SUpporting wellbeing through PEeR-Befriending (SUPERB) feasibility trial: fidelity of peer-befriending for people with aphasia

OBJECTIVE

To evaluate systematically the fidelity of a peer-befriending intervention for people with aphasia.

DESIGN

SUpporting wellbeing through Peer-befriending (SUPERB) was a feasibility randomised controlled trial comparing usual care to usual care +peer-befriending. This paper reports on the fidelity of all intervention aspects (training and supervision of providers/befrienders; intervention visits) which was evaluated across all areas of the Behaviour Change Consortium framework.

SETTING

Community.

PARTICIPANTS

People with aphasia early poststroke and low levels of distress, randomised to the intervention arm of the trial (n=28); 10 peer-befrienders at least 1-year poststroke.

INTERVENTION

Peer-befrienders were trained (4-6 hours); and received regular supervision (monthly group while actively befriending, and one-to-one as and when needed) in order to provide six 1-hour peer-befriending visits over 3 months.

MAIN MEASURES

Metrics included number and length of training, supervision sessions and visits. All training and supervision sessions and one (of six) visits per pair were rated against fidelity checklists and evaluated for inter-rater and intrarater reliability (Gwets AC1 agreement coefficient). Per-cent adherence to protocol was evaluated.

RESULTS

All peer-befrienders received 4-6 hours training over 2-3 days as intended. There were 25 group supervision sessions with a median number attended of 14 (IQR=8-18). Twenty-six participants agreed (92.8%) to the intervention and 21 (80.8%) received all six visits (median visit length 60 min). Adherence was high for training (91.7%-100%) and supervision (83%-100%) and moderate-to-high for befriending visits (66.7%-100%). Where calculable, inter-rater and intrarater reliability was high for training and supervision (Gwets AC1 >0.90) and moderate-to-high for intervention visits (Gwets AC1 0.44-1.0).

CONCLUSION

Planning of fidelity processes at the outset of the trial and monitoring throughout was feasible and ensured good-to-high fidelity for this peer-befriending intervention. The results permit confidence in other findings from the SUPERB trial.

TRIAL REGISTRATION NUMBER

NCT02947776.

Treating limb apraxia via action semantics: a preliminary study

Limb apraxia is evident in approximately 50% of patients after left hemisphere cerebral vascular accident (LCVA) and increases disability and caregiver dependence. Individuals with apraxia exhibit abnormalities in spatio-temporal aspects of gesture production and/or in knowledge of tool-related actions (action semantics). This preliminary study of three LCVA participants aimed to (i) explore the efficacy of a novel Action Network Treatment (ANT) that focused on improving the semantic association between tool actions and other types of tool knowledge, an intervention inspired by successful semantic network treatments in aphasia (e.g., Edmonds et al., 2009), and (ii) explore whether there are individuals with apraxia who benefit from ANT relative to a version of a comparatively well-studied existing apraxia treatment (Smania et al., 2006; Smania et al., 2000) that shapes gesture via focus on practicing the spatio-temporal aspects of gesture production (Tool Use Treatment or TUT). One participant demonstrated treatment benefits from both ANT and TUT, while another only benefited from TUT. These findings indicate that our novel semantic network strengthening approach to gesture training may be efficacious in at least some individuals with apraxia, and provide a foundation for future study of the characteristics of people with apraxia who benefit from each approach.

Immersion learning at an aphasia camp: Analysing student video reflections

PURPOSE

Aphasia camps provide a learning context where students can gain knowledge and skills for clinical practise and regarding the lived experience of individuals affected by aphasia. The aim was to examine student learning experiences at a rustic, residential aphasia camp and explore the potential utility of video reflections.

METHOD

Twenty-two student participants, who served as volunteer staff at an aphasia camp, reflected daily on their learning experiences. Manual, qualitative coding was used to characterise individual, verbal reflections conducted through video modality.

RESULT

Three overarching themes were identified: applied learning, service, and clinical experience. Categories within applied learning included increased application of content knowledge, an evolving perspective of living with aphasia, and collaborative learning. Within service, students identified a commitment to making a meaningful impact, interpersonal relationships, and meeting the challenge. The clinical experience theme included increased confidence/self-efficacy and inspirational/rewarding categories.

CONCLUSION

Aphasia camp is a unique learning environment where hands-on experiences influence students' knowledge, sense of civic responsibility, and developing clinical skills. Being immersed in a remote environment alongside individuals affected by aphasia fosters insights into the lived experience of aphasia and may enhance empathy. Video reflections appear to be a viable means of capturing authentic, organic, and emotional reflections.

The Dutch Main Concept Analysis: Translation and Establishment of Normative Data

Purpose The main concept analysis (MCA; Kong, 2009) quantifies the effectiveness and efficiency of information transfer during verbal discourse by means of four sets of sequential pictorial stimuli. This test was originally developed for a Cantonese-speaking population. The main goals of this study were (a) to translate and adapt the MCA to Dutch; (b) to establish normative data for healthy native Dutch-speaking adults; (c) to assess the effect of age, education level, and gender on MCA outcome; and (d) to establish inter- and intrarater reliability of the Dutch MCA. Method Language samples were collected from 60 healthy native Dutch speakers, equally recruited in different age (20-39 years, 40-59 years, 60-79 years) and education (middle and highly educated) categories through administration of the MCA. Utterances produced by at least 75% of the participants were included as a main concept in the Dutch MCA. Subsequently, age-specific normative data were established for each of the MCA parameters. Finally, an ICC was calculated in order to verify inter- and intrarater reliability of the Dutch MCA. Results The translated MCA consisted of 19 main concepts. Age-specific normative data were obtained. Both age and education level had a significant effect on MCA outcome. Information transfer in elderly was both less effectively and efficiently compared to young- and middle-aged adults. In addition, highly educated participants transferred information less efficiently compared to middle educated participants. Based on inter- and intrarater reliability measures, the Dutch MCA proved to be a reliable measuring instrument. Conclusions The MCA was translated to Dutch, and age-specific normative data were established for a healthy, Dutch-speaking population. The Dutch MCA is a reliable tool for eliciting and quantifying discourse production. Validation of the test for people with aphasia is necessary in order for the test to be useful in a clinical practice.

Self-Report and Caregiver Proxy-Report Agreement of Perceived Chronic Stress and Mutuality in Poststroke Aphasia

Background People with aphasia (PWA) report higher levels of stress in comparison to stroke survivors without aphasia. If untreated, chronic stress is known to have detrimental effects to the body and brain and can negatively impact health and well-being. According to extant literature, self- and proxy-report agreement on objective domains is higher than on subjective domains, like chronic stress. In addition, high levels of mutuality, also known as shared feelings between two people, have been strongly associated with low levels of stress in stroke survivors. Little is known, however, of the agreement between self-report and caregiver proxy-report on perceived chronic stress or mutuality in PWA. Purpose The proposed study sought to examine (a) the degree of agreement between caregiver proxy-report and PWA self-report on perceived stress and (b) the relationship between perceived stress and mutuality between PWA and their caregivers. Method The Modified Perceived Stress Scale and the Mutuality Scale were administered to 21 PWA/caregiver dyads. An independent-samples t test was conducted to determine if there were significant differences in perceived stress and mutuality as reported by PWA, their caregiver, and their caregiver's proxy-report. A Pearson correlation was performed to determine the level of agreement across questionnaires. Results There was a moderate correlation between the proxy-report and self-report for perceived stress. On average, proxy-reports for perceived stress were significantly higher than PWA self-reports. Overall, mutuality was high among the dyads. There was moderate agreement between caregiver's mutuality and proxy-report agreement on perceived stress. Lastly, our findings do not indicate that caregiver's perceived stress influenced their perception of the PWA's perceived stress. Conclusion The results of this study provide support for the use of proxy-derived information in perceived stress with the use of a mutuality scale.

Neural mechanisms of foreign accent syndrome: Lesion and network analysis

BACKGROUND

Foreign accent syndrome (FAS) is a rare acquired speech disorder wherein an individual's spoken accent is perceived as "foreign." Most reported cases involve left frontal brain lesions, but it is known that various other lesions can also cause FAS. To determine whether heterogeneous FAS-causing lesions are localized to a common functional speech network rather than to a single anatomical site, we employed a recently validated image analysis technique known as "lesion network mapping."

METHODS

We identified 25 published cases of acquired neurogenic FAS without aphasia, and mapped each lesion volume onto a reference brain. We next identified the network of brain regions functionally connected to each FAS lesion using a connectome dataset from normative participants. Network maps were then overlapped to identify common network sites across the lesions.

RESULTS

Classical lesion overlap analysis showed heterogeneity in lesion anatomical location, consistent with prior reports. However, at least 80% of lesions showed network overlap in the bilateral lower and middle portions of the precentral gyrus and in the medial frontal cortex. The left lower portion of the precentral gyrus is suggested to be the location of lesions causing apraxia of speech (AOS), and the middle portion is considered to be a larynx-specific motor area associated with the production of vowels and stop/nasal consonants and with the determination of pitch accent.

CONCLUSIONS

The lesions that cause FAS are anatomically heterogeneous, but they share a common functional network located in the bilateral posterior region of the frontal lobe. This network specifically includes not only the lower portion of the central gyrus, but also its middle region, which is referred to as the larynx motor cortex and is known to be associated with phonation. Our findings suggest that disrupted networks in FAS might be anatomically different from those in AOS.

The natural history of primary progressive aphasia: beyond aphasia

INTRODUCTION

Primary progressive aphasia (PPA) is divided into three prototypical subtypes that are all characterized by their single core symptom of aphasia. Although later in their course, other cognitive, behavioral, and motor domains may become involved, little is known about the progression profile of each subtype relative to the other subtypes.

METHODS

In this longitudinal retrospective cohort study, based on the recent biomarker-supported diagnostic criteria, 24 subjects diagnosed with semantic variant (svPPA), 22 with non-fluent variant (nfvPPA), and 18 with logopenic variant (lvPPA) were collected and followed up for 1-6 years. Symptom distribution, cognitive test and neuropsychiatric inventory scores, and progression into another syndrome were assessed.

RESULTS

Over time, lvPPA progressed with broader language problems (PPA-extended) and nfvPPA progressed to mutism, whereas semantic impairment remained the major problem in svPPA. Apart from linguistic problems, svPPA developed pronounced behavioral disturbances, whereas lvPPA exhibited a greater cognitive decline. By contrast, in nfvPPA motor deficits were more common. Furthermore, within 5 years (IQR = 2.5) after clinical onset, 65.6% of the patients additionally fulfilled the clinical criteria for another neurodegenerative syndrome (PPA-plus). Fourteen out of 24 (58%) svPPA patients additionally met the diagnostic criteria of behavioral variant frontotemporal dementia (5.1 years, IQR = 1.1), whereas the clinical features of 15/18 (83%) lvPPA patients were consistent with Alzheimer disease dementia (4.5 years IQR = 3.4). Furthermore, 12/22 (54%) of the subjects with the nfvPPA progressed to meet the diagnostic criteria of corticobasal syndrome, progressive supranuclear palsy, or motor neuron disease (5.1 years IQR = 3.4).

DISCUSSION

Despite aphasia being the initial and unique hallmark of the syndrome, our longitudinal results showed that PPA is not a language limited disorder and progression differs widely for each subtype, both with respect to the nature of symptoms and disease duration.

Telerehabilitation for people with aphasia: A systematic review and meta-analysis

OBJECTIVES

To evaluate effectiveness or non-inferiority of telerehabilitation for people with aphasia when compared to conventional face-to-face speech and language therapy.

MATERIALS AND METHODS

Five electronic databases (PUBMED, EMBASE, WEB OF SCIENCE, SCOPUS and the Cochrane Library) were searched. We extrapolated data from the included studies and evaluated the methodological quality using the Revised Cochrane risk-of-bias tool for Randomized Trials (RoB 2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). A meta-analysis compared effects of intervention, and it was conducted using the Review Manager 5.3 software. GRADE profile to assess overall quality of evidence was carried out.

RESULTS

Out of a total of 1157 records, five studies met the inclusion criteria and were eligible for meta-analysis with a total of 132 participants with post-stroke aphasia.

DISCUSSION

Results revealed that telerehabilitation and face-to-face speech and language treatment are comparable with respect to the gains achieved in auditory comprehension (SMD = -0.02; 95% CI -0.39, 0.35), naming accuracy (SMD = -0.09; 95% CI -0.44, 0.25), Aphasia Quotient (MD = -2.18; 95% CI -16.00, 11.64), generalization (SMD = 0.77; 95% IC -0.95, 2.49) and functional communication skills (SMD = -0.08; 95% IC -0.54, 0.38).

CONCLUSION

Although evidence is still insufficient to guide clinical decision making due to the relatively low quality of the evidence identified, the analysis of the results suggest that telerehabilitation training for aphasia seems to be as effective as the conventional face-to-face treatment.

Conducting a Virtual Study With Special Considerations for Working With Persons With Aphasia

Purpose The use of technology (e.g., telehealth) in clinical settings has rapidly increased, and its use in research settings continues to grow. The aim of this report is to present one potential solution to a clinical issue that of virtual and remote assessment for the purposes of spoken language research in persons with aphasia (PWA). To do so, we report detailed methods for conducting a multitimepoint (test-retest) virtual paradigm, assessing lifestyle, physiological, cognitive, and linguistic factors in persons with and without aphasia. Method Procedures for virtual assessment are detailed in a sample of adults with no brain damage (N = 24) and PWA (N = 25) on a test-retest paradigm (data collection approximately 10 ± 3 days apart). This report provides practical information about pre-assessment (e.g., recruitment, scheduling), assessment (e.g., aphasia-friendly consent presentation, investigator fidelity), and postassessment (e.g., data storage, quality check) procedures for human behavior research using a virtual platform. Results Preliminary study data are provided, indicating high retention rates, high rates of data acquisition, and feasibility. Common technological troubles and solutions are discussed, and solutions are offered. The results suggest that our pre-assessment, assessment, and postassessment procedures contributed to the success of our study. Conclusions We provide a practical methodology for conducting a multitimepoint study, with considerations for PWA, adding to the body of research on telehealth in clinical populations. Future studies should continue to evaluate telemethodology, which may be core for diversifying studies, improving study retention, and enrolling larger sample sizes. Supplemental Material https://doi.org/10.23641/asha.14608101.

A Cognitive Psychometric Investigation of Word Production and Phonological Error Rates in Logopenic Progressive Aphasia

Purpose This study investigated the relationship between word production rates (WPRs) and phonological error rates (PERs) in generative and responsive tasks in logopenic progressive aphasia (lvPPA). We examined whether a portion of the reduced WPR during generative tasks related directly to phonological impairments affecting PER on all tasks, irrespective of other task differences that contributed to WPR. Method Two cognitive psychometric models were hypothesized and fit to the total number of words produced and the number of phonological errors produced by 22 participants on 10 tasks. Bayesian inference was used to construct posterior distributions of participant ability and task difficulty parameters. Model fit statistics were compared. Association strengths for average generative WPR and average responsive PER were also evaluated with linear least-squares regression. Results Average generative WPR and average responsive PER were significantly associated (r = -.77, p = .00002). A cognitive psychometric model that assumed reduced WPR on generative tasks reflects a portion of general phonological impairment yielded better fit than a model that ignored performance differences between generative and responsive tasks. Generative fluency tasks that elicited few phonological errors still reflected phonological impairment, via suppression. Individual participants were estimated to suppress between 62% and 93% of phonological errors on generative tasks that would have emerged on responsive tasks. Conclusions Suppression of phonological errors may present as decreased WPR on generative tasks in lvPPA. Failure to account for this suppression tendency may lead to overestimation of phonological ability. The findings indicate the need to account for task demands in assessing lvPPA.

Delivering an iterative Communication Partner Training programme to multidisciplinary healthcare professionals: A pilot implementation study and process evaluation

BACKGROUND

Despite evidence that Communication Partner Training (CPT) can enable health professionals to communicate more effectively with people with aphasia (PWA), an evidence-practice gap exists. To address this, a tailored implementation intervention was developed and trialled to improve health professionals' implementation of communication strategies in a subacute setting.

AIMS

To explore the outcomes and perceived feasibility, acceptability and potential effectiveness of an iterative CPT implementation intervention on multidisciplinary healthcare professionals' communication with PWA.

METHODS & PROCEDURES

The CPT implementation intervention was delivered to two groups of healthcare professionals (n = 6 and 7) approximately 6 months apart. The intervention underwent two iterations targeting emerging barriers to implementation success, with Group 2 receiving a modified version of the Group 1 intervention. A concurrent qualitative process evaluation was conducted to understand key factors determining implementation outcomes. Quantitative outcomes were recorded at baseline and 3-month follow-up, including the Measure of Skill in Supported Communication (MSC), a customized behavioural determinants survey mapped to the Theoretical Domains Framework (TDF) and the Organizational Readiness for Change survey. Focus groups and semi-structured interviews were conducted with health professional participants and the speech-language therapist trainer to explore perceptions of feasibility, acceptability and potential effectiveness. Content analysis was used to analyse the qualitative data, with categories and themes generated.

OUTCOMES & RESULTS

The Group 2 implementation intervention was adapted based on feedback and reflections from Group 1 participants to incorporate more time for practice interactions and discussion during training, individual follow-up sessions and provision of accessible resources to aid communication attempts. There were greater improvements seen in the Group 2 outcomes on both the MSC and the TDF survey, suggesting that the iterative tailoring of the intervention was successful in addressing the barriers to change and led to improved implementation. The difference between the group's outcomes may also partly be explained by the impact of organizational readiness, which decreased during Group 1's implementation period. Despite similar themes emerging from the stakeholder perspectives in both groups (training factors, implementation facilitators, implementation barriers, and changes in knowledge and practice), these diverted in ways which served to explain the different implementation outcomes.

CONCLUSIONS & IMPLICATIONS

An iteratively adapted CPT implementation intervention targeting healthcare professionals' use of supported communication strategies was feasible and acceptable for most participants. The implementation intervention was potentially effective in changing participants' communication with PWA, particularly for Group 2. Future CPT implementation efforts should continue to incorporate stakeholder input and tailor strategies to the organizational context, and measure whether outcomes are sustained in the long term. What this paper adds What is already known on the subject CPT is a complex intervention that can improve communication access and outcomes for PWA. However, there are barriers to both delivering CPT programmes to staff, and for staff in modifying their communication behaviours. Despite increasing efforts to improve CPT implementation, it remains largely unclear whether CPT implementation interventions are effective in improving interactions between staff and patients, and what elements of an implementation intervention result in changed behaviour. What this study adds to existing knowledge This study showed that adopting an iterative, barriers-focused approach to implementation facilitated practice change for one of the groups that participated in the programme. Incorporating stakeholder feedback in an ongoing way led to improvements in feasibility, acceptability and potential effectiveness, with several of the main barriers being effectively addressed by the intervention. Some key mechanisms of change were identified. What are the potential or actual clinical implications of this work It is necessary to develop active, targeted implementation strategies to support healthcare professionals to modify their communication, monitor implementation barriers as they arise and modify behaviour-change strategies accordingly. In a similar context, it is suggested that CPT implementation interventions should incorporate the use of audit feedback, physical resources and educational lectures paired with interactions with PWA in order to bring about change, with ongoing support and facilitation.

Perceptions of people with aphasia about supporting reading with text-to-speech technology: A convergent mixed methods study

INTRODUCTION

Text-to-speech (TTS) technology is a possible reading support for people with aphasia; however, adoption for functional reading remains rare, and people with aphasia may have limited knowledge about TTS. Given this situation coupled with inherent communication challenges associated with aphasia, the purpose of this convergent mixed methods study was to explore the perceptions of participants about desired features, benefits, and drawbacks of TTS technology after having engaged in one-on-one education and guided practice activities.

METHODS

Nineteen adults with chronic aphasia completed a single education and guided practice session followed by close-ended questions and participation in a semi-structured interview to explain preferences, concerns, beliefs, and opinions about potential TTS technology benefits and drawbacks. Three participants had previously used TTS technology for functional reading; all others had some prior exposure but did not use a system for functional purposes.

RESULTS

Seventeen of 19 participants expressed TTS technology interest after education and guided practice activities. Participants endorsed selection of a preferred voice, control of speech output rate, and highlighting as priority features. Frequently endorsed benefits were improved comprehension and increased reading independence; some participants believed they would succeed in reading a greater variety of materials, communicate more with others, participate in more reading activities, and/or read faster. The greatest concern was mastering device operation; other concerns related to understanding the voice output, needing another person's help for system use, and matching the speech output rate to a preferred reading rate.

CONCLUSIONS

Overall, most participants had positive perceptions about possible benefits afforded by TTS technology. Practitioners need to provide opportunities for people with aphasia to learn about and explore TTS systems to determine whether adoption is desired.

Johann Jakob Wepfer (1620-1695): A review of his contributions to neuropsychology on the quadricentennial of his birth

The effects of brain damage on behavior have been reported by authors from the Greek, Roman, Medieval, Renaissance, and seventeenth-century medical traditions. However, few of the reported cases discussed mind-brain relationships, even fewer reported data that offered a description of cognitive functions, and none described a clear association of a functional mechanism of cognitive impairment with identifiable focal brain damage. An exception is found in the case studies by Johann Jakob Wepfer (1620-1695). After reviewing the pre-seventeenth-century background and Wepfer's milieu, we analyze his texts on neuroanatomy, apoplexy, and brain vascularization (Observationes anatomicae ex cadaveribus eorum, quos sustulit apoplexia cum exercitatione de ejus loco affecto) and his remarkable collection of 222 neurological cases (Observationes medico-practicae de affectibus capitis internis & externis), posthumously published in 1727. We focus on his reports concerning on the presence of aphasia, memory disorders, and unilateral neglect, correlated with focal brain damage, with particular emphasis on his examination of language impairments.

Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease

Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771.

Eye Tracking Measures for Studying Language Comprehension Deficits in Aphasia: A Systematic Search and Scoping Review

Aim The aim of this scoping review is to identify the eye tracking paradigms and eye movement measures used to investigate auditory and reading comprehension deficits in persons with aphasia (PWA). Method MEDLINE via PubMed, Cochrane, CINAHL, Embase, PsycINFO, OTseeker, Scopus, Google Scholar, Grey Literature Database, and ProQuest Search (Dissertations & Theses) were searched for relevant studies. The Covidence software was used to manage the initial and full-text screening process for the search. Results and Discussion From a total of 1,803 studies, 68 studies were included for full-text screening. In addition, 418 records from gray literature were also screened. After full-text screening, 16 studies were included for this review-12 studies for auditory comprehension in PWA and four studies for reading comprehension in PWA. The review highlights the use of common eye tracking paradigms used to study language comprehension in PWA. We also discusse eye movement measures and how they help in assessing auditory and reading comprehension. Methodological challenges of using eye tracking are discussed. Conclusion The studies summarized in this scoping review provide evidence that the eye tracking methods are beneficial for studying auditory and reading comprehension in PWA.

The Role of Processing Speed and Cognitive Control on Word Retrieval in Aging and Aphasia

Purpose When speakers retrieve words, they do so extremely quickly and accurately-both speed and accuracy of word retrieval are compromised in persons with aphasia (PWA). This study examined the contribution of two domain-general mechanisms: processing speed and cognitive control on word retrieval in PWA. Method Three groups of participants, neurologically healthy young and older adults and PWA (n = 15 in each group), performed processing speed, cognitive control, lexical decision, and word retrieval tasks on a computer. The relationship between word retrieval speed and other tasks was examined for each group. Results Both aging and aphasia resulted in slower processing speed but did not affect cognitive control. Word retrieval response time delays in PWA were eliminated when processing speed was accounted for. Word retrieval speed was predicted by individual differences in cognitive control in young and older adults and additionally by processing speed in older adults. In PWA, word retrieval speed was predicted by severity of language deficit and cognitive control. Conclusions This study shows that processing speed is compromised in aphasia and could account for their slowed response times. Individual differences in cognitive control predicted word retrieval speed in healthy adults and PWA. These findings highlight the need to include nonlinguistic cognitive mechanisms in future models of word retrieval in healthy adults and word retrieval deficits in aphasia.

Speech rehabilitation in post-stroke aphasia using visual illustration of speech articulators: A case report study

Recent studies on the remediation of speech disorders suggest that providing visual information of speech articulators may contribute to improve speech production. In this study, we evaluate the effectiveness of an illustration-based rehabilitation method on speech recovery of a patient with non-fluent chronic aphasia. The Ultraspeech-player software allowed visualization by the patient of reference tongue and lip movements recorded using ultrasound and video imaging. This method can improve the patient's awareness of their own lingual and labial movements, which can increase the ability to coordinate and combine articulatory gestures. The effects of this method were assessed by analyzing performance during speech tasks, the phonological processes identified in the errors made during the phoneme repetition task and the acoustic parameters derived from the speech signal. We also evaluated cognitive performance before and after rehabilitation. The integrity of visuospatial ability, short-term and working memory and some executive functions supports the effectiveness of the rehabilitation method. Our results showed that illustration-based rehabilitation technique had a beneficial effect on the patient's speech production, especially for stop and fricative consonants which are targeted (high visibility of speech articulator configurations) by the software, but also on reading abilities. Acoustic parameters indicated an improvement in the distinction between consonant categories: voiced and voiceless stops or alveolar, post-alveolar and labiodental fricatives. However, the patient showed little improvement for vowels. These results confirmed the advantage of using illustration-based rehabilitation technique and the necessity of detailed subjective and objective intra-speaker evaluation in speech production to fully evaluate speech abilities.

Speech timing changes accompany speech entrainment in aphasia

BACKGROUND

Prior speech entrainment studies, where individuals with non-fluent aphasia mimic an audio-visual model, suggest speech entrainment improves speech fluency, as indexed by various linguistic measures (e.g., the total number of different words produced per minute). Here, more precise speech timing adjustments accompanying entrained speech were studied and compared to spontaneous speech to determine how these temporal variables relate to the fluency inducing effects of speech entrainment in aphasia.

METHODS

Thirty-one left hemisphere stroke survivors classified with fluent or non-fluent speech were audio-video recorded as they described a picture and during speech entrainment. Speech fluency was documented using the Western Aphasia Battery-Revised. Acoustic measures of speech timing included total number of syllables, speech rate, articulatory rate, silent pause frequency and duration. Standard descriptive statistics and a two-factor mixed model analysis of variance were used to investigate group, task, and 'group x task' interaction effects.

FINDINGS

All acoustic measures of speech timing differentiated the fluent and nonfluent groups except for silent pause frequency. Differences between speech entrainment and spontaneous speech were found for most acoustic measures of speech timing and speaker groups, yet the direction of the effect varied. Stroke survivors classified with non-fluent aphasia improved speech fluency such that speech entrainment elicited pause adjustments facilitating more typical speech timing in comparison to spontaneous speech.

CONCLUSION

Overall, findings provide further evidence of the impact of speech entrainment on measures of speech timing to help individuals with non-fluent aphasia to practice speaking more fluently. Practicing speaking more fluently may ultimately impact perceptual judgments of speech naturalness and social acceptance for persons with aphasia.

[Foreign Accent Syndrome]

Foreign accent syndrome (FAS) is a rare speech disorder characterized by the emergence of a foreign accent. To date, more than a hundred cases of FAS have been reported, and the impression of accent change is regarded to be the result of a combination of segmental deficits (i.e., phonetic distortions and phonemic paraphasias) and supra-segmental changes (i.e., stress, pitch, or rhythm variation). The most common etiology of FAS is stroke, followed by other causes. Various lesion locations have been identified to cause FAS. Owing to various heterogeneous etiologies and lesion locations, it remains controversial whether there is enough consistency or universality to treat FAS as a "syndrome".

A Longitudinal Evaluation of Speech Rate in Primary Progressive Apraxia of Speech

Purpose Individuals with primary progressive apraxia of speech (PPAOS) have apraxia of speech (AOS) in which disruptions in articulation or prosody predominate the speech pattern, referred to, respectively, as phonetic or prosodic subtypes. Many develop aphasia and/or dysarthria. Past research has demonstrated that simple temporal acoustic measures are sensitive to the presence of AOS. The aim of this study was to describe the change in temporal acoustic measures over time and assess if specific patterns of AOS or co-occurring aphasia or dysarthria impact the rate of change over time. Method Durations for multiple productions of the words cat, catnip, catapult, and catastrophe, in an imitative speech task, were recorded for 73 patients, with two to six visits each. A linear mixed-effects model was used to assess the cross-sectional differences and longitudinal influence of AOS subtype and presence of aphasia/dysarthria on speech rate. Pearson correlations were calculated between rate measures and performance on other clinical measures. Results Cross-sectionally, patients with prosodic-predominant PPAOS produced words more slowly than those with phonetic-predominant PPAOS. Patients with either aphasia or dysarthria produced words more slowly than those without. Longitudinally, the speech rate of patients with phonetic-predominant PPAOS had a reduction of 0.5 syllables per second per year. Patients with prosodic-predominant AOS changed less quickly, as did those who developed aphasia. Dysarthria did not impact rate of change. There were strong associations between speech rate measures and other clinical indices of speech and language functioning. Conclusion Simple temporal acoustic measures may reflect the subtype of AOS (phonetic or prosodic predominant), serve as an index of progression of AOS, and inform prognostication relative to the presenting combination of speech and language features. Supplemental Material https://doi.org/10.23641/asha.13564724.

Expecting Questions Modulates Cognitive Effort in a Syntactic Processing Task: Evidence From Pupillometry

Purpose Pupillary responses captured via pupillometry (measurement of pupillary dilation and constriction during the performance of a cognitive task) are psychophysiological indicators of cognitive effort, attention, arousal, and resource engagement. Pupillometry may be a promising tool for enhancing our understanding of the relationship between cognition and language in people with and without aphasia. Interpretation of pupillary responses is complex. This study was designed as a stepping-stone for future pupillometric studies involving people with aphasia. Asking comprehension questions is common in language processing research involving people with and without aphasia. However, the influence of comprehension questions on pupillometric indices of task engagement (tonic responses) and cognitive effort (task-evoked responses of the pupil [TERPs]) is unknown. We tested whether asking comprehension questions influenced pupillometric results of adults without aphasia during a syntactic processing task. Method Forty adults without aphasia listened to easy (canonical) and difficult (noncanonical) sentences in two conditions: one that contained an explicit comprehension task (question condition) and one that did not (no-question condition). The influence of condition and canonicity on pupillary responses was examined. Results The influence of canonicity was only significant in the question condition: TERPs for difficult sentences were larger than TERPs for easy sentences. Tonic responses did not differ between conditions. Conclusions Although participants had similar levels of attentiveness in both conditions, increases in indices of cognitive effort during syntactic processing were significant only when participants expected comprehension questions. Results contribute to a body of evidence indicating the importance of task design and careful linguistic stimulus control when using pupillometry to study language processing. Supplemental Material https://doi.org/10.23641/asha.13480368.

[The analysis of the characteristics of hearing loss in patients with cochlear nerve aphasia identified by MRI]

Objective:To explore the characteristics of hearing loss in patients with cochlear nerve aphasia（CNA） and to provide evidences for diagnosis and treatment of cochlear nerve aphasia. Methods:A retrospective study was performed. A total of 51 cases were included in the study. The data of hearing test, inner auditory canal MRI and temporal HRCT were analyzed. Results:77.19% of the affected ears had extremely severe hearing loss, and 7.02% of the affected ears had moderate hearing loss. The residual hearing was concentrated in low-medium frequency. A CNA ear with bone cochlear nerve canal atresia can exhibited moderate hearing loss. Conclusion:The patient with CNA may still present residual hearing function. CNA could not be excluded in patients with moderate hearing loss. The "three-dimensional integration" comprehensive evaluation system, which includesinternal auditory canal MRI, temporal thin-layer CT scan and audiology evaluation, could be helpful to the diagnosis of cochlear nerveaphasia.

How clerks understand the requests of people living with aphasia in service encounters

Aphasia often restricts participation. People living with aphasia (PLWA) engage in fewer activities, which leads to fewer interactions than before aphasia. Analyses of interactions with non-familiar people in activities of daily life could provide knowledge about how to integrate these situations in rehabilitation and facilitate ongoing PLWA participation post-rehabilitation. This qualitative study is the first to examine how PLWA make their requests understood in service encounters despite aphasia. Six people living with moderate or severe aphasia were video-recorded in situations of service encounters, e.g., pharmacies, specialised shops, restaurants, and others. We identified fifty-nine occurrences with one or several difficulties in the formulation of the request. They were examined, including the clerks' responses and ensuing interaction using multimodal conversation analysis. Results showed that PLWA used nonverbal communication within the physical environment and the context of the interaction to support verbal production. In the majority of situations, the clerks understood the request promptly. In other situations, they both collaborated to achieve a clear understanding of the request. Moreover, the findings attest to the competence of people living with moderate or severe aphasia in engaging in service encounters and add to the knowledge base about interaction and social participation in aphasia.

A Tool for Automatic Scoring of Spelling Performance

Purpose The evaluation of spelling performance in aphasia reveals deficits in written language and can facilitate the design of targeted writing treatments. Nevertheless, manual scoring of spelling performance is time-consuming, laborious, and error prone. We propose a novel method based on the use of distance metrics to automatically score spelling. This study compares six automatic distance metrics to identify the metric that best corresponds to the gold standard-manual scoring-using data from manually obtained spelling scores from individuals with primary progressive aphasia. Method Three thousand five hundred forty word and nonword spelling productions from 42 individuals with primary progressive aphasia were scored manually. The gold standard-the manual scores-were compared to scores from six automated distance metrics: sequence matcher ratio, Damerau-Levenshtein distance, normalized Damerau-Levenshtein distance, Jaccard distance, Masi distance, and Jaro-Winkler similarity distance. We evaluated each distance metric based on its correlation with the manual spelling score. Results All automatic distance scores had high correlation with the manual method for both words and nonwords. The normalized Damerau-Levenshtein distance provided the highest correlation with the manual scoring for both words (r_s = .99) and nonwords (r_s = .95). Conclusions The high correlation between the automated and manual methods suggests that automatic spelling scoring constitutes a quick and objective approach that can reliably substitute the existing manual and time-consuming spelling scoring process, an important asset for both researchers and clinicians.