Coverbal gestures in the recovery from severe fluent aphasia: a pilot study

Towards efficient, ecological assessment of interaction: A scoping review of co-constructed communication

BACKGROUND

The complexity of communication presents challenges for clinical assessment, outcome measurement and intervention for people with acquired brain injury. For the purposes of assessment or treatment, this complexity is usually managed by isolating specific linguistic functions or speech acts from the interactional context. Separating linguistic functions from their interactional context can lead to discourse being viewed as a static entity comprised of discrete features, rather than as a dynamic process of co-constructing meaning. The ecological validity of discourse assessments which rely on the deconstruction of linguistic functions is unclear. Previous studies have reported assessment tasks that preserve some of the dialogic features of communication, but as yet, these tasks have not been identified as a distinct genre of assessment. We suggest the term 'co-constructed communication' to describe tasks which are specifically designed to capture the dynamic, jointly produced nature of communication within a replicable assessment task.

AIMS

To identify and summarize how co-constructed communication has been assessed with individuals with non-progressive acquired communication disability regarding task design, measures and psychometric robustness.

METHODS

A scoping review methodology was used to identity relevant studies. Systematic database searches were conducted on studies published before July 2021. Studies in the yield were assessed against eligibility criteria, with 37 studies identified as eligible for inclusion.

MAIN CONTRIBUTION

This is the first time that co-constructed communication has been defined as a genre of discourse assessment for stroke and traumatic brain injury populations. Co-constructed communication has been assessed for 144 individuals with aphasia and 111 with cognitive-communication disability. Five categories of co-constructed communication tasks were identified, ranging in complexity. Variability exists in how these assessment tasks are labelled and measured. Assessment measures require further psychometric profiling, specifically regarding test-retest reliability and validity.

CONCLUSIONS

Co-constructed communication is a discourse genre which offers researchers and clinicians a replicable method to assess language and communication in an experimentally rigorous way, within an ecologically valid context, bridging the gap between experimental and ecological assessment approaches.

WHAT THIS PAPER ADDS

What is already known on this subject Standardized assessments of language skills and monologue offer reliable, replicable ways to measure language. However, isolating language from an interactional context fundamentally changes the behaviour under study. This raises questions about the ecological validity of the measures we routinely use to determine diagnoses, guide treatment planning and measure the success of treatment. What this study adds to the existing knowledge This review highlights studies that conceptualize, and often quantify, interaction by combining experimental rigour and aspects of everyday dialogue. This is the first time this genre of discourse assessment has been identified. We propose the term 'co-constructed communication' to describe this genre and provide an operational definition for the term. What are the practical and clinical implications of this study? Co-constructed communication assessment tasks require refinement, particularly regarding aspects of psychometric robustness. In the future, these tasks offer pragmatic, meaningful ways to capture the effect and impact of aphasia and cognitive-communication disability within interaction.

What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.

A description of verbal and gestural communication during postictal aphasia

Patients suffering from drug-resistant temporal lobe epilepsy show substantial language deficits (i.e., anomia) during their seizures and in the postictal period (postictal aphasia). Verbal impairments observed during the postictal period may be studied to help localizing the epileptogenic zone. These explorations have been essentially based on simple tasks focused on speech, thus disregarding the multimodal nature of verbal communication, particularly the fact that, when speakers want to communicate, they often produce gestures of various kinds. Here, we propose an innovative procedure for testing postictal language and communication abilities, including the assessment of co-speech gestures. We provide a preliminary description of the changes induced on communication during postictal aphasia. We studied 21 seizures that induced postictal aphasia from 12 patients with drug-refractory epilepsy, including left temporal and left frontal seizures. The experimental task required patients to memorize a highly detailed picture and, briefly after, to describe what they had seen, thus eliciting a communicative meaningful monologue. This allowed comparing verbal communication in postictal and interictal conditions within the same individuals. Co-speech gestures were coded according to two categories: "Rhythmic" gestures, thought to be produced in support of speech building, and "illustrative" gestures, thought to be produced to complement the speech content. When postictal and interictal conditions were compared, there was decreased speech flow along with an increase of rhythmic gesture production at the expense of illustrative gesture production. The communication patterns did not differ significantly after temporal and frontal seizures, yet they were illustrated separately, owing to the clinical importance of the distinction, along with considerations of interindividual variability. A contrast between rhythmic and illustrative gestures production is congruent with previous literature in which rhythmic gestures have been linked to lexical retrieval processes. If confirmed in further studies, such evidence for a facilitative role of co-speech gestures in language difficulties could be put to use in the context of multimodal language therapies.

What Is Meant by "Multimodal Therapy" for Aphasia?

Purpose Multimodal therapy is a frequent term in aphasia literature, but it has no agreed upon definition. Phrases such as "multimodal therapy" and "multimodal treatment" are applied to a range of aphasia interventions as if mutually understood, and yet, the interventions reported in the literature differ significantly in methodology, approach, and aims. This inconsistency can be problematic for researchers, policy makers, and clinicians accessing the literature and potentially compromises data synthesis and meta-analysis. A literature review was conducted to examine what types of aphasia treatment are labeled multimodal and determine whether any patterns are present. Method A systematic search was conducted to identify literature pertaining to aphasia that included the term multimodal therapy (and variants). Sources included literature databases, dissertation databases, textbooks, professional association websites, and Google Scholar. Results Thirty-three original articles were identified, as well as another 31 sources referring to multimodal research, all of which used a variant of the term multimodal therapy. Treatments had heterogeneous aims, underlying theories, and methods. The rationale for using more than 1 modality was not always clear, nor was the reason each therapy was considered to be multimodal when similar treatments had not used the title. Treatments were noted to differ across 2 key features. The 1st was whether the ultimate aim of intervention was to improve total communication, as in augmentative and alternative communication approaches, or to improve 1 specific modality, as when gesture is used to improve word retrieval. The 2nd was the point in the treatment that the nonspeech modalities were employed. Discussion Our review demonstrated that references to "multimodal" treatments represent very different therapies with little consistency. We propose a framework to define and categorize multimodal treatments, which is based both on our results and on current terminology in speech-language pathology. Video Abstract and Supplemental Material https://doi.org/10.23641/asha.7646717.

Early Recovery of Aphasia through Thrombolysis: The Significance of Spontaneous Speech

BACKGROUND

Aphasia is one of the most devastating stroke-related consequences for social interaction and daily activities. Aphasia recovery in acute stroke depends on the degree of reperfusion after thrombolysis or thrombectomy. As aphasia assessment tests are often time-consuming for patients with acute stroke, physicians have been developing rapid and simple tests. The aim of our study is to evaluate the improvement of language functions in the earliest stage in patients treated with thrombolysis and in nontreated patients using our rapid screening test.

MATERIALS AND METHODS

Our study is a single-center prospective observational study conducted at the Stroke Unit of the University Medical Hospital of Trieste (January-December 2016). Patients treated with thrombolysis and nontreated patients underwent 3 aphasia assessments through our rapid screening test (at baseline, 24 hours, and 72 hours). The screening test assesses spontaneous speech, oral comprehension of words, reading aloud and comprehension of written words, oral comprehension of sentences, naming, repetition of words and a sentence, and writing words.

RESULTS

The study included 40 patients: 18 patients treated with thrombolysis and 22 nontreated patients. Both groups improved over time. Among all language parameters, spontaneous speech was statistically significant between 24 and 72 hours (P value = .012), and between baseline and 72 hours (P value = .017).

CONCLUSIONS

Our study demonstrates that patients treated with thrombolysis experience greater improvement in language than the nontreated patients. The difference between the 2 groups is increasingly evident over time. Moreover, spontaneous speech is the parameter marked by the greatest improvement.

A Comparison of Coverbal Gesture Use in Oral Discourse Among Speakers With Fluent and Nonfluent Aphasia

PURPOSE

Coverbal gesture use, which is affected by the presence and degree of aphasia, can be culturally specific. The purpose of this study was to compare gesture use among Cantonese-speaking individuals: 23 neurologically healthy speakers, 23 speakers with fluent aphasia, and 21 speakers with nonfluent aphasia.

METHOD

Multimedia data of discourse samples from these speakers were extracted from the Cantonese AphasiaBank. Gestures were independently annotated on their forms and functions to determine how gesturing rate and distribution of gestures differed across speaker groups. A multiple regression was conducted to determine the most predictive variable(s) for gesture-to-word ratio.

RESULTS

Although speakers with nonfluent aphasia gestured most frequently, the rate of gesture use in counterparts with fluent aphasia did not differ significantly from controls. Different patterns of gesture functions in the 3 speaker groups revealed that gesture plays a minor role in lexical retrieval whereas its role in enhancing communication dominates among the speakers with aphasia. The percentages of complete sentences and dysfluency strongly predicted the gesturing rate in aphasia.

CONCLUSIONS

The current results supported the sketch model of language-gesture association. The relationship between gesture production and linguistic abilities and clinical implications for gesture-based language intervention for speakers with aphasia are also discussed.