Skip to main content Accessibility help

Treatment of naming in nonfluent aphasia through manipulation of intention and attention: A phase 1 comparison of two novel treatments



Twenty-three chronic nonfluent aphasia patients with moderate or severe word-finding impairments and 11 with profound word-finding impairments received two novel picture-naming treatments. The intention treatment initiated picture-naming trials with a complex left-hand movement and was designed to enhance right frontal participation during word retrieval. The attention treatment required patients to view visual stimuli for picture-naming trials in their left hemispace and was designed to enhance right posterior perisylvian participation during word retrieval. Because the intention treatment addressed action mechanisms and nonfluent aphasia reflects difficulty initiating or maintaining action (i.e., language output), it was hypothesized that intention component of the treatment would enhance re-acquisition of picture naming more than the attention component. Patients with moderate and severe word-finding impairment showed gains with both treatments but greater incremental improvement from one treatment phase to the next with the intention than the attention treatment. Thus, the hypothesis that intention component would be a more active constituent than the attention component was confirmed for these patients. Patients with profound word-finding impairment showed some improvement with both treatments but no differential effects for the intention treatment. Almost all patients who showed treatment gains on either treatment also demonstrated generalization from trained to untrained items. (JINS, 2007, 13, 582–594.)


Corresponding author

Correspondence and reprint requests to: Bruce Crosson, Ph.D., Brain Rehabilitation Research Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, Florida 32608-1197. E-mail:


Hide All


Abdullaev, Y.G. & Posner, M.I. (1998). Event-related brain potential imaging of semantic encoding during processing single words. Neuro Image, 7, 113.
Alexander, M.P. (2003). Aphasia: Clinical and Anatomic Issues. In T.E. Feiberg & M.J. Farah (Eds.), Behavioral Neurology and Neuropsychology (2nd ed.), (pp. 147164). New York: McGraw-Hill.
Alexander, M.P. (2006). Impairments of procedures for implementing complex language are due to disruption of frontal attention processes. Journal of the International Neuropsychological Society, 12, 236247.
Anderson, B. (1996). Semantic neglect? Journal of Neurology, Neurosurgery, and Psychiatry, 60, 349350.
Barris, R.W. & Schuman, H.R. (1953). Bilateral anterior cingulate gyrus lesions: Syndrome of the anterior cingulate gyri. Neurology, 3, 4452.
Basso, A., Gardelli, M., Grassi, M.P., & Mariotti, M. (1989). The role of the right hemisphere in recovery from aphasia. Two case studies. Cortex, 25, 555566.
Cato, M.A., Parkinson, R.B., Wierenga, C.E., & Crosson, B. (2004a). Lesion pattern relates to rehabilitative treatment success in chronic nonfluent aphasia. Program No. 665.13. Society for Neuroscience 2004 Abstract Viewer/Itinerary Planner. Washington, DC: Society for Neuroscience. Online.
Cato, M.A., Parkinson, R.B., Wierenga, C.E., & Crosson, B. (2004b). Predicting rehabilitative treatment success in chronic nonfluent aphasia: Lesion and performance characteristics. International Neuropsychological Society: 32nd Annual Meeting Program & Abstracts. pp. 9293.
Coslett, H.B. (1999). Spatial influences on motor and language function. Neuropsychologia, 37, 695706.
Coslett, H.B., Schwartz, M.F., Goldberg, G., Hass, D., & Perkins, J. (1993). Multi-modal hemispatial deficits after left hemisphere stroke. Brain, 116, 527554.
Crosson, B. (2000a). Systems that support language processes: Attention. In S.E. Nadeau, L.J. G. Rothi, & B. Crosson (Eds.), Aphasia and Language: Theory to Practice (pp. 372398). New York: Guilford Press.
Crosson, B. (2000b). Systems that support language processes: Verbal Working Memory. In S. E. Nadeau, L.J.G. Rothi, & B. Crosson (Eds.), Aphasia and Language: Theory to Practice (pp. 399418). New York: Guilford Press.
Crosson, B., Bacon Moore, A., Gopinath, K., White, K.D., Wierenga, C.E., Gaiefsky, M.E., Fabrizio, K.R., Peck, K.K., Soltysik, D., Milstead, C., Briggs, R.W., Conway, T.W., & Rothi, L.J.G. (2005). Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia. Journal of Cognitive Neuroscience, 17, 392406.
Crosson, B., Benefield, H., Cato, M.A., Sadek, J.R., Moore, A.B., Wierenga, C.E., Gopinath, K., Soltysik, D., Bauer, R.M., Auerbach, E.J., Gökçay, D., Leonard, C.M., & Briggs, R.W. (2003). Left and right basal ganglia and frontal activity during language generation: Contributions to lexical, semantic, and phonological processes. Journal of the International Neuropsychological Society, 9, 10611077.
Crosson, B., Sadek, J.R., Bobholz, J.A., Gökçay, D., Mohr, C.M., Leonard, C.M., Maron, L., Auerbach, E.J., Browd, S.R., Freeman, A.J., & Briggs, R.W. (1999). Activity in the paracingulate and cingulate sulci during word generation: An fMRI study of functional anatomy. Cerebral Cortex, 9, 307316.
Crosson, B., Sadek, J.R., Maron, L., Gökçay, D., Mohr, C.M., Auerbach, E.J., Freeman, A.J., Leonard, C.M., & Briggs, R.W. (2001). Relative shift in activity from medial to lateral frontal cortex during internally versus externally guided word generation. Journal of Cognitive Neuroscience, 13, 272283.
Deloche, B., Ferrand, I., Metz-Lutz, M.N., Dordain, M., Kremin, H., Hannequin, D., Perrier, D., Pichard, B., Quint, S., Larroque, C., Cardebat, D., Naud, E., Gergego, C., Pradat-Diehl, P., & Tssier, C. (1992). Confrontation naming rehabilitation in aphasics: A computerized written technique. Neuropsychological Rehabilitation, 2, 117124.
Deloche, G., Hannequin, D., Dordain, M., Metz-Lutz, M.-N., Kremin, H., Tessier, C., Vendrell, J., Cardebat, D., Perrier, D., Quint, S., & Pichard, B. (1997). Diversity of patterns of improvement in confrontation naming rehabilitation: Some tentative hypotheses. Journal of Communication Disorders, 30, 1122.
Dotson, V.M., Singletary, F., Fuller, R., Koehler, S., Bacon Moore, A., Rothi, L.J.G., & Crosson, B., (in press). Treatment of word-finding deficits in fluent aphasia through the manipulation of spatial attention: Preliminary findings. Aphasiology.
Ellis, A.W. & Young, A.W. (1988). Human Cognitive Neuropsychology. Hillsdale, NJ: Lawrence Erbaum.
Francis, W.N. & Kucera, H. (1982). Frequency Analysis of English Usage: Lexicon and Grammar. Boston: Houghton Mifflin.
Fuster, J.M. (2003). Cortex and Mind: Unifying Cognition. New York: Oxford University Press.
Greenwald, M.L., Nadeau, S.E., & Rothi, L.J.G. (2000). Fluency. In S.E. Nadeau, L.J.G. Rothi, & B. Crosson (Eds.), Aphasia and language: Theory to practice (pp. 3139). New York: Guilford Press.
Heilman, K.M., Watson, R.T., & Valenstein, E. (2003). Neglect and related disorders. In K.M. Heilman & E. Valenstein (Eds.), Clinical Neuropsychology (4th ed.), (pp. 296346). New York: Oxford University Press.
Heiss, W.D., Karbe, H., Weber-Luxenburger, G., Herholz, K., Kessler, J., Pietrzyk, U., & Pawlik, G. (1997). Speech-induced cerebral metabolic activation reflects recovery from aphasia. Journal of Neurological Sciences, 145, 213217.
Hillis, A.E. (1989). Efficacy and generalization of treatment for aphasic naming errors. Archives of Physical Medicine and Rehabilitation, 70, 632636.
Hoodin, R.B. & Thompson, C.K. (1983). Facilitation of verbal labeling in adult aphasia by gestural, verbal or verbal plus gestural training. In R.H. Brookshire (Ed.), Clinical Aphasiology, Vol. 13 (pp. 6264). Minneapolis, MN: BRK Publishers.
Jonas, S. (1981). The supplementary motor region and speech emission. Journal of Communication Disorders, 14, 349373.
Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test (2nd ed.). Philadelphia: Lippincott, Williams & Wilkins.
Kearns, K., Simmon, N.N., & Sisterhen, C. (1982). Gestural sign (Amer-Ind) as a facilitator of verbalization in patients with aphasia. In R.H. Brookshire (Ed.), Clinical Aphasiology, Vol. 12 (pp. 183191). Minneapolis, MN: BRK Publishers.
Kertesz, A. (1982). Western Aphasia Battery. San Antonio, TX: Psychological Corporation.
Kinsbourne, M. (1971). The minor cerebral hemisphere as a source of aphasic speech. Archives of Neurology, 25, 302306.
Kiran, S. & Thompson, C.K. (2003). The role of semantic complexity in treatment of naming deficits: Training semantic categories in fluent aphasia by controlling exemplar typicality. Journal of Speech, Language, and Hearing Research, 46, 773787.
McNeil, M.R. & Doyle, P.J. (2000). Reconsidering the hegemony of linguistic explanations in aphasia: The challenge for the beginning of the millennium. Brain and Language, 71, 154156.
Murray, L.L., Holland, A.L., & Beeson, P.M. (1997). Auditory processing in individuals with mild aphasia: A study of resource allocation. Journal of Speech, Language, and Hearing Research, 40, 792808.
Nadeau, S.E. & Crosson, B. (1997). Subcortical aphasia. Brain and Language, 58, 355402.
Naeser, M.A., Martin, P.I., Nicholas, M., Baker, E.H., Seekins, H., Kobayashi, M., Theoret, H., Fregni, F., Maria-Tormos, J., Kurland, J., Doron, K.W., & Pascual-Leone, A. (2005). Improved picture naming in chronic aphasia after TMS to part of right Broca's area: An open-protocol study. Brain and Language, 93, 95105.
Nielsen, J.M. & Jacobs, L.L. (1951). Bilateral lesions of the anterior cingulate gyri: Report of case. Bulletin of the Los Angeles Neurological Society, 16, 231234.
Pashek, G. (1997). A case study of gesturally cued naming in aphasia: Dominant versus nondominant hand training. Journal of Communication Disorders, 30, 349366.
Petry, M.C., Crosson, B., Rothi, L.J.G., Bauer, R.M., & Schauer, C.A. (1994). Selective attention and aphasia in adults: Preliminary findings. Neuropsychologia, 32, 13971408.
Picard, N. & Strick, P.L. (1996). Motor areas of the medial wall: A review of their location and functional activation. Cerebral Cortex, 6, 342353.
Raymer, A.M., Rowland, L., Haley, M., & Crosson, B. (2002). Nonsymbolic movement training to improve sentence generation in transcortical motor aphasia: A case study. Aphasiology, 16, 493506.
Richards, K., Singletary, F., Rothi, L.J.G., Koehler, S., & Crosson, B. (2002). The activation of intentional mechanisms through utilization of nonsymbolic movements in aphasia rehabilitation. Journal of Rehabilitation Research and Development, 39, 445454.
Rose, M. & Douglas, J. (2001). The differential facilitatory effects of gesture and visualization processes on object naming in aphasia. Aphasiology, 15, 977990.
Skelly, M., Schinsky, L., Smith, R.W., & Solovitz Fust, R. (1974). American Indian sign (AmerInd) as a facilitation of verbalization for the oral verbal apraxic. Journal of Speech and Hearing Disorders, 39, 445456.
Thompson, C.K. & Kearns, K. (1981). Experimental analysis of acquisition, generalization and naming behaviors in patients with anomia. In R.H. Brookshire (Ed.), Clinical Aphasiology, Vol. 11 (pp. 3545). Minneapolis: BRK Publishers.
Tijssen, C.C., Tavy, D.L.J., Hekster, R.E.M., Bots, G.T.A.M., & Endtz, L.J. (1984). Aphasia with a left frontal interhemispheric hematoma. Neurology, 34, 12611264.
Tryon, W.W. (1982). A simplified time-series analysis for evaluating treatment interventions. Journal of Applied Behavioral Analysis, 15, 423429.
Tseng, C.H., McNeil, M.R., & Milenkovic, P. (1993). An investigation of attention allocation deficits in aphasia. Brain and Language, 45, 276296.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed