Sentence Processing in Aphasia: An Examination of Material-Specific and General Cognitive Factors

Telepractice Assessments for Individuals with Aphasia: A Systematic Review

Purpose: Current literature broadly demonstrates the effectiveness and feasibility of telepractice services for people with aphasia. However, the examination of telepractice assessments for people with aphasia is limited. The purpose of this systematic review was to examine the current use of telepractice assessment protocols for people with aphasia. Specifically, the review sought to: (a) identify the assessments utilized in the aphasia telepractice literature; (b) appraise critically the quality of such investigations; and (c) evaluate critically the psychometric properties of the standardized tests used. Methods: A review of the literature published in English since 2000 was conducted in January 2023 by searching MEDLINE, EMBASE, PsychInfo, CINAHL, and Scopus databases. A total of 2,429 articles were screened. Two reviewers assessed records independently finding 11 articles eligible for inclusion. Data extraction was conducted once and validated by a second reviewer. Quality appraisal was carried out for the included studies as well as for the standardized testing measures used in these studies. Results: There was a lack of variation among the telepractice assessment protocols and aphasia tests used across all the included studies. That is, there was limited investigation of screening tests, discourse analysis, extralinguistic cognitive measures, and the use of patient-reported measures. Study characteristics lacked high-quality and free-of-bias examinations. Most standardized tests that were utilized exhibited poor validity and reliability properties. Conclusions: Overall, the current systematic review pointed to the need to investigate a wider range of aphasia assessment protocols that can be offered via telepractice. Moreover, more robust research designs are necessary to examine the variety of assessment tests and/or procedures that are available for in-person aphasia assessment services. Finally, given that many tests used in the included studies had psychometric property issues, the current review raised concerns regarding the use of these tests in research and clinical practices.

The Current State of the Literature on Dual-Task Performance Across Multiple Domains in Individuals With Chronic Poststroke Aphasia: A Scoping Review

BACKGROUND

Understanding the impact that poststroke aphasia has on dual-task performance across multiple domains of function may inform the development of effective interventions. The purpose of this scoping review is to identify (a) the main theoretical frameworks used to explain dual-task performance deficits in individuals with poststroke aphasia; (b) the domains of function measured and the assessments used; (c) interventions aimed to improve dual-task performance; and, finally, (d) gaps that exist in the current body of literature regarding dual-task in persons with aphasia.

METHOD

A search of Linguistics and Language Behavior Abstracts, PsycINFO, Communication & Mass Media Complete, PubMed, CINAHL Plus, ScienceDirect, and the Cochrane Library was undertaken to identify publications on the topic. Articles were included in the review if they (a) were written in English, (b) included individuals with chronic poststroke aphasia, (c) included measures of dual-task performance, and/or (d) consisted of a theoretical narrative with a focus on dual task in persons with aphasia.

RESULTS

Following the full-text screening, a total of 17 studies were in included for synthesis. Fourteen articles focused on dual-task experimental studies; one study consisted of a dual-task intervention; and two papers proposed a theory, framework, or schema to explain dual-task performance.

CONCLUSION

Gaps were identified in the literature, as well as differences in the methodology employed across studies, highlighting the need for consistency across experimental tasks and further examination across domains.

A Preliminary Examination of a Novel Telepractice Screening Protocol for Poststroke Aphasia

BACKGROUND

The delivery of telepractice interventions for people with poststroke aphasia has been found effective and feasible compared to traditional, in-person interventions; however, telepractice assessments, particularly screening protocols, which may foster convenient access to aphasia diagnostic services, have received limited examination within the aphasia literature. Therefore, the purpose of this study was to examine a novel telepractice screening protocol for people with poststroke aphasia that assesses both language and extralinguistic cognitive abilities via both performance-based and patient-reported measures.

METHOD

Twenty-one participants with previously diagnosed poststroke aphasia completed the telepractice administration of the Frenchay Aphasia Screening Test (FAST), the Aphasia Impact Questionnaire-21 (AIQ-21), the Oxford Cognitive Screen (OCS), and the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI). Care partners of the participants completed the Communicative Effectiveness Index (CETI). After the telepractice session, each participant completed a feasibility questionnaire to rate their overall experience.

RESULTS

All participants screened as having aphasia. Pearson correlation analyses yielded a strong positive relationship between OCS and FAST scores (r = .74), a strong relationship between OCS and CCCABI scores (r = -.71), and a moderate relationship between FAST and AIQ-21 scores (r = -.35). Moderate relationships were noted between the performance-based measures and the CETI (r = .30). The overall feasibility of telepractice administration was rated positively by each participant. No significant relationships were found between the feasibility responses and participant characteristics.

CONCLUSIONS

Overall, the telepractice screening protocol yielded an effective and feasible way to identify poststroke aphasia. Similar to in-person administration of screening measures, it was more difficult to identify milder levels of aphasia severity. Future research should examine whether this telescreening protocol can identify poststroke aphasia within the broader stroke population.

Sentence comprehension deficits in aphasia disorders: A systematic review of mapping therapy

Patients with aphasia (PWA), particularly those with agrammatic aphasia, experience problems in sentence comprehension. Studies have found that Mapping Therapy (MT) can improve sentence processing in PWA. This paper aims to review the literature on therapeutic studies using MT for the treatment of sentence processing in PWA. All studies on the treatment of sentence comprehension using MT were found by searching Cochrane Library, ISI Web of Knowledge, Google Scholar, Pubmed, and Scopus from 1986 until December 2023, with the combination of these search keywords: 'aphasia, sentence, comprehension, mapping therapy, treatment, rehabilitation'. All studies (single-subject or group design) on the treatment of sentence comprehension using MT in PWA were reviewed. An adaptation of the Cochrane Collaboration's risk of bias (RoB) tool was used to assess the risk of bias (RoB) in the reviewed studies. A total of 14 studies on 81 participants were selected and reviewed. All studies (13 studies) had employed a single-subject design, except for one study that had used a group design. Twelve studies (86%) showed that MT is effective in the remediation of sentence comprehension in PWA. Generalization to untrained sentences similar to the trained structure was also observed in 12 studies (86%). Generalization to untrained structures (usually passive sentences) was limited. In addition, cross-modal improvement in sentence production was observed in 8 studies (57%). This review highlights the need for a more detailed investigation of the effect of MT on cross-modal generalization using elicited production of the sentence types trained during comprehension treatment.

The effects of adding attention training to naming treatment for individuals with aphasia

AIM

Given the ever-increasing evidence for the co-occurrence of attention impairments and language disorders in chronic aphasia, this study aimed to compare the effects of two naming treatment programs, one with and one without attention training components, on the naming performance of participants with aphasia.

MATERIALS AND METHODS

This was a single-subject crossover study in which six people with chronic aphasia and different degrees of naming and attention impairments participated. Two treatment programs were implemented for each participant, with the sequence of the treatments with crossover design. Each program consisted of 12 treatment sessions plus pre- and post-treatment assessment sessions (15 weeks for each participant). The visual analysis and WEighted STatistics methods were employed for data analysis.

RESULTS

Based on visual analysis, both treatments improved in comparison to the baseline phase. Statistical analysis revealed that the number of participants with significant naming improvement following combined program (5 participants) was larger than the number of participants showing improvement following completion of the single, program.

CONCLUSION

Although integrating attention training into a conventional treatment for anomia can increase the effect of treatment on naming ability, more studies are required to clarify the role of attention in remediating naming impairments in aphasia.

Telling Stories in Noise: The Impact of Background Noises on Spoken Language for People With Aphasia

PURPOSE

The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task.

METHOD

Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions.

RESULTS

Background noise resulted in higher fundamental frequency (fo) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise.

CONCLUSIONS

Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23681703.

The effect of time on lexical and syntactic processing in aphasia

Processing deficits at the lexical level, such as delayed and reduced lexical activation, have been theorized as the source of breakdowns in syntactic operations and thus contribute to sentence comprehension deficits in individuals with aphasia (IWA). In the current study, we investigate the relationship between lexical and syntactic processing in object-relative sentences using eye-tracking while listening in IWA. We explore whether manipulating the time available to process a critical lexical item (the direct-object noun) when it is initially heard in a sentence has an immediate effect on lexical access as well as a downstream effect on syntactic processing. To achieve this aim, we use novel temporal manipulations to provide additional time for lexical processing to occur. In addition to exploring these temporal effects in IWA, we also seek to understand the effect that additional time has on sentence processing in neurotypical age-matched adults (AMC). We predict that the temporal manipulations designed to provide increased processing time for critical lexical items will 1) enhance lexical processing of the target noun, 2) facilitate syntactic integration, and 3) improve sentence comprehension for both IWA and AMC. We demonstrate that strengthening lexical processing via the addition of time can affect lexical processing and facilitate syntactic retrieval of the target noun and lead to enhanced interference resolution in both unimpaired and impaired systems. In aphasia, additional time can mitigate impairments in spreading activation thereby improving lexical access and reducing interference during downstream dependency linking. However, individuals with aphasia may require longer additions of time to fully realize these benefits.

Telehealth Assessments and Interventions for Individuals With Poststroke Aphasia: A Scoping Review

PURPOSE

There are increasing demands for aphasia assessment and intervention services to be delivered remotely. The purpose of this scoping review was to address what is known about the delivery of assessments and interventions using telehealth for people with poststroke aphasia. Specifically, the review sought to (a) identify which telehealth assessment protocols have been used, (b) identify which telehealth intervention protocols have been used, and (c) describe evidence on the effectiveness and feasibility of telehealth for people with poststroke aphasia.

METHOD

A scoping review of the literature published in English since 2013 was conducted by searching MEDLINE, Embase, PsycINFO, CINAHL, and Scopus databases to identify relevant studies. A total of 869 articles were identified. Two reviewers screened records independently, finding 25 articles eligible for inclusion. Data extraction was conducted once and validated by the second reviewer.

RESULTS

Two of the included studies examined telehealth assessment protocols, whereas the remaining studies focused on the delivery of telehealth interventions. The results of the included studies illustrated both effectiveness and feasibility regarding telehealth for people with poststroke aphasia. However, a lack of procedural variation among the studies was found.

CONCLUSIONS

Overall, this scoping review yielded continued support for the use of telehealth practices as an alternate mode of delivering both assessment and intervention services to people with poststroke aphasia. However, further research is needed to investigate the range of aphasia assessment and intervention protocols that can be offered via telehealth, such as assessments or interventions that use patient-reported measures or address extralinguistic cognitive abilities.

Eye Fixation Behaviors and Processing Time of People With Aphasia and Neurotypical Adults When Reading Narratives With and Without Text-to-Speech Support

BACKGROUND

Researchers have used eye-tracking technology to investigate eye movements in neurotypical adults (NAs) when reading. The technology can provide comparable information about people with aphasia (PWA). Eye fixations occurring when PWA do and do not have access to text-to-speech (TTS) technology are of interest because the support improves reading comprehension and decreases processing time for at least some PWA.

AIMS

This study's purpose was to examine forward, regressive, and off-track eye fixations when PWA and NAs read narratives in read-only (RO) and TTS conditions. A secondary aim was to examine the influence of eye fixations on processing time.

METHOD AND PROCEDURE

A Tobii Dynavox Pro Spectrum eye tracker recorded eye movements of nine PWA and nine NAs while reading narratives in two conditions. Movements of interest were forward fixations; within-word, within-sentence, and previous-sentence regressive fixations; and off-track fixations.

OUTCOMES AND RESULTS

PWA exhibited significantly more forward and regressive fixations in the RO than TTS condition, whereas NAs showed opposite behaviors. NAs had significantly more off-track fixations in the TTS than RO condition, whereas PWA exhibited no difference across conditions. PWA took significantly longer to process content in the RO condition, whereas NAs took longer in the TTS condition.

CONCLUSIONS

PWA and NAs differ in important ways when processing texts with and without TTS support. Examining eye-tracking data provides a means of gaining insight into the decoding and reading comprehension challenges of PWA and helps elucidate how assistive technology can mediate these challenges.

The role and use of event-related potentials in aphasia: A scoping review

Event-related potentials (ERPs) can provide important insights into underlying language processes in both unimpaired and neurologically impaired populations and may be particularly useful in aphasia. This scoping review was conducted to provide a comprehensive summary of how ERPs have been used with people with aphasia (PWA), with the goal of exploring the potential clinical application of ERPs in aphasia assessment and treatment. We identified 117 studies that met inclusionary criteria, reflecting six thematic domains of inquiry that relate to understanding both unimpaired and aphasic language processing and the use of ERPs with PWA. In these studies, a wide variety of ERP components were reported. Inconsistencies in reporting of participant characteristics and study protocols limit our ability to generalize beyond the individual studies and understand implications for clinical applicability. We discuss the potential roles of ERPs in aphasia management and make recommendations for further developing ERPs for clinical utility in PWA.

Perspective-shifting are helpful for children in Chinese passive sentence comprehension

Passive sentences have been shown to be more difficult than active sentences for young children in English, German, Italian, Turkish, as well as Japanese, Korean. Many factors, such as syntactic structure, lexical-semantic, language experience, have been proved to affect passive sentence processing. In this paper, two experiments were carried out to investigate the role of perspective-shifting and animacy characteristics of agents and patients in processing passive sentences by 5~6 year-old Chinese children, using a sentence-picture matching task. The results were as follows: (1) Passive sentences were more difficult to comprehend than active sentences in Mandarin Chinese; (2) The ability of perspective-shifting played an important role in processing passive sentences. In sum, addressing sentences involving syntactic transformation is a complex cognitive activity for young children. Many factors, such as syntactic structure, lexical-semantic, language experience, and cognitive flexibility should be given full consideration.

Systematic review of subjective memory measures to inform assessing memory limitations after stroke and stroke-related aphasia

AIM

Primary aims of this systematic review were to: (1) identify the range of subjective memory measures used in the stroke and stroke-related aphasia literature and (2) critically appraise their psychometric properties as well as (3) the methodological qualities of studies that included them, (4) investigate whether such measures provide an accurate reflection of memory impairments (i.e., in comparison to norms from age-matched, neurotypical participants), (5) document the representation of individuals with stroke-related aphasia, and (6) examine the extent to which subjective memory measures correlate with objective memory measures.

METHODS

Systematic review of the literature from 1970 to June 2019 using a comprehensive range of relevant search terms in EMBASE, Medline, PsychINFO, SCOPUS, and Web of Science. Eligibility criteria were for studies to include adults who had suffered of clinical stroke, to report a subjective memory measure that was completed by the stroke survivors, to be reported in a peer-reviewed journal, and to be published in English or Dutch. Quality appraisal was carried out for the included studies as well as the subjective memory measures they employed.

RESULTS

A total of 7,077 titles or abstracts were screened, with 41 studies included in the quantitative and qualitative synthesis. Twenty-six subjective memory measures were used in the included studies. The critical appraisal of their psychometric properties and the methodological quality of the included studies revealed significant shortcomings; for example, neurotypical participants were included in only 14 of the 41 studies. When statistical comparisons were made, different outcomes arose. Only eight studies statistically compared subjective with objective memory measures.

CONCLUSIONS

This literature domain currently provides an unclear picture as to how memory limitations affect participation in stroke and stroke-related aphasia.IMPLICATIONS FOR REHABILITATIONA broad range of subjective memory measures have been used to determine stroke survivors' perceptions of their everyday memory issues.Because of psychometric weaknesses such as inadequate reliability and cross-cultural validity among subjective memory measures, there remains a need to carefully review a given measure's properties to determine if it is appropriate for use with a given stroke survivor.Stroke survivors with aphasia have been infrequently included or inadequately described in studies of subjective memory measures, and thus how these individuals perceive their everyday memory abilities requires further investigation.Although the relationship between subjective and objective memory measures has been infrequently investigated by stroke researchers, both types of measures should be considered as they likely offer complementary rather than redundant information about stroke survivors' memory abilities.

Effects of Acquired Aphasia on the Recognition of Speech Under Energetic and Informational Masking Conditions

Persons with aphasia (PWA) often report difficulty understanding spoken language in noisy environments that require listeners to identify and selectively attend to target speech while ignoring competing background sounds or “maskers.” This study compared the performance of PWA and age-matched healthy controls (HC) on a masked speech identification task and examined the consequences of different types of masking on performance. Twelve PWA and 12 age-matched HC completed a speech identification task comprising three conditions designed to differentiate between the effects of energetic and informational masking on receptive speech processing. The target and masker speech materials were taken from a closed-set matrix-style corpus, and a forced-choice word identification task was used. Target and maskers were spatially separated from one another in order to simulate real-world listening environments and allow listeners to make use of binaural cues for source segregation. Individualized frequency-specific gain was applied to compensate for the effects of hearing loss. Although both groups showed similar susceptibility to the effects of energetic masking, PWA were more susceptible than age-matched HC to the effects of informational masking. Results indicate that this increased susceptibility cannot be attributed to age, hearing loss, or comprehension deficits and is therefore a consequence of acquired cognitive-linguistic impairments associated with aphasia. This finding suggests that aphasia may result in increased difficulty segregating target speech from masker speech, which in turn may have implications for the ability of PWA to comprehend target speech in multitalker environments, such as restaurants, family gatherings, and other everyday situations.