{"schema_version":1,"research_id":"eoa_inverse_innovation_exp04_external_evaluation_20260802","source_assessment_id":"negative_space_design__neuroscience:DISCARDED_AUDIT:H5:v0","cell_id":"negative_space_design__neuroscience","search_queries":["aphasia naming therapy cue latency wait time before cueing naming trial study","aphasia naming treatment response time cue delay latency independent retrieval","aphasia naming therapy adaptive cueing hierarchy response latency distress","Balancing Effortful and Errorless Learning aphasia naming deadline","NCT05653440 response time ratings naming deadlines","adaptive naming deadlines aphasia Evans Pitt","site:asha.org Practice Portal aphasia extra response time","aphasia patient perspective word finding frustration extended response time","aphasia communication partner allow time self-repair","retrieval practice versus errorless learning aphasia naming"],"sources":[{"source_id":"S1","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","publisher":"BMJ Open","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13202119/","source_class":"PRIMARY_RESEARCH","publication_date":"2026-05","accessed_at":"2026-08-02","claims_supported":["Adaptive BEARS already implements patient- and session-specific naming deadlines between 1.5 and 10 seconds.","The ongoing randomized crossover trial compares adaptive deadlines with immediate presentation and a fixed 10-second deadline.","The intervention is clinician-operated and explicitly monitors boredom or frustration.","The trial measures retention of treated words and use of treated vocabulary in connected speech, but has not posted efficacy results."]},{"source_id":"S2","title":"NCT05653440: Balancing Effortful and Errorless Learning in Naming Treatment for Aphasia","publisher":"ClinicalTrials.gov, U.S. National Library of Medicine","url":"https://clinicaltrials.gov/study/NCT05653440","source_class":"GOVERNMENT_OR_REGULATOR","publication_date":"2026-04-13","accessed_at":"2026-08-02","claims_supported":["A recruiting Phase 2 crossover trial with estimated enrollment of 30 is testing adaptive effort-accuracy-balanced naming deadlines.","Its comparators include immediate target presentation and a fixed maximum response interval.","The study began in 2023 and is estimated to complete in 2028; no results are posted."]},{"source_id":"S3","title":"Balancing Effortful and Errorless Learning in Naming Treatment for Aphasia","publisher":"University of Pittsburgh Language Rehabilitation and Cognition Laboratory","url":"https://www.lrcl.pitt.edu/sites/default/files/r01_study1_version_0.03.pdf","source_class":"OFFICIAL_ORGANIZATION_DATA","publication_date":"2024","accessed_at":"2026-08-02","claims_supported":["The adaptive-deadline study uses timed picture naming, 24 treatment sessions, repeated baseline and long-term follow-up sessions, and up to 12 months of participation.","The recruitment material identifies anomia as a primary frustration and long-term retention and generalization as unmet treatment objectives.","The listed participant compensation of up to $1,800 helps bound participant-cost assumptions for a smaller pilot."]},{"source_id":"S4","title":"Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients","publisher":"Journal of Speech, Language, and Hearing Research / American Speech-Language-Hearing Association","url":"https://pubs.asha.org/doi/10.1044/2022_JSLHR-22-00251","source_class":"AUTHORITATIVE_SECONDARY","publication_date":"2023-02-13","accessed_at":"2026-08-02","claims_supported":["Naming-treatment literature already manipulates cue direction, cue timing, feedback, errorless learning, and retrieval practice.","Comparative findings vary by individual and impairment characteristics.","The review identifies unresolved questions about active ingredients and how individual variables should guide treatment administration."]},{"source_id":"S5","title":"The Roles of Retrieval Practice Versus Errorless Learning in Strengthening Lexical Access in Aphasia","publisher":"Journal of Speech, Language, and Hearing Research / American Speech-Language-Hearing Association","url":"https://pubmed.ncbi.nlm.nih.gov/29946697/","source_class":"PRIMARY_RESEARCH","publication_date":"2018","accessed_at":"2026-08-02","claims_supported":["A within-person study of 10 people with chronic aphasia directly compared unaided retrieval practice with immediate errorless repetition.","Retrieval practice and errorless learning showed different advantages depending on the impaired stage of lexical access.","The results undermine a uniform assumption that delaying assistance benefits every person or item."]},{"source_id":"S6","title":"Time for a quick word? The striking benefits of training speed and accuracy of word retrieval in post-stroke aphasia","publisher":"Brain / Oxford University Press","url":"https://pubmed.ncbi.nlm.nih.gov/29672757/","source_class":"PRIMARY_RESEARCH","publication_date":"2018-06-01","accessed_at":"2026-08-02","claims_supported":["A 20-participant study found that combined speed-and-accuracy naming treatment outperformed standard accuracy-focused treatment for trained-item accuracy and latency.","Deployment of treated vocabulary in connected speech improved and gains persisted for one month.","The intervention was reported as well tolerated, supporting feasibility of timed naming treatment."]},{"source_id":"S7","title":"The Timing of Spontaneous Detection and Repair of Naming Errors in Aphasia","publisher":"Cortex / Elsevier","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC5536244/","source_class":"PRIMARY_RESEARCH","publication_date":"2017-08","accessed_at":"2026-08-02","claims_supported":["People with aphasia spontaneously detect and repair some naming errors.","Detection and repair timing varies with error type and repair accuracy.","Observable search or repair behavior is heterogeneous, complicating a simple universal distress-versus-productive-search trigger."]},{"source_id":"S8","title":"Aphasia","publisher":"American Speech-Language-Hearing Association","url":"https://www.asha.org/practice-portal/clinical-topics/aphasia/","source_class":"OFFICIAL_GUIDANCE","publication_date":"n.d.","accessed_at":"2026-08-02","claims_supported":["Speech-language pathologists have central authority for aphasia assessment and treatment.","Aphasia treatment should be individualized and person- and family-centered.","Cueing, response shaping, communication-partner strategies, and technology-supported therapy are within established aphasia practice."]},{"source_id":"S9","title":"Communication Supports","publisher":"National Aphasia Association","url":"https://staging.aphasia.org/communication-supports/","source_class":"OFFICIAL_GUIDANCE","publication_date":"n.d.","accessed_at":"2026-08-02","claims_supported":["Established communication guidance already advises allowing response time and waiting rather than interrupting or completing a person's thought.","The guidance suggests pausing or counting to five before asking whether help is wanted.","Patience and permission-based assistance are therefore established adjacent practices rather than novel principles."]},{"source_id":"S10","title":"The Subjective Experience of Word-Finding Difficulties in People With Aphasia: A Thematic Analysis of Interview Data","publisher":"American Journal of Speech-Language Pathology / American Speech-Language-Hearing Association","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9135016/","source_class":"PRIMARY_RESEARCH","publication_date":"2022","accessed_at":"2026-08-02","claims_supported":["People with aphasia describe frustration, embarrassment, and relationship effects associated with word-finding difficulty.","Supported interviews with people with aphasia require extended response time.","The findings support the importance of monitoring emotional experience rather than evaluating naming accuracy alone."]},{"source_id":"S11","title":"What Happens to Topics and Conversations When People with Aphasia Have Time to Repair Their Speaking Turns? A Systematic, Functional Investigation","publisher":"Topics in Language Disorders; indexed by ERIC, Institute of Education Sciences","url":"https://eric.ed.gov/?id=EJ1444638","source_class":"PRIMARY_RESEARCH","publication_date":"2024","accessed_at":"2026-08-02","claims_supported":["Analysis of conversations involving 10 people with aphasia found that allowing self-repair supported substantial portions of participant-initiated conversation.","The study supports the functional importance of protected response time in conversation.","It does not test naming-therapy cue latency, untrained-item retrieval, or distress-triggered stopping."]}],"problem_evidence":{"support":"STRONG","rationale":"Anomia is a common, consequential aphasia symptom, and patient accounts document frustration, embarrassment, and relational effects. Existing guidance emphasizes adequate response time, while retrieval-practice research makes premature assistance a credible treatment concern. Evidence does not quantify how often clinicians cue prematurely during naming therapy, so the precise workflow failure is less directly established than the broader problem.","source_ids":["S1","S3","S5","S9","S10"]},"stakeholder_evidence":{"support":"STRONG","rationale":"People with aphasia identify word finding and durable, everyday communication gains as priorities, describe negative emotional consequences, and benefit from patience and time for self-expression. ASHA identifies SLPs as the treatment authority and supports individualized, person-centered intervention.","source_ids":["S1","S3","S8","S9","S10","S11"]},"prior_art":{"proximity":"SUBSTANTIAL_COLLISION","closest_analogues":[{"name":"Adaptive BEARS adaptive naming deadlines","similarity":"Near-direct collision: patient- and session-specific silent naming intervals are recalculated from ongoing accuracy and response-time performance and compared with immediate presentation and a fixed 10-second interval in aphasia naming treatment.","remaining_difference":"The protocol does not use a trial-level clinician judgment of observable distress as the deadline-ending rule and focuses on treated-word retention and connected-speech use rather than uncued accuracy on untrained items.","source_ids":["S1","S2","S3"]},{"name":"Retrieval practice versus errorless learning","similarity":"Directly contrasts unaided word retrieval with immediate word presentation and tests later naming retention in chronic aphasia.","remaining_difference":"It does not adapt the prompt-to-cue interval from trial behavior or include distress-triggered reintroduction.","source_ids":["S4","S5"]},{"name":"Repeated, increasingly-speeded production","similarity":"Actively adjusts naming speed demands and demonstrates naming and connected-speech benefits from combining speed and accuracy.","remaining_difference":"It accelerates successful production rather than protecting clinician silence until a response, distress signal, or patient maximum.","source_ids":["S6"]},{"name":"Aphasia communication wait-time guidance","similarity":"Established guidance tells partners to allow response time, avoid completing thoughts, and ask before helping.","remaining_difference":"It is communication guidance rather than a controlled naming-treatment algorithm with generalization outcomes.","source_ids":["S9","S11"]}],"distinctive_claim_remaining":"The narrow residual claim is that a live clinician can terminate a patient-specific silent interval using reliable trial-level response or distress signals and thereby improve uncued naming of wholly untrained items without increasing session distress. No direct evaluation of that complete combination was found, but the central adaptive-latency intervention and immediate-cue comparator are already the subject of an ongoing randomized trial.","confidence":"HIGH"},"implementation_evidence":{"support":"MODERATE","rationale":"Timed picture presentation, clinician response coding, immediate or delayed cues, individualized deadlines, and frustration monitoring are already operationalized in an active protocol. Implementation is therefore technically straightforward. However, the hypothesis does not define observable distress signals, establish inter-rater reliability, specify calibration of the patient maximum, or show that live clinician judgments can be delivered consistently without confounding cue type, feedback, or trial dose.","source_ids":["S1","S2","S3","S7","S8"]},"scores":{"meaningful_impact":{"score":3,"rationale":"Improved independent naming and generalization could matter substantially, but transfer to untrained items is harder and less supported than gains on treated vocabulary.","source_ids":["S1","S6","S10"]},"stakeholder_pull":{"score":4,"rationale":"Word-finding difficulty, patience, emotional safety, and everyday generalization are explicit patient and practice priorities.","source_ids":["S3","S9","S10","S11"]},"incremental_advantage":{"score":1,"rationale":"An active randomized trial already compares individualized adaptive naming deadlines with immediate and fixed-delay conditions; only the distress-trigger and untrained-item outcome remain incremental.","source_ids":["S1","S2"]},"distinctiveness_plausibility":{"score":1,"rationale":"The causal lever is substantially occupied by Adaptive BEARS, and permission-based waiting is established communication guidance.","source_ids":["S1","S2","S9"]},"technical_implementability":{"score":4,"rationale":"The core timing and cue-delivery workflow is already implemented in a recruiting trial and requires no novel hardware.","source_ids":["S1","S2"]},"adoption_authority_feasibility":{"score":4,"rationale":"SLPs have clear authority to individualize aphasia treatment and use cueing procedures; clinic-level protocol approval and training would be sufficient after evidence is available.","source_ids":["S8"]},"evidence_readiness":{"score":2,"rationale":"Relevant mechanisms and a near-identical active trial exist, but no results from the adaptive trial are posted and no direct evidence supports distress-triggered timing or untrained-item transfer.","source_ids":["S1","S2","S4","S5"]},"safety_net_benefit":{"score":3,"rationale":"A distress-triggered stop and patient-specific maximum could reduce the risk of silence being experienced as abandonment, but the trigger lacks validation and may vary across aphasia profiles.","source_ids":["S7","S10"]},"scalability":{"score":3,"rationale":"The intervention can fit ordinary naming trials, but reliable individualized timing and distress judgments would require training, fidelity monitoring, and potentially software support.","source_ids":["S1","S8"]}},"score_confidence":"HIGH","costs":{"first_evidence":{"band_2026_usd":"50K_TO_250K","scope":"Single-site, randomized within-participant feasibility study with approximately 12–20 adults with chronic aphasia, counterbalanced item sets, blinded outcome scoring, short follow-up, distress measurement, and clinician-fidelity assessment.","confidence":"MODERATE","assumptions":["Uses existing clinic and picture-naming infrastructure.","Requires multiple treatment and assessment visits plus participant compensation.","Does not develop a new regulated device.","The larger comparator trial's session burden and compensation indicate that personnel and participant costs exceed a minimal unfunded study."],"source_ids":["S1","S3"]},"initial_deployment_startup":{"band_2026_usd":"10K_TO_50K","scope":"One outpatient aphasia service: protocol adaptation, clinician training, timing materials or simple software configuration, consent materials, and initial fidelity review.","confidence":"MODERATE","assumptions":["Deployment occurs only after efficacy and signal-reliability evidence.","Existing clinic staff and treatment platforms are reused.","No automated distress-detection system is built."],"source_ids":["S1","S8"]},"operational_launch":{"band_2026_usd":"50K_TO_250K","scope":"Multi-clinician launch across several sites with standardized training, calibration, outcome collection, implementation support, and quality assurance.","confidence":"LOW","assumptions":["Three to five sites participate.","Launch includes centralized fidelity review and patient-reported distress monitoring.","Clinical treatment time is largely reimbursed through existing pathways."],"source_ids":["S1","S8"]},"annual_recurring":{"band_2026_usd":"10K_TO_50K","scope":"Per small network: refresher training, protocol maintenance, fidelity sampling, outcome review, and software or data-management support.","confidence":"LOW","assumptions":["No dedicated full-time staff are required.","The intervention remains embedded in existing naming-therapy sessions.","Recurring costs exclude ordinary clinical labor and reimbursement."],"source_ids":["S1","S8"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"YES","reason":"Anomia, slow or effortful retrieval, emotional consequences, and the need for adequate response time are supported by primary research and professional guidance.","source_ids":["S5","S9","S10"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"ASHA identifies SLPs as central aphasia-treatment authorities and endorses individualized, person-centered intervention using cueing and communication supports.","source_ids":["S8"]},"distinct_testable_incremental_claim":{"status":"NO","reason":"Although the stated outcome is testable, the central adaptive prompt-to-cue latency claim and immediate-cue comparator substantially collide with Adaptive BEARS. The residual distress-trigger and untrained-item outcome are not enough to make the hypothesis, as a whole, a clearly differentiated opportunity.","source_ids":["S1","S2"]},"bounded_next_evidence_step":{"status":"YES","reason":"A protocol-level differentiation analysis followed, only if warranted, by a small randomized within-participant feasibility experiment can resolve the remaining distress-signal and untrained-transfer questions.","source_ids":["S1","S4","S7"]},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"The intervention is noninvasive, within SLP scope, and includes a protective stop rule. Undefined distress criteria are an evidence and fidelity problem, but not an unmanageable safety or authority stop for an ethics-approved pilot.","source_ids":["S1","S8","S10"]},"credible_cost_scope_and_range":{"status":"YES","reason":"The next study can reuse established naming-treatment infrastructure, while the published trial schedule and compensation provide a practical lower bound on participant and personnel burden.","source_ids":["S1","S3"]}},"next_evidence_step":"First conduct a protocol-level differentiation study comparing the hypothesis line by line with Adaptive BEARS, including its supplements and eventual results. If a residual claim survives, preregister a 12–20 participant randomized within-person pilot comparing the hypothesis exactly as written with immediate cueing; define patient-specific maximums in advance, operationalize and reliability-test response and distress signals, counterbalance trained and untrained item sets, blind outcome scoring, and measure uncued untrained-item accuracy plus session-level distress.","blocking_evidence":["Adaptive BEARS already occupies the central adaptive silent-latency intervention and immediate-cue comparison.","The active Adaptive BEARS trial has not posted efficacy results, so incremental benefit over static timing is unresolved.","No validated observable rule was found that reliably distinguishes productive lexical search from confusion, disengagement, or distress during a naming trial.","No direct evidence was found that this timing intervention improves uncued correct retrieval of wholly untrained items.","The hypothesis does not specify how patient-specific maximum latency is calibrated or how cue type, total trials, feedback, and treatment time are held constant."],"research_disposition":"PRIOR_ART_DIFFERENTIATION_STUDY","world_novelty_boundary":"The search through 2026-08-02 cannot support world novelty for adaptive protected silence or individualized cue latency in aphasia naming therapy: an active randomized trial and published protocol already implement that core mechanism against immediate and fixed-delay comparators. Novelty, if any, is bounded to a clinician-observed distress termination rule combined with uncued untrained-item transfer, neither of which has direct supporting evidence.","arm":"DISCARDED_AUDIT","candidate_version":0,"controller_recommendation":{"action":"TARGETED_RESEARCH","repairable":true,"material_progress_observed":true,"progress_targets":["Determine whether the distress-triggered clinician rule is operationally and scientifically distinct from Adaptive BEARS frustration monitoring and adaptive deadlines.","Establish reliable observable criteria for productive search, confusion, and distress.","Obtain direct comparative evidence for uncued retrieval on untrained items without increased distress."],"reason":"The hypothesis does not satisfy the preregistered strict differentiated-opportunity endpoint as written because the distinct-claim gate fails under substantial prior-art collision. It remains a plausible empirical question, but only a narrow differentiation study—not rescue-oriented adoption work—is justified."}}