Retrieval practice and spacing effects in multi-session treatment of naming impairment in aphasia
Open accessAbstract
Retrieval practice and spacing are two factors shown to enhance learning in basic psychological research. The present study investigated the clinical applicability of these factors to naming treatment in aphasia. Prior studies have shown that naming treatment that provides retrieval practice (i.e., practice retrieving names for objects from semantic memory) improves later naming performance in people with aphasia (PWA) more so than repetition training. Repetition training is a common form of naming treatment that can support errorless production of names for objects, but it does not provide retrieval practice. Prior work has also demonstrated enhanced naming treatment benefit in PWA when an item's training trials are separated by multiple intervening trials (i.e., spacing) compared to only one intervening trial (i.e., massing). However, in those studies, items were only trained in one session. Also, the effects of the learning factors were probed after one day and one week. The goal of the present study was to examine the effects of retrieval practice and spacing in a more clinically-inspired schedule of delivery and to assess the effects of the learning factors at retention intervals of greater functional significance. Matched sets of errorful items for each of four PWA were presented for multiple trials of retrieval practice or repetition in a spaced or massed schedule in each of multiple training sessions. Mixed regression analyses revealed that retrieval practice outperformed repetition, and spacing outperformed massing, at an initial post-treatment test administered after one week. Furthermore, the advantage for retrieval practice over repetition persisted at a follow-up test administered after one month. The potential clinical relevance of retrieval practice and spacing for multi-session interventions in speech-language treatment is discussed.
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When spacing is implemented (increasing difficulty), improved results are shown compared to massed study.
“and when spacing is implemented (increasing difficulty), improved results are shown compared to massed study (Middleton et al., 2016, 2019).”
From Does difficulty moderate learning? A comparative analysis of the desirable difficulties framework and cognitive load theory (2025) · cites this paper as Middleton et al., 2019
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Effects of distributed practice and criterion level on word retrieval in aphasia
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Self-citationWord Learning as a Window to Memory and Rehabilitation Outcomes in Traumatic Brain Injury
Morrow, E. L., & Duff, M. C. (2022) · American Journal of Speech-Language Pathology · doi:10.1044/2022_ajslp-22-00073 · Cited by 11 · see citing works
Quique, Y. M., Cavanaugh, R., Lescht, E., & Evans, W. S. (2022) · Journal of Communication Disorders · doi:10.1016/j.jcomdis.2022.106249 · Cited by 10 · see citing works
Sandberg, C. (2022) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2021_persp-21-00176 · Cited by 8 · see citing works
Morrow, E. L., Nelson, L. A., Duff, M. C., & Mayberry, L. S. (2024) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/59630 · Cited by 7 · see citing works
“Contextual diversity includes retrieving information at dispersed times and in different locations (ie, spaced retrieval [33,34], mimicking the real-world nature of learning [31,32,34].”
Rishi, P., Nunn, K., & Rohter, S. V. (2024) · Aphasiology · doi:10.1080/02687038.2024.2432022 · Cited by 3 · see citing works
“Coding responses as accurate despite minor deviations is consistent with prior work (Middleton et al., 2016, 2019) and is designed to provide credit for successful word retrieval while ignoring minor deviations.”
InfluentialMcCurdy, R. A., & Duff, M. C. (2024) · American Journal of Speech-Language Pathology · doi:10.1044/2024_ajslp-24-00145 · Cited by 4 · see citing works
Effortful retrieval practice effects in lexical access: a role for semantic competition
Patra, A., Traut, H. J., Stabile, M. J., & Middleton, E. L. (2022) · Language Cognition and Neuroscience · doi:10.1080/23273798.2022.2027991 · Cited by 3 · see citing works
“…naming practice) is more beneficial to later naming accuracy in PWA compared to practice that does not involve retrieving names from long-term memory (e.g. Friedman et al., 2017; Middleton et al., 2019; Middleton et al., 2015; Middleton et al., 2016; Schuchard & Middleton, 2018a, 2018b).”
BackgroundResultSelf-citationQuique, Y. M., Larkin, E., Cavanaugh, R., Heinemann, A. W., & Cherney, L. R. (2025) · American Journal of Speech-Language Pathology · doi:10.1044/2025_ajslp-24-00550 · Cited by 2 · see citing works
Morrow, E. L., Nelson, L. A., Duff, M. C., & Mayberry, L. S. (2026) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001147 · Cited by 2 · see citing works
“9,17 18-20 This diversity may involve retrieving information at different times and places (i.e., spaced retrieval 21,22 ), emulating the way people learn in the real world.”
Song, Y., Liu, F., Kang, L., Xue, C., Wang, X., Yang, Y., Sun, M., Zhao, M., & Lu, S. (2023) · Folia Phoniatrica et Logopaedica · doi:10.1159/000534188 · Cited by 2 · see citing works
“One frequent symptom of aphasia is naming disorder, sometimes speci fi ed as “ graph naming disorder, ” which involves dif fi culties in naming or misnaming familiar words or objects [8].”
Spacing effects in learning and memory
Carpenter, S. K., & Pan, S. C. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15754-7.00020-1 · Cited by 2 · see citing works
Middleton, E. L., Duquette, K. L., Rawson, K. A., & Mirman, D. (2022) · Neuropsychology · doi:10.1037/neu0000848 · Cited by 2 · see citing works
“…psychological literature on retrieval practice effects (a.k.a. test-enhanced learning) to inform naming treatment in aphasia (e.g., Friedman et al., 2017; Middleton et al., 2015, 2016, 2019; Schuchard et al., 2020; Schuchard & Middleton, 2018a, 2018b; for recent review, see de Lima et al., 2020).”
BackgroundMethodInfluentialSelf-citationAsynchronous, online spaced-repetition training alleviates word-finding difficulties in aphasia
de Grosbois, J. P., Canthiya, L., Philipp-Muller, A. E., Hickey, N. K., Hodzic-Santor, B. H., Heleno, M. C., Jokel, R., & Meltzer, J. A. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2022.2143822 · Cited by 2 · see citing works
“…communication, and the relative ease of quantifying its severity and response to intervention, a large number of research studies have examined behavioural techniques for improving word fi nding in persons with aphasia, typically using a simple picture-naming approach (e.g., Middleton et al., 2019).”
BackgroundResultHula, W. D., Dickey, M. W., Autenreith, A., Swiderski, A. M., Babiak, M. C., Nunn, K., Johnson, J. P., Nader, M. M., Tessmer, R., Hula, S. N. A., et al. (2026) · Journal of Speech Language and Hearing Research · doi:10.1044/2026_jslhr-26-00097 · Cited by 1 · see citing works
Imaezue, G. C., & Goral, M. (2025) · Journal of Communication Disorders · doi:10.1016/j.jcomdis.2025.106553 · Cited by 1 · see citing works
The effects of glosses on English L2 incidental vocabulary learning through reading: a meta-analysis
He, S., Shaari, A. H., & Shi, N. L. (2026) · Frontiers in Language Sciences · doi:10.3389/flang.2026.1815571
Increasing Word Learning Efficiency in Deaf and Hard of Hearing Children Through Retrieval Practice
McDaniel, J. (2026) · Journal of Speech Language and Hearing Research · doi:10.1044/2026_jslhr-25-01039
RehabilitIA: Generative AI Agents for Personalized Aphasia Therapy in Spanish
Galindo-Cera, A., Navarrete, S., Manrique, R., & Herrera, A. (2026) · Lecture notes in computer science · doi:10.1007/978-3-032-35390-0_13
Rehabilitation of language disorders after stroke (“aphasia”)
Hildebrandt, H., Turgut, N., & Holland-Letz, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45450-9.00010-2
Morrow, E. L., & Duff, M. C. (2026) · American Journal of Speech-Language Pathology · doi:10.1044/2026_ajslp-26-00143
Morrow, E. L. (2026) · American Journal of Speech-Language Pathology · doi:10.1044/2026_ajslp-26-00155
- Authors
- Middleton, E. L., Rawson, K. A., & Verkuilen, J.
- Affiliations
- Moss Rehabilitation Hospital (US)
- Kent State University (US)
- The Graduate Center, CUNY (US)
- Corresponding author
- Middleton, Erica L.
- Venue
- Cortex
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 119
- Pages
- 386-400
- ISSN
- 0010-9452 (ISSN-L)
- PMC
- PMC6783359
- OpenAlex
- W2958789462
- Cited by
- 29
- References
- 85
- Citations by year
- 2026: 8 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 7 · 2021: 1 · 2020: 3
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cortex (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Funders
- National Institutes of Health
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
- Keywords
- retrieval practice, spacing effect, aphasia, naming impairment, object naming, repetition training, semantic memory, speech therapy, retention
- MeSH terms
- Adult, Aphasia, Female, Humans, Learning, Male, Memory, Middle Aged, Names, Mental Recall, Verbal Learning, Stroke
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