Inner Speech and Naming Treatment for Individuals with Aphasia

Aphasia, a language disorder commonly acquired through stroke, has chronic negative impacts on communication abilities and quality of life. The specific language deficits associated with aphasia typically vary from person to person, but a universal element of aphasia is anomia, or difficulty with naming and word-finding. It is well-known that individuals with aphasia struggle to convey their ideas through overt speech, but little is known about this population's ability to access and utilize inner speech (IS). IS can be defined in many ways, but one simple definition that is well known to most language users is the mental imagery of having a little voice in one's head. Importantly, individuals with aphasia often endorse a mismatch between this "little voice" (IS) and what they can actually say out loud. In a prior interview-based study, over 75% of individuals with aphasia endorsed the specific experience of being able to say a word in their head despite being unable to say it aloud.

Previous research examined whether self-reported "successful IS" (sIS) (i.e., I can say the word in my head and it sounds right) predicted therapy outcomes in two participants. In both participants, self-reported IS predicted whether or not (and how quickly) individual words were successfully re-learned during a paired-associate treatment for anomia, and the effect was visible within just a few treatment sessions. This trial provides preliminary evidence that IS can be leveraged to improve outcomes of naming therapy for individuals with aphasia. This study aims to extend these prior finding by implementing a behavioral treatment for anomia using a single-subject experimental design in a larger group of individuals with aphasia.

The investigators predict that items reported as sIS will be more effectively learned during anomia treatment than items that are reported as uIS. Because sIS items are already being retrieved by the individual, one can think of them as being closer to successful spoken output than items that are not able to be retrieved (i.e., those reported as uIS).

Inclusion criteria

• Have aphasia resulting from stroke occurring at least 6 months ago
• Are at least 18 years old
• Learned English at age 5 years or younger
• Normal or corrected-to-normal hearing and vision
• Have access to reliable internet at home for remote participation

Exclusion criteria

• Have a history of other brain conditions that could impact interpretation of results (such as Parkinson's Disease or dementia)
• Have a history of psychiatric disease requiring hospitalization, electroconvulsive therapy, or ongoing medication use (other than common antidepressants)