"There are endless areas that they can use it for": speech-language pathologist perspectives of technology support for aphasia self-management

BACKGROUND

Aphasia is a debilitating acquired language disorder that often persists as a chronic condition. However, long-term support options are scarce, necessitating the consideration of alternative approaches. Chronic condition self-management approaches, which aim to build self-efficacy and empower people to take responsibility for the day-to-day management of their health condition, may benefit people with aphasia (PwA). Technology is widely used in chronic condition self-management and investigation is required to determine whether it could play a role in aphasia self-management.

OBJECTIVE

This study aimed to explore speech-language pathologist (SLP) perspectives on the potential use of technology to support aphasia self-management.

METHODS

A qualitative study was conducted with 15 SLPs using semi-structured interviews. Qualitative content analysis was applied to verbatim transcripts to identify codes, categories, and sub-themes which were developed into themes.

RESULTS

Three themes were identified: (1) technology supports holistic aphasia self-management by providing additional avenues for service delivery, overall communication, and learning opportunities thus enhancing independence and life participation; (2) SLP and communication partner (CP) assistance can support PwA to use technology for aphasia self-management; (3) considerations and potential barriers to PwA use of technology for aphasia self-management.

CONCLUSIONS

Technology can support aphasia self-management by expanding service delivery options, allowing for increased frequency and intensity of therapy practise, and facilitating communication and participation. Personal, professional, and organizational barriers should be addressed in the development of technology-enabled aphasia self-management approaches. SLPs and CPs can offer PwA assistance with technology but may themselves need additional support. Solutions for identified barriers should be considered, such as providing training in the use of technology and implementing aphasia-friendly modifications.IMPLICATIONS FOR REHABILITATIONSelf-management approaches are being explored in the area of aphasia management as a means of offering a holistic, sustainable intervention option that meets the long-term needs of people with aphasia.A range of technology-based resources are currently used in chronic condition self-management and in aphasia therapy, and there are many possibilities for the use of technology in aphasia self-management approaches.Speech-language pathologists identified that technology could facilitate aphasia self-management by expanding service delivery options (e.g., real-time and asynchronous telepractice), enabling increased frequency and intensity of therapy through providing a means of independent practise, offering options for augmentative alternative communication, and enhancing life participation by supporting social communication and daily tasks.,Speech-language pathologists are interested in using technology for aphasia self-management; however, barriers related to organizational policies, individual experience and confidence using technology, and technology itself must be addressed.

Language impairments in people with autoimmune neurological diseases: A scoping review

INTRODUCTION

Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used.

METHODS

We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria.

RESULTS

We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used.

CONCLUSIONS

Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.

[Case of hereditary Y69H (p.Y89H) transthyretin variant leptomeningeal amyloidosis presenting with drop attacks and recurrent transient language disorder]

We report a 73-year-old woman who started developing recurrent transient aphasia at the age of 66 years. During the attacks, she was aware she could not understand what was being said and both her spoken and written speech were meaningless. The attacks usually lasted for a few days, following which she could explain what had happened. Anti-epileptics did not improve her symptoms. She also noticed tremor of her right hand and gait disturbance at the age of 71 years. The recurrent transient aphasia was followed by drop attacks. At the time of her admission to our hospital, she showed paraplegia, phonological paraphasia, and difficulty in understanding complex sentences. Her language disturbance resembled a logopenic variant of primary progressive aphasia. However, the symptoms fluctuated for a few days and subsequently improved. Electroencephalography showed no abnormalities. Gadolinium-enhanced brain and spinal MRI showed diffuse leptomeningeal enhancement over the surface of the spinal cord, brain stem, and cerebrum on T1-weighed imaging. Surgical biopsy of a varicose vein in the subarachnoid space at the level of the Th11 spinal cord was performed. Pathological evaluation of the biopsied specimens revealed TTR-immunolabeled amyloid deposits in the subarachnoid vessel walls and on the arachnoid membrane. Gene analysis revealed c.265T>C, p.Y89H (Y69H) TTR mutation, which is known as one of the causative mutations of familial leptomeningeal amyloidosis. Leptomeningeal forms of transthyretin amyloidosis might present transient focal neurological episodes.

The Impact of Telehealth on the Efficacy of Sound Production Treatment

PURPOSE

This investigation was designed to systematically examine the acquisition, maintenance, and response generalization effects of Sound Production Treatment (SPT) delivered via telehealth in comparison to existing in-person outcomes for SPT.

METHOD

A multiple-baseline design across behaviors and participants was used with two individuals with chronic apraxia of speech (AOS) and aphasia. Accuracy of target speech sounds in treated and untreated words within phrases served as the dependent variable.

RESULTS

Both participants demonstrated positive gains for treatment and generalization items. Participant 1 demonstrated gains for both sets of treatment items with the application of treatment, but production accuracy at 2 and 6 weeks posttreatment was inconsistent. Participant 2 demonstrated large gains for both sets of treatment items with good maintenance at 2 and 6 weeks posttreatment. Effect sizes for both participants were similar to the traditional (in-person) SPT effect size benchmarks.

CONCLUSIONS

The positive outcomes from this study indicate that individuals with AOS can benefit from SPT delivered via telehealth. These findings warrant further research examining the effects of SPT through telehealth and should include individuals with AOS with varying severity. This investigation serves as the first telehealth study to systematically examine treatment outcomes for SPT.

Cognitive impairment after a stroke in young adults: A systematic review and meta-analysis

BACKGROUND

Information about cognitive functioning is vital in the management of stroke, but the literature is mostly based on data from individuals older than 50 years of age who make up the majority of the stroke population. As cognitive functioning is subject to change due to aging, it is unclear whether such cognitive impairment patterns from the general stroke literature apply to the growing population of younger people with a stroke.

AIM

The aim of the study was to conduct a systematic review and meta-analysis of the proportion and severity of cognitive impairment in young-stroke patients.

SUMMARY OF REVIEW

MEDLINE, Embase, PsycINFO, and Web of Science were systematically searched up to 11 October 2022. Studies were included if they reported on a population of young-stroke patients, evaluated cognitive functioning as an outcome measure, and reported original data. We estimated the pooled prevalence rates for cognitive impairment and for aphasia. In addition, we calculated the pooled estimates for the severity of impairment per cognitive domain in the chronic phase (defined as >6 months post-stroke). Six hundred thirty-five articles were identified, of which 29 were eligible for inclusion. The pooled prevalence of cognitive impairment was 44% (k = 10; 95% confidence interval (CI): 34-54%) and of aphasia 22% (k = 13; 95% CI: 12-39%). Young-stroke patients in the chronic phase performed worse than stroke-free healthy age-appropriate controls across all cognitive domains examined, with Hedges' g effect sizes ranging from -0.49 to -1.64.

CONCLUSION

Around half of all young-stroke patients present with cognitive impairment and around a quarter with aphasia. Our data suggest that patterns of impairment in young-stroke patients follow those in the general stroke literature.

Language abilities, not cognitive control, predict language mixing behavior in bilingual speakers with aphasia

PURPOSE

Language Mixing (LM) occurs among neurotypical bilinguals as well as among bilingual persons with aphasia (BiPWAs). The current study aimed to investigate whether LM in BiPWAs stems from a linguistic impairment, an impairment in cognitive control, or both.

METHOD

Twenty Russian-Hebrew-speaking BiPWAs were split into two groups based on aphasia severity (Severe/Moderate vs. Mild). Frequencies and patterns of LM in narrative production by BiPWAs in L1-Russian and in L2-Hebrew were analyzed. To investigate the underlying mechanisms of LM, all participants completed linguistic background questionnaires, the Bilingual Aphasia Test (BAT) in both languages, and a battery of 10 cognitive tests.

RESULTS

The results indicated an effect of aphasia severity and an effect of language. Higher LM frequency was observed in BiPWAs with severe/moderate aphasia symptoms as compared to BiPWAs with mild symptoms. In both groups, higher LM frequency was observed in L2-Hebrew narratives, the weaker post-stroke language for most participants in the sample. The results also showed qualitative LM differences in L1-Russsian and L2-Hebrew contexts. In L1-Russian narratives, BiPWAs mainly switched to L2-Hebrew nouns, while in L2-Hebrew narratives, they mainly inserted L1-Russian discourse markers and function words.

CONCLUSIONS

Linguistic factors such as pre- and post-stroke self-rated language proficiency and level of language impairment due to aphasia were found to predict LM frequency in L1-Russian and in L2-Hebrew. Cognitive abilities did not predict LM frequency. Based on our findings, we suggest that LM behavior in BiPWAs might be primarily related to language skills in L1 and L2, rather than to cognitive control impairments.

A scoping review of friendship intervention for older adults: lessons for designing intervention for people with aphasia

PURPOSE

Map the landscape of friendship interventions/programs for older adults to guide intervention/program development inclusive of the unique needs of older people with aphasia (PWA).

METHODS

A search query of multiple databases was completed for articles published before 4 January 2021. Studies included all the following: (1) participants aged 55 years or older; (2) addressed an intervention/program designed to prevent social isolation and/or friendship loss; (3) used an outcome variable related to social isolation and/or friendship; and (4) published in a peer-reviewed journal. Title and abstract screening were conducted using Covidence software, which tracked disagreements across the study team. All studies included in the full-text review were identified as relevant by a minimum of two study authors, and a consensus was reached on all full-text reviews. Data were extracted according to (1) theoretical frameworks used; (2) interventionist and discipline; (3) participant characteristics; (4) intervention/program replicability; (5) format of intervention/program; (6) measures used in the intervention/programs; (7) and, reported effects of intervention/programs on individuals.

RESULTS

A total of 40 articles with 42 intervention/programs were included and represented 4584 intervention/program participants ranging in age from 40 to 104 years. Intervention/programs involved a wide range of theoretical frameworks (e.g., theories of loneliness, feminist theory, positive psychology). Disciplines such as psychology and exercise science informed intervention/programs. Interventionists included many types of individuals like therapists, volunteers and home health aides. Intervention/programs often lacked adequate description for replication and included individual and group formats, most commonly delievered in the participants homes. Outcomes usually included self-report measures of loneliness, social networks, or well-being, and intervention/programming was primarily educational, activity-based, or networking-based in nature.

CONCLUSIONS

The intervention/programs reviewed yield important lessons to support innovation in developing friendship intervention/programs for older PWA as most yielded positive results and were acceptable to participants.IMPLICATIONS FOR REHABILITATIONPeople with aphasia want their friendships addressed as part of their rehabilitation; however, the research literature has little guidance in this area.Studies reviewed of friendship intervention/programs for older adults yielded helpful lessons for consideration in developing this type of intervention/programming for people with aphasia.Interprofessional teams made up of rehabilitation professionals should address friendship for people with aphasia in both research and clinical practice.

Communication partner training for SLT students: Changes in communication skills, knowledge and confidence

This paper describes the changes in communication skills, knowledge and confidence in Speech Language Therapy (SLT) students in conversations with People With Aphasia (PWA) after Training Con-tAct, a Dutch Communication Partner Training.

METHODS

On a voluntary basis, nine SLT students (2nd yr) completed Training Con-tAct, in which People With Aphasia (PWA) were involved as co-workers. A mixed method design with pre- and post-measures was used to analyze the students' communication skills, knowledge and confidence. A quantitative video analysis was used to measure changes in students' communication skills. Besides, a self-report questionnaire was used to measure the changes in students' knowledge and confidence regarding their communication with PWA. To evaluate the perspectives of the students on Training Con-tAct, additionally a focus group interview was held.

RESULTS

Regarding students' communication skills the outcomes revealed a significantly higher score on the 'supporting' competence in students who took part in Training Con-tAct. The mean scores for the 'acknowledging' and 'checking information' competences did not improve significantly. The outcomes of the questionnaire showed students gained more knowledge and confidence regarding communication with PWA. The focus group interview provided insights into: motivation for participating in Communication Partner Training, content and structure of the training, feedback in CPT, and learning experiences.

CONCLUSION

The present study suggests that SLT students may benefit from Training Con-tAct as the training leads to better skills, more knowledge about aphasia and more confidence in communicating with PWA. Training Con-tAct could be a valuable addition to the curricula of all healthcare disciplines, and eventually support interprofessional collaboration, resulting in improved access to health care, which is important for communication vulnerable people. Further research with a larger sample size and a control group is required.

Neural oscillations reveal disrupted functional connectivity associated with impaired speech auditory feedback control in post-stroke aphasia

The oscillatory brain activities reflect neuro-computational processes that are critical for speech production and sensorimotor control. In the present study, we used neural oscillations in left-hemisphere stroke survivors with aphasia as a model to investigate network-level functional connectivity deficits associated with disrupted speech auditory feedback control. Electroencephalography signals were recorded from 40 post-stroke aphasia and 39 neurologically intact control participants while they performed speech vowel production and listening tasks under pitch-shifted altered auditory feedback (AAF) conditions. Using weighted phase-lag index, we calculated broadband (1-70 Hz) functional neural connectivity between electrode pairs covering the frontal, pre- and post-central, and parietal regions. Results revealed reduced fronto-central delta and theta band and centro-parietal low-beta band connectivity in left-hemisphere electrodes associated with diminished speech AAF compensation responses in post-stroke aphasia compared with controls. Lesion-mapping analysis demonstrated that stroke-induced damage to multi-modal brain networks within the inferior frontal gyrus, Rolandic operculum, inferior parietal lobule, angular gyrus, and supramarginal gyrus predicted the reduced functional neural connectivity within the delta and low-beta bands during both tasks in aphasia. These results provide evidence that disrupted neural connectivity due to left-hemisphere brain damage can result in network-wide dysfunctions associated with impaired sensorimotor integration mechanisms for speech auditory feedback control.

How do valence and meaning interact? The contribution of semantic control

The hub-and-spoke model of semantic cognition proposes that conceptual representations in a heteromodal 'hub' interact with and emerge from modality-specific features or 'spokes', including valence (whether a concept is positive or negative), along with visual and auditory features. As a result, valence congruency might facilitate our ability to link words conceptually. Semantic relatedness may similarly affect explicit judgements about valence. Moreover, conflict between meaning and valence may recruit semantic control processes. Here we tested these predictions using two-alternative forced-choice tasks, in which participants matched a probe word to one of two possible target words, based on either global meaning or valence. Experiment 1 examined timed responses in healthy young adults, while Experiment 2 examined decision accuracy in semantic aphasia patients with impaired controlled semantic retrieval following left hemisphere stroke. Across both experiments, semantically related targets facilitated valence matching, while related distractors impaired performance. Valence congruency was also found to facilitate semantic decision-making. People with semantic aphasia showed impaired valence matching and had particular difficulty when semantically related distractors were presented, suggesting that the selective retrieval of valence information relies on semantic control processes. Taken together, the results are consistent with the hypothesis that automatic access to the global meaning of written words affects the processing of valence, and that the valence of words is also retrieved even when this feature is task-irrelevant, affecting the efficiency of global semantic judgements.

Translation and Adaptation of the English Story Retell Procedure to Portuguese: A Preliminary Study

INTRODUCTION

The comprehension and production of connected language are essential for effective communication. However, few assessment and intervention programs requiring connected language have been made available in Brazilian Portuguese. One connected language sampling procedure, the Story Retell Procedure (SRP), has been widely studied in English and primarily for people with aphasia. The SRP employs 12 stories, whose individual plots are quite different and still equivalent in terms of verbal productivity measures. The first objective of this study was to present the translation and adaptation of the SRP stories into Portuguese and to determine whether the translations are similar to English stories. The second objective was to analyze a small group of healthy adults' responses to this assessment, thus observing whether the retellings of the SRP story forms in Portuguese would be similar to each other in the number of words, information units (IUs), and propositions - as demonstrated in English.

METHODS

This preliminary study translated and adapted into Portuguese, the 12 original English SRP stories. Only small cultural adaptations were made, preserving the essential content of the stories. The stories were then presented to 14 healthy adults, and the participants' retellings from each story were compared to the other stories regarding the number of words, IUs, and propositions.

RESULTS

Few differences were found in the retellings considering the variables analyzed. Particularly, the retells of Gasolina (Gas), Biblioteca (Library), Empréstimo (Loan), Sanduíche (Sandwich), Futebol (Baseball), and Multas (Ticket) were not significantly different in the three aspects investigated in this study (percentages of words, IUs, and propositions).

CONCLUSION

The SRP stories adapted to Portuguese, despite having a quite close number of words, IUs, and propositions to those in the original stories, did not result in retellings with similar number of words, IUs, or propositions across stories. Nonetheless, the parameters analyzed were not significantly different among the majority of the stories, and some were nearly identical. This study identified the SRP stories that can be equivalently used in assessment, reassessment, and possibly in the rehabilitation of patients with communication disorders. Likewise, differences must be considered when the stories are used with pathological populations.

Anatomical MRI staging of frontotemporal dementia variants

INTRODUCTION

The three clinical variants of frontotemporal dementia (behavioral variant [bvFTD], semantic dementia, and progressive non-fluent aphasia [PNFA]) are likely to develop over decades, from the preclinical stage to death.

METHODS

To describe the long-term chronological anatomical progression of FTD variants, we built lifespan brain charts of normal aging and FTD variants by combining 8022 quality-controlled MRIs from multiple large-scale data-bases, including 107 bvFTD, 44 semantic dementia, and 38 PNFA.

RESULTS

We report in this manuscript the anatomical MRI staging schemes of the three FTD variants by describing the sequential divergence of volumetric trajectories between normal aging and FTD variants. Subcortical atrophy precedes focal cortical atrophy in specific behavioral and/or language networks, with a "radiological" prodromal phase lasting 8-10 years (time elapsed between the first structural alteration and canonical cortical atrophy).

DISCUSSION

Amygdalar and striatal atrophy can be candidate biomarkers for future preclinical/prodromal FTD variants definitions.

HIGHLIGHTS

We describe the chronological MRI staging of the most affected structures in the three frontotemporal dementia (FTD) syndromic variants. In behavioral variant of FTD (bvFTD): bilateral amygdalar, striatal, and insular atrophy precedes fronto-temporal atrophy. In semantic dementia: bilateral amygdalar atrophy precedes left temporal and hippocampal atrophy. In progressive non-fluent aphasia (PNFA): left striatal, insular, and thalamic atrophy precedes opercular atrophy.

Cerebral atrophy as a cause of aphasia: From Pick to the modern era

In his epoch-making monograph, Wernicke (1874) claimed that atrophy of the brain cannot cause aphasia. Refuting this claim, Pick (1892, 1898, 1901, 1904a) documented in increasing detail several cases of aphasia with circumscribed atrophy of the left temporal lobe, frontal lobe, or both, which persuaded Wernicke (1906). To explain why the atrophy is circumscribed and leads to focal symptoms, Pick (1908a) advanced a functional network account. Behavioral, neuroanatomical, and histopathological studies by Dejerine and Sérieux, Fischer, Alzheimer, Altman, Gans, Onari and Spatz, and Stertz further illuminated the clinical syndromes, the exact spatial distributions of the atrophy, the underlying disease, and its laminar specificity. Unaware of these seminal studies, research from the 1970s until now has independently rediscovered all key findings, and also supports Pick's forgotten functional account of the distribution of atrophy and the focal symptoms. His frontal and temporal forms of aphasia foreshadowed what are now called the nonfluent/agrammatic and semantic variants of primary progressive aphasia. Moreover, aphasic symptoms may occur with frontal degeneration (what used to be called "Pick's disease") that yields personality changes and behavioral disturbances, now called the behavioral variant of frontotemporal dementia.

Mapping spoken language and cognitive deficits in post-stroke aphasia

Aphasia is an acquired disorder caused by damage, most commonly due to stroke, to brain regions involved in speech and language. While language impairment is the defining symptom of aphasia, the co-occurrence of non-language cognitive deficits and their importance in predicting rehabilitation and recovery outcomes is well documented. However, people with aphasia (PWA) are rarely tested on higher-order cognitive functions, making it difficult for studies to associate these functions with a consistent lesion correlate. Broca's area is a particular brain region of interest that has long been implicated in speech and language production. Contrary to classic models of speech and language, cumulative evidence shows that Broca's area and surrounding regions in the left inferior frontal cortex (LIFC) are involved in, but not specific to, speech production. In this study we aimed to explore the brain-behaviour relationships between tests of cognitive skill and language abilities in thirty-six adults with long-term speech production deficits caused by post-stroke aphasia. Our findings suggest that non-linguistic cognitive functions, namely executive functions and verbal working memory, explain more of the behavioural variance in PWA than classical language models imply. Additionally, lesions to the LIFC, including Broca's area, were associated with non-linguistic executive (dys)function, suggesting that lesions to this area are associated with non-language-specific higher-order cognitive deficits in aphasia. Whether executive (dys)function - and its neural correlate in Broca's area - contributes directly to PWA's language production deficits or simply co-occurs with it, adding to communication difficulties, remains unclear. These findings support contemporary models of speech production that place language processing within the context of domain-general perception, action and conceptual knowledge. An understanding of the covariance between language and non-language deficits and their underlying neural correlates will inform better targeted aphasia treatment and outcomes.

The human language system, including its inferior frontal component in "Broca's area," does not support music perception

Language and music are two human-unique capacities whose relationship remains debated. Some have argued for overlap in processing mechanisms, especially for structure processing. Such claims often concern the inferior frontal component of the language system located within "Broca's area." However, others have failed to find overlap. Using a robust individual-subject fMRI approach, we examined the responses of language brain regions to music stimuli, and probed the musical abilities of individuals with severe aphasia. Across 4 experiments, we obtained a clear answer: music perception does not engage the language system, and judgments about music structure are possible even in the presence of severe damage to the language network. In particular, the language regions' responses to music are generally low, often below the fixation baseline, and never exceed responses elicited by nonmusic auditory conditions, like animal sounds. Furthermore, the language regions are not sensitive to music structure: they show low responses to both intact and structure-scrambled music, and to melodies with vs. without structural violations. Finally, in line with past patient investigations, individuals with aphasia, who cannot judge sentence grammaticality, perform well on melody well-formedness judgments. Thus, the mechanisms that process structure in language do not appear to process music, including music syntax.

Abnormal resting-state function within language network and its improvement among post-stroke aphasia

Several studies with resting-state magnetic resonance imaging (rs-fMRI) have examined functional impairments and plasticity within language network in patients with post-stroke aphasia (PSA). However, there is still ubiquitous inconsistency across these studies, partly due to restricted to very small sample size and the absence of validation with follow-up data. In the current study, we aimed at providing relatively strong evidence to support functional impairments and its reorganization in PSA. Here, the amplitude of low frequency fluctuations (ALFF) and functional connectivity were used to assess functional alterations of PSA with moderate sample size at baseline (thirty-five PSA patients and thirty-five healthy controls). Functional abnormalities at baseline were observed whether improved among sixteen follow-up patients. Compared with controls, PSA at baseline presented decreased ALFF in the left inferior frontal gyrus (IFG) and decreased functional connectivity of the left IFG with the bilateral supplementary motor area (SMA) and right superior temporal gyrus (STG). The decreased ALFF in IFG, decreased IFG-SMA and IFG-STG connectivity were enhanced among follow-up patients and was synchronized with language-performance improvement. Our results revealed reduced intrinsic neural activity and inter-connections within language network in PSA, which would be normalized synchronously as the improvement of language performance.

The Effects of High-Altitude Mountaineering on Cognitive Function in Mountaineers: A Meta-Analysis

BACKGROUND

Nowadays, with the convenience of international traveling and driven by many individuals' fond dreams of challenging high-altitude exercises, high-altitude mountaineering is becoming increasingly popular worldwide. Therefore, we performed a meta-analysis to determine the effects of high-altitude mountaineering on cognitive functions in mountaineers before and after climbing.

METHODS

After a thorough electronic literature search and selection, eight studies were included in this meta-analysis, and the conducted test cycles ranged from 8 to 140 days. Eight variables were included in this meta-analysis: the Trail-Making Test (TMB), Digit Span-Forward (DSF), Digit Span-Backward (DSB), Finger Tapping Test-Right (FTR) Finger Tapping Test-Left (FTL), Wechsler Memory Scale Visual (WMSV), the Aphasia Screening Test (Verbal Items) (AST-Ver), and the Aphasia Screening Test (Visual Motor Errors) (AST-Vis). The effect sizes (ES) and forest plots of these eight variables were generated.

RESULTS

Five variables (TMB, ES = 0.39; DSF, ES = 0.57; FTR, ES = 0.50; FTL, ES = 0.16; WMSV, ES = 0.63) out of eight were significantly improved after high-altitude mountaineering, whereas the ES values of DSB, AST-Ver, and AST-Vis did not show significant improvement after climbing.

CONCLUSION

Despite two limitations, namely, methodological issues inherent in the meta-analysis and the inability to explain high heterogeneity between studies, this study is the first meta-analysis that has attempted to specify and compare the cognitive functions of mountaineers before and after high-altitude mountaineering. Furthermore, as a short-term plateau exercise, high-altitude mountaineering has no significant negative impacts on the cognitive functions of climbers. Future research is needed for a long period of high-altitude mountaineering.

ParAlg: A Paraphasia Algorithm for Multinomial Classification of Picture Naming Errors

PURPOSE

A preliminary version of a paraphasia classification algorithm (henceforth called ParAlg) has previously been shown to be a viable method for coding picture naming errors. The purpose of this study is to present an updated version of ParAlg, which uses multinomial classification, and comprehensively evaluate its performance when using two different forms of transcribed input.

METHOD

A subset of 11,999 archival responses produced on the Philadelphia Naming Test were classified into six cardinal paraphasia types using ParAlg under two transcription configurations: (a) using phonemic transcriptions for responses exclusively (phonemic-only) and (b) using phonemic transcriptions for nonlexical responses and orthographic transcriptions for lexical responses (orthographic-lexical). Agreement was quantified by comparing ParAlg-generated paraphasia codes between configurations and relative to human-annotated codes using four metrics (positive predictive value, sensitivity, specificity, and F1 score). An item-level qualitative analysis of misclassifications under the best performing configuration was also completed to identify the source and nature of coding discrepancies.

RESULTS

Agreement between ParAlg-generated and human-annotated codes was high, although the orthographic-lexical configuration outperformed phonemic-only (weighted-average F1 scores of .78 and .87, respectively). A qualitative analysis of the orthographic-lexical configuration revealed a mix of human- and ParAlg-related misclassifications, the former of which were related primarily to phonological similarity judgments whereas the latter were due to semantic similarity assignment.

CONCLUSIONS

ParAlg is an accurate and efficient alternative to manual scoring of paraphasias, particularly when lexical responses are orthographically transcribed. With further development, it has the potential to be a useful software application for anomia assessment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22087763.

Communicative participation with public authorities: Experiences of people with aphasia, people who stutter, and employees of public authorities

INTRODUCTION

Several studies have examined the communicative participation of people with communication disorders (PWCD). Hindering and facilitating factors were analyzed in different population groups considering various private and public communication contexts. However, knowledge about (a) the experiences of persons with different communication disorders, (b) communication with public authorities, and (c) the perspective of communication partners in this area remains limited. Therefore, this study aimed to explore the communicative participation of PWCD with public authorities. We analyzed communicative experiences (hindering and facilitating factors) and suggestions for improving communicative access described by persons with aphasia (PWA) and persons who stutter (PWS) as well as by employees of public authorities (EPA).

METHODS

In semi-structured interviews, PWA (n = 8), PWS (n = 9), and EPA (n = 11) reported specific communicative encounters with public authorities. The interviews were analyzed using qualitative content analysis, focusing on hindering/facilitating experiences and suggestions for improvement.

RESULTS

The personal experiences of the participants during authority encounters were represented by the interwoven themes of familiarity and awareness, attitudes and behavior, and support and autonomy. The perspectives of the three groups overlap in several areas; however, the results also indicate specific differences between PWA and PWS as well as between PWCD and EPA.

CONCLUSION

The results indicate a need to improve awareness/knowledge about communication disorders and communicative behavior in EPA. Moreover, PWCD should actively engage in encounters with authorities. In both groups, awareness must be raised about how each communication partner can contribute to successful communication, and avenues to achieve this goal must be demonstrated.

Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors

BACKGROUND

Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose.

METHODS

Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons.

RESULTS

Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses.

CONCLUSIONS

Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.

Communication partner training with familiar partners of people with aphasia: A systematic review and synthesis of barriers and facilitators to implementation

BACKGROUND

Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using disparate approaches. To date there has been no synthesis of these factors using a common theoretical framework. Investigating CPT implementation factors using a common theoretical framework may further our understanding of universal barriers and guide future development of tailored, theoretically informed implementation strategies.

AIMS

(1) To determine the perceived and/or observed barriers and facilitators to implementing CPT with familiar partners of adults with aphasia; (2) to map extracted barriers and facilitators to a common theoretical framework; (3) to synthesize extracted barriers and facilitators; and (4) to identify potential implementation strategies to address the most frequently identified barriers and facilitators.

METHODS & PROCEDURES

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science) were systematically searched in April 2021. Empirical qualitative and/or quantitative research studies reporting barriers/facilitators to speech-language therapists (SLTs) implementing CPT with familiar partners of adults with aphasia were included. The search was limited to English or French articles with no date limit applied. Methodological quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT). A framework and content analysis was then conducted to extract and synthesize the implementation factors in alignment with the Theoretical Domains Framework (TDF), followed by a theoretically informed mapping exercise to identify potential implementation strategies.

RESULTS & MAIN CONTRIBUTION

The database searches yielded 2115 studies. Following screening, 17 studies were included in the review. Overall, the included studies had good methodological quality. Extracted implementation factors were classified as barriers, facilitators or mixed (i.e., both) and aligned with 13 of the 14 TDF domains, plus two additional domains: 'carer perspectives on the CPT intervention' and 'patient/carer characteristics'. Synthesized data revealed eight key theoretical domains: Environmental context and resources; Social influences; Beliefs about consequences; Skills; Memory, attention and decision-making; Knowledge; Beliefs about capabilities; and Reinforcement. Within each domain, the research team identified common categories and developed illustrative examples of theoretically informed implementation strategies.

CONCLUSIONS & IMPLICATIONS

This systematic review and theory-informed synthesis of previously reported CPT implementation factors enabled the identification of key barriers to SLTs delivering this best practice. This led to proposed implementation strategies that should be validated, refined and evaluated in future research involving stakeholders who have contextual understanding of implementing CPT.

WHAT THIS PAPER ADDS

What is already known on the subject CPT of familiar partners of PWA is an effective intervention that is inconsistently used in clinical settings. Factors influencing CPT implementation have previously been identified, but using disparate approaches and frameworks. A synthesis of these factors articulated around a common framework is currently not available. What this paper adds to existing knowledge This paper provides a theory-informed synthesis of previously reported barriers and facilitators to SLTs implementing CPT with familiar partners of PWA. It highlights key factors influencing the uptake of this best practice and includes suggestion of implementation strategies to address them. What are the potential or actual clinical implications of this work? The key influencing factors and proposed implementation strategies reported in this paper may support stakeholders in the future design of tailored and theoretically informed implementation strategies aiming to improve the delivery of familiar CPT in their setting.

Precision of phonological errors in aphasia supports resource models of phonological working memory in language production

Working memory (WM) is critical for many cognitive functions including language production. A key feature of WM is its capacity limitation. Two models have been proposed to account for such capacity limitation: slot models and resource models. In recent years, resource models have found support in both visual and auditory perception, but do they also extend to production? We investigate this by analyzing sublexical errors from four individuals with aphasia. Using tools from computational linguistics, we first define the concept of "precision" of sublexical errors. We then demonstrate that such precision decreases with increased working memory load, i.e., word length, as predicted by resource models. Finally, we rule out alternative accounts of this effect, such as articulatory simplification. These data provide the first evidence for the applicability of the resource model to production and further point to the generalizability of this account as a model of resource division in WM.

An access deficit or a deficit in the phonological representations themselves: What can we learn from naming errors?

Anomic aphasia is characterized by good comprehension and non-word repetition but poor naming. Two sub-types of deficits might be hypothesized: faulty access to preserved phonological representations or preserved access to impaired representations. Phonological errors may occur only when representations are impaired or in post-lexical deficits (conduction aphasia). We analysed the incidence of phonological naming errors of 30 individuals, 25 with anomic aphasia based on poor naming but good repetition and comprehension, and five with conduction aphasia based on poor naming and poor repetition. Individuals with anomic aphasia produced very few phonological errors compared to individuals with conduction aphasia (0-19.1% versus 42-66%). However, six individuals with anomia produced more than 11% phonological errors, suggesting two patterns of deficit: either impaired lexical representations or impaired access to them. The lack of phonological errors in most individuals with anomic aphasia suggests that access to the phonological output lexicon is semantically, not phonologically driven.

Refining Semantic Similarity of Paraphasias Using a Contextual Language Model

PURPOSE

ParAlg (Paraphasia Algorithms) is a software that automatically categorizes a person with aphasia's naming error (paraphasia) in relation to its intended target on a picture-naming test. These classifications (based on lexicality as well as semantic, phonological, and morphological similarity to the target) are important for characterizing an individual's word-finding deficits or anomia. In this study, we applied a modern language model called BERT (Bidirectional Encoder Representations from Transformers) as a semantic classifier and evaluated its performance against ParAlg's original word2vec model.

METHOD

We used a set of 11,999 paraphasias produced during the Philadelphia Naming Test. We trained ParAlg with word2vec or BERT and compared their performance to humans. Finally, we evaluated BERT's performance in terms of word-sense selection and conducted an item-level discrepancy analysis to identify which aspects of semantic similarity are most challenging to classify.

RESULTS

Compared with word2vec, BERT qualitatively reduced word-sense issues and quantitatively reduced semantic classification errors by almost half. A large percentage of errors were attributable to semantic ambiguity. Of the possible semantic similarity subtypes, responses that were associated with or category coordinates of the intended target were most likely to be misclassified by both models and humans alike.

CONCLUSIONS

BERT outperforms word2vec as a semantic classifier, partially due to its superior handling of polysemy. This work is an important step for further establishing ParAlg as an accurate assessment tool.

Is Shadowing Behavior Caused by Body Representation Disorders and Apraxia?

Shadowing is a person-following behavior, commonly observed in dementia (e.g., Alzheimer's disease). It may be caused by neuropsychological impairments associated with posterior brain lesions, as Kudo et al. described it in a patient with posterior cortical atrophy and no frontal signs. These authors have suggested that shadowing may arise from the combination of visuospatial impairments, aphasia, apraxia, and prosopagnosia. However, how these symptoms may contribute to shadowing remains unclear. It is suggested that the combination of visuospatial impairments, body representation disorders, and apraxia, may result in complete loss of spatial representations and hence, shadowing behavior.