{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:07:29Z","timestamp":1779289649557,"version":"3.51.4"},"reference-count":72,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The National Institute of Deafness and Other Communication Disorders of the National Institutes of Health","award":["1R01DC019325"],"award-info":[{"award-number":["1R01DC019325"]}]},{"name":"The National Institute of Deafness and Other Communication Disorders of the National Institutes of Health","award":["3R01DC019325-04S1"],"award-info":[{"award-number":["3R01DC019325-04S1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anomia is a primary feature of aphasia that negatively impacts quality of life. Although current anomia treatments improve word retrieval, long-term retention and generalisation of trained words to discourse-level communication are rarely measured. Treatment that produces lasting naming gains and generalises to real-world use is one of the top priorities of people living with aphasia. Here, we report the protocol for a randomised clinical trial that investigates individualised anomia treatment through adaptive naming deadlines to achieve \u2018desirable difficulty\u2019 to promote learning retention and generalisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We implement a within-subject sequential, crossover design in which 30 participants with chronic post-stroke aphasia will complete three anomia treatment conditions in randomised order: (1) an adaptive condition where the naming deadline (ie, amount of time the participant is given to name the item) dynamically adjusts between 1.5 and 10 s based on ongoing participant performance and (2) a static Effort-Maximised condition where there is a fixed 10-second naming deadline for all treatment sessions and (3) a static Accuracy-Maximised condition where items are presented immediately in auditory and orthographic form and are repeated by the participant. In each condition, participants are treated on 40 unique non-overlapping words across eight treatment sessions. Before and after each condition, participants complete naming probes and discourse probes. Treatment outcomes from the adaptive treatment will be tested against the two static conditions using linear mixed-effects modelling. Our primary outcome is performance on noun picture naming at 3\u2009months post-treatment. We evaluate production of treated words in discourse probes as a secondary analysis. We predict that our novel, adaptive naming treatment will produce more successful outcomes compared with the static treatment conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Institutional Review Board of the University of Pittsburgh approved the trial protocol (Study 21120130). Following study completion, results will be disseminated in peer-reviewed journals. If hypothesised results are observed, the adaptive treatment will be a novel, empirically based intervention for long-term retention of anomia treatment gains, positively impacting the lives and recovery of individuals living with aphasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05653440\">NCT05653440<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-116172","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:10:33Z","timestamp":1779286233000},"page":"e116172","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive balancing of effort, accuracy and response speed in anomia treatment for post-stroke aphasia in community-based settings in the USA: a within-subjects randomised controlled trial protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05653440","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05653440","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02005016","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1265-352X","authenticated-orcid":false,"given":"Candace M","family":"van der Stelt","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2114-6565","authenticated-orcid":false,"given":"Robert","family":"Cavanaugh","sequence":"additional","affiliation":[{"name":"MGH Institute of Health Professions, Charlestown Navy Yard, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1635-0753","authenticated-orcid":false,"given":"William D","family":"Hula","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA"},{"name":"VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Starns","sequence":"additional","affiliation":[{"name":"University of Massachusetts Amherst, Amherst, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6851-6449","authenticated-orcid":false,"given":"Alyssa","family":"Kelly","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0950-7496","authenticated-orcid":false,"given":"Mara L","family":"Goodman","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2326-8005","authenticated-orcid":false,"given":"Lauren","family":"Terhorst","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8893-8454","authenticated-orcid":false,"given":"Mohammad","family":"Hassany","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1902-1464","authenticated-orcid":false,"given":"Peter","family":"Brusilovsky","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5124-3473","authenticated-orcid":false,"given":"William S","family":"Evans","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026052007102245000_16.5.e116172.1","unstructured":"Simmons-Mackie N . 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