Word-finding difficulty
Difficulty retrieving words, or anomia, is one of the most common features of aphasia after stroke. The person usually knows what they want to say and may be able to describe the object, gesture its use or recognise the word when they hear it, but cannot produce the word itself on demand.
Treatment approaches for anomia broadly work by strengthening the links between meaning (semantics) and word form (phonology and spelling). Semantic feature analysis focuses on the meaning side.
What SFA involves
Semantic feature analysis was described as a treatment for aphasic dysnomia by Boyle and Coelho (1995). Instead of drilling the target word, the person is guided to describe the object by generating its semantic features: what group it belongs to, what it is used for, where it is found and so on. The idea is that activating a network of related meaning helps retrieval of the word itself, and may support naming of other related words.
A typical item works like this:
- Show a picture and ask the person to name it.
- Whether or not they name it, work through the feature chart, with the person generating each feature and the clinician prompting or supplying features as needed.
- Ask for the name again after the features have been reviewed.
The emphasis is on the person producing the features themselves, not just listening to them.
The feature categories
| Feature | Prompt | Example: scissors |
|---|---|---|
| Group | What kind of thing is it? | A tool |
| Use | What is it used for? | Cutting paper or cloth |
| Action | What does it do, or what do you do with it? | Open and close to snip |
| Properties | What does it look or feel like? | Two metal blades, finger holes |
| Location | Where would you find it? | A kitchen drawer, a sewing kit |
| Association | What does it make you think of? | Paper, a haircut, crafts |
Cueing hierarchies
Many naming sessions also use a cueing hierarchy: a planned sequence of cues from least to most support, given only as far as needed for the person to retrieve the word (Linebaugh & Lehner, 1977, described an early cueing-hierarchy programme). A common ladder is:
- Independent: no cue.
- Semantic cue: information about meaning, such as the group, use or location.
- Phonemic cue: the first sound of the word, or a word that starts the same way.
- Orthographic cue: the first letter or letters, and how long the word is.
- Model: the whole word, for repetition.
The order and the cues used should suit the person. Some people respond better to phonemic cues, others to written ones, and a hierarchy is most useful when it is applied consistently so that changes over time mean something.
What to record
- The highest cue level needed for each item, not just whether the item was named in the end.
- Time to name, since slow but independent retrieval is different from fast retrieval.
- Error types (semantic substitutions, phonological errors, descriptions), which may suggest which cues will help.
- Which features the person generated without help.
A simple score per item, for example full credit for independent naming and less for each cue level, lets you compare blocks and see whether the person needs less support over sessions.
Practical tips
- Choose items that matter to the person: objects from their home, hobbies and work.
- Allow time before giving a cue; retrieval can be slow.
- Keep blocks short and watch for fatigue, which often affects word finding.
- Mix trained and untrained items when checking progress, to see whether gains extend beyond the practice set.