This issue considers principles of learning in the treatment of acquired communication disorders, specifically incorporating a study that examines intervention for adolescents with acquired brain injury and four studies that examine principles of learning as they apply to aphasia. The predominance of articles on learning in aphasia represents a bit of a shift, as traditionally work in aphasia has focused on characterizing the language deficits that define and are central to aphasia and on evaluating the effectiveness of interventions for aphasia. Increasingly, however, studies are identifying the presence of cognitive deficits in aphasia (see Lesniak, Bak, Czepiel, Seniow, & Czlonkowska, 2008 for review) and the potential influence this may have on an individual with aphasia's interaction with and progress with therapy.
Learning, defined as “knowledge or skill acquired by instruction or study” (Merriam Webster Dictionary, n.d.), is central to the process of rehabilitation (Hopper & Holland, 2005). Rehabilitation aims to bring about a reduction of impairments and/or improvement in function through instruction, practice, education, and the development of strategies. Therefore, although not the core deficit in communication disorders, learning is a critical component for developing tailored intervention approaches that can target goals while utilizing appropriate supporting cognitive networks and skills.
LEARNING WAYS TO RETURN TO LEARN
The first article of this special issue is the report of a case series analysis of therapy practices carried out by speech–language pathologists within multidisciplinary teams caring for adolescents experiencing prolonged concussive syndrome (PCS). Wright, Sohlberg, Watson-Stites, and McCart (2020) report on the number and types of incidents associated with PCS in adolescents, they outline methods of intervention utilized to address academic goals for students, and consider the relative effectiveness of categories of interventions. The article addresses learning from two perspectives: (1) the return to learning as a goal, and (2) learning as an integral component of cognitive rehabilitation strategies.
Guidelines for treatment following concussion are predominantly position statements or descriptions of unique implementations models. Authors present the current work as a means of examining existing cases and building foundations upon which future empirical studies can be designed to evaluate the effectiveness of cognitive rehabilitation interventions.
PRACTICE SCHEDULES OF LEARNING
In a review article, Middleton, Shuchard, and Rawson (2020) report on a body of psychological research that has examined how practice schedules influence rates and retention of new knowledge. In the first part of the review, the authors identify four key principles of practice schedules that have been repeatedly identified as meaningful to promote long-term retention of learning in participants without neurological insult:
- Item repetition—in succession (massed) versus after intervening trials (spaced): Separating trial repetitions with more than one intervening trial enhances long-term retention of learning.
- Item lag: In a spaced practice schedule, longer lags between trial repetitions promote greater long-term retention of learning.
- Item distribution—within session versus across session: Training items across two sessions rather than within a single session promotes long-term retention of learning.
- Session lag: Longer lags between sessions promote greater long-term retention of learning.
In the second part of the review, authors examine results from research involving individuals with aphasia that manipulates principles of distributed practice in studies evaluating the effectiveness of naming and language interventions. This review brings forth interesting and important clinical implications for therapy. Although in current practice speech–language pathologists work closely with individuals with aphasia to determine the targets of therapy and the approaches to be used, minimal attention is paid to details such as the spacing of repeated trials and lag between sessions. In a clinical context where therapy sessions are often limited, any application of principles that can enhance the improvements brought about through therapy should be considered and incorporated when possible.
PRIMING IN APHASIA
The next article in the issue is the report of an experimental study that examines priming behaviors in individuals with aphasia and controls. Silkes, Baker, and Love (2020) examine priming effects—whether a participant responds faster to a target that is preceded by a related stimulus (prime) than when preceded by an unrelated stimulus—under a variety of prime–target conditions. Authors manipulated the time interval between prime and target and also manipulated the linguistic load of targets (e.g., words vs. shapes), with the goal of better understanding priming in aphasia.
This study brings forth the important notion that learning can be carried out consciously or without conscious awareness. Much of conscious learning depends upon reasoning, hypothesis testing, and feedback processing, which may draw upon language and thus be impacted by language impairments. Learning that is carried out without conscious awareness does not depend upon language and has been explored as an avenue to support aphasia intervention.
WORD LEARNING IN APHASIA
In contrast to priming, which is considered implicit and as occurring below conscious awareness, in most instances of learning, the learner is aware that learning is the goal or is taking place. Coran, Rodriguez-Fornells, Ramos-Escobar, Martin, and Laine (2020) report on a word-learning paradigm carried out with conscious intention by individuals with aphasia. Over the course of 4 weeks, individuals with aphasia engaged in two weekly hours of training in which they learned to recognize and repeat target names associated with images. Authors probe the novel hypothesis that repeated practice with learning will lead to associated improvements in verbal short-term memory, evaluating learning results as they relate to cognitive–linguistic and memory measures. Authors additionally examine the structural integrity of the arcuate fasciculus to gain insights into the relationship between the integrity of the dorsal language pathway and word learning in aphasia.
Study results suggest that verbal short-term memory improves as a result of repeated novel word-learning practice, demonstrating that learning is not only a vehicle for therapy but that the act of learning can bring about cognitive change.
ATTENTIONAL ALLOCATION DURING LEARNING IN APHASIA
Finally, Vallila-Rohter and Czupryna (2020) report on an experimental study that utilizes eye tracking to examine attentional allocation during category learning in a group of individuals with aphasia and age-matched controls. Research has documented the presence of deficits in attention in individuals with aphasia relative to controls (e.g., Murray, 2012; Peach, Newhoff, & Rubin, 1993; Villard & Kiran, 2015) and prior work in category learning has identified reduced learning ability in individuals with aphasia (Vallila-Rohter & Kiran, 2013, 2015). Authors aimed to examine patterns of visual attention during learning to gain insights into the process of learning.
Stimulus animals comprised four features, each predicting category membership with a different degree of reliability (77% vs. 55% of trials). Prior studies using this task (Rehder & Hoffman, 2005) have demonstrated that through the course of learning, participants adjust their attentional allocation, focusing only on features that are highly predictive of category membership be the end of training. Findings suggest that older adults and individuals with aphasia may have difficulty inhibiting visual distractors and/or shifting visual attention drawing attention to the importance of considering the visual demands of materials presented in therapy.
Together, this collection of articles touches upon manipulations to contexts of learning that can contribute to variable success with learning and long-term retention of information. There are many more variables of learning (e.g., further manipulations of schedule and intensity, additional methods of implicit and explicit instruction, and modality and timing of feedback presentation) that can impact learning outcomes. Given that learning is central to the process of rehabilitation, individualizing intervention approaches for individuals with communication disorders likely depends upon evaluations of the strength and weakness of the language system, considerations of functional goals, and also on evaluations of learning and additional cognitive systems that are recruited in the process of rehabilitation that enable and support intervention. Understanding these principles is essential to developing, selecting, and carrying out interventions in ways that will promote maximal gains for individuals with communication disorders.
—Sofia Vallila-Rohter, PhD, CCC-SLP
MGH Institute of Health Professions
Coran M., Rodriguez-Fornells A., Ramos-Escobar N., Martin N., Laine M. (2020). Word learning in aphasia: Treatment implications and structural connectivity analyses. Topics in Language Disorders, 40(1), 81–109.
Hopper T., Holland A. L. (2005). Aphasia and learning in adults: Key concepts and clinical considerations. Topics in Geriatric Rehabilitation, 21(4), 315–322.
Learning [Def. 2]. (n.d.). In Merriam-Webster.com. Retrieved January 10, 2020, from https://www.merriam-webster.com/dictionary/learning
Lesniak M., Bak T., Czepiel W., Seniów J., Członkowska A. (2008). Frequency and prognostic value of cognitive disorders in stroke patients. Dementia and Geriatric Cognitive Disorders, 26(4), 356–363.
Middleton E., Schuchard J., Rawson K. (2020). A review of the application of distributed practice principles to naming treatment in aphasia. Topics in Language Disorders, 40(1), 36–53.
Murray L. L. (2012). Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. American Journal of Speech–Language Pathology, 21(2), S51–S64.
Peach R. K., Newhoff M., Rubin S. S. (1993). Attention in aphasia as revealed by event-related potentials: A preliminary investigation. Clinical Aphasiology, 21, 323–333.
Rehder B., Hoffman A. B. (2005). Thirty-something categorization results explained: Selective attention, eye tracking, and models of category learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 31(5), 811.
Silkes J., Baker C., Love T. (2020). The time course of primary in aphasia: An exploration of learning along a continuum of linguistic processing demands. Topics in Language Disorders, 40(1), 54–80.
Vallila-Rohter S., Czupryna B. (2020). Investigating attentional allocation with eye tracking during category learning in people with aphasia. Topics in Language Disorders, 40(1), 110–123.
Vallila-Rohter S., Kiran S. (2013). Non-linguistic learning and aphasia: Evidence from a paired associate and feedback-based task. Neuropsychologia, 51(1), 79–90.
Vallila-Rohter S., Kiran S. (2015). An examination of strategy implementation during abstract nonlinguistic category learning in aphasia. Journal of Speech, Language, and Hearing Research, 58(4), 1195–1209.
Villard S., Kiran S. (2015). Between-session intra-individual variability in sustained, selective, and integrational non-linguistic attention in aphasia. Neuropsychologia, 66, 204–212.
Wright J., Sohlberg M. M., Watson-Stites R., McCart M. (2020). Identification of key therapy ingredients for SLPs serving on multidisciplinary teams facilitating return to learn for students with prolonged cognitive effects after concussion: A retrospective case series analysis. Topics in Language Disorders, 40(1), 6–35.