Balancing Effortful and Errorless Learning in Naming Treatment for Aphasia

NCT ID: NCT05653440

Last Updated: 2025-12-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-27

Study Completion Date

2028-01-31

Brief Summary

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Aphasia is a language disorder caused by stroke and other acquired brain injuries that affects over two million people in the United States and which interferes with life participation and quality of life. Anomia (i.e., word- finding difficulty) is a primary frustration for people with aphasia. Picture-based naming treatments for anomia are widely used in aphasia rehabilitation, but current treatment approaches do not address the long-term retention of naming abilities and do not focus on using these naming abilities in daily life. The current research aims to evaluate novel anomia treatment approaches to improve long-term retention and generalization to everyday life.

This study is one of two that are part of a larger grant. This record is for sub-study 1, which will adaptively balance effort and accuracy using speeded naming deadlines.

Detailed Description

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Study 1: Evaluate the benefits of balancing effortful and errorless learning via adaptive naming deadlines.

* Study design: The investigators will enroll 30 people with aphasia in a randomized within-subjects crossover design comparing trained words in three retrieval conditions. Stimuli will be balanced across conditions using an established item-response theory algorithm developed by Dr. Hula (consultant). Participants will receive 8 sessions of treatment per condition (2x/ week for 4 weeks), with probes administered at baseline and 1 week, 3 months, and 6 months post-treatment. Condition treatment order will be randomly assigned and counter- balanced across participants. In total, Sub-study 1 includes typically 3-4 (but up to 6) assessment sessions, 24 treatment sessions, and 24 baseline and follow-up probe assessment sessions per participant over an approximately 10-month period, but up to 18 months. Data collection will take place at the Language Rehabilitation and Cognition Laboratory (LRCL) at the University of Pittsburgh, in participants' homes, or in private rooms in public spaces (e.g. libraries, community centers).
* Participants: The investigators will recruit 30 male and female community-dwelling people with aphasia \>6 months post- onset of aphasia due to left-hemisphere stroke. Aphasia diagnosis will be confirmed by Comprehensive Aphasia Test (CAT) performance and medical history. Investigators will exclude potential participants with a history of other acquired or progressive neurological disease, significant language comprehension impairments, unmanaged drug/alcohol dependence, and severe diagnosed mood or behavioral disorders that require specialized mental health interventions.
* Assessment Procedures: Participants will be tested on a comprehensive initial battery of standardized assessments characterizing their aphasia severity and overall language profile, naming and discourse abilities, semantic processing, verbal short-term and working memory at baseline. Patient-reported measures of treatment motivation and pre-post changes in communication effectiveness will also be measured in response to each treatment condition. These tests will ensure that our participants well-characterized from a behavioral perspective, and measures will be used in secondary analyses and model development exploring predictors of treatment response.
* Treatment description: Each training trial will consist of a fixation cross and picture presentation. A repetition cue (audio recording and written from of the target) will be provided to participants based on the deadlines described above. Participants will be instructed to name the picture and indicate when they have given their final answer via key press, with responses also timed and scored by clinician key press. In the errorless condition, they will be instructed to repeat the target, while in the other conditions they will be asked to try to name the picture independently before they hear the target. Once they have indicated that they have provided their final answer, they will receive accuracy feedback on the computer screen based on clinician scoring. To maximize the clinical relevance of this study, investigators will control total amount of treatment time (8 hours) between conditions, instead of controlling the total number of trials. This is because many more trials can be completed per hour in the errorless or balanced conditions compared to the effort-maximized condition, and investigators want study outcomes to practically inform clinicians on how best to spend limited treatment time.

Conditions

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Aphasia Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Research assistants responsible for coding data will be masked to treatment condition.

Study Groups

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Effort-maximized, then effort-accuracy balanced, then accuracy-maximized

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group Type EXPERIMENTAL

Accuracy-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Effort-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Effort-accuracy balanced condition

Intervention Type BEHAVIORAL

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Accuracy-maximized, then effort-maximized, then effort-accuracy balanced

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group Type EXPERIMENTAL

Accuracy-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Effort-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Effort-accuracy balanced condition

Intervention Type BEHAVIORAL

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Accuracy-maximized, then effort-accuracy balanced, then effort-maximized

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group Type EXPERIMENTAL

Accuracy-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Effort-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Effort-accuracy balanced condition

Intervention Type BEHAVIORAL

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Effort-accuracy balanced, then effort-maximized, then accuracy maximized

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group Type EXPERIMENTAL

Accuracy-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Effort-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Effort-accuracy balanced condition

Intervention Type BEHAVIORAL

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Effort-accuracy balanced, then accuracy-maximized, then effort-maximized

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group Type EXPERIMENTAL

Accuracy-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Effort-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Effort-accuracy balanced condition

Intervention Type BEHAVIORAL

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Effort-maximized, then accuracy-maximized, then effort-accuracy balanced

All participants will receive all three naming treatment conditions in a randomized order - this is one possible ordering of those conditions.

Group Type EXPERIMENTAL

Accuracy-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Effort-maximized condition

Intervention Type BEHAVIORAL

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Effort-accuracy balanced condition

Intervention Type BEHAVIORAL

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Interventions

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Accuracy-maximized condition

Naming treatment condition in which the target will be immediately provided for repetition at picture onset.

Intervention Type BEHAVIORAL

Effort-maximized condition

Naming treatment condition in which participants will have up to 10 seconds to respond before the target is provided for repetition.

Intervention Type BEHAVIORAL

Effort-accuracy balanced condition

Naming treatment condition in which naming deadlines will be determined based on the balanced effort-to-accuracy benefit ratio formalized above, calculated on clinician-provided accuracy and response time ratings. Deadlines will be recalculated session-by-session to adjust to participant-specific treatment gains over time.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Existing diagnosis of chronic (\>6 months) aphasia subsequent to left hemisphere stroke.
* Impaired performance on 2/8 sections of the Comprehensive Aphasia Test.

Exclusion Criteria

* History of other acquired or progressive neurological disease.
* Significant language comprehension impairments
* Unmanaged drug / alcohol dependence.
* Severe diagnosed mood or behavioral disorders that require specialize mental health interventions.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Massachusetts, Amherst

OTHER

Sponsor Role collaborator

National Institute on Deafness and Other Communication Disorders (NIDCD)

NIH

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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William Evans

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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William Evans, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

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Language Rehab and Cognition Lab, Department of Communication Sciences and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Alyssa Kelly, M.A., CCC-SLP

Role: CONTACT

412-648-3274

Facility Contacts

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William Evans, PhD

Role: primary

412-383-6943

Other Identifiers

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1R01DC019325-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY21120130 (Study 1)

Identifier Type: -

Identifier Source: org_study_id

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