Treatment to improve word retrieval in sentences and discourse for persons with aphasia due to stroke. |
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| Measure | Description | Time Frame |
|---|---|---|
| Trained Sentence Probe | Picture description task that include trained words. | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
| Untrained Sentence Probes | Picture description with sentences containing untrained words. | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
| Complete Utterances in Discourse | Sentence in discourse that were relevant to topic and syntactically correct | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
| Measure | Description | Time Frame |
|---|---|---|
| Noun Naming | Confrontation naming of 162 objects | pre-treatment and post-treatment |
| Verb Naming | Confrontation of 100 action pictures |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lisa A. Edmonds, PhD | North Florida/South Georgia Veterans Health System | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| North Florida/South Georgia Veterans Health System | Gainesville | Florida | 32608 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Verb Network Strengthening Treatment | Treatment tasks involve the retrieval of nouns related to a target verb. For example, for the verb measure, participants would come up with people who measure and what they measure (e.g., carpenter/lumber, chef/sugar). They would then answer questions related to why, where, and when these things might occur (e.g., for carpenter/measure, they might say "to get the right length of board," (why) "at a construction site," (where) and "when building a house" (where). Cues and assistance are provided to the participants when they are unable to complete any given task. As the participants improve, cues are reduced. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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Number of participants was based on pilot study results and consistent with the relevant literature.
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| ID | Title | Description |
|---|---|---|
| BG000 | Verb Network Strengthening Treatment | Treatment tasks involve the retrieval of nouns related to a target verb. For example, for the verb measure, participants would come up with people who measure and what they measure (e.g., carpenter/lumber, chef/sugar). They would then answer questions related to why, where, and when these things might occur (e.g., for carpenter/measure, they might say "to get the right length of board," (why) "at a construction site," (where) and "when building a house" (where). Cues and assistance are provided to the participants when they are unable to complete any given task. As the participants improve, cues are reduced. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Trained Sentence Probe | Picture description task that include trained words. | Posted | Mean | Standard Deviation | percentage of correct sentences | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
|
3 years, 6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Verb Network Strengthening Treatment | Treatment tasks involve the retrieval of nouns related to a target verb. For example, for the verb measure, participants would come up with people who measure and what they measure (e.g., carpenter/lumber, chef/sugar). They would then answer questions related to why, where, and when these things might occur (e.g., for carpenter/measure, they might say "to get the right length of board," (why) "at a construction site," (where) and "when building a house" (where). Cues and assistance are provided to the participants when they are unable to complete any given task. As the participants improve, cues are reduced. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Lisa Edmonds, PhD | Brain Rehabilitation Research Center, Malcom Randall VA, Gainesville, FL | 352.262.4465 | lisa.annamarie.edmonds@gmail.com |
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| ID | Term |
|---|---|
| D001037 | Aphasia |
| ID | Term |
|---|---|
| D013064 | Speech Disorders |
| D007806 | Language Disorders |
| D003147 | Communication Disorders |
| D019954 | Neurobehavioral Manifestations |
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|
| pre-treatment and post-treatment |
| Western Aphasia Battery | Standardized measure of aphasia severity | pre-treatment and post-treatment |
| Communicative Effectiveness Ratings | This questionnaire (Lomas et al, 1989) was provided to persons who communicated with the treatment participant regularly (e.g., a spouse). They rated how well the participant was able to perform on 16 common communication tasks (e.g., participating in a conversation over coffee). They rated each scenario along a line that spanned between the two extremes of ability, from "not at all able" to "as able as before the stroke." The line was 100 mm. To score responses, the place where they bisected the line was measured. An average of their responses across the 16 questions was calculated. | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Noun naming | Participants were asked to name the 162 object pictures (e.g., basket, arm) from An Object and Action Naming Battery. There was no time limit, and their final response was scored. An average of their correct responses was then calculated. | Mean | Standard Deviation | Percentage of correct naming |
|
| Verb naming | Participants were asked to name the 100 action pictures (e.g., climbing, sitting) from An Object and Action Naming Battery. There was no time limit, and their final response was scored. An average of their correct responses was then calculated. | Mean | Standard Deviation | Percentage of correct naming |
|
| Trained sentence probes | This task required the production of a sentence to a given picture (N=10). Each picture contained a person or animal doing something with/to something. E.g.,, "A carpenter is measures the lumber." For a sentence to be considered correct (1 point), it had to contain the correct subject (carpenter), verb (measure) and object (lumber). These words could not be substituted by pronouns (he) or general words (man). Articles and verb inflections (i.e., "the," "is," "ing") were not required. This task is called the "Trained Sentence Probes," because the verb was trained in treatment. | Mean | Standard Deviation | Percentage correct sentence production |
|
| Untrained sentence probe | This task required the production of a sentence to a given picture (N=10). Each picture contained a person or animal doing something with/to something. E.g., "A farmer is weighing apples." To be correct (1 point), the sentence had to contain the correct subject (farmer), verb (weigh) and object (apples). These words could not be substituted by pronouns (he) or general words (man). Articles and verb inflections ("the," "is," "ing") were not required. This is called the "Untrained Sentence Probes," because the verb in the picture (weigh) was semantically related to a trained verb (measure). | Mean | Standard Deviation | Percentage correct sentence production |
|
| Complete Utterances in discourse | We elicited 10 discourse responses that included personal information (What you do on Sundays), picture descriptions and procedural information (how to wash dishes) (Nicholas & Brookshire 1993). Each utterance was evaluated against the criteria for complete utterances (containing a subject, verb and object (if required) while ALSO being relevant). E.g., "The woman is something" lacks a main verb and is not fully informative, whereas "The woman is pouring a drink" is complete and relevant to the picture. Percentage of complete utterances relative to total number of utterances was calculated. | Mean | Standard Deviation | Percentage of complete utterances |
|
| Western Aphasia Battery | The Western Aphasia Battery-Revised is a standardized aphasia battery which evaluates the severity and type of aphasia. It is a criterion measure that results in an Aphasia Quotient (AQ) (range: 0-100, where lower scores indicate more severe aphasia). An AQ of 0-25 is very severe; an AQ of 26-50 is severe; an AQ of 51-75 is moderate; and AQ of 76 and above is mild. This aphasia quotient considers language production, comprehension and repetition. The score provided here is the mean AQ across participants. | Mean | Standard Deviation | units on a scale |
|
| Communicative Effectiveness Ratings | This questionnaire (Lomas et al, 1989) was provided to persons who communicated with the treatment participant regularly (e.g., a spouse). They rated how well the participant was able to perform on 16 common communication tasks (e.g., participating in a conversation over coffee). They rated each scenario along a line that spanned between the two extremes of ability, from "not at all able" to "as able as before the stroke." The line was 100 mm. To score responses, the place where they bisected the line was measured. An average of their responses across the 16 questions was calculated. | Mean | Standard Deviation | units on a scale |
|
| Units | Counts |
|---|---|
| Participants |
|
|
| Primary | Untrained Sentence Probes | Picture description with sentences containing untrained words. | Posted | Mean | Standard Deviation | percentage of correct sentences | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
|
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| Secondary | Noun Naming | Confrontation naming of 162 objects | Posted | Mean | Standard Deviation | percentage of correct naming | pre-treatment and post-treatment |
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| Secondary | Verb Naming | Confrontation of 100 action pictures | Posted | Mean | Standard Deviation | percentage of correct naming | pre-treatment and post-treatment |
|
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| Primary | Complete Utterances in Discourse | Sentence in discourse that were relevant to topic and syntactically correct | Posted | Mean | Standard Deviation | percentage of complete utterances | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
|
|
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| Secondary | Western Aphasia Battery | Standardized measure of aphasia severity | Posted | Mean | Standard Deviation | units on a scale | pre-treatment and post-treatment |
|
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| Secondary | Communicative Effectiveness Ratings | This questionnaire (Lomas et al, 1989) was provided to persons who communicated with the treatment participant regularly (e.g., a spouse). They rated how well the participant was able to perform on 16 common communication tasks (e.g., participating in a conversation over coffee). They rated each scenario along a line that spanned between the two extremes of ability, from "not at all able" to "as able as before the stroke." The line was 100 mm. To score responses, the place where they bisected the line was measured. An average of their responses across the 16 questions was calculated. | Posted | Mean | Standard Deviation | units on a scale | pre-treatment, post-treatment and 3-months post-treatment (maintenance) |
|
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| 0 |
| 11 |
| 0 |
| 11 |
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| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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|---|---|
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