Using strengths to treat deficits: A case study in anomia treatment Laurie S. Glezer * , Rhonda B. Friedman Georgetown University Medical Center, 4000 Reservoir Road, 205C, Building D, USA Available online 29 July 2004 Introduction In many treatments for anomia the patient is given oral cues and asked to repeat the word after the therapist. Such treatments depend upon the ability of the patient to repeat successfully. If the patient’s repetition skills are poor, such treatments are not likely to be suc- cessful. Treatments may also include a written component but few, if any, are purely written (Nickels, 2002). Hillis (1998) compared a written naming treatment with an oral naming treatment, and found both improved naming performance. However, each condition in- cluded both oral and written cues. The present study tests the efficacy of a purely written naming treatment on a single patient with anomia and severe repetition diffi- culties whose reading and writing skills remain relatively strong. We hypothesized that treatment that requires an oral response and gives only phonologic cues will be less successful than one using a treatment involving written input and oral output, and that a purely ortho- graphic treatment will be the most successful. We report on two experiments designed to examine RKR’s oral and orthographic skills. We then describe a third experiment that compares three naming treatments: oral, written, and mixed oral/ written. Case history RKR is an 81-year-old right-handed, English speaking woman with 20 years of education. She suffered a left CVA 30 months prior to entering our study. She presents with severe oral and written naming difficulties and severe repetition deficits. Her reading and writing abilities are relatively strong. Experimental studies Experiment 1 RKR was presented with 81 two- and three-syllable pictureable nouns . They were presented in five conditions over five different ses- sions over a 3-week period. The conditions were: written naming (C1), writing to dictation (C2), writing to dictation with picture present (C3), repetition (C4), and oral reading (C5). One-third of the pictures in each of the first three conditions were presented in each of the first three sessions. In the fourth session all 81 words were presented for repeti- tion, and in session five RKR was asked to read all the words aloud. The results are as follows: C1, 22/81; C2, 33/81; C3, 43/81; C4, 44/ 81; and C5, 70/81. These results indicate that RKR has difficulty with written naming, writing to dictation (with and without the picture present), and repetition. However, she performed well when reading these same words. Based on this pattern of deficits, we hypothesized that RKR should benefit more from an anomia treatment employing orthographic cues than one relying upon the repetition of oral cues. Experiment 2 Experiment 1 indicated that RKR had difficulty writing words that were presented in three different conditions: as pictures (C1), as spoken words (C2), or both (C3). Experiment 2 was designed to determine whether her oral and written production difficulties extend to ortho- graphic input. There were three conditions: purely written (W) input, written input and oral output (WO), and purely oral (O). There were 72 words per condition, matched for length and fre- quency. In the W task, words were presented on the screen for 1000 ms and RKR was asked to write down the word she saw. In the WO task, words were presented on the screen for 1000 ms and she was asked to read the word aloud. Finally, in the O task she was asked to repeat a word given orally. Results (Fig. 1) indicate that for RKR, oral and written output improve significantly when orthographic information is available. Experiment 3 Because of RKR’s strength with orthographic input and difficulty with repetition we designed a study that compares a purely ortho- graphic treatment (TC1), a combination of oral and written treatment (TC2), and a purely oral treatment (TC3). Methods To identify pictures RKR cannot name, 132 pictures with high name agreement were presented over four sessions. First, RKR was asked to name the pictures aloud. In sessions two and three she was asked to name the pictures in writing. Finally, she was asked to name a different exemplar (picture) of the same word in writing. The pictures RKR was unable to name in all four sessions were chosen for treat- ment. These 102 words were divided into three groups of 34 words to be trained in TC1, TC2, and TC3. Half of the 34 words will be trained using an errorful paradigm and the other half using an errorless par- adigm. Brain and Language 91 (2004) 187–188 www.elsevier.com/locate/b&l * Corresponding author. E-mail address: lsg5@georgetown.edu (L.S. Glezer). 0093-934X/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi: 10.1016/j.bandl.2004.06.096