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A Single-Subject Study Examining the Effects of a Behavioral Intervention for Verbal Recurrent Perseveration
Juengling-Sudkamp, Jenifer
Louisiana state university
Doctor of Philosophy (Ph.D.),2012
 Abstract:BACKGROUND: Approximately 1 million people in the United States suffer from aphasia and > 50% of those people may demonstrate recurrent perseverations. No consensus has been forthcoming on whether (1) a therapy that directly confronts clients with imminent pre-articulatory automatisms (the perseverations) or (2) a more typical neuropsychological therapy that eschews any direct confrontation with automatic behaviors works best.

PURPOSE: The purpose of this study was to determine the treatment efficacy of a non-confrontational picture naming intervention on naming ability in individuals with aphasia and recurrent perseverations.

METHODS: This is a prospective single-subject ABAB multiple baseline design replicated across 3 right-handed individuals with moderate fluent aphasia subsequent to left hemisphere ischemic strokes to answer the study��s experimental questions. Participants ranged from 61 to 77 years of age and ranged from 7.5 to 13.0 months post stroke. Further, the participants demonstrated total and/or blended perseverations errors on ��10% of a confrontational picture naming task that consisted of 60 items derived from the categories of the Naming in Categories subtest of the Boston Diagnostic Aphasia Examination Third Edition (Goodglass, Kaplan, & Barresi, 2001).

Multiple measurements of accuracy and efficiency were taken during the naming intervention, after the intervention, and during other speech tasks including single word repetition, reading, and picture description. Consistent with single-subject design, we used visual inspection to determine whether or not improvement in picture naming associated with the non-confrontational intervention had occurred. We also opted to analyze the data using paired t-test, Ordinary Least Squares (OLS) and Generalized Least Squares (GLS) with type 1 error rate set at �� = 0.05.

RESULTS: All three subjects increased performance on picture naming accuracy and decreased their number of recurrent perseverative responses with intervention. Only one subject elicited anticipatory errors in this study, and he demonstrated an increase in anticipatory proportion when presented with facilitating cues compared to pre-intervention performance. Preliminary results suggested communication improvements after the intervention extended beyond the speech process undergoing treatment. Significant individual variation in improvement was seen in response to therapy.

CONCLUSION: The results of this study provided preliminary evidence regarding the efficacy of a non-confrontational picture naming intervention as a strategy to improve speech accuracy and efficiency. In addition, preliminary evidence suggests that the immediate improvements are feasible with relatively short duration and frequency of intervention.

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