Reading and listening in people with aphasia: effects of syntactic complexity

Comprehension, Processing Time, and Modality Preferences When People With Aphasia and Neurotypical Healthy Adults Read Books: A Pilot Study

BACKGROUND

Many people with aphasia (PWA) want to read books. Text-to-speech (TTS) technology sometimes provides comprehension and processing time benefits when PWA read short, multisentence passages. Currently, no research examines the effect of TTS support when PWA read books.

AIMS

This study's primary purpose was to examine comprehension accuracy and total processing time of PWA and neurotypical healthy adults (NHAs) when reading book sections in read-only versus TTS-supported conditions. A secondary aim was to examine condition preference and perceived degree of understanding by people in both participant groups.

METHOD AND PROCEDURE

Ten PWA and 10 NHAs alternated between read-only and TTS-supported conditions to read a book. Participants answered comprehension questions and provided feedback about their reading experience, condition preference, and desire to use TTS technology for future book reading. Outcomes and Result: Overall, PWA exhibited less accurate comprehension and slower processing times compared to NHAs in both conditions. No significant comprehension accuracy difference occurred between conditions for either group. However, four PWA exhibited a 10% or greater increase in comprehension accuracy when receiving TTS support. A significant processing time difference occurred with PWA processing text faster with TTS support, whereas NHAs did not demonstrate processing time differences. Most PWA preferred the TTS condition and expressed a desire to use TTS technology in the future. Most NHAs expressed the opposite preference.

CONCLUSIONS

TTS support during book reading promotes faster processing without compromising comprehension for PWA. Clinicians should discuss with PWA the relative importance of comprehension accuracy, processing time, and comfort with technology when determining whether using TTS support during book reading is desirable.

Using word-picture verification to inform language impairment locus in chronic post-stroke aphasia

Word-picture verification, a task that requires a yes/no response to whether a word and a picture match, has been used for both receptive and expressive language; however, there is limited systematic investigation on the linguistic subprocesses targeted by the task. Verification may help to identify linguistic strengths and weaknesses to ultimately provide more targeted, individualized lexical retrieval intervention. The current study assessed the association of semantic and phonological skills with verification performance to demonstrate early efficacy of the paradigm as an aphasia assessment. Sixteen adults with chronic post-stroke aphasia completed a battery of language assessments in addition to reading and auditory verification tasks. Verification scores were positively correlated with auditory and reading comprehension. Accuracy of semantic and phonological verification were positively correlated with accuracy on respective receptive language tasks. More semantic errors were made during verification than naming. The relationship of phonological errors between naming and verification varied by modality (reading or listening). Semantic and phonological performance significantly predicted verification response accuracy and latency. In sum, we propose that verification tasks are particularly useful because they inform semantics pre-lemma selection and phonological decoding, helping to localize individual linguistic strengths and weaknesses, especially in the presence of significant motor speech impairment that can obscure expressive language abilities.

Moment-to-Moment Processing of Complex Sentences by Adults with and without Developmental Language Disorder

INTRODUCTION

. Limited evidence suggests that adults with developmental language disorder (DLD) take different information into account as they process sentences as compared to peers with typical language. The purpose of this study was to evaluate how two factors affect sentence processing in adults with DLD: online storage costs and lexical expectations created by nouns.

METHODS

. Forty-three adults, 21 with DLD, listened to complex sentences presented word-by-word, and their listening times were recorded. The sentences included either object relative clauses or sentential complements which differed in online storage demands. The main clause subject nouns differed in co-occurrence frequency with "that" in sentences produced by typical adults. Participants completed a running span task to assess verbal working memory capacity.

RESULTS

. Mixed effects models found differences by sentence region. Participants with DLD processed embedded clause verbs faster than participants with typical language, and poorer language ability was associated with faster processing of conjunctions "that" and "which." Participants with greater verbal working memory capacity or typical language were affected by noun co-occurrence frequencies but those with lower working memory or DLD were not.

CONCLUSIONS

. The results align with prior findings that verbal working memory capacity influences what information affects moment-to-moment sentence processing. Those with greater capacity appeared to be more affected by temporary ambiguity. As compared to adults with typical language, processing times of adults with DLD were less sensitive to information on words that frequently co-occur with nouns. This aligns with prior findings suggesting that adults with DLD are less sensitive to the frequency of the structures and arguments that co-occur with verbs.

Aphasia and acquired reading impairments: What are the high-tech alternatives to compensate for reading deficits?

BACKGROUND

People with aphasia (PWA) frequently present impairments in reading comprehension. Such impairments can be particularly debilitating due to the limitations and constraints they impose on everyday life. Recent technological advancements in the field of information and communication technologies offer many compensative tools for PWA. However, most technological tools are designed for patients with speech production impairments. Instruments addressing reading impairments associated with aphasia remain scarce and underrepresented in the scientific literature.

AIMS

To conduct a state-of-the-art review of the technologies currently available to PWA and acquired reading impairments. In particular, this review covers (1) research on technologies explicitly developed to compensate for reading difficulties associated with aphasia; and (2) research into which accessibility features included in mainstream high-tech systems are helpful for PWA when trying to access written material.

METHODS & PROCEDURES

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) international standard, the authors conducted a systematic review from 2009 to 2019. The databases inspected were Scopus, Web of Science, PubMed, the Cochrane collection, IEEE Xplore, ScienceDirect and SpringerLink. Other research papers were included after checking the references of the selected papers.

MAIN CONTRIBUTION

The review reveals that research on compensative devices for reading impairments largely neglects tools for individuals with aphasia and acquired reading difficulties. Most of the studies in this field are qualitative investigations of how patients with literacy difficulties tackle everyday tasks with the help of mainstream technology (e.g., smartphone applications). Therefore, this paper highlights the scarce high-tech alternatives that support text comprehension in PWA and acquired reading impairments, and suggests further work on the development of customized software for smartphones and personal computers.

CONCLUSIONS

High-tech reading tools may help PWA to regain reading autonomy. PWA and acquired reading impairments employ a wide array of devices to overcome reading difficulties, which underlines the importance of reading in everyday life. However, the supports currently available are not yet flexible and accurate enough to answer their day-to-day needs. Thus, further work is necessary to enhance the compensative devices available to them. For instance, existing new technologies in the area of natural language processing (such as automatic text simplification) could potentially be used in compensative devices. What this paper adds What is already known on the subject Most research on high-tech compensative reading tools is focused on investigating how patients with aphasia and acquired reading impairments cope with their reading difficulties in everyday life by resorting to different types of technology. Yet, we still lack specific research on compensative reading technology for PWA. What this paper adds to existing knowledge This review shows that PWA with acquired reading impairments are offered limited options for accessing written content easily and autonomously-and those few resources that are available are not specifically designed for PWA. What are the potential or actual clinical implications of this work? Both aphasia and acquired reading impairments can vary in terms of both their severity and the associated typology of cognitive impairments. Therefore, it might be interesting to investigate flexible and highly adaptable reading support designed for them-and innovations in the field of information and communication technology might prove particularly fruitful.

Effect of Digital Highlighting on Reading Comprehension Given Text-to-Speech Technology for People with Aphasia

BACKGROUND

Many people with aphasia have a strong desire to participate in reading activities despite persistent reading challenges. Digital reading devices and text-to-speech (TTS) technology are increasing in popularity and have the potential to help people with aphasia. Systematic investigation of modifiable TTS features provides a means of exploring this potential.

AIMS

This study's aim was to evaluate the effect of digital highlighting synchronised with TTS auditory and written output on reading comprehension by people with aphasia and to determine their highlighting preferences.

METHODS & PROCEDURES

This work was registered with clinicaltrials.gov and assigned the clinical trial registry number 01446r prior to initiation of data collection. Twenty-five adults with aphasia read and listened to passages presented in three synchronised highlighting conditions: sentence highlighting, single word highlighting, and no highlighting. Participants answered comprehension questions, selected most and least preferred conditions, and provided feedback explaining highlighting preferences.

OUTCOME & RESULTS

Comprehension accuracy did not vary significantly across presentation conditions, but participants preferred either single word or sentence highlighting over no highlighting.

CONCLUSIONS

Neither word nor sentence highlighting benefitted or hindered comprehension by people with aphasia as a group, but individual differences may occur. Clinicians should attend to personal preferences when implementing digital highlighting as a reading support strategy.

Effect of Text-to-Speech Rate on Reading Comprehension by Adults With Aphasia

Purpose Accessing auditory and written material simultaneously benefits people with aphasia; however, the extent of benefit as well as people's preferences and experiences may vary given different auditory presentation rates. This study's purpose was to determine how 3 text-to-speech rates affect comprehension when adults with aphasia access newspaper articles through combined modalities. Secondary aims included exploring time spent reviewing written texts after speech output cessation, rate preference, preference consistency, and participant rationales for preferences. Method Twenty-five adults with aphasia read and listened to passages presented at slow (113 words per minute [wpm]), medium (154 wpm), and fast (200 wpm) rates. Participants answered comprehension questions, selected most and least preferred rates following the 1st and 3rd experimental sessions and after receiving performance feedback, and explained rate preferences and reading and listening strategies. Results Comprehension accuracy did not vary significantly across presentation rates, but reviewing time after cessation of auditory content did. Visual data inspection revealed that, in particular, participants with substantial extra reviewing time took longer given fast than medium or slow presentation. Regardless of exposure amount or receipt of performance feedback, participants most preferred the medium rate and least preferred the fast rate; rationales centered on reading and listening synchronization, benefits to comprehension, and perceived normality of speaking rate. Conclusion As a group, people with aphasia most preferred and were most efficient given a text-to-speech rate around 150 wpm when processing dual modality content; individual differences existed, however, and mandate attention to personal preferences and processing strengths.

Effects of Written, Auditory, and Combined Modalities on Comprehension by People With Aphasia

Background People with aphasia experience reading challenges affecting participation in daily activities. Researchers have found combined auditory and written presentation modalities help people with aphasia comprehend contrived sentences and narratives, but less is known about the effects of combined modalities on functional, expository text comprehension. Aims This study's purpose was to examine comprehension accuracy, reviewing time, and modality preference of people with aphasia when presented with edited newspaper articles in written only, auditory only, and combined written and auditory modalities. Method and Procedure Twenty-eight adults with chronic aphasia read and/or listened to 36 passages. Following each passage, participants answered comprehension questions. Then, they ranked the modalities in accordance with preference and provided a rationale for their ranking. Outcomes and Results Comprehension accuracy was significantly better in the combined than auditory-only condition and in the written-only than auditory-only condition; the difference between combined and written-only conditions was not significant. Reviewing time differed significantly among conditions with the written-only condition taking longest and the auditory-only condition taking shortest. Most participants preferred the combined condition. Conclusions Access to combined modalities helps people with aphasia comprehend expository passages such as those found in newspapers better than auditory-only presentation. Furthermore, combined presentation decreases reviewing time from that needed for unsupported reading without compromising comprehension accuracy. Given that most participants preferred combined modality presentation, providing simultaneous auditory and written access to content through text-to-speech technology is a viable strategy when aphasia results in persistent reading challenges.

Perceptual span in individuals with aphasia

BACKGROUND

Perceptual span refers to the field of effective vision during reading comprehension. It is determined by many factors, including reading proficiency. No studies have investigated the perceptual span in people with reading comprehension impairments due to aphasia.

AIMS

The present study examined whether perceptual span is smaller in individuals with aphasia than controls.

METHODS AND PROCEDURES

The task was a gaze-contingent moving windows paradigm during silent reading using an eye tracker. Data from 11 individuals with aphasia and 15 neurotypical controls were analyzed.

OUTCOMES AND RESULTS

Perceptual span in individuals with aphasia was the fixated word plus one word to the right of fixation, whereas perceptual span in controls was the fixated word plus two words to the right of fixation.

CONCLUSION

Individuals with aphasia have a smaller perceptual span than controls, which likely reflects increased effort during reading comprehension.

Using Images With Individuals With Aphasia: Current Research and Clinical Trends

PURPOSE

Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia.

METHOD

The aim of this review-resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference-was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice.

RESULTS

Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices.

CONCLUSIONS

Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).

Effects of Lexical Variables on Silent Reading Comprehension in Individuals With Aphasia: Evidence From Eye Tracking

PURPOSE

Previous eye-tracking research has suggested that individuals with aphasia (IWA) do not assign syntactic structure on their first pass through a sentence during silent reading comprehension. The purpose of the present study was to investigate the time course with which lexical variables affect silent reading comprehension in IWA. Three lexical variables were investigated: word frequency, word class, and word length.

METHODS

IWA and control participants without brain damage participated in the experiment. Participants read sentences while a camera tracked their eye movements.

RESULTS

IWA showed effects of word class, word length, and word frequency that were similar to or greater than those observed in controls.

CONCLUSIONS

IWA showed sensitivity to lexical variables on the first pass through the sentence. The results are consistent with the view that IWA focus on lexical access on their first pass through a sentence and then work to build syntactic structure on subsequent passes. In addition, IWA showed very long rereading times and low skipping rates overall, which may contribute to some of the group differences in reading comprehension.

Comprehension of synthetic speech and digitized natural speech by adults with aphasia

Using text-to-speech technology to provide simultaneous written and auditory content presentation may help compensate for chronic reading challenges if people with aphasia can understand synthetic speech output; however, inherent auditory comprehension challenges experienced by people with aphasia may make understanding synthetic speech difficult. This study's purpose was to compare the preferences and auditory comprehension accuracy of people with aphasia when listening to sentences generated with digitized natural speech, Alex synthetic speech (i.e., Macintosh platform), or David synthetic speech (i.e., Windows platform). The methodology required each of 20 participants with aphasia to select one of four images corresponding in meaning to each of 60 sentences comprising three stimulus sets. Results revealed significantly better accuracy given digitized natural speech than either synthetic speech option; however, individual participant performance analyses revealed three patterns: (a) comparable accuracy regardless of speech condition for 30% of participants, (b) comparable accuracy between digitized natural speech and one, but not both, synthetic speech option for 45% of participants, and (c) greater accuracy with digitized natural speech than with either synthetic speech option for remaining participants. Ranking and Likert-scale rating data revealed a preference for digitized natural speech and David synthetic speech over Alex synthetic speech. Results suggest many individuals with aphasia can comprehend synthetic speech options available on popular operating systems. Further examination of synthetic speech use to support reading comprehension through text-to-speech technology is thus warranted.

Determining the Association between Language and Cognitive Tests in Poststroke Aphasia

BACKGROUND

Individuals with aphasia are often excluded from studies exploring poststroke cognition because so many of the standard cognitive assessments rely on language ability. Our primary objective was to examine the association between performance on cognitive tests and performance on comprehension and naming tests in poststroke aphasia. Second, we aimed to determine the association between language performance and a real-life measure of cognition (Kettle Test). Third, we explored the feasibility of administering cognitive tests in aphasia.

METHODS

Thirty-six participants with poststroke aphasia and 32 controls were assessed on a battery of pen-and-paper cognitive tests recommended in stroke. Auditory comprehension was measured using the Comprehensive Aphasia Test and naming was measured using the Boston Naming Test. Twenty-two community dwelling participants with aphasia and controls were also asked to complete the Kettle Test. Multiple linear regressions were used to explore the relationship between language performance and performance on the cognitive tests. Feasibility was determined by quantifying missing data.

RESULTS

The cognitive tests with the highest variance accounted for by auditory comprehension and naming were animal fluency (R2 = 0.67, R2 = 0.78) and the Hopkins Verbal Learning Test (recognition discrimination index) (R2 = 0.65, R2 = 0.78). All cognitive tests were significantly associated with auditory comprehension and naming, except for the Star Cancellation Test and the Kettle Test. Thirty-three percent of participants with aphasia were unable to complete all the cognitive tests.

CONCLUSION

Language and non-linguistic cognitive processes are often interrelated. Most pen-and-paper cognitive tests were significantly associated with both auditory comprehension and naming, even in tests that do not require a verbal response. Language performance was not significantly associated with a real-life cognitive performance measure. Task instructions, stimuli, and responses for completion need to be tailored for individuals with aphasia to minimize the influence of language deficits when testing non-linguistic cognitive performance.

Using the Visual World Paradigm to Study Retrieval Interference in Spoken Language Comprehension

The cue-based retrieval theory (Lewis et al., 2006) predicts that interference from similar distractors should create difficulty for argument integration, however this hypothesis has only been examined in the written modality. The current study uses the Visual World Paradigm (VWP) to assess its feasibility to study retrieval interference arising from distractors present in a visual display during spoken language comprehension. The study aims to extend findings from Van Dyke and McElree (2006), which utilized a dual-task paradigm with written sentences in which they manipulated the relationship between extra-sentential distractors and the semantic retrieval cues from a verb, to the spoken modality. Results indicate that retrieval interference effects do occur in the spoken modality, manifesting immediately upon encountering the verbal retrieval cue for inaccurate trials when the distractors are present in the visual field. We also observed indicators of repair processes in trials containing semantic distractors, which were ultimately answered correctly. We conclude that the VWP is a useful tool for investigating retrieval interference effects, including both the online effects of distractors and their after-effects, when repair is initiated. This work paves the way for further studies of retrieval interference in the spoken modality, which is especially significant for examining the phenomenon in pre-reading children, non-reading adults (e.g., people with aphasia), and spoken language bilinguals.

Online Sentence Reading in People With Aphasia: Evidence From Eye Tracking

PURPOSE

There is a lot of evidence that people with aphasia have more difficulty understanding structurally complex sentences (e.g., object clefts) than simpler sentences (subject clefts). However, subject clefts also occur more frequently in English than object clefts. Thus, it is possible that both structural complexity and frequency affect how people with aphasia understand these structures.

METHOD

Nine people with aphasia and 8 age-matched controls participated in the study. The stimuli consisted of 24 object cleft and 24 subject cleft sentences. The task was eye tracking during reading, which permits a more fine-grained analysis of reading performance than measures such as self-paced reading.

RESULTS

As expected, controls had longer reading times for critical regions in object cleft sentences compared with subject cleft sentences. People with aphasia showed the predicted effects of structural frequency. Effects of structural complexity in people with aphasia did not emerge on their first pass through the sentence but were observed when they were rereading critical regions of complex sentences.

CONCLUSIONS

People with aphasia are sensitive to both structural complexity and structural frequency when reading. However, people with aphasia may use different reading strategies than controls when confronted with relatively infrequent and complex sentence structures.

Effects of animacy on processing relative clauses in older and younger adults

Sentences with object relative clauses are more difficult to process than sentences with subject relative clauses, but the processing penalty associated with object relatives is greater when the sentential subject is an animate than when it is an inanimate noun. The present study tested the hypothesis that older adults are more sensitive to this type of semantic constraint than younger adults. Older and younger adults (n = 28 per group) participated in a self-paced listening study. The critical sentences contained subject and object relative clauses and had animate or inanimate subjects. Both older and younger adults had longer listening times for critical segments in object than in subject relative clause in both animacy conditions. Critically, the animacy manipulation disrupted older adults more than younger adults. These results are consistent with the claim that older adults rely on experience-based expectations to a greater extent than younger adults.