All these occur prior to motor programming for speech (Ziegler, 2002). Detailed single case studies link aphasic individuals’ patterns of language strengths and weaknesses to difficulties with a particular level of processing. For example, E.E. (Howard, 1995) was held to have a deficit within the phonological output lexicon: PD-166866 solubility dmso he was consistent in the items he was unable to retrieve and was not helped by phonological cues. Howard suggests items were lost from his lexicon. Franklin et al.

(2002) describe M.B. whose output included many phonological errors and whose performance was better on short than long words. M.B.’s difficulty was in assembling phonemes for production. There is a confound in much of the research to date between the level of deficit and the target of intervention. mTOR inhibitor This study employs the same intervention with participants with different levels of deficit enabling us to investigate the relationship between the level of impairment and outcome, in particular any generalisation to untreated items. In a seminal study, Hillis (1989) investigated a cueing therapy designed to improve written naming in two participants with severe aphasia. The participant with more lexical-semantic difficulty (stage 1 on the model above and common to accessing both written and spoken forms for production) improved and the change generalised

to untreated items (and spoken naming). The second participant, with written naming difficulties arising from an orthographic

equivalent to level 2, improved only on written naming of treated items. Hillis argued it is important to determine the source of an individual’s naming difficulty in order to predict the outcome of intervention. However, more recently, Lorenz TCL and Ziegler (2009) did not find a direct relationship between the nature of the deficit and treatment approach. Participants with post-semantic anomia (stages 2 or 3 above) benefited from semantic intervention and also participants with semantic anomia (stage 1 on the model outlined above) benefitted from phonological/orthographic (word form) approach. Neither of these findings would be predicted from a straightforward link between intervention approach and breakdown in level of word production. Fillingham et al. (2006) compared errorless learning with errorful learning. All participants completed a detailed language and neuropsychological assessment battery prior to intervention. Fillingham et al. found strong relationships between response to therapy and underlying neuropsychological profiles, with participants who responded better overall to both types of therapy having better recognition memory, executive/problem solving skills and monitoring ability. Strikingly, however, there was no clear relationship between language skill and therapy outcome.