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Traditionally, 'fluency' is used first to refer to an aphasic syndrome and second to describe only a symptom, a defining speech output feature. Both of these uses may be questioned. Different dimensions of fluency, for instance articulatory agility and use of grammatical words, may be found independent; thus fluency does not identify with a consistent association of speech characteristics. When these dimensions are considered separately, other methodological and theoretical problems arise because the several decisions which are made in assessing the rate and ease of speaking do not relate explicitly to current models of speech production. The alternatives to fluency measures are various qualitative analyses of speech on the morpheme and sentence levels. Nevertheless, the inclusion of temporal variables remains useful when combined with a description of the morphological and structural aspects of the performance, when narratives are studied on the discourse level and, in a clinical setting, when therapists have specifically to deal with changes in fluency during the treatment of single cases of aphasia.

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Background: So far 11 therapy studies have been reported which aimed to re-teach semantic knowledge in brain-damaged patients presenting with a semantic deficit consecutive to stroke, herpes encephalitis, or semantic dementia. All these semantic therapy studies but one recorded a significant improvement in the patients' performance on tasks requiring semantic processing. The exception to this pattern was the semantic therapy study by Sartori, Miozzo, and Job (1994), which yielded negative results. Because the study concerned two patients with anterograde amnesia associated with the semantic deficit, Sartori et al. concluded that reacquiring semantic knowledge was not possible when such association of deficits was present. Aims: Sartori et al.'s study, like all the other semantic therapy studies, applied an errorful learning procedure during the therapy. However, the question can be raised of whether such procedure is appropriate when amnesia is associated with the semantic deficit. Because error elimination is likely a function of explicit memory, which is impaired in amnesic patients, wrong stimulus-response associations would be repeatedly retrieved and strengthened in (spared) implicit memory, thus preventing the patient from learning novel semantic knowledge. In the present single-case study we addressed this issue by using an errorless learning procedure during semantic therapy in a post-encephalitis patient (DL) who suffered both a semantic deficit and anterograde amnesia. Methods & Procedures:The therapy aimed at re-teaching semantic attributes of 16 items. The design included, further to these 16 target items, 16 contrast and 16 control items, which were semantic coordinates of the target items. Both shared (category) and distinctive (non-category) attributes were included in the learning set. Learning was based on an attribute classification task in which the properties of the target items had to be contrasted with those of coordinate items, within a paradigm that greatly reduced the chance of making errors. A pre-and post-therapy picture naming and an attribute verification task allowed us to assess the therapy effects at the end of therapy and 1 year later. Outcomes & Results: Significant therapy effects were observed in the attribute verification task and were still present 1 year afterwards. Thus, the patient's performance significantly improved for the category (i.e., shared) attributes of the target, contrast, and control items, and for the non-category (i.e., distinctive) attributes of the target items.

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