Medical Essay on Using of Ortho-Phonemic Cueing Therapy for Anomia in Aphasia

Anomia, which referred to the difficult word retrieve spontaneously, find in nearly all people with aphasia, regardless of the pattern of their other language symptoms (Goodglass & Wingfield, 1997). It could be due to weak access to semantic, lexical, and phonological representations (Martin et al., 2006; Schwartz, Dell, Martin, Gahl, & Sobel, 2006). It also considers one of the most challenging and stressful aspects of aphasia, which can adversely affect the person's ability to communicate and social interact (Nickels, 2002). Therefore, an effective word retrieval treatment should be addressed to enhance the communicative competence of the person with aphasia (PWA) (Nickels, 2002). Thus, a significant amount of attention has been directed towards examining treatments for anomia using a wide range of tasks with individuals who have different levels of impairment. According to Greenwood et al., (2010) treatment outcomes that show improvements beyond the treated items could be considered the most successful.

Naming therapy approaches can be divided into semantically based and word-form based (Law et al., 2008). Semantically based includes tasks that emphasize the semantic processing, involving discussion of semantic properties of the object to be named (e.g. Boyle, 2004; Boyle & Coelho, 1995), categorizing objects or pictures (e.g. Kiran & Thompson, 2001), matching the words to pictures (e.g. Marshall, Pound, White-Thomson, & Pring, 1990), providing synonyms (e.g. Hough, 1993), or describing semantic features (e.g. Nickels & Best, 1996). On the other hand, the word-form-based focus on the processing of the phonological or orthographic forms of the target words. It can include the following task: reading aloud, repetition which can be found in most treatments to provide the target name after cueing (e.g. Howard, 1994; Nickels & Best, 1996), phonological cueing (e.g. Raymer & Ellsworth, 2002), performing rhyme judgment, counting syllables, dividing words into phonemes (e.g. Robson, Marshall, Pring, & Chiat, 1998), or letter cueing (e.g. Howard & Harding, 1998; Nickels, 1992; Nickels & Best, 1996). Previously, most of the researches has focused more on semantic techniques which were well established both in research and clinical practice. For several years, it was believed that the effects of semantic treatment were more effective and longer-lasting (see Nickles, 2002 systemic review). However, the findings of other studies, in which compared semantic treatment tasks compared to the phonological ones, showed no significant difference (Howard, 2000; Howard et al., 1985b).

With regard to ortho-phonological cueing OPC a comprehensive literature search of the EBSCOhost was conducted aiming to select appropriate, reliable, and relevant published electronic medical journals, to review phonological and orthographical therapy approaches for anomia. Fourteen recent studies for the last ten years were extracted; six of which seemed more relevant and applicable evidence to define OPC therapy that focuses on improving word-retrieval in PWAs. One of the extracted studies is conducted by Hickin et al., (2002) examining the lasting effect of word retrieval by utilized OPC as a choice, applied to eight participants. The participants were requested to make the choice of the distracted and correct cue (Hickin et al., 2002). Results showed that all seven participants considerably improved with no superior effect of one cue type over the other; Furthermore, there was a remarkable relationship between the progress of the therapy and gains of facilitation for the whole group (Hickin et al., 2002). Nevertheless, this study has shown no generalization for the untreated item since the word mapping was specific and idiosyncratic. The potential correlation between short and long term impact of cues deliver the foundation emerging a theory therapy (Byng & Black, 1995; Howard & Hatfield, 1987), and it appears that some strategies are successful as short term which would be possible modified and combined to be part of anomia treatment that produces a significant lasting effect. Hickin et al., (2002) point out that using orthographic cueing considered the best choice for the aphasic individual with severe auditory processing problems or hearing loss (Hickin et al, 2002), in addition to those patients who demonstrate better skills in written naming in comparison to spoken naming (Nickles, 2002).

Another relevant extracted study, a single case study conducted by Wambaugh & Wright (2007) investigate the effect of combined orthographic form of the target word to a phonological cueing treatment (PCT), and to a semantic cueing treatment (SCT). The results showed that both combined treatments improve participants ability to retrieve the treated items. Since the same participant didnt benefit from the prior study (Wambaugh, Nessler, Cameron, & Wright, 2007) which apply the same strategy but without written cues, the authors (Wambaugh & Wright 2007) assumed that even obtained limited remaining orthographic processing skills could play a role facilitate word-retrieval progress. Nevertheless, such an outcomes cant be generalized for other PWA since it a single case study. Moreover, Law et al., (2008) conducted a study examining the effectiveness of OPC on four chines people with aphasia. All participants displayed significant gain from treatment and lasting effect sustained for one month post-therapy (Law et al., 2008). In details, two participants had improvement limited to the trained items while the other two participants showed improvement extended to the untrained targets with significant generalization effect that experienced by one of them into items with initial consonants different from the trained items (Law et al., 2008). The study found that (OPC) is a highly effective choice for rehabilitating in Chinese PWA (Law et al., 2008). Law et al., (2008), furthermore, point out that involving orthographic cues, help to continue improvement of treatment or even increase the progress of participants performance which could be applied by independent home practice. Therefore, word-form based intervention is the practical choice for active PWA. For example, training pre-or post-treatment for letter cues that illustrates the initial consonants of target words were used with anomic speaker help to make them produce syllabic cues (Law, et al., 2008). However, the cues of orthographic have some restrictions and limitation of using such as providing the written letter cues for the dyslexic speaker with anomia as they will not be benefited from this type cues (Law, et al., 2008).

Also, Greenwood et al., (2010) conducted a single case study evaluate the effect of weekly delivered of OPC on anomia, connected speech, conversation, and on the participants perspective on aphasia. There was maintained progress of treatment for both treated, untreated item, connected speech and participants views of communication activity, the outcomes furthermore, indicated that there is an important correlation between the change of participants opinion regarded her aphasia and progress of anomia; thus, there was a positive influence on participants quality of life (Greenwood et al.,2010). Since this intervention applied (OPC) at the same time participant profited from developing the connection between orthography and phonology, that play a critical role facilitating the phonological lexicon which already proving by (Best et al., 1997). Critically, the indication of this article wouldnt be practical since it is only one participant with highly personalized treatments, to the generalization for all aphasic patient.

With regard the lasting effect of OPC, a study conducted by Best et al., (2002) on 11 PWAs, to prove the lasting effect of PCT on anomia treatment and to examine the different of providing the different choice of the cue. The results revealed that participants improved from an orthographic and phonological form and the delayed effect last for over 10 minutes and there was no link between the level of naming impairment and improvement from cues (Best et al., 2002). They conclude that there was no major difference between the efficacy of orthographic and phonological cues. Nevertheless, they discussed that phonological and orthographic cues depend on different mechanisms for their effects. Phonological cues were discussed to be active via the lexical system, and orthographic cues by the sub-lexical system (Best et al., 2002). Moreover, it is well known nowadays that those cues if applied frequently over several sessions within one set of treated items could produce constant improvement that continues up to several weeks after therapy. (Hickin, Herbert, Best, & Howard, 2002; Wambaugh et al., 2001).On the other hand, Lorenz and Nickels (2007) carried out a study to evaluate the mechanism of the effectiveness of the orthographic cues in two terms: the relationship between decoding ability of the sub-lexical process and the efficiency of orthographic cues, and the correlation between the effect of orthographic cues and the effect of phonological cues. There were three participants involved in this study with moderate to severe naming impairment. The finding reveals that all participants, improved in immediate and delayed naming were proved after providing the initial letter cue of the target word (Lorenz and Nickels 2007). In detail, both orthographic and phonological cues showed the similar effect on one participant while other two participants, were improved from orthographic cues only; thus, the phonological cues were not successful for those two participants (Lorenz and Nickels 2007). Lorenz and Nickels (2007) attribute that the reason might be due the use of the computer to generate phoneme cues instated of the examiner (Lorenz and Nickels 2007). They suggest that phonological cues with information of mouth-shape by examiner increasing the chance for the more efficient effect of the cue than the use of computer program to present the cues (Lorenz and Nickels 2007). However, there is another argument regarding the correlation between the effectiveness of phonological and orthographic cues. For instance, Bruce and Howard (1988) discuss that, for letter cues to be successful, phonological cues must also be effective for the person with aphasia.

An aphasia therapy in clinical setting throughout Saudi Arabia recently tends to apply OPC during naming therapy. Despite, an absence of published studies addressing OPC on Saudi PWA, and even there is the lack of generally published study regard the aphasia. Thus, a significant gap exists between our knowledge of aphasia among Arabic society. Consequently, they tend to rely on the foreign published studies. As the earlier mentioned studies proved that the (OPC) was the effective naming therapy of aphasia either in western literature (Hickin et al., 2002; Best, 2008; Lorenz and Nickels 2007; Wambaugh & Wright 2007). And was also applied in different language and culture (i.e. Chinese PWA by Law, et al., 2008). Therefore, these reviewed studies and other relevant literature can be considered a point of departure for research on the effectiveness of applying OPC as naming therapy for Saudi population with aphasia.

To sum up, studies mentioned above were suitable to be used as relevant, reliable and valid evidence to examined the use of OPC with PWA, which include the establishment of this method, the positive and negative aspect of using OPC and a contradiction of the productivity of the OPC approach with a semantic cueing approach. The overall outcomes were indicating that OPC has positive therapeutic effects on enhancing the word retrieval in...