{"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 response time cue delay latency errorless effortful retrieval adaptive deadline","aphasia naming treatment wait time before cue clinician cueing response latency","Adaptive BEARS aphasia naming trial protocol deadline distress","aphasia naming therapy generalization untrained items cueing systematic review","Balancing Effortful and Errorless Learning aphasia naming treatment","aphasia clinician cueing premature cues qualitative word finding frustration response time study","aphasia conversation self repair time speaking turns 2024 Topics in Language Disorders","European Stroke Organisation guideline aphasia rehabilitation individualized therapy"],"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":"2026-05-20","accessed_at":"2026-08-02","claims_supported":["Adaptive BEARS already implements patient- and session-specific naming deadlines between 1.5 and 10 seconds.","The randomized crossover trial compares adaptive deadlines with immediate target presentation and a fixed 10-second deadline.","The clinician-operated intervention monitors subjective effort, boredom and 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 randomized 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.","Deadlines are recalculated session by session from clinician-rated accuracy and response time.","The study is estimated to complete in 2028 and has no posted results."]},{"source_id":"S3","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://pmc.ncbi.nlm.nih.gov/articles/PMC10023178/","source_class":"PRIMARY_RESEARCH","publication_date":"2023-02-02","accessed_at":"2026-08-02","claims_supported":["Retrieval practice and errorless learning are established, actively studied approaches to aphasia naming treatment.","Reviewed evidence sometimes favors retrieval practice over errorless learning at retention, but effects vary with the locus of lexical impairment.","The literature already includes progressive cueing, cue hierarchies and timed retrieval ingredients.","Treatment ingredients and generalization outcomes remain heterogeneous."]},{"source_id":"S4","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://pmc.ncbi.nlm.nih.gov/articles/PMC6195057/","source_class":"PRIMARY_RESEARCH","publication_date":"2018-07-13","accessed_at":"2026-08-02","claims_supported":["A study of 10 people with chronic aphasia directly compared retrieval practice with immediate errorless repetition.","Retrieval practice requires an independent naming attempt, whereas immediate repetition can bypass semantically driven retrieval.","Relative benefit depended on the inferred stage of lexical-access impairment, supporting patient heterogeneity rather than a universal timing rule."]},{"source_id":"S5","title":"Facilitating Word Retrieval in Aphasia: Which Type of Cues for Which Aphasic Speakers?","publisher":"Frontiers in Human Neuroscience","url":"https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2021.747391/full","source_class":"PRIMARY_RESEARCH","publication_date":"2021-11-26","accessed_at":"2026-08-02","claims_supported":["In 15 speakers with aphasia, cue effects on naming latency varied by cue type and anomic profile.","Auditory and auditory-visual phonological cues reduced naming latency, while accuracy did not improve at group level.","The results support individualized cue selection but do not establish that delaying cues improves later uncued retrieval or generalization."]},{"source_id":"S6","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":"2022-01-18","accessed_at":"2026-08-02","claims_supported":["People with aphasia described strong awareness of word-finding breakdown, negative emotions and effects on relationships.","Participants differed in coping strategies and support needs.","The findings support monitoring emotional experience rather than evaluating naming accuracy alone."]},{"source_id":"S7","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.","On average, 35% of turns and 38% of words occurred in segments initiated through repaired turns by people with aphasia.","The study supports the functional importance of protected response time in conversation but does not test naming-therapy cue latency, untrained-item retrieval or distress-triggered stopping."]},{"source_id":"S8","title":"European Stroke Organisation (ESO) guideline on aphasia rehabilitation","publisher":"European Stroke Organisation / European Stroke Journal","url":"https://academic.oup.com/esj/article/10/4/1189/8377346","source_class":"OFFICIAL_GUIDANCE","publication_date":"2025-05","accessed_at":"2026-08-02","claims_supported":["The guideline recognizes the substantial communication, psychosocial and quality-of-life burden of post-stroke aphasia.","It recommends or suggests speech-language therapy delivered by suitable rehabilitation services and tailored to functional relevance and language-task difficulty.","Direct randomized comparisons of different speech-language therapy approaches remain limited.","The guideline provides a credible clinical authorization pathway but does not endorse adaptive cue latency specifically."]}],"problem_evidence":{"support":"MODERATE","rationale":"Independent retrieval attempts are mechanistically distinguishable from immediate repetition, cue effects vary across people, and protected response time has functional value in conversation. However, no located study directly demonstrates that clinicians commonly cue too early during naming therapy or that premature cueing causes inferior untrained-item retrieval.","source_ids":["S3","S4","S5","S7"]},"stakeholder_evidence":{"support":"MODERATE","rationale":"People with aphasia report negative emotions and relationship effects from word-finding difficulty, and conversational evidence shows that time for self-repair preserves agency and topic control. These sources do not establish expressed demand for the proposed adaptive naming-trial rule specifically.","source_ids":["S6","S7","S8"]},"prior_art":{"proximity":"SUBSTANTIAL_COLLISION","closest_analogues":[{"name":"Adaptive BEARS","similarity":"Nearly the same causal lever and comparator structure: patient-specific adaptive prompt-to-target deadlines are compared with immediate target presentation and a fixed 10-second maximum in post-stroke anomia treatment.","remaining_difference":"Adaptive BEARS adapts from accuracy and response-time ratings and monitors affect, whereas H5 explicitly terminates a trial on a distress signal and specifies uncued correct retrieval on untrained items plus session-level distress as joint endpoints.","source_ids":["S1","S2"]},{"name":"Retrieval practice versus errorless learning","similarity":"Directly contrasts independent effortful naming attempts with immediate provision and repetition of the target word.","remaining_difference":"The published study stratifies effects by lexical-access impairment and treated items; it does not evaluate an adaptive silent interval, distress-triggered termination or the exact untrained-item endpoint.","source_ids":["S3","S4"]},{"name":"Protected time for conversational self-repair","similarity":"Withholds partner completion so a person with aphasia can complete a word-search or repair and retain communicative agency.","remaining_difference":"It concerns natural conversation rather than clinician-run naming treatment and does not manipulate cue deadlines or measure later naming generalization.","source_ids":["S7"]}],"distinctive_claim_remaining":"The narrow remaining distinction is a clinician-operated adaptive silence rule that ends immediately on an observable distress signal and is evaluated specifically for uncued retrieval of untrained items without higher session distress. That combination was not found as a completed efficacy study, but it is adjacent to an ongoing trial with nearly identical timing logic and comparators.","confidence":"HIGH"},"implementation_evidence":{"support":"STRONG","rationale":"Adaptive BEARS demonstrates that individualized 1.5-10-second naming deadlines, immediate and fixed-deadline comparators, clinician ratings and affect monitoring can be operationalized in a community-based randomized protocol. The unvalidated component is a reliable real-time distress termination rule, not the basic timing intervention.","source_ids":["S1","S2","S6","S8"]},"scores":{"meaningful_impact":{"score":4,"rationale":"Aphasia materially affects communication, psychosocial well-being and quality of life; improving generalizable independent retrieval without added distress would matter, although the magnitude attributable to cue latency is unknown.","source_ids":["S6","S7","S8"]},"stakeholder_pull":{"score":3,"rationale":"Stakeholders value time, self-expression and emotionally responsive support, but direct demand for this therapy rule was not located.","source_ids":["S6","S7"]},"incremental_advantage":{"score":2,"rationale":"Distress-triggered termination and untrained-item testing add useful safeguards and outcomes, but the core adaptive-deadline intervention and immediate-cue comparator are already in an active trial.","source_ids":["S1","S2"]},"distinctiveness_plausibility":{"score":1,"rationale":"The core opportunity substantially collides with Adaptive BEARS; the remaining distinction is a narrow guardrail-and-endpoint combination rather than a different intervention architecture.","source_ids":["S1","S2"]},"technical_implementability":{"score":5,"rationale":"The intervention requires clinician timing, simple adaptive rules and routine outcome collection; a closely analogous protocol is already operating.","source_ids":["S1","S2"]},"adoption_authority_feasibility":{"score":4,"rationale":"Speech-language therapists already control cue delivery and are the appropriate clinical authority; guidelines support individualized therapy, though protocol approval and training would still be needed.","source_ids":["S1","S8"]},"evidence_readiness":{"score":3,"rationale":"Mechanistic and feasibility evidence exists and a Phase 2 analogue is recruiting, but no efficacy result establishes superiority for adaptive timing, untrained items or distress noninferiority.","source_ids":["S1","S2","S3","S4"]},"safety_net_benefit":{"score":4,"rationale":"Ending silence on distress and using session-level distress as a joint outcome directly addresses the principal foreseeable harm, although signal definitions and reliability require validation.","source_ids":["S1","S6"]},"scalability":{"score":4,"rationale":"A timing rule could scale through clinician training or software support with little equipment, but personalization and affect monitoring limit fully unattended use.","source_ids":["S1","S2","S8"]}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"10K_TO_50K","scope":"A protocol-level differentiation study plus a 6-10-participant feasibility exercise testing distress-signal definitions, inter-rater agreement and trial logging before any efficacy trial.","confidence":"LOW","assumptions":["Uses an existing aphasia clinic and salaried investigator time.","Does not attempt a powered clinical-effect estimate.","Reuses standard naming and distress instruments."],"source_ids":["S1","S6"]},"initial_deployment_startup":{"band_2026_usd":"10K_TO_50K","scope":"One-site protocol development, clinician training, timer or software configuration, consent materials and quality-assurance setup.","confidence":"LOW","assumptions":["No new regulated medical device is developed.","The rule is embedded in clinician-supervised naming therapy.","Existing clinical documentation systems are used."],"source_ids":["S1","S8"]},"operational_launch":{"band_2026_usd":"50K_TO_250K","scope":"Launch across one rehabilitation service, including training, protected clinician time, outcome collection and initial audit over 6-12 months.","confidence":"LOW","assumptions":["Approximately 5-15 clinicians participate.","Naming therapy already exists in the service.","Costs exclude a multicenter randomized trial."],"source_ids":["S1","S8"]},"annual_recurring":{"band_2026_usd":"10K_TO_50K","scope":"Refresher training, protocol audits, distress-signal calibration, software maintenance and outcome reporting for one service.","confidence":"LOW","assumptions":["No dedicated full-time staff are required.","The intervention adds seconds of workflow logic rather than separate treatment sessions.","Local IT and clinical governance absorb routine support."],"source_ids":["S1","S8"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"YES","reason":"Independent retrieval, heterogeneous cue response and the value of protected self-repair time are externally supported, although prevalence of premature clinician cueing is not quantified.","source_ids":["S3","S4","S5","S7"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"Speech-language therapists control cue timing, and an international stroke guideline authorizes individualized aphasia rehabilitation under appropriate clinical supervision.","source_ids":["S1","S8"]},"distinct_testable_incremental_claim":{"status":"NO","reason":"The claim is testable, but its core adaptive-deadline intervention, immediate-cue comparator and affect monitoring substantially collide with Adaptive BEARS. Untrained-item testing and distress-triggered stopping are too narrow to establish the hypothesis as a differentiated opportunity as written.","source_ids":["S1","S2"]},"bounded_next_evidence_step":{"status":"YES","reason":"A bounded differentiation study can compare the full Adaptive BEARS protocol with H5 and test whether observable distress signals can be defined reliably before duplicative efficacy work begins.","source_ids":["S1","S2","S6"]},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"No categorical safety or authority stop was found. Clinician supervision and an immediate distress termination rule provide a plausible safeguard, subject to operational validation.","source_ids":["S1","S6","S8"]},"credible_cost_scope_and_range":{"status":"YES","reason":"A limited protocol-differentiation and signal-reliability study is separable from deployment and can be bounded using an existing clinic, while the stated ranges explicitly exclude a powered multicenter trial.","source_ids":["S1","S8"]}},"next_evidence_step":"Before enrolling an efficacy cohort, conduct a 4-6-week prior-art differentiation and feasibility study: map every H5 timing, adaptation, stopping and outcome element against Adaptive BEARS; preregister observable distress criteria; and measure two-clinician agreement on those criteria in 6-10 people with aphasia. Proceed only if the stopping rule is reliable and the remaining claim is not already an Adaptive BEARS outcome or analysis.","blocking_evidence":["The strict differentiated-opportunity endpoint is not satisfied as written because the distinct-testable-incremental-claim gate is NO.","No completed trial shows that adaptive protected silence improves uncued retrieval on untrained items versus immediate cueing.","No source quantifies how often clinicians cue prematurely during naming therapy or links that behavior causally to poorer generalization.","The ongoing Adaptive BEARS trial substantially collides with the intervention, comparator and personalization logic and has not reported efficacy results.","Observable distress signals and their inter-rater reliability during naming trials have not been established."],"research_disposition":"PRIOR_ART_DIFFERENTIATION_STUDY","world_novelty_boundary":"As of 2026-08-02, adaptive patient-specific naming deadlines versus immediate and fixed-delay target presentation are already under active randomized study, so that core cannot support world-novelty or strict differentiation. The only potentially unoccupied boundary is the joint use of a trial-level distress-triggered stopping rule and uncued untrained-item retrieval with distress noninferiority; no completed efficacy evidence for that exact combination was found.","arm":"DISCARDED_AUDIT","candidate_version":0,"controller_recommendation":{"action":"STOP_EMPIRICAL_RESEARCH_NEEDED","repairable":true,"material_progress_observed":false,"progress_targets":["Obtain or await efficacy results from NCT05653440 before launching a duplicative timing trial.","Determine whether Adaptive BEARS already captures untrained-item retrieval or permits distress-triggered deadline termination.","Operationalize observable distress signals and demonstrate acceptable clinician inter-rater reliability.","Quantify premature cueing prevalence in ordinary aphasia naming therapy."],"reason":"This audit does not identify a false negative under the preregistered strict differentiated-opportunity endpoint. The problem and implementation are credible, but substantial prior-art collision leaves no sufficiently distinct incremental opportunity as written, and the decisive efficacy evidence is still pending."}}