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Hannig Russell KM, Wambaugh JL, Davis JL, Redmond SM. Efficacy of Complexity-Based Target Selection for Treating Morphosyntactic Deficits in Children With Developmental Language Disorder and Children With Down Syndrome: A Single-Case Experimental Design. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-33. [PMID: 39302858 DOI: 10.1044/2024_ajslp-24-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
PURPOSE Selecting targets for morphosyntactic intervention is a critical component of treatment planning. The complexity approach suggests that, by treating a complex morphosyntactic target, improvements will occur for the treated structure and for related, simpler structures. This study evaluated the efficacy of the complexity approach for treating morphosyntactic deficits by targeting a complex BE verb question structure for children with developmental language disorder (DLD) and children with Down syndrome (DS) and observing its impact on treated and untreated BE verb structures. We also explored whether etiology impacted our participants' treatment responses. METHOD Three participants with DLD and three with DS received treatment for the BE verb question structure in the context of a single-case multiple-baseline design across participants. Accuracy of production for the treated structure and untreated BE verb structures was measured across baseline, treatment, and posttreatment phases. RESULTS Treatment of the complex BE verb question structure resulted in change on the treated structure for three participants (i.e., two with DLD and one with DS). Generalization of treatment to untreated, related BE verb structures occurred for all six participants. Outcomes indicated participants from both etiologies benefited from treatment. CONCLUSIONS This study provides evidence supporting the use of a complexity-based approach for selecting morphosyntactic treatment targets for children with DLD and children with DS. Additional research is needed to identify specific characteristics that may influence individual treatment responses. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.27018124.
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Affiliation(s)
| | - Julie L Wambaugh
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - John L Davis
- Department of Educational Psychology, The University of Texas at San Antonio
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Valinejad V, Salehi Darjani M, Shekari E. Sentence comprehension deficits in aphasia disorders: A systematic review of mapping therapy. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 39244662 DOI: 10.1080/23279095.2024.2394091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
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.
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Affiliation(s)
- Vahid Valinejad
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Ehsan Shekari
- Department of Advanced Technologies In Medicine, Iran University of Medical Sciences, Tehran, Iran
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El Ouardi L, Yeou M. Are Personal and Reflexive Pronouns Dissociated in Agrammatic Comprehension? An Individual Participant Meta-Analysis With Clinical Implications. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-18. [PMID: 38968276 DOI: 10.1044/2024_ajslp-23-00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
PURPOSE This study had three objectives: (a) to verify if Grodzinsky et al.'s (1993) findings of worse comprehension of personal than reflexive pronouns can be replicated in a larger meta-analysis of individual participant data, (b) to examine if the heterogeneity found in the patterns of pronoun comprehension in agrammatism can be attributed to task effects, and (c) to evaluate the risk of bias in the reviewed studies. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search was performed to identify studies examining the personal-reflexive pronoun dissociation in agrammatic comprehension. Seven studies met the search criteria and were included in the meta-analysis. For each participant, individual accuracy scores for the comprehension of personal and reflexive pronouns were extracted in addition to information on the study methods. Individual accuracy data were analyzed using the Fisher's exact test and the binomial test. The risk of bias in the studies was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. RESULTS The meta-analysis had three main findings: (a) The majority of the persons with agrammatic aphasia (89%) had no dissociation between the comprehension of personal and reflexive pronouns; (b) 8% revealed a pattern consistent with a neuropsychological dissociation, faring worse on the comprehension of personal than reflexive pronouns; and (c) 2% performed worse on reflexive than personal pronouns. The type of the task used affected pronoun comprehension accuracy and accounted for the heterogeneity in the patterns of pronoun comprehension attested across the different participants. CONCLUSIONS Taken together, the meta-analysis did not support a dissociation between personal and reflexive pronoun comprehension in agrammatic comprehension. When confirmed, the dissociation was driven by task effects. The clinical implications of these findings were discussed together with implications to minimize the risk of bias in future examinations of the topic.
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Affiliation(s)
- Loubna El Ouardi
- Department of Hearing & Speech Sciences, College of Behavioral and Social Sciences, University of Maryland, College Park
- Applied Language & Culture Studies Lab, Faculty of Letters and Humanities, Chouaib Doukkali University, El Jadida, Morocco
| | - Mohamed Yeou
- Applied Language & Culture Studies Lab, Faculty of Letters and Humanities, Chouaib Doukkali University, El Jadida, Morocco
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Valinejad V, Mehri A, Khatoonabadi A, Darzi A, Barbieri E, Shekari E, Zare Sadeghi A, Shati M, Habibi SAH, Almasi-Dooghaee M. Treatment of verb tense inflection and sentence production in Persian individuals with agrammatism. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-15. [PMID: 38190255 DOI: 10.1080/23279095.2023.2297085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Production of verb morphology, especially tense inflection, is usually impaired in individuals with agrammatism. There have been relatively few studies on treatment of verb tense inflection in agrammatic aphasia. In this study we adapted ACTION (a linguistically motivated treatment) to Persian language, to treat the production of regular and irregular verbs separately in sentence context. A single-subject multiple-baseline across behaviors design was used to establish the treatment effect. Using a non-probable convenience sampling, four Persian agrammatic patients with Broca's aphasia resulting from cerebrovascular accident (CVA) were recruited for this study. Two participants received treatment first for regular verbs (Phase 1, 4 weeks), and then for irregular verbs (Phase 2, 4 weeks). The other two participants received treatment in reverse order. In the final phase of treatment (Phase 3, 4 weeks), all 4 participants underwent a sentence construction treatment. All participants showed improvement in the production of trained tenses. Treatment also generalized to production of untrained regular verbs while generalization to irregular verbs was modest. Furthermore, improvement was found on narrative scores (e.g. MLU) after treatment. These findings suggest that Persian individuals with agrammatism could be trained to correctly apply temporal information to verb inflection in elicited speech.
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Affiliation(s)
- Vahid Valinejad
- Department of Speech Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Mehri
- Department of Speech Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Darzi
- Department of Literature and Humanities Sciences, Tehran University, Tehran, Iran
| | - Elena Barbieri
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Chicago, IL, USA
| | - Ehsan Shekari
- Department of Advanced Technologies In Medicine, Iran University of Medical Sciences, Tehran Iran
| | - Arash Zare Sadeghi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shati
- Mental Health Research Centre, School of Behavioural Science and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hasan Habibi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Leaman MC, Edmonds LA. Pilot Results for ECoLoGiC-Tx: A New Conversation-Level Intervention Improving Language in People With Moderate to Severe Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:153-172. [PMID: 37934890 DOI: 10.1044/2023_ajslp-23-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE This study reports pilot data for a novel intervention, ECoLoGiC-Tx, delivered to four people with moderate to severe aphasia. ECoLoGiC-Tx addresses language and communication in unstructured, participant-led conversation. The speech-language pathologist (SLP) uses a framework to choose turns that facilitate a social interaction. When communication breakdown occurs, the SLP implements a least-to-most hierarchy to maximize the people with aphasia's (PWA's) independence in self-repair. ECoLoGiC-Tx draws its theoretical underpinnings from conversation analysis and theories of rehabilitation, including principles of complexity, neuroplasticity, and learning. METHOD Four PWA attended 60-min sessions twice weekly for 10 weeks. Assessment occurred at pretreatment, posttreatment, and 6-week maintenance. Outcomes included established discourse measures for conversation and monologue, tests of language and functional communication, and patient-/family-reported outcome measures (P/FROMs). Discourse samples were collected three times per assessment. Interrater reliability and fidelity for assessment and treatment procedures are reported. RESULTS Participants presented with Broca's aphasia (one moderate, one severe) or conduction aphasia (one moderate, one severe). Each demonstrated improvements in discourse, test batteries, and P/FROMs. They all demonstrated reduced aphasia severity measured by the Western Aphasia Battery-Revised at posttreatment or maintenance. Change in conversation and monologue was robust for three participants, but was mixed for one person (P1: moderate Broca's aphasia). P/FROMs indicated improvement at posttreatment and maintenance for all participants. Most treatment gains were maintained at 6-week follow-up. CONCLUSIONS This study provides promising results for ECoLoGiC-Tx to improve language function of people with chronic moderate to severe aphasia. Generalization occurred to tests, functional communication, spontaneous conversation, and structured monologue tasks.
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Affiliation(s)
| | - Lisa A Edmonds
- Teachers College, Columbia University, New York City, NY
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Mayer JF, Madden EB, Mozeiko J, Murray LL, Patterson JP, Purdy M, Sandberg CW, Wallace SE. Generalization in Aphasia Treatment: A Tutorial for Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:57-73. [PMID: 38052053 DOI: 10.1044/2023_ajslp-23-00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24714399.
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Affiliation(s)
- Jamie F Mayer
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Elizabeth B Madden
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Jennifer Mozeiko
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs
| | - Laura L Murray
- School of Communication Sciences and Disorders, Canadian Centre for Activity and Aging, Western University, London, Ontario, Canada
| | | | - Mary Purdy
- Department of Communication Disorders, Southern Connecticut State University, New Haven
| | - Chaleece W Sandberg
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Sarah E Wallace
- Department of Communication Science and Disorders, University of Pittsburgh, PA
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Lee J, Keen AD, Farr E, Christ S. TelePriming sentence production in aphasia. Front Hum Neurosci 2023; 17:1274620. [PMID: 38021242 PMCID: PMC10665571 DOI: 10.3389/fnhum.2023.1274620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The application of videoconferencing to the assessment and treatment of aphasia has been rapidly increasing; however, there is a need to develop treatments targeting sentence production in persons with aphasia (PWA) that can be delivered through videoconferencing. Structural priming has received recent attention as a potential training method for PWA. We investigated the feasibility and efficacy of a collaborative structural priming task delivered via the internet, TelePriming, in facilitating sentence production in PWA and healthy adults. Method In Study 1, young adults (YA), older adults (OA), and PWA participated in a collaborative dialogue-like priming task through videoconferencing, taking turns with an interlocutor (experimenter) to describe transitive action pictures with the goal of finding matching pictures. We measured whether participants produced more passive sentences to describe their picture after hearing their interlocutor produce passive compared to active sentences (primes). In Study 2, we compared the data from the OA and PWA of Study 1 (TelePriming) to different groups of OA and PWA, who completed the same priming task in person. Results All three groups showed robust priming effects in Study 1, producing more passive sentences to describe target pictures after hearing the experimenter produce passive versus active sentences. In Study 2, when controlling for demographic information (age, education) and aphasia severity, TelePriming resulted in larger priming effects for OA and PWA, compared to the in-person priming task. Survey results revealed that both OA and PWA experienced increased comfort and satisfaction with using technology following the task. Conclusion Interactive message-structure alignment processes remain largely intact in PWA, and the positive effects of structural priming in a collaborative communicative task are not diminished by remote delivery. The findings demonstrate the feasibility and validity of TelePriming in OA and PWA, laying experimental groundwork for future use of TelePriming in the assessment and treatment of clinical populations with limited access to face-to-face sessions.
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Affiliation(s)
- Jiyeon Lee
- Aphasia Research Laboratory, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Austin D. Keen
- Aphasia Research Laboratory, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Ellis Farr
- Aphasia Research Laboratory, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Sharon Christ
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, United States
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Sandberg CW, Khorassani H, Gray T, Dickey MW. Novel participant-level meta-analytic evidence for AbSANT efficacy. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1017389. [PMID: 37608806 PMCID: PMC10441547 DOI: 10.3389/fresc.2023.1017389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
The current study employed interrupted time series (ITS) models to analyze all available (published and unpublished) Abstract Semantic Associative Network Training (AbSANT) data. AbSANT is a semantically focused anomia treatment that targets not only concrete but abstract words, unique among existing anomia treatments. However, evidence to date for the positive effects of AbSANT comes only from small-sample, single-subject design studies, limiting the strength of this evidence and the inferences that can be drawn from it. The statistical power and greater representativeness afforded by this larger aggregated sample enabled us to look for group-level efficacy evidence for AbSANT, examine specific questions about AbSANT's direct training and generalization effects, and identify potential predictors and mechanisms of AbSANT treatment response. We found that across 33 participants from four different data sources, AbSANT appears to be a robust word retrieval therapy protocol, with overall direct training and generalization effects that were more meaningful than exposure effects. Similar to previous smaller-sample study conclusions, we found that in this large sample, training abstract words results not only in larger direct training effects than training concrete words, but also larger generalization effects, suggesting that while AbSANT successfully improves both abstract and concrete word retrieval, it may be better suited for training abstract words. In general, direct training effects were more persistent after treatment ended than generalization effects and effects for concrete words were more persistent than for abstract words. Additionally, the effects of generalization appear to be distinct from the effects of simple exposure to words, and generalization effects are consistent with AbSANT's hypothesized mechanism of action: spreading activation from directly trained concepts to related concepts. Also consistent with this mechanism, we found that milder aphasia and both conceptual and lexical semantic processing ability predicted both direct training and generalization gains, and that executive function was predictive of generalization effects. These factors are thus important to consider when evaluating the appropriateness of AbSANT for individual clients.
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Affiliation(s)
- Chaleece W. Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA, United States
| | - Hannah Khorassani
- Department of Speech, Language and Hearing Sciences, San Francisco State University, San Francisco, CA, United States
| | - Teresa Gray
- Department of Speech, Language and Hearing Sciences, San Francisco State University, San Francisco, CA, United States
| | - Michael Walsh Dickey
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Shah-Basak P, Boukrina O, Li XR, Jebahi F, Kielar A. Targeted neurorehabilitation strategies in post-stroke aphasia. Restor Neurol Neurosci 2023; 41:129-191. [PMID: 37980575 PMCID: PMC10741339 DOI: 10.3233/rnn-231344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability. OBJECTIVE This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia. METHODS We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation. RESULTS This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia. CONCLUSIONS This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.
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Affiliation(s)
| | - Olga Boukrina
- Kessler Foundation, Center for Stroke Rehabilitation Research, West Orange, NJ, USA
| | - Xin Ran Li
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fatima Jebahi
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Aneta Kielar
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
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Cherney LR, Van Vuuren S. Complexity and feedback during script training in aphasia: A feasibility study. Arch Phys Med Rehabil 2022; 103:S205-S214. [PMID: 35304120 DOI: 10.1016/j.apmr.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To explore the impact of complexity and feedback on script training outcomes in aphasia DESIGN: Randomized balanced single-blind 2 × 2 factorial design SETTING: Freestanding urban rehabilitation hospital. PARTICIPANTS Adults with fluent and nonfluent aphasia (at least six months post-onset). INTERVENTIONS Experimental treatment was AphasiaScripts®, a computer-based script training program. Scripts were 10-turns long and developed at different complexity levels to allow for comparison of high versus low complexity. The program was modified to contrast high versus low feedback conditions during sentence practice. Participants were instructed to practice three 30-minute sessions per day, six days a week for three weeks. MAIN MEASURES Gains achieved from baseline in accuracy and rate of production of trained and untrained script sentences at post-treatment and at 3-, 6- and 12-weeks after the end of treatment. RESULTS Sixteen participants completed the intervention. On the trained script, gains were statistically significant for both accuracy and words per minute, at post-treatment and 3-, 6- and 12-week maintenance. Gains on the untrained script were smaller than on the trained script; they were statistically significant only for accuracy at post-treatment and 3-week maintenance. Complexity had an influence on accuracy at post-treatment (F(1) = 4.8391, p = 0.0501) and at maintenance (F(1) = 5.3391, p = 0.04125). Practicing scripts with high complexity increased accuracy by 11.33% at post-treatment and by 9.90% at maintenance compared to scripts with low complexity. Participants with nonfluent aphasia made greater gains than those with fluent aphasia. There was no significant effect of feedback. CONCLUSION This study reinforces script training as a treatment option for aphasia. Results highlight the use of more complex scripts to better promote acquisition and maintenance of script production skills. There is a need for further investigation of these variables with larger samples and with other types of aphasia treatments. CLINICALTRIALS gov identifier: NCT01597037.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL.
| | - Sarel Van Vuuren
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
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Combiths P, Pruitt-Lord S, Escobedo A, Barlow JA. Phonological complexity in intervention for Spanish-speaking children with speech sound disorder. CLINICAL LINGUISTICS & PHONETICS 2022; 36:219-240. [PMID: 34112044 PMCID: PMC8660952 DOI: 10.1080/02699206.2021.1936186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 05/12/2023]
Abstract
The efficiency of intervention for children with speech sound disorder may be influenced by linguistic complexity of the phonological intervention target. Complex targets, particularly, later-acquired, less-known consonants and consonant clusters, have been linked to greater post-intervention generalization to untargeted phonological structures. Yet there is little direct evidence to support target selection based on linguistic complexity for Spanish-speaking children with speech sound disorder. This intervention study utilizes an experimental single-case design to examine the efficacy of intervention in Spanish using different complex targets (i.e. /ɡɾ/, /bɾ/, and /l/). For each of the four Spanish-speaking children with speech sound disorder, sounds at 0% accuracy during baseline were monitored across the baseline period, during and post-intervention, and at one- and two-month follow-up visits. Over the course of intervention, only one participant achieved mastery of the targeted structure in practiced words. However, all participants demonstrated some amount of broad phonological generalization to untargeted consonants or clusters. Variable learning trajectories and broad phonological generalization are discussed as they relate to participant characteristics and linguistic complexity.
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Affiliation(s)
- Philip Combiths
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, USA
- Department of Cognitive Science, University of California, San Diego, USA
| | - S. Pruitt-Lord
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, USA
| | - A. Escobedo
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, USA
- Department of Cognitive Science, University of California, San Diego, USA
| | - J. A. Barlow
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, USA
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12
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Cherney LR, Carpenter J. Behavioral interventions for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:197-220. [PMID: 35078599 DOI: 10.1016/b978-0-12-823384-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Department of Communication Sciences & Disorders, Northwestern University, Chicago, IL, United States.
| | - Julia Carpenter
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States
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What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation. Neuropsychol Rev 2022; 32:937-973. [PMID: 35076868 PMCID: PMC9630202 DOI: 10.1007/s11065-021-09531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Hickin J, Cruice M, Dipper L. A Systematically Conducted Scoping Review of the Evidence and Fidelity of Treatments for Verb and Sentence Deficits in Aphasia: Sentence Treatments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:431-462. [PMID: 34941377 DOI: 10.1044/2021_ajslp-21-00120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This review article synthesizes and evaluates the evidence for sentence production treatments in aphasia, systematically charting impairment-based and functional communication outcomes. It reports (a) the level of evidence and fidelity of sentence treatments; (b) the impact of treatment on production of trained and untrained verbs and sentences, functional communication, and discourse; and (c) the potential active ingredients of treatment. METHOD The search included studies from January 1980 to June 2019. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to treatment methods used. RESULTS Thirty-three studies were accepted into the review and predominantly constituted Level 4 evidence (e.g., case control studies and case series). Thirty studies (90%) described treatment in sufficient detail to allow replication, but dosage was poorly reported, and fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were mapping (10 studies: 30%), predicate argument structure treatment (six studies: 18%), and verb network strengthening treatment (five studies: 15%). Production of trained sentences improved for 83% of participants, and improvements generalized to untrained sentences for 59% of participants. Functional communication was rarely assessed, but discourse production improved for 70% of participants. CONCLUSIONS The evidence for sentence treatments is predominantly generated from Level 4 studies. Treatments were effective for the majority of participants regarding trained sentence and discourse production. However, there is inconsistent use of statistical analysis to verify improvements, and diverse outcome measures are used, which makes interpretation of the evidence difficult. The quality of sentence treatment research would be improved by agreeing a core set of outcome measures and extended by ascertaining the views of participants on sentence treatments.
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Affiliation(s)
- Julie Hickin
- Division of Language and Communication Science, City, University of London, United Kingdom
| | - Madeline Cruice
- Division of Language and Communication Science, City, University of London, United Kingdom
| | - Lucy Dipper
- Division of Language and Communication Science, City, University of London, United Kingdom
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15
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Hoover E, DeDe G, Maas E. A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4861-4875. [PMID: 34731574 PMCID: PMC10110355 DOI: 10.1044/2021_jslhr-21-00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Evidence has shown that group conversation treatment may improve communication and reduce social isolation for people with aphasia. However, little is known about the impact of conversation group treatment on measures of discourse. This project explored the impact of conversation treatment on measures of monologic discourse. METHOD In this randomized controlled trial, 48 participants with chronic aphasia were randomly assigned to dyadic, large group, or control conditions. Conversation group treatment was provided for 1 hr, twice per week, for 10 weeks. Discourse samples were collected and coded at pretreatment, posttreatment, and 6-week maintenance. There were three narrative tasks: (a) Comprehensive Aphasia Test (CAT) picture description, (b) Cat Rescue Picture, and (c) Cinderella retell. All narratives were coded using the percent correct information units (percent CIUs), the CAT standardized narrative analysis method, and the complete utterance (CU) method. RESULTS No significant changes were observed on percent CIU, which was the primary outcome measure. The treated groups demonstrated improvement on aspects of the CU method following treatment, whereas the control group did not. Significant changes were observed for other CIU measures and the CAT standardized narrative analysis in both the treated and control groups. CONCLUSIONS The results suggest that the CU measures were more sensitive to the effects of conversation treatment in monologic discourse compared to CIU and CAT measures. Changes were more common in absolute rather than relative values, suggesting that conversation treatment impacts the overall amount of language produced rather than efficiency of production.
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Affiliation(s)
- Elizabeth Hoover
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Gayle DeDe
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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16
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Swiderski AM, Quique YM, Dickey MW, Hula WD. Treatment of Underlying Forms: A Bayesian Meta-Analysis of the Effects of Treatment and Person-Related Variables on Treatment Response. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4308-4328. [PMID: 34694908 DOI: 10.1044/2021_jslhr-21-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This meta-analysis synthesizes published studies using "treatment of underlying forms" (TUF) for sentence-level deficits in people with aphasia (PWA). The study aims were to examine group-level evidence for TUF efficacy, to characterize the effects of treatment-related variables (sentence structural family and complexity; treatment dose) in relation to the Complexity Account of Treatment Efficacy (CATE) hypothesis, and to examine the effects of person-level variables (aphasia severity, sentence comprehension impairment, and time postonset of aphasia) on TUF response. Method Data from 13 single-subject, multiple-baseline TUF studies, including 46 PWA, were analyzed. Bayesian generalized linear mixed-effects interrupted time series models were used to assess the effect of treatment-related variables on probe accuracy during baseline and treatment. The moderating influence of person-level variables on TUF response was also investigated. Results The results provide group-level evidence for TUF efficacy demonstrating increased probe accuracy during treatment compared with baseline phases. Greater amounts of TUF were associated with larger increases in accuracy, with greater gains for treated than untreated sentences. The findings revealed generalization effects for sentences that were of the same family but less complex than treated sentences. Aphasia severity may moderate TUF response, with people with milder aphasia demonstrating greater gains compared with people with more severe aphasia. Sentence comprehension performance did not moderate TUF response. Greater time postonset of aphasia was associated with smaller improvements for treated sentences but not for untreated sentences. Conclusions Our results provide generalizable group-level evidence of TUF efficacy. Treatment and generalization responses were consistent with the CATE hypothesis. Model results also identified person-level moderators of TUF (aphasia severity, time postonset of aphasia) and preliminary estimates of the effects of varying amounts of TUF for treated and untreated sentences. Taken together, these findings add to the TUF evidence and may guide future TUF treatment-candidate selection. Supplemental Material https://doi.org/10.23641/asha.16828630.
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Affiliation(s)
- Alexander M Swiderski
- University of Pittsburgh, PA
- Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
| | - Yina M Quique
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Walsh Dickey
- University of Pittsburgh, PA
- Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
| | - William D Hula
- University of Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
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Cherney LR, DeDe G, Hoover EL, Murray L, Obermeyer J, Pompon RH. Applying the Rehabilitation Treatment Specification System (RTSS) to Functional Communication Treatment Approaches for Aphasia. Arch Phys Med Rehabil 2021; 103:599-609. [PMID: 34742706 DOI: 10.1016/j.apmr.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
There are many different approaches to the rehabilitation of aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called "functional communication interventions" aims to enhance communication success as opposed to solely improve linguistic abilities. This approach encompasses many skills (e.g., gesturing) and factors (e.g., access to communication supports) that support sending and receiving messages in "real world" daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes three connected elements - a single target, one or more ingredients, and a mechanism of action - that, taken together, attempt to explain how and why a treatment works. While the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics' Communicative Effectiveness (PACE), Modified Response Elaboration Training (M-RET), Script Training, Conversation Treatment, and Communication Partner Training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.
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Affiliation(s)
- Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, IL; Physical Medicine and Rehabilitation, Communication Sciences and Disorders, Northwestern University, Chicago, IL.
| | - Gayle DeDe
- Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | | | - Laura Murray
- Communication Disorders and Sciences, Western University, London, Ontario, CA
| | - Jessica Obermeyer
- Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC
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Gleichgerrcht E, Roth R, Fridriksson J, den Ouden D, Delgaizo J, Stark B, Hickok G, Rorden C, Wilmskoetter J, Hillis A, Bonilha L. Neural bases of elements of syntax during speech production in patients with aphasia. BRAIN AND LANGUAGE 2021; 222:105025. [PMID: 34555689 PMCID: PMC8546356 DOI: 10.1016/j.bandl.2021.105025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
The ability to string together words into a structured arrangement capable of conveying nuanced information is key to speech production. The assessment of the neural bases for structuring sentences has been challenged by the need of experts to delineate the aberrant morphosyntactic structures in aphasic speech. Most studies have relied on focused tasks with limited ecological validity. We characterized syntactic complexity during connected speech produced by patients with chronic post-stroke aphasia. We automated this process by employing Natural Language Processing (NLP). We conducted voxel-based and connectome-based lesion-symptom mapping to identify brain regions crucially associated with sentence production and syntactic complexity. Posterior-inferior aspects of left frontal and parietal lobes, as well as white matter tracts connecting these areas, were essential for syntactic complexity, particularly the posterior inferior frontal gyrus. These findings suggest that sentence structuring during word production depends on the integrity of Broca's area and the dorsal stream of language processing.
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Affiliation(s)
| | - Rebecca Roth
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - John Delgaizo
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Brielle Stark
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN, USA
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Janina Wilmskoetter
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Argye Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
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Fromm D, Greenhouse J, Pudil M, Shi Y, MacWhinney B. Enhancing the Classification of Aphasia: A Statistical Analysis Using Connected Speech. APHASIOLOGY 2021; 36:1492-1519. [PMID: 36457942 PMCID: PMC9708051 DOI: 10.1080/02687038.2021.1975636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 08/30/2021] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Davida Fromm
- Department of Psychology, Carnegie Mellon University
| | - Joel Greenhouse
- Department of Statistics & Data Science, Carnegie Mellon University
| | - Mitchell Pudil
- Department of Statistics & Data Science, Carnegie Mellon University
| | - Yichun Shi
- Department of Statistics & Data Science, Carnegie Mellon University
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20
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Sandberg CW, Zacharewicz M, Gray T. Bilingual Abstract Semantic Associative Network Training (BAbSANT): A Polish-English case study. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106143. [PMID: 34364041 DOI: 10.1016/j.jcomdis.2021.106143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This article presents a novel approach to anomia therapy (i.e., BAbSANT: Bilingual Abstract Semantic Associative Network Training) for bilingual persons with aphasia (B-PWA) that capitalizes both on lexico-semantic theories in bilingualism and general theories of semantic organization and learning. Based on previous work, we hypothesized that training abstract words in either language would promote within-language generalization, while training in the nondominant language would promote both within- and cross-language generalization. METHODS This case study used a single-subject A1BA2CA3 design. The participant was living with aphasia secondary to stroke and spoke both Polish and English, with Polish being his native and dominant language. Phase B consisted of abstract word training in Polish and phase C consisted of abstract word training in English. Prior to initiating therapy, in addition to a comprehensive language battery, we administered a cognitive control task to explore the relationship between cognitive control and treatment outcome. RESULTS We found within-language generalization regardless of the trained language, replicating previous work in monolingual persons with aphasia, further supporting the utility of training abstract words. However, contrary to our second hypothesis, cross-language generalization only occurred when the stronger language was trained. CONCLUSIONS The discussion of the results of this case study is framed within previous work and theories of bilingualism. The lack of cross-language generalization when the weaker language was trained is discussed, taking into account nonverbal cognitive control deficits. In addition to showing the efficacy of BAbSANT, these results highlight the importance of considering cognitive control as a factor influencing therapeutic outcomes in anomia treatment in bilingual PWA.
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Affiliation(s)
- Chaleece W Sandberg
- Department of Communication Sciences and Disorders, Penn State University, 308 Ford Building, University Park, PA 16802, United States.
| | - Monika Zacharewicz
- Department of Speech, Language, and Hearing Sciences, San Francisco State University, 1600 Holloway Avenue, Burk Hall, Room 114, San Francisco, CA 94132, United States
| | - Teresa Gray
- Department of Speech, Language, and Hearing Sciences, San Francisco State University, 1600 Holloway Avenue, Burk Hall, Room 114, San Francisco, CA 94132, United States.
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21
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Sung JE, Ahn H, Choi S, Lee K. Age and Education Effects on a Novel Syntactic Assessment Battery for Elderly Adults. Front Psychol 2021; 12:639866. [PMID: 34220611 PMCID: PMC8249940 DOI: 10.3389/fpsyg.2021.639866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to delineate the properties of a novel syntactic assessment battery and to present descriptive data on normal elderly individuals. We administered the Syntactic Assessment Battery (hereinafter SAB) using a sentence-picture paradigm to 195 normal elderly adults in three age groups (60-69, 70-79, and 80-90) and five educational levels (No formal education, Elementary School Graduation, Middle School Graduation, High School Graduation, College Graduation and Above). A multiple linear regression model was applied to verify the age and education effects. A summary of results indicated that the SAB effectively detected age and education effects. People generally demonstrated worse performance as they aged but better performance as their educational levels increased. People with high school education and above generally demonstrated stronger performance on the test, although educational effects were not significantly different between elementary and middle school graduation groups. The current novel syntactic assessment battery can serve as a screening measure that sensitively detects age and education effects.
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Affiliation(s)
- Jee Eun Sung
- Department of Communication Disorders, Ewha Womans University, Seoul, South Korea
| | - Heekyung Ahn
- Department of Statistics, Purdue University, West Lafayette, IN, United States
| | - Sujin Choi
- Department of Communication Disorders, Ewha Womans University, Seoul, South Korea
| | - Kiseop Lee
- Department of Statistics, Purdue University, West Lafayette, IN, United States
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22
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Cheng HS, Buchwald A. Does Voicing Affect Patterns of Transfer in Nonnative Cluster Learning? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2103-2120. [PMID: 33909447 PMCID: PMC8740656 DOI: 10.1044/2021_jslhr-20-00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/30/2020] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
Purpose Previous studies have demonstrated that speakers can learn novel speech sequences, although the content and specificity of the learned speech motor representations remain incompletely understood. We investigated these representations by examining transfer of learning in the context of nonnative consonant clusters. Specifically, we investigated whether American English speakers who learn to produce either voiced or voiceless stop-stop clusters (e.g., /gd/ or /kt/) exhibit transfer to the other voicing pattern. Method Each participant (n = 34) was trained on disyllabic nonwords beginning with either voiced (/gd/, /db/, /gb/) or voiceless (/kt/, /kp/, /tp/) onset consonant clusters (e.g., /gdimu/, /ktaksnæm/) in a practice-based speech motor learning paradigm. All participants were tested on both voiced and voiceless clusters at baseline (prior to practice) and in two retention sessions (20 min and 2 days after practice). We compared changes in cluster accuracy and burst-to-burst duration between baseline and each retention session to evaluate learning (performance on the trained clusters) and transfer (performance on the untrained clusters). Results Participants in both training conditions improved with respect to cluster accuracy and burst-to-burst duration for the clusters they practiced on. A bidirectional transfer pattern was found, such that participants also improved the cluster accuracy and burst-to-burst duration for the clusters with the other untrained voicing pattern. Post hoc analyses also revealed that improvement in the production of untrained stop-fricative clusters that originally were added as filler items. Conclusion Our findings suggest the learned speech motor representations may encode the information about the coordination of oral articulators for stop-stop clusters independently from information about the coordination of oral and laryngeal articulators.
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Affiliation(s)
- Hung-Shao Cheng
- Department of Communicative Sciences and Disorders, New York University, New York City
| | - Adam Buchwald
- Department of Communicative Sciences and Disorders, New York University, New York City
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23
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Mis R, Giovannetti T. Similarities between Cognitive Models of Language Production and Everyday Functioning: Implications for Development of Interventions for Functional Difficulties. Top Cogn Sci 2021; 14:295-310. [PMID: 34128585 DOI: 10.1111/tops.12550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
The loss of the ability to independently complete activities of daily living, such as meal preparation and household chores, is a defining characteristic of clinical dementia; however, minor difficulties in completing everyday activities emerge in the mild cognitive impairment stage, and even healthy older adults exhibit subtle functional difficulties compared to younger adults. These functional difficulties are associated with an array of negative outcomes, including decreased quality of life, higher costs of care, and increased frustration, depression, caregiver burden, and institutionalization. While cognitive models have been proposed to explain the functional deficits seen in dementia and subtler forms of cognitive decline, in contrast to other cognitive disorders such as aphasia, there are essentially no theoretically motivated interventions to address difficulties in everyday functioning. Proposed models of functional impairment share features with cognitive processing models of language, including hierarchical organization of representations and interactive, spreading activation; thus, an examination of aphasia interventions has the potential to inform the development of theoretically motivated interventions for everyday activities. This review first addresses the shared characteristics of cognitive models of everyday function and language, with a focus on linguistic production. Next, we will present aphasia interventions that target single-word production, sentence production, short-term memory, and semantics, and discuss their implications for everyday functioning interventions. We conclude with a discussion of limitations of the language-everyday functioning comparison as well as areas of future research.
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Affiliation(s)
- Rachel Mis
- Department of Psychology, Temple University
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24
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Maggu AR, Kager R, To CKS, Kwan JSK, Wong PCM. Effect of Complexity on Speech Sound Development: Evidence From Meta-Analysis Review of Treatment-Based Studies. Front Psychol 2021; 12:651900. [PMID: 33995208 PMCID: PMC8113766 DOI: 10.3389/fpsyg.2021.651900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
In the current study, we aimed at understanding the effect of exposure to complex input on speech sound development, by conducting a systematic meta-analysis review of the existing treatment-based studies employing complex input in children with speech sound disorders. In the meta-analysis review, using a list of inclusion criteria, we narrowed 280 studies down to 12 studies. Data from these studies were extracted to calculate effect sizes that were plotted as forest plots to determine the efficacy of complexity-based treatment approaches. The outcome variables of interest were improvement on the treated and generalization to the untreated sounds. Meta-analysis revealed that the exposure to complex input not only promoted improvement in production of complex speech sounds (d = 1.08, CI = 0.98–1.19) but also facilitated the production of untreated simple speech sounds (d = 2.69, CI = 1.98–3.54). Overall, the current findings revealed that the exposure to complex input promotes acquisition of both complex and simple speech sounds. The current findings are in line with the models of language learnability. The current findings have implications in the treatment of speech sound disorders.
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Affiliation(s)
- Akshay R Maggu
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Hong Kong, China.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - René Kager
- Department of Languages, Literature and Communication, Utrecht Institute of Linguistics OTS, Utrecht University, Utrecht, Netherlands.,The Chinese University of Hong Kong - Utrecht University Joint Centre for Language, Mind and Brain, Hong Kong, China
| | - Carol K S To
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong, China
| | - Judy S K Kwan
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick C M Wong
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Hong Kong, China.,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.,The Chinese University of Hong Kong - Utrecht University Joint Centre for Language, Mind and Brain, Hong Kong, China
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25
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German Language Adaptation of the NAVS (NAVS-G) and of the NAT (NAT-G): Testing Grammar in Aphasia. Brain Sci 2021; 11:brainsci11040474. [PMID: 33918022 PMCID: PMC8069474 DOI: 10.3390/brainsci11040474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 11/17/2022] Open
Abstract
Grammar provides the framework for understanding and producing language. In aphasia, an acquired language disorder, grammatical deficits are diversified and widespread. However, the few assessments for testing grammar in the German language do not consider current linguistic, psycholinguistic, and functional imaging data, which have been shown to be crucial for effective treatment. This study developed German language versions of the Northwestern Assessment of Verbs and Sentences (NAVS-G) and the Northwestern Anagram Test (NAT-G) to examine comprehension and production of verbs, controlling for the number and optionality of verb arguments, and sentences with increasing syntactic complexity. The NAVS-G and NAT-G were tested in 27 healthy participants, 15 right hemispheric stroke patients without aphasia, and 15 stroke patients with mild to residual aphasia. Participants without aphasia showed near-perfect performance, with the exception of (object) relative sentences, where accuracy was associated with educational level. In each patient with aphasia, deficits in more than one subtest were observed. The within and between population-groups logistic mixed regression analyses identified significant impairments in processing syntactic complexity at the verb and sentence levels. These findings indicate that the NAVS-G and NAT-G have potential for testing grammatical competence in (German) stroke patients.
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26
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Thompson CK, Barbieri E, Mack JE, Wilkins A, Xie KY. Plasticity of sentence processing networks: evidence from a patient with agrammatic variant of primary progressive aphasia (PPA). Neurocase 2021; 27:39-56. [PMID: 33378229 PMCID: PMC8026534 DOI: 10.1080/13554794.2020.1862241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
This study reports the results of a longitudinal study examining the effects of treatment for sentence processing deficits for a 70-year-old gentleman (DK) with the agrammatic variant of Primary Progressive Aphasia (PPA). On entry into the study, he presented with a 2-year history of impaired verb and sentence processing and concomitant neural atrophy in primarily subcortical regions. Spanning an 18-month period, treatment focused on improving comprehension and production of syntactically complex, passive and object cleft, structures, consecutively. Results, derived from extensive behavioral and neurocognitive testing, showed not only improved ability to comprehend and produce both trained and untrained, less complex, linguistically related structures in offline tasks, but also improved online sentence processing strategies as revealed by partially normalized eye movements in online comprehension (i.e., emergence of thematic prediction and thematic integration) and production (i.e., use of incremental processing) tasks. Changes in neural activation from pre- to post-treatment of both structures also were found, with upregulation of tissue in both the left and right hemispheres, overlapping with regions recruited by neurotypical adults performing the same task. These findings indicate that Treatment of Underlying Forms (TUF) is effective for treatment of patients with the agrammatic variant of PPA (as it is for those with stroke-induced agrammatism), and show that unaffected neural tissue in patients with PPA is malleable and may be recruited to support language, providing evidence of experience-based plasticity in neurodegenerative disease.
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Affiliation(s)
- Cynthia K. Thompson
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, Northwestern University, Chicago, IL, United States
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University, Chicago, IL, United States
| | - Elena Barbieri
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Jennifer E. Mack
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Aaron Wilkins
- Center for Audiology, Speech, Language, and Learning, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Kathy Y. Xie
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
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Zhang M, Geng L, Yang Y, Ding H. Cohesion in the discourse of people with post-stroke aphasia. CLINICAL LINGUISTICS & PHONETICS 2021; 35:2-18. [PMID: 32200658 DOI: 10.1080/02699206.2020.1734864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 06/10/2023]
Abstract
Aphasic discourse has been investigated through two major approaches: a micro-linguistic approach and a macro one, but the separate analysis of the micro and macro aspects of aphasic discourse has led to a noticeable gap between them. Cohesion analysis is one of the possible ways that can directly connect these two aspects. However, few studies have investigated cohesion in aphasic discourse in an integrated manner. The present study employs a mixed-methods approach to examine whether and how patients with fluent and non-fluent stroke-induced aphasia differ from normal individuals in the cohesion of their discourse, aiming to provide a more comprehensive understanding of this issue. We compared the use of cohesive devices in the discourse of 7 non-fluent aphasics (4 males, mean age = 70.9) and 9 fluent aphasics (4 males, mean age = 70.7) against 16 non-aphasic controls (NACs) (8 males, mean age = 71.0). Transcripts were analysed and conclusions were drawn based on the combination of quantitative and qualitative observations. As predicted, discourse by aphasic participants is less cohesive than that by non-aphasic participants and the three groups' discourse differs from each other in the distribution of cohesion categories, with non-fluent aphasics having more trouble in using grammatical cohesive devices while fluent aphasics more severely affected in constructing lexical cohesion. Results suggest that cohesion in post-stroke aphasic discourse may vary between different aphasia types and thus can be rather complicated. Additional work involving more aphasia types and more dimensions of discourse cohesion is needed to provide further insight into this question.
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Affiliation(s)
- Minyue Zhang
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University , Shanghai, China
| | - Luyuan Geng
- Department of English, School of Foreign Languages, East China Normal University , Shanghai, China
| | - Yanning Yang
- Department of English, School of Foreign Languages, East China Normal University , Shanghai, China
| | - Hongwei Ding
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University , Shanghai, China
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De Anda S, Blossom M, Abel AD. Cross-Morpheme Generalization Using a Complexity Approach in School-Age Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3501-3524. [PMID: 32955972 PMCID: PMC8060021 DOI: 10.1044/2020_jslhr-19-00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/21/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Purpose This single-case study examines a complexity approach to target selection in grammatical intervention in three children with varying levels of mastery of tense and agreement. Specifically, we examine whether targeting a complex tense and agreement grammatical structure (auxiliary BE in questions) leads to generalization to other less complex and related tense and agreement markers (auxiliary BE in declaratives, copula BE, third-person singular -s, and past tense -ed). Method Three children (all boys; aged 5;5-9;7 [years;months]) with deficits in morphosyntax were enrolled in a treatment program targeting a complex grammatical structure (auxiliary BE in questions) following collection of multiple baselines. Children's performance on the complex structure and related tense and agreement markers were tracked before, during, and after the intervention across three different tasks. Results Results show that, despite its grammatical complexity, the target was elicited in all three children with incomplete mastery of the tense and agreement system. Furthermore, all children demonstrated generalization to expressive language by increasing their mean length of utterance by approximately one morpheme during spontaneous language production following intervention. All children demonstrated individual patterns of generalization to other tense and agreement structures not targeted during intervention. Conclusions These functional changes observed following intervention set the stage for future controlled studies to establish a stronger cause-effect relation. Taken together, this study contributes to an emerging body of work showing that complex grammatical targets may be used in intervention earlier than previously thought.
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Affiliation(s)
| | | | - Alyson D. Abel
- School of Speech, Language and Hearing Sciences, San Diego State University, CA
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29
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Sandberg CW, Gray T. Abstract Semantic Associative Network Training: A Replication and Update of an Abstract Word Retrieval Therapy Program. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1574-1595. [PMID: 32628510 DOI: 10.1044/2020_ajslp-19-00066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose We report on a study that replicates previous treatment studies using Abstract Semantic Associative Network Training (AbSANT), which was developed to help persons with aphasia improve their ability to retrieve abstract words, as well as thematically related concrete words. We hypothesized that previous results would be replicated; that is, when abstract words are trained using this protocol, improvement would be observed for both abstract and concrete words in the same context-category, but when concrete words are trained, no improvement for abstract words would be observed. We then frame the results of this study with the results of previous studies that used AbSANT to provide better evidence for the utility of this therapeutic technique. We also discuss proposed mechanisms of AbSANT. Method Four persons with aphasia completed one phase of concrete word training and one phase of abstract word training using the AbSANT protocol. Effect sizes were calculated for each word type for each phase. Effect sizes for this study are compared with the effect sizes from previous studies. Results As predicted, training abstract words resulted in both direct training and generalization effects, whereas training concrete words resulted in only direct training effects. The reported results are consistent across studies. Furthermore, when the data are compared across studies, there is a distinct pattern of the added benefit of training abstract words using AbSANT. Conclusion Treatment for word retrieval in aphasia is most often aimed at concrete words, despite the usefulness and pervasiveness of abstract words in everyday conversation. We show the utility of AbSANT as a means of improving not only abstract word retrieval but also concrete word retrieval and hope this evidence will help foster its application in clinical practice.
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Affiliation(s)
- Chaleece W Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA
| | - Teresa Gray
- Department of Speech, Language and Hearing Sciences, San Francisco State University, CA
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Silagi ML, Ferreira OP, de Almeida IJ, Simões JDS, Zampieri SA, de Santana BRF, Mansur LL. Treatment of agrammatism in oral and written production in patients with Broca's aphasia The use of implicit and explicit learning. Dement Neuropsychol 2020; 14:103-109. [PMID: 32595878 PMCID: PMC7304269 DOI: 10.1590/1980-57642020dn14-020002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods.
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Affiliation(s)
- Marcela Lima Silagi
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
| | - Olavo Panseri Ferreira
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
| | - Isabel Junqueira de Almeida
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
| | - Janaina de Souza Simões
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
| | - Sueli Aparecida Zampieri
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
| | - Beatriz Raz Franco de Santana
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
| | - Letícia Lessa Mansur
- Speech Pathologist. Department of Physical Therapy, Speech, and Occupational Therapy of the School of Medicine - University of Sao Paulo, SP, Brazil
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Lindsey A, Bunker L, Mozeiko J, Coelho C. Primed to cue. JOURNAL OF COMMUNICATION DISORDERS 2020; 86:105998. [PMID: 32470645 DOI: 10.1016/j.jcomdis.2020.105998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
The behavioral effects of lexical priming are well studied in the cognitive sciences. Clinical use of the term and widespread implementation of priming based behavioral interventions has remained limited. This is despite the fact that response-contingent cueing, a behavioral intervention technique used during many cognitive-linguistic interventions, is grounded in theories of priming research. The aim of this manuscript is to connect behavioral performance changes observed following priming with those noted following cueing, providing a theoretical rationale for the therapeutic use of both priming and cueing in language and cognitive interventions. In this review, we establish a conceptual basis for how both primes and cues serve to pre-engage the neural system by triggering the retrieval of linked conceptual knowledge, resulting in faster and more accurate responses. Differences between the two (primes and cues) have been linked to timing and conscious intentional engagement, though these distinctions are often task dependent. Additionally, this paper will provide evidence of the clinical utility of priming. Studies of priming in adults with acquired brain injuries are discussed and clinical interventions based on theories of priming are examined. Furthermore, the present work will briefly detail the inhibitory effects of priming to aid clinicians and researchers in deciding how to pair primes and cues with intended retrieval targets. In summation, the present work is intended to bridge two related fields providing both theoretical and clinical insight with respect to the use of primes and cues.
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Affiliation(s)
- André Lindsey
- Department of Speech, Language, and Hearing Sciences, University of Connecticut Storrs, CT, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States.
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Jennifer Mozeiko
- Department of Speech, Language, and Hearing Sciences, University of Connecticut Storrs, CT, United States; Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States.
| | - Carl Coelho
- Department of Speech, Language, and Hearing Sciences, University of Connecticut Storrs, CT, United States; Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States.
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Gilmore N, Meier EL, Johnson JP, Kiran S. Typicality-based semantic treatment for anomia results in multiple levels of generalisation. Neuropsychol Rehabil 2020; 30:802-828. [PMID: 30027828 PMCID: PMC6339853 DOI: 10.1080/09602011.2018.1499533] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Abstract
This study investigated the effects of typicality-based semantic feature analysis (SFA) treatment on generalisation across three levels: untrained related items, semantic/phonological processing tasks, and measures of global language function. Using a single-subject design with group-level analyses, 27 persons with aphasia (PWA) received typicality-based SFA to improve their naming of atypical and/or typical exemplars. Progress on trained, untrained, and monitored items was measured weekly. Pre- and post-treatment assessments were administered to evaluate semantic/phonological processing and overall language ability. Ten PWA served as controls. For the treatment participants, the likelihood of naming trained items accurately was significantly higher than for monitored items over time. When features of atypical items were trained, the likelihood of naming untrained typical items accurately was significantly higher than for untrained atypical items over time. Significant gains were observed on semantic/phonological processing tasks and standardised assessments after therapy. Different patterns of near and far transfer were seen across treatment response groups. Performance was also compared between responders and controls. Responders demonstrated significantly more improvement on a semantic processing task than controls, but no other significant change score differences were found between groups. In addition to positive treatment effects, typicality-based SFA naming therapy resulted in generalisation across multiple levels.
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Affiliation(s)
- Natalie Gilmore
- Aphasia Research Laboratory Speech, Language & Hearing Sciences, Boston University, Boston, MA
| | - Erin L. Meier
- Aphasia Research Laboratory Speech, Language & Hearing Sciences, Boston University, Boston, MA
| | - Jeffrey P. Johnson
- Aphasia Research Laboratory Speech, Language & Hearing Sciences, Boston University, Boston, MA
| | - Swathi Kiran
- Aphasia Research Laboratory Speech, Language & Hearing Sciences, Boston University, Boston, MA
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Middleton EL, Schuchard J, Rawson KA. A Review of the Application of Distributed Practice Principles to Naming Treatment in Aphasia. TOPICS IN LANGUAGE DISORDERS 2020; 40:36-53. [PMID: 32831450 PMCID: PMC7437680 DOI: 10.1097/tld.0000000000000202] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is uncontroversial in psychological research that different schedules of practice, which govern the distribution of practice over time, can promote radically different outcomes in terms of gains in performance and the durability of learning. In contrast, in speech-language treatment research, there is a critical need for well-controlled studies examining the impact of the distribution of treatment on efficacy (for reviews, see Cherney, 2012; Warren, Fey, & Yoder, 2007). In this paper, we enumerate key findings from psychological research on learning and memory regarding how different schedules of practice differentially confer durable learning. We review existing studies of aphasia treatment with a focus on naming impairment that have examined how the distribution of practice affects treatment efficacy. We close by discussing potential productive lines of research to elaborate the clinical applicability of distributed practice principles to language treatment.
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Thompson CK. Neurocognitive Recovery of Sentence Processing in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3947-3972. [PMID: 31756151 PMCID: PMC7203523 DOI: 10.1044/2019_jslhr-l-rsnp-19-0219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 05/04/2023]
Abstract
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.
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Affiliation(s)
- Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Department of Neurology and Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Evanston/Chicago, IL
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Bailey DJ, Bunker L, Mauszycki S, Wambaugh JL. Reliability and stability of the metrical stress effect on segmental production accuracy in persons with apraxia of speech. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:902-913. [PMID: 31338954 DOI: 10.1111/1460-6984.12493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acquired apraxia of speech (AOS) involves speech-production deficits on both the segmental and suprasegmental levels. Recent research has identified a non-linear interaction between the metrical structure of bisyllabic words and word-production accuracy in German speakers with AOS, with trochaic words (strong-weak stress) being resistant to errors compared with iambic words (weak-strong). AIMS To replicate previous findings in English speakers with AOS, to measure the test-retest reliability of the effect, and to examine the potential impact of different methods of word scoring. METHODS & PROCEDURES Speech samples were collected from 27 speakers with AOS and aphasia. Participants were at least 12 months post-stroke or penetrating brain injury, and represented a large range of AOS and aphasia severities. Productions were elicited via verbal model. Sampling was conducted on three separate occasions: the initial data-collection session and then repeated samplings at 1- and 4-week intervals. Bisyllabic words with a CVCVC segmental structure were selected. The list was divided into sublists representing differing lexical stress patterns: A list of 42 trochees, and one of 37 iambs. All speech samples were phonetically transcribed and then aligned with canonical transcriptions via an edit distance algorithm that followed transcription alignment principles. Phonetic-level errors (distortions) were penalized less severely than phonemic-level errors. Per cent consonants correct and whole-word accuracy were also examined. Trochee and iamb lists were analysed separately. OUTCOMES & RESULTS Paired samples t-tests indicated that the modified edit distance was significantly lower for the trochee lists than for the iamb lists. There was a lack of a significant effect of time on the absolute difference between modified edit distance for both lists. Intraclass coefficients suggested the list and procedures used are appropriate as an outcome measure for group research. CONCLUSIONS & IMPLICATIONS The results suggest that in English, as in German, the trochaic structure is more resistant to segmental errors in persons with AOS and aphasia, providing replication of the findings of Aichert et al. in 2016. Further, this effect is stable over repeated sampling occasions. Implications for clinical management of AOS include possible ways to scaffold item difficulty and potentially improve stimulus generalization.
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Affiliation(s)
- Dallin J Bailey
- Department of Communication Disorders, Auburn University, Auburn, AL, USA
| | - Lisa Bunker
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Shannon Mauszycki
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Julie L Wambaugh
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA
- Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
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Canu E, Agosta F, Imperiale F, Ferraro PM, Fontana A, Magnani G, Mesulam MM, Thompson CK, Weintraub S, Moro A, Cappa SF, Filippi M. Northwestern Anagram Test-Italian (Nat-I) for primary progressive aphasia. Cortex 2019; 119:497-510. [PMID: 31527011 PMCID: PMC6785992 DOI: 10.1016/j.cortex.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/08/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To test the ability of the Northwestern Anagram Test-Italian (NAT-I) to distinguish between the non-fluent/agrammatic (nfv-) and phonological/logopenic (lv-) variants of primary progressive aphasia (PPA), and to determine the relationship between NAT-I variables and brain integrity in PPA patients. METHODS 13 nfvPPA and 8 lvPPA patients underwent the 44-item-version of NAT-I and brain MRI. The NAT-I was also administered to six patients with the semantic variant (sv) PPA to sample performance in cases with no grammatical deficits. Performances were recorded and compared between patient groups. Receiver Operating Characteristic curve analysis assessed the ability of NAT-I to discriminate nfvPPA and lvPPA. The correlation between anatomical changes and NAT-I variables were assessed. A shortened (22-item)-version of NAT-I was also tested for classification ability. RESULTS Participants with NfvPPA performed more poorly than lvPPA patients on canonical and non-canonical sentences. NAT-I non-canonical sentence and total scores achieved the highest diagnostic accuracy in discriminating the two patient groups (area under the curve: .93 and .91, respectively). SvPPA participants showed performances similar to lvPPA. NAT-I variables correlated with the integrity of the left inferior frontal gyrus and the body of the corpus callosum. The NAT-I 22-item-version total and non-canonical sentences scores reached diagnostic accuracy comparable to the full version. CONCLUSIONS The NAT-I, in particular the measure of non-canonical syntax, is an effective tool for distinguishing nfvPPA and lvPPA patients and correlated with the integrity of crucial brain regions implicated in syntactic processing. The 22-item-brief version of NAT-I is suitable for clinical practice and research.
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Affiliation(s)
- Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Imperiale
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pilar M Ferraro
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giuseppe Magnani
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marek-Marsel Mesulam
- Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Chicago, IL, USA
| | - Cynthia K Thompson
- Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Chicago, IL, USA; Department of Communication Sciences and Disorders, and Neurology, Northwestern University, Evanston/Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Chicago, IL, USA
| | | | - Stefano F Cappa
- IUSS Pavia, Pavia, Italy; IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Shiani A, Joghataei MT, Ashayeri H, Kamali M, Razavi MR, Yadegari F. Comprehension of Complex Sentences in the Persian-Speaking Patients With Aphasia. Basic Clin Neurosci 2019; 10:199-208. [PMID: 31462975 PMCID: PMC6712637 DOI: 10.32598/bcn.9.10.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/25/2016] [Accepted: 04/30/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction: To study sentence comprehension in Persian-speaking Patients with Aphasia considering the factors of complexity. Methods: In this cross-sectional study, the performance of 6 non-fluent aphasic patients were tested and their performance was compared to 15 matched control group. Comprehension of semantically reversible sentences was assessed using a binary sentence-picture matching task. The stimuli were as follows: clefts; subject clefts and object clefts, also relative clauses; subject relatives and object relatives. All of them were types of movement-derived structures and also simple declarative sentences as the control task. Results: The best performance of aphasic patients were seen in the comprehension of subject clefts, although prior to this result we assumed that simple declarative sentences (in which there is no structural factor of complexity) can be understood easily. They showed the highest difficulty in the comprehension of object relatives. Furthermore, the performance of patients in the comprehension of relative clauses was significantly weaker than understanding the clefts. Conclusion: The outcomes of this study suggest that the sentence comprehension deficits of aphasic patients, in contrast to the specific deficit models, may not be related to linguistic disabilities. Moreover, the problems in the comprehension of non-canonical sentences may be related to failure in the allocation of attention. Finally, our results support the claims that neural characterization of the cognitive resources (e.g. working memory) is disrupted in sentence comprehension deficits.
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Affiliation(s)
- Amir Shiani
- Department of Radiology, Faculty of Allied Medical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Taghi Joghataei
- Cellular and Molecular Research Center, Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Ashayeri
- Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamali
- Department of Basic Rehabilitation Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fariba Yadegari
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Peach RK, Beck KM, Gorman M, Fisher C. Clinical Outcomes Following Language-Specific Attention Treatment Versus Direct Attention Training for Aphasia: A Comparative Effectiveness Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2785-2811. [PMID: 31348732 DOI: 10.1044/2019_jslhr-l-18-0504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This study was conducted to examine the comparative effectiveness of 2 different approaches, 1 domain-specific and the other domain-general, to language and attention rehabilitation in participants with stroke-induced aphasia. The domain-specific treatment consisted of language-specific attention treatment (L-SAT), and the domain-general treatment consisted of direct attention training (DAT) using the computerized exercises included in Attention Process Training-3 (Sohlberg & Mateer, 2010). Method Four individuals with mild-moderate aphasia participated in this study. A randomized controlled cross-over single-subject design was used to assess the effectiveness of the 2 treatments administered in this study. Treatment outcomes were evaluated in terms of participants' task performance for each program, standardized language and attention measures, tests of functional abilities, and patient-reported outcomes. Results Visual comparisons demonstrated linear improvements following L-SAT and variable patterns following DAT. Omnibus effect sizes were statistically significant for 9 of the 13 L-SAT tasks. The weighted standardized effect sizes for posttreatment changes following L-SAT ranged from small to large, with the exception of 1 task. The average group gain following DAT was 5%. The Western Aphasia Battery-Revised Aphasia Quotients (Kertesz, 2007) demonstrated reliable improvements for 3 of the 4 participants following L-SAT, whereas only 1 of the participants improved reliably following DAT. The margins of improvements in functional language were substantially larger following L-SAT than DAT. Performance on the Test of Everyday Attention improved significantly for 2 participants following L-SAT and for 1 participant following DAT on selected Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) subtests. Patient-reported outcomes for communication and attention following treatment favored L-SAT compared to DAT. Conclusions The results support the view that attention is allocated in ways that are particular to specific tasks rather than as a general resource that is allocated equivalently to all processing tasks. Domain-specific treatment for language deficits due to attentional impairment appears to be a suitable, if not preferable, approach for aphasia rehabilitation. Supplemental Material https://doi.org/10.23641/asha.8986427.
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Affiliation(s)
- Richard K Peach
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
| | - Katherine M Beck
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
| | - Michelle Gorman
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
| | - Christine Fisher
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL
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Barbieri E, Mack J, Chiappetta B, Europa E, Thompson CK. Recovery of offline and online sentence processing in aphasia: Language and domain-general network neuroplasticity. Cortex 2019; 120:394-418. [PMID: 31419597 DOI: 10.1016/j.cortex.2019.06.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/09/2019] [Accepted: 06/13/2019] [Indexed: 12/29/2022]
Abstract
This paper examined the effects of treatment on both offline and online sentence processing and associated neuroplasticity within sentence processing and dorsal attention networks in chronic stroke-induced agrammatic aphasia. Twenty-three neurotypical adults and 19 individuals with aphasia served as participants. Aphasic individuals were randomly assigned to receive a 12-week course of linguistically-based treatment of passive sentence production and comprehension (N = 14, treatment group) or to serve as control participants (N = 5, natural history group). Both aphasic groups performed two offline tasks at baseline and three months following (at post-testing) to assess production and comprehension of trained passive structures and untrained syntactically related and unrelated structures. The aphasic participants and a healthy age-matched group also performed an online eyetracking comprehension task and a picture-verification fMRI task, which were repeated at post-testing for the aphasic groups. Results showed that individuals in the treatment, but not in the natural history, group improved on production and comprehension of both trained structures and untrained syntactically related structures. Treatment also resulted in a shift toward more normal-like eye movements and a significant increase in neural activation from baseline to post-testing. Upregulation encompassed right hemisphere regions homologs of left hemisphere regions involved in both sentence processing and domain-general functions and was positively correlated with treatment gains, as measured by offline comprehension accuracy, and with changes in processing strategies during sentence comprehension, as measured by eyetracking. These findings provide compelling evidence in favor of the contribution of both networks within the right hemisphere to the restoration of normal-like sentence processing patterns in chronic aphasia.
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Affiliation(s)
- Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.
| | - Jennifer Mack
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
| | - Brianne Chiappetta
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
| | - Eduardo Europa
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
| | - Cynthia K Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA; Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Chicago, IL, USA; Department of Neurology, Northwestern University, Chicago, IL, USA
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Man G, Meehan S, Martin N, Branigan H, Lee J. Effects of Verb Overlap on Structural Priming in Dialogue: Implications for Syntactic Learning in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1933-1950. [PMID: 31112446 PMCID: PMC6808374 DOI: 10.1044/2019_jslhr-l-18-0418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/16/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
Purpose Although there is increasing interest in using structural priming as a means to ameliorate grammatical encoding deficits in persons with aphasia (PWAs), little is known about the precise mechanisms of structural priming that are associated with robust and enduring effects in PWAs. Two dialogue-like comprehension-to-production priming experiments investigated whether lexically independent (abstract structural) priming and/or lexically (verb) specific priming yields immediate and longer, lasting facilitation of syntactic production in PWAs. Method Seventeen PWAs and 20 healthy older adults participated in a collaborative picture-matching task where participant and experimenter took turns describing picture cards using transitive and dative sentences. In Experiment 1, a target was elicited immediately following a prime. In Experiment 2, 2 unrelated utterances intervened between a prime and target, thereby allowing us to examine lasting priming effects. In both experiments, the verb was repeated for half of the prime-target pairs to examine the lexical (verb) boost on priming. Results Healthy older adults demonstrated abstract priming in both transitives and datives not only in the immediate (Experiment 1) but also in the lasting (Experiment 2) priming condition. They also showed significantly enhanced priming by verb overlap (lexical boost) in transitives during immediate priming. PWAs demonstrated abstract priming in transitives in both immediate and lasting priming conditions. However, the magnitude of priming was not enhanced by verb overlap. Conclusions Abstract structural priming, but not lexically specific priming, is associated with reliable and lasting facilitation of message-structure mapping in aphasia. The findings also suggest that implicit syntactic learning via a dialogue-like comprehension-to-production task remains preserved in aphasia.
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Affiliation(s)
- Grace Man
- Department of Speech, Language, & Hearing Sciences, Purdue University, West Lafayette, IN
| | - Sarah Meehan
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Nadine Martin
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Holly Branigan
- Department of Psychology, University of Edinburgh, United Kingdom
| | - Jiyeon Lee
- Department of Speech, Language, & Hearing Sciences, Purdue University, West Lafayette, IN
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Gilmore N, Dwyer M, Kiran S. Benchmarks of Significant Change After Aphasia Rehabilitation. Arch Phys Med Rehabil 2019; 100:1131-1139.e87. [PMID: 30240594 PMCID: PMC6422764 DOI: 10.1016/j.apmr.2018.08.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/30/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To establish benchmarks of significant change for aphasia rehabilitation outcome measures (ie, Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differ across subgroups (ie, time post onset, dose frequency, treatment type). DATA SOURCES A comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice materials was conducted. STUDY SELECTION Randomized controlled trials, quasi-experimental studies, single-subject design, and case studies that used a standardized outcome measure to assess change were included. Titles and full-text articles were screened using a dual review process. Seventy-eight studies met criteria for inclusion. DATA EXTRACTION Data were extracted independently, and 25% of extractions were checked for reliability. All included studies were assigned quality indicator ratings and an evidence level. DATA SYNTHESIS Random-effects meta-analyses were conducted separately for each study design group (ie, within-/between-group comparisons). For within-group designs, the summary effect size after aphasia rehabilitation was 5.03 points (95% confidence interval, 3.95-6.10, P<.001) on the WAB-AQ, 10.37 points (6.08-14.66, P<.001) on the CETI, and 3.30 points (2.43-4.18, P<.001) on the BNT. For between-group designs, the summary effect size was 5.05 points (1.64-8.46, P=.004) on the WAB-AQ and 0.55 points (-1.33 to 2.43, P=.564) on the BNT, the latter of which was not significant. Subgroup analyses for the within-group designs showed no significant differences in the summary effect size as a function of dose frequency or treatment type. CONCLUSIONS This study established benchmarks of significant change on 3 standardized outcome measures used in aphasia rehabilitation.
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Affiliation(s)
- Natalie Gilmore
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA.
| | - Michaela Dwyer
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Swathi Kiran
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
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Combiths PN, Barlow JA, Richard JT, Pruitt-Lord SL. Treatment Targets for Co-Occurring Speech-Language Impairment: A Case Study. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2019; 4:240-256. [PMID: 31214657 PMCID: PMC6581461 DOI: 10.1044/2019_pers-sig1-2018-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The intersection of speech and language impairments is severely understudied. Despite repeatedly documented overlap and co-occurrence, treatment research for children with combined phonological and morphosyntactic deficits is limited. Especially little is known about optimal treatment targets for combined phonological-morphosyntactic intervention. We offer a clinically focused discussion of the existing literature pertaining to interventions for children with combined deficits and present a case study exploring the utility of a complex treatment target in word-final position for co-occurring speech and language impairment. METHOD Within a school setting, a kindergarten child (age 5;2) with co-occurring phonological disorder and developmental language disorder received treatment targeting a complex consonant cluster in word-final position inflected with third-person singular morphology. RESULTS For this child, training a complex consonant cluster in word-final position resulted in generalized learning to untreated consonants and clusters across word positions. However, morphological generalization was not demonstrated consistently across measures. CONCLUSION These preliminary findings suggest that training complex phonology in word-final position can result in generalized learning to untreated phonological targets. However, limited improvement in morphology and word-final phonology highlights the need for careful monitoring of cross-domain treatment outcomes and additional research to identify the characteristics of treatment approaches, techniques, and targets that induce cross-domain generalization learning in children with co-occurring speech-language impairment.
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Lee J, Hosokawa E, Meehan S, Martin N, Branigan HP. Priming sentence comprehension in aphasia: Effects of lexically independent and specific structural priming. APHASIOLOGY 2019; 33:780-802. [PMID: 31814655 PMCID: PMC6897506 DOI: 10.1080/02687038.2019.1581916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Impaired message-structure mapping results in deficits in both sentence production and comprehension in aphasia. Structural priming has been shown to facilitate syntactic production for persons with aphasia (PWA). However, it remains unknown if structural priming is also effective in sentence comprehension. We examined if PWA show preserved and lasting structural priming effects during interpretation of syntactically ambiguous sentences and if the priming effects occur independently of or in conjunction with lexical (verb) information. METHODS Eighteen PWA and 20 healthy older adults (HOA) completed a written sentence-picture matching task involving the interpretation of prepositional phrases (PP; the chef is poking the solider with an umbrella) that were ambiguous between high (verb modifier) and low attachment (object noun modifier). Only one interpretation was possible for prime sentences, while both interpretations were possible for target sentences. In Experiment 1, the target was presented immediately after the prime (0-lag). In Experiment 2, two filler items intervened between the prime and the target (2-lag). Within each experiment, the verb was repeated for half of the prime-target pairs, while different verbs were used for the other half. Participants' off-line picture matching choices and response times were measured. RESULTS After reading a prime sentence with a particular interpretation, HOA and PWA tended to interpret an ambiguous PP in a target sentence in the same way and with faster response times. Importantly, both groups continued to show this priming effect over a lag (Experiment 2), although the effect was not as reliable in response times. However, neither group showed lexical (verb-specific) boost on priming, deviating from robust lexical boost seen in the young adults of prior studies. CONCLUSIONS PWA demonstrate abstract (lexically-independent) structural priming in the absence of a lexically-specific boost. Abstract priming is preserved in aphasia, effectively facilitating not only immediate but also longer-lasting structure-message mapping during sentence comprehension.
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Baliki MN, Babbitt EM, Cherney LR. Brain network topology influences response to intensive comprehensive aphasia treatment. NeuroRehabilitation 2018; 43:63-76. [DOI: 10.3233/nre-182428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marwan N. Baliki
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edna M. Babbitt
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Leora R. Cherney
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Dick J, Fredrick J, Man G, Huber JE, Lee J. Sentence production in Parkinson's disease. CLINICAL LINGUISTICS & PHONETICS 2018; 32:804-822. [PMID: 29494261 DOI: 10.1080/02699206.2018.1444791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
While growing evidence reports changes in language use in non-demented individuals with Parkinson's disease (PD), the presence and nature of the deficits remain largely unclear. Researchers have proposed that dysfunctioning fronto-basal ganglia circuit results in impaired grammatical processes, predicting qualitatively similar language impairments between individuals with PD and agrammatic Broca's aphasia, whereas others suggest that PD is not associated with language-specific grammatical impairment. In addition, there is a paucity of research examining syntactic production in PD at the sentence-level. This study examined sentence production of individuals with PD, healthy older adults, and individuals with agrammatic Broca's aphasia. In Experiment 1, using a Cinderella story-telling task, proportion of grammatical sentences, number of embedded clauses and production of verb arguments in sentences were examined. In Experiment 2, a structured sentence elicitation task was used in which syntactic complexity of sentences (canonical vs. non-canonical word order) was systematically manipulated while minimizing demands for non-syntactic processing. Only the participants with agrammatic Broca's aphasia showed significantly impaired syntactic production in both experiments. Participants with PD did not show impaired syntactic production in either task, despite impairments in lexical retrieval, repetition of words and sentences, and speech production. These findings suggest that impaired syntactic processing may not be a core deficit underlying the changes in language use in non-demented PD. Changes in language use in PD are qualitatively different from language deficits in aphasia.
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Affiliation(s)
- Jessica Dick
- a Department of Speech, Language, and Hearing Sciences , Purdue University , West Lafayette , IN , USA
| | - Jennifer Fredrick
- a Department of Speech, Language, and Hearing Sciences , Purdue University , West Lafayette , IN , USA
| | - Grace Man
- a Department of Speech, Language, and Hearing Sciences , Purdue University , West Lafayette , IN , USA
| | - Jessica E Huber
- a Department of Speech, Language, and Hearing Sciences , Purdue University , West Lafayette , IN , USA
| | - Jiyeon Lee
- a Department of Speech, Language, and Hearing Sciences , Purdue University , West Lafayette , IN , USA
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Crosson B, Hampstead BM, Krishnamurthy LC, Krishnamurthy V, McGregor KM, Nocera JR, Roberts S, Rodriguez AD, Tran SM. Advances in neurocognitive rehabilitation research from 1992 to 2017: The ascension of neural plasticity. Neuropsychology 2017; 31:900-920. [PMID: 28857600 DOI: 10.1037/neu0000396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The last 25 years have seen profound changes in neurocognitive rehabilitation that continue to motivate its evolution. Although the concept of nervous system plasticity was discussed by William James (1890), the foundation for experience-based plasticity had not reached the critical empirical mass to seriously impact rehabilitation research until after 1992. The objective of this review is to describe how the emergence of neural plasticity has changed neurocognitive rehabilitation research. METHOD The important developments included (a) introduction of a widely available tool that could measure brain plasticity (i.e., functional MRI); (b) development of new structural imaging techniques that could define limits of and opportunities for neural plasticity; (c) deployment of noninvasive brain stimulation to leverage neural plasticity for rehabilitation; (d) growth of a literature indicating that exercise has positively impacts neural plasticity, especially for older persons; and (e) enhancement of neural plasticity by creating interventions that generalize beyond the boundaries of treatment activities. Given the massive literature, each of these areas is developed by example. RESULTS The expanding influence of neural plasticity has provided new models and tools for neurocognitive rehabilitation in neural injuries and disorders, as well as methods for measuring neural plasticity and predicting its limits and opportunities. Early clinical trials have provided very encouraging results. CONCLUSION Now that neural plasticity has gained a firm foothold, it will continue to influence the evolution of neurocognitive rehabilitation research for the next 25 years and advance rehabilitation for neural injuries and disease. (PsycINFO Database Record
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Affiliation(s)
- Bruce Crosson
- Veterans Affairs Rehabilitation Research and Development Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center
| | - Benjamin M Hampstead
- Neuropsychology Section, Department of Mental Health Services, Veterans Affairs Ann Arbor Healthcare Systems
| | | | | | | | | | | | - Amy D Rodriguez
- Atlanta Veterans Affairs Rehabilitation Research and Development Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center
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Mack JE, Thompson CK. Recovery of Online Sentence Processing in Aphasia: Eye Movement Changes Resulting From Treatment of Underlying Forms. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1299-1315. [PMID: 28474086 PMCID: PMC5755549 DOI: 10.1044/2016_jslhr-l-16-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/06/2016] [Accepted: 11/07/2016] [Indexed: 05/03/2023]
Abstract
Purpose The present study tested whether (and how) language treatment changed online sentence processing in individuals with aphasia. Method Participants with aphasia (n = 10) received a 12-week program of Treatment of Underlying Forms (Thompson & Shapiro, 2005) focused on production and comprehension of passive sentences. Before and after treatment, participants performed a sentence-picture matching task with active and passive sentences as eye movements were tracked. Twelve age-matched controls also performed the task once each. Results In the age-matched group, eye movements indicated agent-first predictive processing after hearing the subject noun, followed by rapid thematic reanalysis after hearing the verb form. Pretreatment eye movements in the participants with aphasia showed no predictive agent-first processing, and more accurate thematic analysis in active compared to passive sentences. After treatment, which resulted in improved offline passive sentence production and comprehension, participants were more likely to respond correctly when they made agent-first eye movements early in the sentence, showed equally reliable thematic analysis in active and passive sentences, and were less likely to use a spatially based alternative response strategy. Conclusions These findings suggest that treatment focused on improving sentence production and comprehension supports the emergence of more normal-like sentence comprehension processes.
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Affiliation(s)
- Jennifer E Mack
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, ILCognitive Neurology and Alzheimer's Disease Center, Northwestern University, Evanston, ILDepartment of Neurology, Northwestern University, Evanston, IL
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Johnson JP, Ross K, Kiran S. Multi-step treatment for acquired alexia and agraphia (Part I): efficacy, generalisation, and identification of beneficial treatment steps. Neuropsychol Rehabil 2017; 29:534-564. [PMID: 28421858 DOI: 10.1080/09602011.2017.1311271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Reading and writing impairments are common in individuals with post-stroke aphasia. Treatment typically aims to improve the function of one of these modalities by strengthening aspects of either lexical or sublexical processing. In the present study, eight adults with acquired alexia and agraphia were administered a comprehensive treatment targeting specific lexical and sublexical processes underlying reading and/or writing. Two participants were trained in reading and six were trained in writing. Throughout treatment, reading and writing accuracy were monitored for trained items, as well as untrained but orthographically and semantically related items. Linear mixed effects models indicated that the most substantial gains were made on trained items in the trained modality; generalisation to trained items in the untrained modality and untrained but related items in both modalities was also observed. Participants improved significantly on a subset of treatment steps intended to address lexical access and representations, sublexical conversion mechanisms, and the graphemic and/or phonological buffer processes in both modalities. These results demonstrate the efficacy of a novel, comprehensive treatment protocol and suggest that targeting multiple reading and writing processes in conjunction may facilitate widespread generalisation.
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Affiliation(s)
- Jeffrey P Johnson
- a Department of Speech, Language & Hearing Sciences , Boston University , Boston , USA
| | - Katrina Ross
- a Department of Speech, Language & Hearing Sciences , Boston University , Boston , USA
| | - Swathi Kiran
- a Department of Speech, Language & Hearing Sciences , Boston University , Boston , USA
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Mack JE, Nerantzini M, Thompson CK. Recovery of Sentence Production Processes Following Language Treatment in Aphasia: Evidence from Eyetracking. Front Hum Neurosci 2017; 11:101. [PMID: 28348524 PMCID: PMC5346573 DOI: 10.3389/fnhum.2017.00101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/20/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction: Sentence production impairments in aphasia often improve with treatment. However, little is known about how cognitive processes supporting sentence production, such as sentence planning, are impacted by treatment. Methods: The present study used eyetracking to examine changes in sentence production resulting from a 12-week language treatment program focused on passive sentences (Treatment of Underlying Forms (TUF); Thompson and Shapiro, 2005). In two pre-treatment and two post-treatment sessions, nine participants with mild-to-moderate agrammatic aphasia performed a structural priming task, which involved repeating primed sentences (actives or passives) and then, using the same verb, producing sentences describing pictured events. Two individuals with aphasia performed the eyetracking task on the same schedule without intervening language treatment. Ten unimpaired older adults also performed the task to identify normal performance patterns. Sentence production accuracy and speech onset latencies were examined, and eye movements to the pictured Agent and Theme characters were analyzed in the first 400 ms after picture onset, reflecting early sentence planning, and in the regions preceding the production of the sentence subject and post-verbal noun, reflecting lexical encoding. Results: Unimpaired controls performed with high accuracy. Their early eye movements (first 400 ms) indicated equal fixations to the Agent and Theme, consistent with structural sentence planning (i.e., initial construction of an abstract structural frame). Subsequent eye movements occurring prior to speech onset were consistent with encoding of the correct sentence subject (i.e., the Agent in actives, Theme in passives), with encoding of the post-verbal noun beginning at speech onset. In participants with aphasia, accuracy improved significantly with treatment, and post-treatment (but not pre-treatment) eye movements were qualitatively similar to those of unimpaired controls, indicating correct encoding of the Agent and Theme nouns for both active and passive sentences. Analysis of early eye movements also showed a treatment-induced increase in structural planning. No changes in sentence production accuracy or eye movements were found in the aphasic participants who did not receive treatment. Conclusion: These findings indicate that treatment improves sentence production and results in the emergence of normal-like cognitive processes associated with successful sentence production, including structural planning.
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Affiliation(s)
- Jennifer E Mack
- Department of Communication Sciences and Disorders, Northwestern University Evanston, IL, USA
| | - Michaela Nerantzini
- Department of Communication Sciences and Disorders, Northwestern University Evanston, IL, USA
| | - Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern UniversityEvanston, IL, USA; Cognitive Neurology and Alzheimer's Disease Center, Northwestern UniversityEvanston, IL, USA; Department of Neurology, Northwestern UniversityEvanston, IL, USA
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