When Finding the Right Word Starts with the Right Sounds
For many speech-language pathologists, phonological awareness is closely associated with early literacy. We think about rhyming, identifying the first sound in a word, segmenting syllables, or manipulating phonemes as foundational skills for children learning to read.
But what if these same skills could also play an important role in helping adults regain spoken language after a stroke?
Recent research suggests that they can.
For individuals with conduction aphasia, the challenge is often not understanding language or knowing what they want to say. Instead, the difficulty lies in accessing and maintaining the precise sound structure of a word long enough to produce it accurately. This breakdown frequently results in phonemic paraphasias, repeated self-corrections, impaired repetition, and the familiar experience of "having the word" but being unable to say it correctly.
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Looking Beyond Naming
For years, therapy for word retrieval has focused primarily on semantic activation or cueing strategies. While these approaches remain valuable, growing evidence suggests that another piece of the puzzle deserves equal attention: the phonological system itself.
Current neurocognitive models propose that explicit phonological awareness tasks and spoken naming rely on the same central phonological network. Rather than viewing phonological awareness as a literacy skill that belongs exclusively in pediatric practice, researchers increasingly describe it as a window into the integrity of the phonological system that supports spoken language in adults. When this system is disrupted, as it commonly is in conduction aphasia, both naming and phonological processing may become less efficient.
This perspective also helps explain something many clinicians observe in practice. Patients who struggle to retrieve words often have greater difficulty with longer or more phonologically complex words. They may produce sound substitutions, omit phonemes, or make several attempts before arriving at the correct word. These behaviours are not random. They reflect an unstable phonological representation that breaks down before successful word production can occur.
Importantly, the research does not suggest that poor phonological awareness directly causes anomia. Rather, both naming and explicit phonological tasks appear to depend on a shared phonological system. When that system is compromised, performance may decline across both domains. This distinction shifts our focus from treating isolated naming failures to strengthening the broader phonological network that supports successful word retrieval.
From Research to Clinical Practice
This evolving understanding has practical implications for assessment and intervention. Rather than evaluating naming in isolation, clinicians may benefit from examining multiple aspects of phonological processing, including initial sound identification, rhyme judgment, syllable awareness, phonological manipulation, nonword repetition, and patterns of phonemic errors. Together, these measures provide a richer understanding of where communication is breaking down and can help guide more targeted intervention.
Research on phonology-based interventions is equally encouraging. Approaches such as Phonological Components Analysis (PCA), phonomotor treatment, and phonemic cueing have demonstrated meaningful improvements in trained word retrieval, with some studies also reporting maintenance over time and generalisation to untrained items. Although further conduction aphasia-specific research is still needed, the current evidence strongly supports incorporating phonological processing into therapy alongside semantic approaches.
Putting Evidence into Practice with Cognishine
Translating research into meaningful clinical practice is often the greatest challenge. That's exactly why we developed a new collection of evidence-based therapy activities for phonological awareness within the Cognishine platform.
Designed specifically for adult neurorehabilitation, these neurorehabilitation activities bring evidence-based phonological training into everyday therapy sessions through engaging, interactive digital therapy exercises.
The collection includes activities targeting:
- Initial and final sound identification
- Syllable segmentation and blending
- Rhyme recognition
- Phonological manipulation
- Progressive word retrieval from short to longer words
The activities can be used with individuals presenting with conduction aphasia, anomia, and other acquired language disorders where phonological processing contributes to word retrieval difficulties.
Because every patient progresses differently, therapists can easily tailor task difficulty, gradually increase phonological complexity, and integrate these exercises alongside naming therapy. This flexible approach supports intensive, individualised practice while reducing therapy session preparation time and keeping therapy engaging for both clinicians and patients.
A New Perspective on Word Retrieval
As our understanding of aphasia continues to evolve, so should our treatment approaches.
Word retrieval is rarely just about finding a word. It is about rebuilding the phonological system that supports accurate spoken language.
By combining current evidence with practical speech and language therapy tools, clinicians can provide structured opportunities to strengthen the phonological foundations of communication and help patients regain greater confidence in everyday conversation.
Sometimes, helping a patient find the right word begins with strengthening the sounds that build it.
References
Baldo, J. V., Katseff, S., & Dronkers, N. F. (2012). Brain regions underlying repetition and auditory-verbal short-term memory deficits in aphasia: Evidence from voxel-based lesion symptom mapping. Aphasiology, 26(3-4), 338-354.
Beeson, P. M., Rising, K., Kim, E. S., et al. (2022). Common predictors of spoken and written language performance in aphasia, alexia, and agraphia. Frontiers in Human Neuroscience, 16, 1025468.
Buchsbaum, B. R., Baldo, J., Okada, K., Berman, K. F., Dronkers, N., D'Esposito, M., & Hickok, G. (2011). Conduction aphasia, sensory-motor integration, and phonological short-term memory: An aggregate analysis of lesion and fMRI data. Brain and Language, 119(3), 119-128.
Brady, M. C., et al. (2025). European Stroke Organisation (ESO) guideline on aphasia rehabilitation. European Stroke Journal, 10(4), 1189-1220.
Gvion, A., & Friedmann, N. (2012). Phonological short-term memory in conduction aphasia. Aphasiology, 26(3-4), 579-614.
Hickok, G. (2012). Computational neuroanatomy of speech production. Nature Reviews Neuroscience, 13, 135-145.
Kendall, D. L., Oelke, M., Brookshire, C. E., & Nadeau, S. E. (2015). The influence of phonomotor treatment on word retrieval abilities in individuals with chronic aphasia: An open trial. Journal of Speech, Language, and Hearing Research, 58, 798-812.
Leonard, C., Rochon, E., & Laird, L. (2008). Treating naming impairments in aphasia: Findings from a Phonological Components Analysis treatment. Aphasiology, 22(9), 923-947.
Python, G., Durand, E., & Masson-Trottier, M. (2025). A systematic review of Phonological Components Analysis therapy studies for aphasia. Brain Research Bulletin, 223, 111269.
Schwartz, M. F., Faseyitan, O., Kim, J., & Coslett, H. B. (2012). The dorsal stream contribution to phonological retrieval in object naming. Brain, 135(12), 3799-3814.
van Hees, S., Angwin, A., McMahon, K., & Copland, D. (2013). A comparison of Semantic Feature Analysis and Phonological Components Analysis for the treatment of naming impairments in aphasia. Neuropsychological Rehabilitation, 23(1), 102-132.
About the Author
Natalie Yona, SLT, M.A., is Vice President of Clinical Strategy at Cognishine, where she leads the clinical vision, strategic development, and global implementation of digital therapeutic solutions across speech-language pathology, cognition, and emotional well-being.
A speech-language pathologist with over 16 years of experience across pediatric and adult rehabilitation, Natalie combines extensive clinical expertise with digital innovation to develop evidence-based, scalable solutions that support healthcare professionals worldwide. She works closely with multidisciplinary teams, healthcare organizations, and international partners to translate real-world clinical needs into accessible technologies that enhance therapy, improve continuity of care, and promote meaningful participation and quality of life.
