Word-finding exercises for aphasia

Difficulty finding words, called anomia, is the most common problem in aphasia. The word is usually still known; the trouble is getting to it.

Word-finding exercises work by practicing that route to the word, with help that fades over time:

• Describe the meaning (what it is, what it does, where it is found) to approach the word through its meaning.
• Use cues, from weak (a description) to strong (the first sound), so the person finds the word with as little help as possible.
• Repeat often. Naming the same set of useful words many times over several weeks works better than seeing many words once.

Most people have had a word on the tip of their tongue. Anomia is that experience many times a day, for ordinary words like “cup” or a grandchild’s name. People with anomia often:

• pause for a long time mid-sentence;
• talk around the word (“the thing you drink out of”);
• say a related word instead (“fork” for “spoon”) or a word with similar sounds;
• know the word is wrong as soon as they say it.

Anomia occurs in every type of aphasia, from mild to severe, and is also common after traumatic brain injury.

Semantic feature analysis is one of the most widely used word-finding treatments. Instead of trying to pull the word out directly, the person works through questions about the object’s meaning. Thinking about those features activates the network of related knowledge, which helps bring up the word.

With a picture in front of you, ask about:

1. Group: What kind of thing is it? (“It’s a fruit.”)
2. Use: What do you do with it? (“You eat it.”)
3. Action: What does it do, or what do you do to it? (“You peel it.”)
4. Properties: What does it look, feel, or taste like? (“It’s yellow and long.”)
5. Location: Where do you find it? (“In the kitchen, in a bowl.”)
6. Association: What does it remind you of? (“Monkeys.”)

Then try the name again. Even when the word does not come, the description is a useful way to get the message across in conversation.

A cueing hierarchy is a set of hints that go from least to most helpful. The aim is to give only as much help as needed, so the person does as much of the work as possible.

1. Show the picture and wait at least 5–10 seconds.
2. Give a meaning cue: “You use it to stir your coffee.”
3. Give a sentence to finish: “You eat soup with a …”
4. Give the first sound: “It starts with ‘sp’.”
5. Say the word and have the person repeat it.

Keep track of which cue was needed. Over weeks, the same words should need weaker cues, which is a practical sign of progress.

• Category lists: name as many items as possible in a category in one minute.
• First-letter lists: name words that start with a given letter.
• Word association: say a word, and the person says the first related word that comes to mind.

These are harder than naming a picture, because there is no picture to start from. Save them for when picture naming is going well.

Pick words the person actually needs: family names, foods they like, things in their home, words for their hobbies and work. Practicing 20 to 50 personally useful words repeatedly is a better use of time than working through hundreds of random pictures once each.

For general guidance on setting up practice, see aphasia exercises at home, and for how much practice to aim for, see how much aphasia practice is enough.

What is anomia?

Anomia is difficulty finding words, especially names of objects and people. The person usually knows exactly what they want to say but cannot retrieve the word. It is the most common symptom of aphasia and occurs in every type of aphasia.

What is the best exercise for word-finding problems?

No single exercise is best for everyone. Approaches with good evidence include semantic feature analysis (describing an object’s features to reach its name) and naming practice with a cueing hierarchy (giving progressively stronger hints). A speech-language pathologist can tell you which suits the person’s pattern of errors.

Should I give the word when someone with aphasia is stuck?

Wait first, then give a hint, and give the word only if hints do not work. After you give it, have the person say it themselves. Jumping in immediately removes the practice; leaving someone stuck for too long is discouraging.

Do word-finding exercises help with words that were not practiced?

Sometimes. Improvement on practiced words is common. Improvement spreading to words that were not practiced is less consistent, but it has been reported, including in a study of Parrot Software’s anomia programs with people who had chronic aphasia.