Comprehension of Single Versus Combined Modality Information by People With Aphasia

A Mixed-Methods Exploration of the Experience of People With Aphasia Using Text-to-Speech Technology to Support Virtual Book Club Participation

PURPOSE

This mixed-methods research sought to examine the experience of people with aphasia who used text-to-speech (TTS) support to read a novel for virtual book club participation.

METHOD

Six people with chronic aphasia used a TTS system to review portions of a novel about which they conversed during eight virtual book club meetings occurring over 5 weeks. During one-on-one interactions prior to each meeting, participants answered comprehension questions and provided feedback about reading experiences. Then, during group meetings, they reviewed and discussed relevant book content and predicted upcoming content. During a structured individual interview, participants reflected on their supported reading and book club experience.

RESULTS

Participants reported a range of reading confidence prior to study participation, mostly influenced by decreased comprehension or reading speed. After book club participation, four participants expressed increased confidence. Some reported searching for key words and skipping difficult words as strategies additional to TTS support. All reviewed at least some book sections more than once either with or without TTS support. Highly motivated participants expressed low frustration and high reading ease and enjoyment. Perceived comprehension was roughly consistent with actual comprehension across participants. Most believed TTS support promoted faster reading than otherwise possible. Participants liked adjustable features affecting speech output rate, word or sentence highlighting, and font size. Psychosocial benefits included decreased isolation and increased friendship.

CONCLUSIONS

The findings extend previous evidence about perceived and actual benefits associated with TTS support. People with aphasia express positive experiences when given TTS support during book club participation.

Neuroanatomical correlates of macrostructural receptive abilities in narrative discourse in unilateral left hemisphere stroke: A behavioural and voxel-based morphometry study

BACKGROUND

Little is known about story retelling and comprehension abilities in groups with lower levels of education and socio-economic status (SES). A growing body of evidence suggests the role of an extended network supporting narrative comprehension, but few studies have been conducted in clinical populations, even less in developing countries.

AIMS

To extend our knowledge of the impact of a stroke on macrostructural aspects of discourse processes, namely main and complementary information, in individuals with middle-low to low SES and low levels of education. Relationships were tested between the performance in story retell and comprehension and reading and writing habits (RWH). Also, the associations between retelling and comprehension measures and their structural grey matter (GM) correlates were explored.

METHODS & PROCEDURES

A total of 17 adults with unilateral left hemisphere (LH) chronic ischaemic stroke without the presence of significant aphasia and 10 matched (age, education and SES) healthy controls (HC) participated in the study. Retell and comprehension tasks were performed after listening or reading narrative stories. Voxel-based morphometry (VBM) analysis was conducted on a subgroup of nine individuals with LH stroke and the 10 matched controls using structural magnetic resonance imaging (MRI).

OUTCOMES & RESULTS

Retelling and comprehension abilities were not significantly different between LH and HC, nonetheless quantitively lower in LH. Exploratory correlations showed that retelling and comprehension abilities in both written and auditory modalities were correlated with naming abilities. At the neural level, written comprehension positively correlated with GM density of the LH, including areas in the temporal pole, superior and middle temporal gyrus as well as the orbitofrontal cortex, precentral and postcentral gyri. Auditory narrative comprehension was associated with GM density of the lingual gyrus in the right hemisphere.

CONCLUSIONS & IMPLICATIONS

The present results suggest that retelling and comprehension of auditory and written narratives are relatively well-preserved in individuals with a LH stroke without significant aphasia, but poorer than in HC. The findings replicate previous studies conducted in groups with higher levels of education and SES both at the behavioural and neural levels. Considering that naming seems to be associated with narrative retell and comprehension in individuals with lower SES and education, this research provides evidence on the importance of pursuing further studies including larger samples with and without aphasia as well as with various SES and education levels.

WHAT THIS PAPER ADDS

What is already known on this subject Story retell and comprehension of auditory and written discourse have been shown to be affected after stroke, but most studies have been conducted on individuals with middle to high SES and high educational levels. What this paper adds to existing knowledge The study reports on narrative retell and comprehension in both auditory and written modalities in groups of HC and individuals with LH brain damage, with low-to-middle SES and lower levels of education. What are the potential or actual clinical implications of this work? This study highlights the importance of taking into consideration the sociodemographic and RWH of patients when assessing discourse retell and comprehension in both auditory and written modalities. It also underlines the importance of including patients without significant aphasia following LH stroke to look at the effect of both stroke and aphasia on narrative comprehension and story retelling.

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

BACKGROUND

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

AIMS

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

METHOD AND PROCEDURE

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

OUTCOMES AND RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

AIMS

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

METHOD AND PROCEDURE

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

CONCLUSIONS

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

Reading Comprehension and Processing Time When People With Aphasia Use Text-to-Speech Technology With Personalized Supports and Features

BACKGROUND

Person-centered approaches promote consistent use of supportive technology and feelings of empowerment for people with disabilities. Feature personalization is an aspect of person-centered approaches that can affect the benefit people with aphasia (PWA) derive from using text-to-speech (TTS) technology as a reading support.

AIMS

This study's primary purpose was to compare the comprehension and processing time of PWA when performing TTS-supported reading with preferred settings for voice, speech output rate, highlighting type, and highlighting color versus unsupported reading. A secondary aim was to examine initial support and feature preference selections, preference changes following TTS exposure, and anticipated functional reading activities for utilizing TTS technology.

METHOD AND PROCEDURE

Twenty PWA read passages either via written text or text combined with TTS output using personally selected supports and features. Participants answered comprehension questions, reevaluated their preference selections, and provided feedback both about feature selections and possible future TTS technology uses.

OUTCOMES AND RESULTS

Comprehension accuracy did not vary significantly between reading conditions; however, processing time was significantly less in the TTS-supported condition, thus suggesting TTS support promoted greater reading speed without compromising comprehension. Most participants preferred the TTS condition and several anticipated benefits when reading lengthy and difficult materials. Alterations to initial settings were relatively rare.

CONCLUSIONS

Personalizing TTS systems is relevant to person-centered interventions. Reading with desired TTS system supports and features promotes improved reading efficiency by PWA compared with reading without TTS support. Attending to client preferences is important when customizing and implementing TTS technology as a reading support.

Reading behaviors and text-to-speech technology perceptions of people with aphasia

People with aphasia often have reading impairments that affect participation in daily activities. Text-to-speech (TTS) devices are technology-based supports that can facilitate processing of written materials. The purpose of this study was to gather information about the reading behaviors and TTS technology perceptions of people with aphasia who had first learned about system features and options. Sixteen people with chronic aphasia participated in single, one-on-one instructional and guided practice sessions using TTS systems. They answered close-ended questions about current reading behaviors and materials and ways they believed these would change given TTS system access. Participants reported reading at home and community locations. Most read calendars, newspapers, magazines, and mail. Participants who did not read lengthy materials - such as newspapers, magazines, and novels - indicated their interest in these materials would likely increase given TTS support. Although participants did not predict substantial comprehension changes given TTS support, most expressed interest in the technology after learning about it. Thus, people with aphasia perceive TTS systems as helpful for comprehending lengthy materials. Given modest predictions about comprehension benefits, presenting TTS as one of several support strategies is an appropriate recommendation.

Perceptions of people with aphasia about supporting reading with text-to-speech technology: A convergent mixed methods study

INTRODUCTION

Text-to-speech (TTS) technology is a possible reading support for people with aphasia; however, adoption for functional reading remains rare, and people with aphasia may have limited knowledge about TTS. Given this situation coupled with inherent communication challenges associated with aphasia, the purpose of this convergent mixed methods study was to explore the perceptions of participants about desired features, benefits, and drawbacks of TTS technology after having engaged in one-on-one education and guided practice activities.

METHODS

Nineteen adults with chronic aphasia completed a single education and guided practice session followed by close-ended questions and participation in a semi-structured interview to explain preferences, concerns, beliefs, and opinions about potential TTS technology benefits and drawbacks. Three participants had previously used TTS technology for functional reading; all others had some prior exposure but did not use a system for functional purposes.

RESULTS

Seventeen of 19 participants expressed TTS technology interest after education and guided practice activities. Participants endorsed selection of a preferred voice, control of speech output rate, and highlighting as priority features. Frequently endorsed benefits were improved comprehension and increased reading independence; some participants believed they would succeed in reading a greater variety of materials, communicate more with others, participate in more reading activities, and/or read faster. The greatest concern was mastering device operation; other concerns related to understanding the voice output, needing another person's help for system use, and matching the speech output rate to a preferred reading rate.

CONCLUSIONS

Overall, most participants had positive perceptions about possible benefits afforded by TTS technology. Practitioners need to provide opportunities for people with aphasia to learn about and explore TTS systems to determine whether adoption is desired.

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

BACKGROUND

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

AIMS

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

METHODS & PROCEDURES

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

MAIN CONTRIBUTION

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

CONCLUSIONS

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

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

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

Book Club Experiences, Engagement, and Reading Support Use by People With Aphasia

Background People with chronic aphasia often exhibit a decrease in social engagement and reading ability that negatively influences quality of life. Book clubs can provide a supportive environment that facilitates both socialization and reading. However, limited data exist examining the use of book clubs for individuals with chronic aphasia. Purpose The purpose of this qualitative descriptive study was to describe the experiences, engagement, and reading supports used by people with aphasia participating for the 1st time in a book club. Method and Procedure Ten people with chronic aphasia and co-occurring reading deficits engaged in 7 book club sessions. Participants first completed a questionnaire about pre- and poststroke reading experiences. Individualized interviews with participants during and post-book club explored the experiences, preferences, and reading comprehension strategies used within the structure of the book club. Results Three main categories of findings emerged from the data analysis: (a) perceived changes in attitudes regarding reading and club participation post-book club, (b) variations in use of reading supports and strategies across participants, and (c) perceived social benefits of the book club. Conclusion The current study provides evidence that people with varying types and severities of chronic aphasia and reading comprehension challenges can successfully increase reading and social engagement through book club participation. The results from this study highlight the need to provide evidence to support services that extend beyond standard rehabilitation protocols and identify engaging ways to facilitate active participation in functional reading activities for people with chronic aphasia.