Semantic Feature Analysis and Self-Cueing Strategies in Aphasia

Abstract

Purpose: Semantic Feature Analysis (SFA) has proven to be successful in facilitating naming of trained words in persons with aphasia and is grounded in current theories of word retrieval. Briefly, traditional Semantic Feature Analysis charts for use with persons with aphasia include six boxes, each labeled with a semantic feature surrounding a picture of a target word. The major shortcoming of traditional Semantic Feature Analysis treatments is little generalization from treated words to untreated words. One avenue for optimizing the use of SFA for treatment of word retrieval deficits in this population is to provide the person with aphasia with a strategy for self-cueing of the semantic features. This study seeks to optimize an SFA- based intervention through the use of a color- and symbol-coded strand of beads (the Expanding Expression Tool, EET) to increase generalization of word-finding abilities to untrained words during one-on-one treatment delivered remotely. Methods: Three persons with chronic aphasia secondary to left-hemisphere stroke participated in SFA intervention sessions using the Expanding Expression Tool. All supplies were delivered to the homes of the participants via no-contact drop offs, and the participants took part in the sessions from their homes via their own electronic devices. The sessions took place over password-protected, secured telehealth Zoom lines. Family members/caregivers assisted with initial set-up as needed, and administration of assessments. During the intervention, participants were asked to name pictured nouns that were screen-shared, and SFA intervention was implemented along with the physical manipulation of beads on the EET strand as the picture was described, with examiner-provided cues to describe the semantic feature as needed. Finally, the participant was given another opportunity to name the item; failure to name the pictured noun was followed by a phonemic cue from the examiner. If the phonemic cue failed to elicit the target word, the examiner provided the target word, and the participant repeated it. Five target words were treated in each session, and treated and untreated words were probed at the end of each session in random order. Ten words in each of four semantic categories were chosen for each participant, with words in three of those categories receiving treatment. Follow-up probes were taken at two and six weeks post-treatment. Results: Remotely-delivered training in Semantic Feature Analysis using the Expanding Expression Tool (EET) resulted in an increase in naming treated pictured nouns for all three participants. Naming untreated words in the same semantic category as the treated words increased for one of three categories for Participant 1, showed a slight increase in overall average in all three categories for Participant 2, and did not increase for Participant 3. Naming untreated words in a different semantic category mostly did not increase from baseline. Naming of treated nouns at the two- and six-week follow-up probes was at or well above scores at baseline in all instances except for one participant in two categories, but follow-up naming scores were typically slightly below those attained at the conclusion of intervention. Scores on a standardized measure of naming (the BNT-2) also increased slightly during post-testing. Conclusions: Overall findings support that EET may show promise as a supplement to traditional SFA to serve as a self-cueing strategy to increase word-finding for persons with aphasia. While generalization of results to untrained stimuli remained limited in this study, further research is warranted to develop a systematic approach to instructing the use of the EET and delivering the intervention to a more diverse population of persons with aphasia. Results also demonstrate that Semantic Feature Analysis modified for use with EET can be successfully implemented as a remote intervention for persons with aphasia.