Social validity of changes in informativeness and efficiency of aphasic discourse following linguistic specific treatment (LST)

Can a writing intervention using mainstream Assistive Technology software compensate for dysgraphia and support reading comprehension for people with aphasia?

BACKGROUND

Stroke profoundly affects quality of life (QOL), including loss of employment, reduced social activity, shrinking social networks and low mood. Dysgraphia (impaired writing) is a common symptom of aphasia yet is rarely targeted in rehabilitation. Recent technological advances might challenge this, since much communication is now conducted digitally through writing. The rehabilitation of writing may therefore help to address the wider consequences of stroke and aphasia.

AIMS

Can assistive technology (AT) training for people with dysgraphia: (1) improve written output, and are gains achieved only with AT? (2) improve reading comprehension scores, and are gains achieved only with AT? and (3) affect social participation, mood or QOL METHODS AND PROCEDURES: DESIGN: A mixed-methods, repeated measures, small group study design was adopted (qualitative outcomes will be reported elsewhere).

PARTICIPANTS

Recruited from community settings, for example, Stroke Association communication support groups.

INCLUSION CRITERIA

over 18 years old, aphasia due to stroke, acquired dysgraphia, writing more impaired than speech, fluent English prior to stroke, access to computer and Internet.

EXCLUSION CRITERIA

currently receiving speech and language therapy, significant cognitive impairment, neuromuscular/motor-speech impairments/structural abnormalities, developmental dyslexia, uncorrected visual/auditory impairments.

PROCEDURES

Screening and diagnostic assessments at time T1 (first baseline). Outcome measures at T1; repeated at T2 (second baseline), T3 (end of intervention), T4 (3-month follow up). Social participation assessment and cognitive monitoring at T2, T3, T4.

INTERVENTION

Seven-ten hours individual therapy weekly and additional email support. Participants were trained to operate Dragon NaturallySpeaking (speech to text package) and ClaroRead (read writing aloud). Outcome measures were administered on pen and paper (control) and on computer, with AT enabled only at T3, T4.

OUTCOMES AND RESULTS

Computer narrative writing was significantly improved by AT training (Friedman's χ2 (3) = 8.27, p = 0.041), indicating a compensatory effect of AT. Though reading comprehension significantly improved in the computer condition (Friedman's χ2 (3) = 21.07, p = 0.001), gains could not be attributed to the AT. Gains were achieved only when measures were administered on the keyboard, with AT enabled. Thus, a compensatory rather than remediatory effect was suggested. Social network size significantly increased; there were no significant changes in mood/QOL. Individual success rates varied.

CONCLUSION AND IMPLICATIONS

The customisable AT training was acceptable to participants and resulted in significantly improved narrative writing. Compensatory AT interventions are a useful adjunct to remediatory writing interventions and may particularly support functional writing.

WHAT THIS PAPER ADDS

What is already known on this subject Writing is rarely spared in aphasia and may present as the most impaired communication modality. Yet, people with aphasia report that writing is seldom included in their rehabilitation. Many communication activities are now conducted digitally through writing, therefore rehabilitation of this is more important than ever before. This study sought to address whether an assistive technology (AT) software package can improve writing and whether any changes were compensatory or remediatory. What this study adds to existing knowledge This group study found that AT training led to gains in written discourse and social network in people with aphasia and dysgraphia. Gains were not replicated in handwritten tasks, suggesting this was a compensatory therapeutic approach. What are the clinical implications of this work? AT programs such as this may present speech and language therapists with a practical, pragmatic adjunct to writing or typing therapy, particularly for clients with chronic, intractable impairments for whom remediatory therapy may have a low chance of success.

A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research

BACKGROUND

It is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians' and researchers' desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation.

AIMS

To use scoping review methodology to identify transcription-less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: 'What transcription-less tools and analysis procedures are available to assess discourse in people with aphasia?' and included several sub-questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties.

METHODS

The scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer-reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. 'Transcription-less' analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review.

MAIN CONTRIBUTION

An overview of the state of transcription-less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings.

CONCLUSION

Transcription-less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings.

WHAT THIS PAPER ADDS

What is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech-language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription-less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients' desired outcomes. However, little is known about the current state of transcription-less discourse analysis, blocking progress. What this paper adds to existing knowledge This study provides an overview of currently available transcription-less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription-less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro-structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription-less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription-less procedures are lacking psychometric data including information about validity and reliability. What are the potential or actual clinical implications of this work? Transcription-less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription-less discourse analysis to better monitor clients' desired treatment outcomes.

Evaluating circumlocution in naming as a predictor of communicative informativeness and efficiency in discourse

Background

Discourse analyses yield quantitative measures of functional communication in aphasia. However, they are historically underutilized in clinical settings. Confrontation naming assessments are used widely clinically and have been used to estimate discourse-level production. Such work shows that naming accuracy explains moderately high proportions of variance in measures of discourse, but proportions of variance remain unexplained. We propose that the inclusion of circumlocution productions into predictive models will account for a significant amount more of the variance. Circumlocution productions at the naming-level, while they may not contain the target word, are similar to the content that contributes to discourse informativeness and efficiency. Thus, additionally measuring circumlocution may improve our ability to estimate discourse performance and functional communication.

Aim

This study aimed to test whether, after controlling for naming accuracy, the addition of a measure of circumlocution into predictive models of discourse-level informativeness and efficiency would account for a significant amount more of the variance in these discourse-level outcomes.

Methods & Procedures

Naming and discourse data from 43 people with poststroke aphasia were analyzed. Naming data were collected using 120 pictured items and discourse data were collected using two picture description prompts. Data scoring and coding yielded measures of naming accuracy, incorrect response type, communicative informativeness, and efficiency. We used robust hierarchical regression to evaluate study predictions.

Outcomes & Results

After controlling for naming accuracy, the inclusion of circumlocution into predictive models accounted for a significant amount more of the variance in both informativeness and efficiency. The subsequent inclusion of other response types, such as real word and nonword errors, did not account for a significant amount more of the variance in either outcome.

Conclusions

In addition to naming accuracy, the production of circumlocution during naming assessments may correspond with measures of informativeness and efficiency at the discourse-level. Reducing the burden of estimating patients' functional communication will increase our ability to estimate functional communication using tools that are easy to administer and interpret.

Evaluating the Accuracy of Self-Ratings of Language in Adults with Aphasia and Non-Brain Injured Adults: A Pilot Study

Rating scales are frequently used in research and clinical practice with people with aphasia (PWA) to characterize communication in the home environment. However, it remains unclear whether responses provided on rating scales accurately reflect the communication that occurs. We aim to evaluate the accuracy of PWA's self-perceptions of verbal language use as measured by a rating scale and determine whether this accuracy is different from that of non-brain-injured (NBI) participants. Four PWA and four NBI participants completed a rating scale estimating their amount of verbal language production as compared with their communication partner. Audio recordings from participants' home environments were analyzed for proportion of words and conversational turns contributed by the participant, which were compared with rating scale estimates. Perceptions of verbal language output among both PWA and NBI participants showed variable accuracy, with discrepancies between estimates and objective data across both groups. The reliability of rating scales in quantifying language output appears questionable, suggesting they may not accurately represent naturalistic language environments of PWA. Additional research with larger sample sizes is warranted to investigate whether this trend is consistent across a larger population of individuals with aphasia.

Enhancing the Classification of Aphasia: A Statistical Analysis Using Connected Speech

BACKGROUND

Large shared databases and automated language analyses allow for the application of new data analysis techniques that can shed new light on the connected speech of people with aphasia (PWA).

AIMS

To identify coherent clusters of PWA based on language output using unsupervised statistical algorithms and to identify features that are most strongly associated with those clusters.

METHODS & PROCEDURES

Clustering and classification methods were applied to language production data from 168 PWA. Language samples were from a standard discourse protocol tapping four genres: free speech personal narratives, picture descriptions, Cinderella storytelling, procedural discourse.

OUTCOMES & RESULTS

Seven distinct clusters of PWA were identified by the K-means algorithm. Using the random forests algorithm, a classification tree was proposed and validated, showing 91% agreement with the cluster assignments. This representative tree used only two variables to divide the data into distinct groups: total words from free speech tasks and total closed class words from the Cinderella storytelling task.

CONCLUSION

Connected speech data can be used to distinguish PWA into coherent groups, providing insight into traditional aphasia classifications, factors that may guide discourse research and clinical work.

Final results of the NINFA project: impact of new technologies in the daily life of elderly people

BACKGROUND

The paper presents the work carried out within NINFA (iNtelligent Integrated Network For Aged people), a project for the wellbeing of the elderly people at home.

AIMS

The impact of new technologies on elderly people is evaluated with respect to the three main topics faced by NINFA.

METHODS

NINFA was structured into three main topics: (1) active user engagement from the very beginning of the planning stage: the use of specially designed questionnaires to evaluate the acceptability of new technology in general and robot caregiver specifically; (2) assessment of the well-being through non-invasive techniques: natural language processing for language change monitoring in elderly subjects; (3) automated assessment of motor and cognitive functions at home: systems to deliver tests and exergames through user interfaces compliant with elderly subjects.

RESULTS

The analysis shows that there is no a priori closure to support the technology, but it must not be invasive and must allow social interactions. The study of speech transcripts shows that a large variations in the number of words used to describe the same situation could be a sign on the onset of cognitive impairments. The specifically designed systems highlight, after the training period, significant improvements in the performances of the participants and a satisfaction with regards to the systems usability.

CONCLUSIONS

The outcomes of NINFA project highlight some important aspects of the relationship between elderly people and new technologies concerning: engagement and acceptability, assessment of the wellbeing and of the modifications of motor, cognitive and language functions.

Creating a Theoretical Framework to Underpin Discourse Assessment and Intervention in Aphasia

Discourse (a unit of language longer than a single sentence) is fundamental to everyday communication. People with aphasia (a language impairment occurring most frequently after stroke, or other brain damage) have communication difficulties which lead to less complete, less coherent, and less complex discourse. Although there are multiple reviews of discourse assessment and an emerging evidence base for discourse intervention, there is no unified theoretical framework to underpin this research. Instead, disparate theories are recruited to explain different aspects of discourse impairment, or symptoms are reported without a hypothesis about the cause. What is needed is a theoretical framework that would clarify the specific linguistic skills that create completeness, coherence, and complexity (i.e., richness) in discourse, and illuminate both the processes involved in discourse production and the reasons for breakdown. This paper reports a review and synthesis of the theoretical literature relevant to spoken discourse in aphasia discourse, and we propose a novel theoretical framework which unites these disparate sources. This framework is currently being tested as the foundation for Linguistic Underpinnings of Narrative in Aphasia (LUNA) treatment research. In this paper, we outline the novel framework and exemplify how it might be used to guide clinical practice and research. Future collaborative research is needed to develop this framework into a processing model for spoken discourse.

Neurocognitive Recovery of Sentence Processing in Aphasia

Purpose Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring throughout the life span, including following brain damage; (b) plasticity is highly experience dependent; and (c) as with any learning system, language reorganization involves a synergistic interplay between organism-intrinsic (i.e., cognitive and brain) and organism-extrinsic (i.e., environmental) variables. A major goal for clinical treatment of aphasia is to be able to prescribe treatment and predict its outcome based on the neurocognitive deficit profiles of individual patients. This review article summarizes the results of research examining the neurocognitive effects of psycholinguistically based treatment (i.e., Treatment of Underlying Forms; Thompson & Shapiro, 2005) for sentence processing impairments in individuals with chronic agrammatic aphasia resulting from stroke and primary progressive aphasia and addresses both behavioral and brain variables related to successful treatment outcomes. The influences of lesion volume and location, perfusion (blood flow), and resting-state neural activity on language recovery are also discussed as related to recovery of agrammatism and other language impairments. Based on these and other data, principles for promoting neuroplasticity of language networks are presented. Conclusions Sentence processing treatment results in improved comprehension and production of complex syntactic structures in chronic agrammatism and generalization to less complex, linguistically related structures in chronic agrammatism. Patients also show treatment-induced shifts toward normal-like online sentence processing routines (based on eye movement data) and changes in neural recruitment patterns (based on functional neuroimaging), with posttreatment activation of regions overlapping with those within sentence processing and dorsal attention networks engaged by neurotypical adults performing the same task. These findings provide compelling evidence that treatment focused on principles of neuroplasticity promotes neurocognitive recovery in chronic agrammatic aphasia. Presentation Videohttps://doi.org/10.23641/asha.10257587.

Communicative Informativeness in Aphasia: Investigating the Relationship Between Linguistic and Perceptual Measures

Purpose Informativeness refers to how successfully a person is able to convey their intended message. This study explores the relationship between perceptual ratings of informativeness and selected linguistic measures of lexical and structural content. It considers which linguistic measures have ecological validity in terms of what listeners view as important. Method Two complex picture description samples from 20 people with aphasia were analyzed. Linguistic measures included number of correct information units (NCIU), percentage of correct information units, number of propositions (NP), propositional idea density (PID), and mean length of utterance in words (MLU-w). Eleven naïve listeners produced direct magnitude estimation (DME) ratings of informativeness. A correlational design was used to investigate the relationship between mean DME informativeness ratings and each of the linguistic measures. Results The 2 picture description samples elicited similar informativeness ratings. Positive significant correlations were identified between mean DME informativeness ratings and NCIU, percentage of correct information units, NP, and MLU-w; the strength of correlation differed across variables. No significant correlation was found between mean DME informativeness ratings and PID. Significant correlations were also seen between the linguistic variables, particularly between NP and PID as well as NP and MLU-w. Conclusions Overall, the linguistic measures corresponded to rated informativeness, highlighting their ecological validity. The strongest relationship was between NCIU and rated informativeness, emphasizing the importance of complete and accurate production of lexical information, particularly nouns. Less strong, but still significant, relationships were seen with variables looking at the efficiency of information giving and the connection of ideas within sentences. The importance of different types of informative measures is considered in relation to the elicitation stimuli.

The relationship between trained ratings and untrained listeners' judgments of global coherence in extended monologues

BACKGROUND

Global coherence rating scales have been used by a number of researchers to examine spoken discourse in populations with and without acquired neurogenic communication disorders. The 4-point global coherence (GC) scale in the current study has demonstrated reliability and convergent validity. However, we have not yet established how a global coherence rating corresponds to functional communication.

AIMS

The current study explores the clinical meaningfulness of the 4-point GC rating scale. Survey questions and ratings were developed to examine discourse quality and functional coherence as perceived by untrained listeners. Ratings by untrained listeners were compared to trained discourse ratings using the established 4-point GC scale.

METHODS

Twelve discourse samples, scored by a trained rater, were selected for the current study from a previously collected set of discourse transcripts. Transcripts were extended monologues in response to one of four possible open-ended questions that were re-recorded by the trained rater to remove any distracting features of the original recordings, such as articulatory errors. Twenty-four untrained listeners rated the discourse samples using a short questionnaire that included questions for each sample about: topic maintenance, inclusion of unnecessary information, and the listener level of interest and attention. Questions for untrained listeners were based on operational definitions of global coherence and discourse quality respectively. These untrained ratings were compared to trained ratings of global coherence. Outcome measures were compared using non-parametric tests and a Spearman Rank Order test was also used to examine relationships among variables.

OUTCOMES AND RESULTS

Untrained listeners' ratings for topic maintenance and inclusion of unnecessary information were significantly different between trained low, medium, and high global coherence ratings. Topic maintenance and inclusion of unnecessary information were also both significantly correlated with global coherence. Untrained listeners' ratings of their level of interest and attention for a sample were significantly different between trained medium-high and low-high global coherence ratings. Interest and attention ratings were also significantly correlated with ratings of global coherence.

CONCLUSIONS

Untrained raters did differentiate between levels of global coherence using ratings of topic maintenance, inclusion of unnecessary information, and their level of attention and interest. Global coherence was also significantly correlated with the untrained ratings. These findings provide preliminary external validity for the global coherence scale and support its clinical utility.

Technology-enhanced writing therapy for people with aphasia: results of a quasi-randomized waitlist controlled study

BACKGROUND

Acquired writing impairment, or dysgraphia, is common in aphasia. It affects both handwriting and typing, and may recover less well than other aphasic symptoms. Dysgraphia is an increasing priority for intervention, particularly for those wishing to participate in online written communication. Effective dysgraphia treatment studies have been reported, but many did not target, or did not achieve, improvements in functional writing. Functional outcomes might be promoted by therapies that exploit digital technologies, such as voice recognition and word prediction software.

AIMS

This study evaluated the benefits of technology-enhanced writing therapy for people with acquired dysgraphia. It aimed to explore the impact of therapy on a functional writing activity, and to examine whether treatment remediated or compensated for the writing impairment. The primary question was: Does therapy improve performance on a functional assessment of writing; and, if so, do gains occur only when writing is assisted by technology? Secondary measures examined whether therapy improved unassisted written naming, functional communication, mood and quality of life.

METHODS & PROCEDURES

The study employed a quasi-randomized waitlist controlled design. A total of 21 people with dysgraphia received 12 h of writing therapy either immediately or after a 6-week delay. The primary outcome measure was a functional assessment of writing, which was administered in handwriting and on a computer with assistive technology enabled. Secondary measures were: The Boston Naming Test (written version), Communication Activities of Daily Living-2, Visual Analogue Mood Scales (Sad question), and the Assessment of Living with Aphasia. Analyses of variance (ANOVA) were used to examine change on the outcome measures over two time points, between which the immediate group had received therapy but the delayed group had not. Pre-therapy, post-therapy and follow-up scores on the measures were also examined for all participants.

OUTCOMES & RESULTS

Time × group interactions in the ANOVA analyses showed that therapy improved performance on the functional writing assessment. Further interactions with condition showed that gains occurred only when writing was assisted by technology. There were no significant interactions in the analyses of the secondary outcome measures. A treatment effect on these measures was therefore unconfirmed.

CONCLUSIONS & IMPLICATIONS

This study showed that 21 people with dysgraphia improved on a functional writing measure following therapy using assistive technology. The results suggest that treatment compensated for, rather than remediated, the impairment, given that unassisted writing did not change. Further studies of technology-enhanced writing therapy are warranted.

Reviewing the quality of discourse information measures in aphasia

BACKGROUND

Discourse is fundamental to everyday communication, and is an increasing focus of clinical assessment, intervention and research. Aphasia can affect the information a speaker communicates in discourse. Little is known about the psychometrics of the tools for measuring information in discourse, which means it is unclear whether these measures are of sufficient quality to be used as clinical outcome measures or diagnostic tools.

AIMS

To profile the measures used to describe information in aphasic discourse, and to assess the quality of these measures against standard psychometric criteria.

METHODS & PROCEDURES

A scoping review method was employed. Studies were identified using a systematic search of Scopus, Medline and Embase databases. Standard psychometric criteria were used to evaluate the measures' psychometric properties.

MAIN CONTRIBUTION

The current review summarizes and collates the information measures used to describe aphasic discourse, and evaluates their quality in terms of the psychometric properties of acceptability, reliability and validity. Seventy-six studies described 58 discourse information measures, with a mean of 2.28 measures used per study (SD = 1.29, range = 1-7). Measures were classified as 'functional' measures (n = 33), which focused on discourse macrostructure, and 'functional and structural' measures (n = 25), which focused on micro-linguistic and macro-structural approaches to discourse. There were no reports of the acceptability of data generated by the measures (distribution of scores, missing data). Test-retest reliability was reported for just 8/58 measures with 3/8 > 0.80. Intra-rater reliability was reported for 9/58 measures and in all cases percentage agreement was reported rather than reliability. Per cent agreement was also frequently reported for inter-rater reliability, with only 4/76 studies reporting reliability statistics for 12/58 measures; this was generally high (>.80 for 11/12 measures). The majority of measures related clearly to the discourse production model indicating content validity. A total of 36/58 measures were used to make 41 comparisons between participants with aphasia (PWA) and neurologically healthy participants (NHP), with 31/41 comparisons showing a difference between the groups. Four comparisons were made between discourse genres, with two measures showing a difference between genres, and two measures showing no difference.

CONCLUSIONS

There is currently insufficient information available to justify the use of discourse information measures as sole diagnostic or outcome measurement tools. Yet the majority of measures are rooted in relevant theory, and there is emerging evidence regarding their psychometric properties. There is significant scope for further psychometric strengthening of discourse information measurement tools.

Análise do discurso de indivíduos afásicos fluentes e com leve dificuldade de compreensão oral

RESUMO: Objetivo: analisar os discursos narrativo, descritivo, conversacional e procedural de indivíduos afásicos fluentes e compará-los com indivíduos saudáveis. Métodos: foram selecionados, por meio de amostragem sistemática, 22 indivíduos afásicos fluentes com queixas de dificuldade discursiva e que apresentam alteração de linguagem pós-acometimento em Sistema Nervoso Central decorrente de Acidente Vascular Encefálico, que estão ou já estiveram em tratamento na instituição de origem. Estes foram pareados a indivíduos saudáveis de mesma idade e escolaridade e ambos os grupos foram submetidos a um protocolo de tarefas discursivas orais para avaliação dos discursos narrativo, explicativo, conversacional e procedural. Resultados: houve diferenças estatisticamente significantes na maioria das variáveis investigadas em todos os tipos de discursos tanto na análise quantitativa quanto na qualitativa. Conclusão: indivíduos afásicos apresentaram maior facilidade no discurso narrativo e maior dificuldade nos demais discursos, porém comparando-os aos indivíduos saudáveis apresentaram maior dificuldade em todos os gêneros discursivos orais.

Verb production tasks in the measurement of communicative abilities in aphasia

BACKGROUND

The neurofunctional correlates of verbs and nouns have been the focus of many theoretically oriented studies. In clinical practice, however, more attention is typically paid to nouns, and the relative usefulness of tasks probing nouns and verbs is unclear. The routine administration of tasks that use verbs could be a relevant addition to current batteries. Evaluating performance on both noun and verb tasks may provide a more reliable account of everyday language abilities than an evaluation restricted to nouns.

AIMS

To assess the benefits of administering verb tasks in addition to noun tasks, and their relation to three functional measures of language.

METHOD AND PROCEDURE

Twenty-one subjects with poststroke language disorders completed four picture-naming tasks and a role-playing test (Communicative Abilities in Daily Living, Second Edition, CADL-2), commonly used as measure of everyday language abilities. Two questionnaires (Communicative Effectiveness Index, CETI, and Communicative Activity Log, CAL) were completed by caregivers. Picture-naming tasks were matched for psycholinguistic variables to avoid lexicosemantic and morphosyntactic confounds.

RESULTS

No significant differences emerged across picture-naming tasks. Scores on the role-playing test and the two questionnaires differed; scores between the two questionnaires did not. The four naming tasks correlated significantly with CADL-2, CETI, and CAL. The strength of the correlation with CADL-2 was significantly greater for Naming Finite Verbs than for Object Naming. Thirteen participants showed no differences in performance between tasks, 6 fared significantly worse on verb tasks than on Object Naming, 1 fared better at Naming Finite Verbs though his performance was poor overall, and 1 was significantly more impaired on verbs.

CONCLUSIONS

Performance on tasks that use verbs, and especially Naming Finite Verbs, may provide a more accurate estimate of language abilities in daily living than Object Naming alone. Administering both verb and noun tasks may be recommended in clinical practice.

Rehabilitation of language in expressive aphasias: a literature review

Objective

This paper reviews the methodological characteristics of studies on rehabilitation of expressive aphasia, describing the techniques of rehabilitation used.

Methods

The databases Medline, Science Direct and PubMed were searched for relevant articles (January 1999 to December 2011) using the keywords Expressive / Broca / Nonfluent Aphasia, combined with Language or Speech Rehabilitation / Therapy / Intervention.

Results

A total of 56 articles were retrieved describing rehabilitation techniques, including 22 with a focus on lexical processing, 18 on syntax stimulation, seven with the aim of developing speech and nine with multiple foci.

Conclusion

A variety of techniques and theoretical approaches are available, highlighting the heterogeneity of research in this area. This diversity can be justified by the uniqueness of patients' language deficits, making it difficult to generalize. In addition, there is a need to combine the formal measures of tests with measures of pragmatic and social skills of communication to determine the effect of rehabilitation on the patient's daily life.

TRAINING VERB PRODUCTION IN COMMUNICATIVE CONTEXT: EVIDENCE FROM A PERSON WITH CHRONIC NON-FLUENT APHASIA

BACKGROUND: The use of constraint-induced treatment in aphasia therapy has yielded promising but mixed results. AIMS: We conducted a treatment study with an individual with chronic non-fluent aphasia. The goal of the treatment was to improve verb production in sentence- and narrative- contexts. METHODS #ENTITYSTARTX00026; PROCEDURES: We administered a modified constraint-induced aphasia treatment in a single-subject design. Treatment emphasized the production of verbs within informative exchanges. Verb production in narratives was assessed before and after the treatment. OUTCOMES #ENTITYSTARTX00026; RESULTS: Results demonstrated a significant increase in the number of verbs produced during narrative generation following treatment. Moreover, a positive change was perceived by naïve listeners who rated the social-communicative impact of the participant's narratives. CONCLUSIONS: The increase in verb production seen in the post-treatment measures is attributed to a combination of the constraints imposed on sentence production during the treatment sessions, the informative nature of the treatment exchanges, and the relative intensity of the treatment schedule.

Informativeness ratings of messages created on an AAC processing prosthesis

BACKGROUND: SentenceShaper() (SSR) is a computer program that supports spoken language production in aphasia by recording and storing the fragments that the user speaks into the microphone, making them available for playback and allowing them to be combined and integrated into larger structures (i.e., sentences and narratives). A prior study that measured utterance length and grammatical complexity in story-plot narratives produced with and without the aid of SentenceShaper demonstrated an "aided effect" in some speakers with aphasia, meaning an advantage for the narratives that were produced with the support of this communication aid (Linebarger, Schwartz, Romania, Kohn, & Stephens, 2000). The present study deviated from Linebarger et al.'s methods in key respects and again showed aided effects of SentenceShaper in persons with aphasia. AIMS: Aims were (1) to demonstrate aided effects in "functional narratives" conveying hypothetical real-life situations from a first person perspective; (2) for the first time, to submit aided and spontaneous speech samples to listener judgements of informativeness; and (3) to produce preliminary evidence on topic-specific carryover from SentenceShaper, i.e., carryover from an aided production to a subsequent unaided production on the same topic. METHODS #ENTITYSTARTX00026; PROCEDURES: Five individuals with chronic aphasia created narratives on two topics, under three conditions: Unaided (U), Aided (SSR), and Post-SSR Unaided (Post-U). The 30 samples (5 participants, 2 topics, 3 conditions) were randomised and judged for informativeness by graduate students in speech-language pathology. The method for rating was Direct Magnitude Estimation (DME). OUTCOMES #ENTITYSTARTX00026; RESULTS: Repeated measures ANOVAs were performed on DME ratings for each participant on each topic. A main effect of Condition was present for four of the five participants, on one or both topics. Planned contrasts revealed that the aided effect (SSR >U) was significant in each of these cases. For two participants, there was also topic-specific carryover (Post-U >U). CONCLUSIONS: Listeners judged functional narratives generated on SentenceShaper to be more informative than comparable narratives spoken spontaneously. This extends the evidence for aided effects of SentenceShaper. There was also evidence, albeit weaker, for topic-specific carryover, suggesting that the program might be used effectively to practise for upcoming face-to-face interactions.

Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002

OBJECTIVE

To update the previous evidence-based recommendations of the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 1998 through 2002.

DATA SOURCES

PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, and reasoning combined with each of the terms rehabilitation, remediation, and training. Reference lists from identified articles were reviewed and a bibliography listing 312 articles was compiled.

STUDY SELECTION

One hundred eighteen articles were initially selected for inclusion. Thirty-one studies were excluded after detailed review. Excluded articles included 14 studies without data, 6 duplicate publications or follow-up studies, 5 nontreatment studies, 4 reviews, and 2 case studies involving diagnoses other than TBI or stroke.

DATA EXTRACTION

Articles were assigned to 1 of 7 categories reflecting the primary area of intervention: attention; visual perception; apraxia; language and communication; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria.

DATA SYNTHESIS

Of the 87 studies evaluated, 17 were rated as class I, 8 as class II, and 62 as class III. Evidence within each area of intervention was synthesized and recommendations for practice standards, practice guidelines, and practice options were made.

CONCLUSIONS

There is substantial evidence to support cognitive-linguistic therapies for people with language deficits after left hemisphere stroke. New evidence supports training for apraxia after left hemisphere stroke. The evidence supports visuospatial rehabilitation for deficits associated with visual neglect after right hemisphere stroke. There is substantial evidence to support cognitive rehabilitation for people with TBI, including strategy training for mild memory impairment, strategy training for postacute attention deficits, and interventions for functional communication deficits. The overall analysis of 47 treatment comparisons, based on class I studies included in the current and previous review, reveals a differential benefit in favor of cognitive rehabilitation in 37 of 47 (78.7%) comparisons, with no comparison demonstrating a benefit in favor of the alternative treatment condition. Future research should move beyond the simple question of whether cognitive rehabilitation is effective, and examine the therapy factors and patient characteristics that optimize the clinical outcomes of cognitive rehabilitation.

Narrative and procedural discourse production by severely aphasic patients

Five cbronically aphasic subjects were trained on a computerized iconographic communication system (C-VIC). Their performance in producing single sentences scripts. and narratives was assessed using both spoken English and C-VIC. The requisite vocabulary necessary and the narrative complexity of the target productions were controlled. Subject performance using C-VIC indicates that the ability to construct discourse at the macrostructural level is largely intact. Despite significant improvements in spoken production after C-VIC training, especially at the single sentence level, the subjects' spoken discourse remains severely impaired by their failures at the microlinguistic level. These results point to the limits of currently available approaches to the remediation of aphasia and suggest avenues for future research.