ASHA journals
4 files

Playing with BEARS + SFA (Evans et al., 2021)

journal contribution
posted on 2021-07-13, 21:53 authored by William S. Evans, Robert Cavanaugh, Yina Quique, Emily Boss, Jeffrey J. Starns, William D. Hula
Purpose: The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed–accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV).
Method: Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of “pass” responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed.
Results: Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of “pass” responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency.
Conclusions: BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy.

Supplemental Material S1. By-participant description of individualized BEARS training.

Supplemental Material S2. Additional language testing results.

Supplemental Material S3a. Pass rate (proportion of “pass” responses relative to paraphasia and nonresponse error types) by session. P1, P5, and P7 were the three participants who responded least to the treatment in terms of naming probe accuracy.

Supplemental Material S3b. Practice efficiency during treatment over time, as measured by cumulative feedback points by session.

Evans, W. S., Cavanaugh, R., Quique, Y., Boss, E., Starns, J. J., & Hula, W. D. (2021). Playing with BEARS: Balancing effort, accuracy, and response speed in a semantic feature verification anomia treatment game. Journal of Speech, Language, and Hearing Research. Advance online publication.


This research was funded by the VA Pittsburgh Healthcare System Geriatric Research Education and Clinical Center, the VA Healthcare Network VISN 4 Competitive Career Development Fund, and the VA RR&D service (IK1 RX002475), with funds awarded to William S. Evans.