Working memory treatment in aphasia: A theoretical and quantitative review

Abstract

A B S T R A C TWorking memory (WM) is a frequent and long-lasting deficit in patients with aphasia. Progress has been made in our understanding of the nature of WM impairment, by considering deficits at the level of maintenance of item and serial order information (short-term memory), deficits at the level of attentional control, and their complex interactions with language impairment. However, WM treatment studies in aphasic patients remain scarce. This theoretical and quantitative review of 15 single-case treatment studies (24 patients) reveals that WM treatment in aphasic patients is associated with robust near transfer effects and smaller far transfer effects. WM treatment can also raise verbal WM capacity to normal range performance levels. The specificity of WM treatment is more difficult to establish as control tasks/treatments are associated with treatment effects of comparable size as far transfer effects. Existing treatments cover phonological maintenance and control of attention components of WM but do not target difficulties at the level of item interference or serial order processing. In order to improve the specificity of WM treatments, future studies should define WM impairment and treatment targets in a more precise and theoretically informed manner. Also, although the vast majority of reviewed studies meet minimal methodological requirements for single case experimental designs, the use of a larger number of baseline, treatment and control measures is recommended. Finally, publication of treatment studies with negative outcomes should be encouraged as it is currently difficult to estimate the impact of publication bias on observed treatment effects.

Maintenance Versus Transmission Deficits: The Effect of Delay on Naming Performance in Aphasia

“…The goal is not just to say what representations are impaired, but the nature of the impairment. This motivates an emphasis on cognitive abilities such as short-term memory (Saffran, 1990; Martin et al, 1994; Martin and Saffran, 1997), working memory (Wright and Shisler, 2005; Wright and Fergadiotis, 2012; Majerus, 2018), attention (Tseng et al, 1993; Murray et al, 1998; Hula and McNeil, 2008; Martin and Allen, 2012) and executive functions (Miyake et al, 2000; Martin and Allen, 2008; Allen et al, 2012). Thus, a theory of aphasia is evolving to encompass both representational and processing components.…”

The methodological quality of short-term/working memory treatments in post-stroke aphasia: a systematic review

“…Low internal and external validity makes it difficult to draw conclusions about the beneficial effects of STM/WM treatments in stroke aphasia. A recent, related review by Majerus (2017) described the efficacy of STM/WM treatments using calculations of effect sizes for individual participants (Beeson & Robey, 2006) and a Bayesian one-sample t test to calculate overall effects across participants in the included studies. The conclusion drawn by Majerus, who acknowledged issues about specificity of treatment and content validity, was that STM/WM treatment studies appear to show satisfactory levels of efficacy.…”

“…To date, little is known about the evidence-base of STM/WM treatments in aphasia. While there have been recent narrative reviews (Majerus, 2017;Minkina, Rosenberg, Kalinyak-Fliszar, & Martin, 2017;Murray, 2012;Salis et al, 2015), to our knowledge, systematic reviews of STM/WM treatment studies in stroke aphasia have not been reported previously. Also, previous reviews have not focused on broad and systematic evaluation of the methodological quality of STM/WM treatments, which is the main focus of the present systematic review.…”

“…Also, previous reviews have not focused on broad and systematic evaluation of the methodological quality of STM/WM treatments, which is the main focus of the present systematic review. Majerus (2017) focused on identifying the statistical properties of effect sizes of STM/WM treatments in terms of near and far transfer. The review by Minkina and colleagues (2017) focused on treatment studies with a particular interest in word retrieval deficits in aphasia.…”

Abstracts 20th International Science of Aphasia Conference, Rome, September 2019

“…Therefore, aphasiologists developed different training methods to enhance deficient non-language cognitive functions. Several studies have reported beneficial effects of working memory and attention trainings on sentence comprehension in individuals with aphasia (Javadipour et al, 2018;Majerus, 2018;Zakarias et al, 2018). In our Laboratory of Neuropsychology, Nencki Institute of Experimental Biology PAS, the innovative therapeutic tool Dr. Neuronowski® based on TIP was developed.…”