Cerebral hypoxia, common in cardiac arrest (Wagner et al., 2020), can lead to brain lesions, potentially impairing brain function. Approximately 20–50% of cardiac arrest survivors, and those who survive myocardial infarction, may experience a decline in global cognition and long-term cognitive impairments, including language difficulties such as anomia (Middelkamp et al., 2007; Polanowska et al., 2014; Cronberg et al., 2020; Wagner et al., 2020; Johansen et al., 2023). While cognitive function may improve within the first year post-event, long-term deficits persist, impacting independence and quality of life (Middelkamp et al., 2007; Polanowska et al., 2014), highlighting the necessity for specialized cognitive rehabilitation.

Aphasia, resulting from brain lesions, affects verbal expression and comprehension components, classified into non-fluent and fluent conditions (Sinanović et al., 2011; Sheppard and Sebastian, 2021). Anomic aphasia, a mild fluent type, involves word retrieval difficulties while maintaining comprehension and fluency (Lorwatanapongsa, 2005; Sheppard and Sebastian, 2021), often attributed to left hemisphere lesions, primarily in the parietal–temporal junction (Whatmough et al., 2002).

Moreover, functional communication, as described by van der Meulen et al. (2010), referring to the practical use of language and communication skills in real-life situations to achieve specific goals and meet daily communication needs is also impaired in aphasia.

Although no universally effective treatment exists for aphasia (Fridriksson and Hillis, 2021; Vitti and Hillis, 2021), semantic-feature-based treatments (SFTs) seem to be effective in aphasia therapy. Bontemps et al. (2024) found that combining executive function training with SFA improved naming and discourse in chronic aphasia. Scimeca et al. (2024) demonstrated significant naming improvements in bilingual aphasia, influenced by language treatment and baseline severity. Hameau et al. (2019) showed that semantic neighborhood density affects naming accuracy in aphasia, highlighting the role of semantic context in word production. To our knowledge, Applied Behavior Analysis (ABA) has not been explored for anomic aphasia. ABA focuses on understanding and shaping human behavior by manipulating environmental variables (Cooper et al., 2020). Applied Verbal Behavior (AVB), a subset of ABA, emphasizes verbal function rather than form (Cooper et al., 2020).

A recent scoping review concluded that, although telehealth methods seem to be valid for the treatment of aphasia, further research is required to explore the variety of aphasia assessment and intervention protocols that can be delivered through telehealth (Teti et al., 2023).

This report presents ABA tact training for anomic aphasia rehabilitation in a patient with mild Neurocognitive Disorder (m-NCD; American Psychiatric Association, 2013) 1 year post-acute myocardial infarction with cardiac arrest and brain hypoxia, the first such study. Following Lorwatanapongsa’s (2005) treatment aims for anomic aphasia, our objectives were to improve picture naming and sorting, generalize gains through telehealth sessions, extend to untrained pictures, and assess retention after 1 month.

The steps of the procedure are detailed in the following paragraphs.

Results are shown in Figure 1 (SET 1) and Figure 2 (SET 2). As for SET 1 (animals-fruits-vehicles), the mastery criterion (80% correct stimulus tacts for three consecutive times, simultaneously for all categories) was achieved in session 70, during the telehealth phase. Correct tacts of pictures in each category gradually increased over time, especially vehicles, for which the 80% correct responses was achieved at the 27^th session. Category tacts and sorting quickly reached 100% correct responses, but also at baseline correct responses ranged from 80 to 100%. At the retest time of untrained stimuli (second baseline), no increase in percentages of correct picture tacts was found; instead, category tacts and sorting showed 100% correct responses. At follow-up the patient provided 70% correct responses in animal and fruit pictures, and 100% in vehicles. Category tacts and sorting showed 100% correct responses at follow-up, too.

As for SET 2 (vegetables, clothes, household), the mastery criterion was achieved at session 110. The graph shows a gradual increase over time in percentages of clothes pictures correctly named, for which the mastery criterion was achieved in session 65. Vegetable and food pictures did not show an appreciable increase in correct responses up to the 75^th session. For this reason, the food category was replaced by the household one, and after this change a gradual increase over time of both vegetables and household correct picture tacts was shown; also category tacts and sorting quickly reached 100% correct responses. At the untrained stimuli retest, no increase in correct responses was found. At follow-up, 70 to 90% correct picture tacts were achieved, 100% in category tacts and sorting.

For both SET 1 and SET 2, the transition to telehealth intervention did not lead to significant modifications in the trends of correct responses.

Aphasia profoundly affects patients’ daily lives, along with their families and friends, leading to changes in social roles, job loss, and social isolation (Boden-Albala et al., 2005; Baker et al., 2018; Berg et al., 2020). Two main behavioral interventions for post-stroke aphasia are identified: Impairment-based approaches, focusing on specific language tasks improvement, and Functional communication approaches, emphasizing context and multimodality of communication (Doedens and Meteyard, 2022). To our knowledge this is the first study in which ABA procedures were implemented in a case of aphasia associated with cognitive disorders. ABA, emphasizing functional links between behavior and the environment, breaks down expressive language into functional sub-units (verbal operants) (Skinner, 1957). While past literature has overlooked ABA-based treatments for acquired language disorders (Heinicke and Carr, 2014; Becker and Baltazar, 2022), this study aims to contribute to this field.

Regarding our study objectives, we focus on enhancing correct picture tacts, especially in different category sets. Sorting and category tact improvements were less significant, except for household categories, showing immediate increases. Baseline correct responses were already high for SET 1 and clothes of SET 2, while instability in vegetable category responses was observed until session 75, possibly due to interference with the food category.

Results showed a functional relationship between tact training and increased correct picture tacts, meeting the mastery criterion for trained stimuli. This suggests that specific tact training procedures can effectively rehabilitate post-stroke anomic aphasia, expanding rehabilitation options beyond traditional treatments.

While ABA-based treatments are uncommon in Italy for adult neurocognitive disorders, our patient’s outcomes suggest their potential inclusion in rehabilitation protocols, potentially improving outcomes and reducing healthcare costs. Telehealth sessions post-discharge showed similar trends to face-to-face sessions, indicating their potential for cost-effective remote rehabilitation. This can be considered a positive result because telehealth seems to provide important social and economic benefits for patients and their families, as well as the health system (Jennett et al., 2003).

Generalization to untrained pictures did not show improvement, consistent with previous studies suggesting limited generalization in aphasia treatment effects (Quique et al., 2019; Scholl et al., 2021). The observed retention of correct picture tacts 1 month post-training suggests satisfactory outcomes, though further studies are warranted to explore influencing factors and long-term maintenance of gains.

Strengths of our study include being the first to apply ABA tact training in acquired anomic aphasia, demonstrating its potential effectiveness in adults with neurocognitive disorders. Telehealth sessions’ effectiveness post-discharge indicates their potential for cost-effective remote rehabilitation.

Limitations include single-participant application and the need for further studies across different aphasia types and neurodegenerative disorders. Careful category selection is crucial to avoid interference effects. Despite achieving mastery criteria for trained stimulus sets, our study found no significant increase in correct responses for untrained items. Enhancing the generalization of learned skills to a broader range of stimuli could strengthen the practical applicability and effectiveness of the intervention. Generalization to real objects warrants further investigation to enhance the social validity of rehabilitation interventions. The study’s sample size and diversity could be improved to enhance the generalizability of findings to a broader population of individuals with post-stroke aphasia.

The datasets presented in this article are not readily available because privacy and ethical aspects. Requests to access the datasets should be directed to cataniavalentina@hotmail.it.

The studies involving humans were approved by COMITATO ETICO IRCCS SICILIA-OASI MARIA SS. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

VC: Conceptualization, Data curation, Investigation, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing. GD’A: Conceptualization, Formal analysis, Supervision, Validation, Writing – review & editing. SP: Conceptualization, Data curation, Supervision, Writing – original draft, Writing – review & editing. BL: Data curation, Writing – review & editing. RF: Data curation, Funding acquisition, Visualization, Writing – review & editing.