Mental imagery practice as a therapy for naming impairments: a preliminary study

Anomia remains one of the most recalcitrant linguistic disruptions in aphasia to treat. Developing successful interventions to address the word-finding deficits are complicated by the post-stroke symptom variability and inconsistent recovery patterns associated with anomia. Most of the current treatment methods, with a focus on specific compensating techniques and the repetitive practice of a limited set of items, have had variable success in naming treatment. However, it has not been possible to predict the gains in generalizing the learning beyond the stimuli used in practice or the controlled clinical setting. In this preliminary case study, we explore the value of a novel treatment concept, grounded in centuries of cognitive-perceptual exercises in mindfulness training. It incorporates the practice of mental imagery and focused attention to remedy the broken phonological assembly patterns found in word finding deficits. The aim of this study was to evaluate the potential effectiveness of practicing the repeated activation of mental imagery of concrete objects as a therapeutic tool for repairing disorders of lexical retrieval in a subject with chronic moderate to severe word-finding deficits. This trial treatment was used to assist a right-handed, 68-year old educated male with a two-and-a-half years post-onset chronic severe aphasia (anomic type) secondary to a left hemispheric infarct. Two five-week long training protocols involving common (typical) and uncommon (less typical) categories of pictured objects were used for treating anomia. The first trial involved the blocked presentation of stimuli; the second trial, undertaken a year after, included a random presentation of stimuli. It was found that the impact was manifested in three ways: (1) an improved verbal naming of the treated objects; (2) retention of therapeutic gains by a successful generalization to untreated similar lexical items; and (3) importantly, serendipitous gains in the ability to concurrently write the names of the pictured objects. The post-treatment data on all blocked lexical trials, and some random lexical trials, were found to be significant on the Fisher’s exact test. The use of the visual mental imagery-based therapy had a positive impact on the partial restoration of the subject’s naming.