“The Palest Ink Is Superior to the Strongest Memory”: Evaluating Word-Finding Therapy Outcomes of Two Orthographic Cues in Adults With Aphasia

Purpose: Word-finding difficulties (anomia) are common in poststroke aphasia. Although recent evidence suggests that written cues may benefit anomia, their optimal use remains unclear. This study investigates two parameters of orthographic cue use: the optimal unit for cueing and the durability of cueing effects on spoken word production across three outcomes (accuracies of initial and final naming responses, together with response time). Examining multiple dimensions of naming, for example, accuracies of both initial and final naming responses, provides a more rounded perspective on anomia treatment outcomes. Method: Cueing interventions delivered over the internet and based on two different orthographic units, initial letters and whole words, were compared in five adults with chronic anomia using a crossover design. The three outcomes were measured 1 week and 4 weeks posttherapy to evaluate the durability of the cueing effects. Results: After accounting for practice-related gains from repeated task exposure, four out of five participants showed significant improvement on at least two outcomes following whole-word written prompts at 1 and/or 4 weeks posttreatment. In contrast, initial letter cues yielded significant improvement in two participants. Gains from whole-word orthographic cues can persist up to 4 weeks posttherapy for three participants; effects from initial letter cues did not persist beyond 1 week posttreatment. Conclusions: This telepractice spoken naming aphasia therapy provides case series evidence that whole-word written cues produced superior therapeutic impacts compared to initial letter cues, with whole words benefiting a wider range of individuals and whose effects were more enduring. Clinicians are therefore encouraged to consider orthographic prompts, especially at the whole-word level, when designing spoken language treatments, including in telehealth. Researchers and clinicians are also encouraged to code and analyze naming responses across multiple outcomes to maximize our understanding, since individuals may show progress on one naming dimension but not on others. Supplemental Material: https://doi.org/10.23641/asha.32960696