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Dutta M, Mohapatra B. Expanding the scope: multimodal dimensions in aphasia discourse analysis-preliminary findings. Front Hum Neurosci 2024; 18:1419311. [PMID: 39386283 PMCID: PMC11461255 DOI: 10.3389/fnhum.2024.1419311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/04/2024] [Indexed: 10/12/2024] Open
Abstract
Background Aphasia, resulting from acquired brain injury, disrupts language processing and usage, significantly impacting individuals' social communication and life participation. Given the limitations of traditional assessments in capturing the nuanced challenges faced by individuals with aphasia, this study seeks to explore the potential benefits of integrating multimodal communication elements into discourse analysis to better capture narrative proficiency in this population. Objective This study examined how incorporating multimodal communication elements (e.g., physical gestures, writing, drawing) into discourse analysis may affect the narrative outcomes of persons with aphasia compared to those observed using methods that exclude multimodal considerations. Methods Participants included individuals with chronic aphasia and age-and education-matched healthy controls who completed a storytelling task-the Bear and the Fly story. Macrolinguistic scores were obtained using verbal-only and multimodal scoring approaches. Additionally, the frequency and type of multimodal communication use during storytelling were examined in relation to aphasia characteristics. Statistical analyses included both within-group and between-group comparisons as well as correlational analyses. Results Individuals with aphasia scored significantly higher in terms of their macrolinguistic abilities when multimodal scoring was considered compared to verbal-only scoring. Within the aphasia group, there were prominent differences noted in macrolinguistic scores for both fluent and nonfluent aphasia. Specifically, both groups scored higher on Main Concepts when multimodal scoring was considered, with the nonfluent group demonstrating significantly higher Main Concept and total macrolinguistic rubric scores in multimodal scoring compared to verbal scoring on the storytelling task. Additionally, aphasia severity showed moderate positive correlations with total macrolinguistic scores, indicating that individuals with less severe aphasia tended to produce higher quality narratives. Lastly, although persons with aphasia used different types of nonverbal modalities (i.e., drawing, writing), the use of meaning-laden gestures was most predominant during storytelling, emphasizing the importance of multimodal elements in communication for individuals with aphasia. Conclusion Our preliminary study findings underscore the importance of considering multimodal communication in assessing discourse performance among individuals with aphasia. Tailoring assessment approaches based on aphasia subtypes can provide valuable insights into linguistic abilities and inform targeted intervention strategies for improving communication outcomes.
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Affiliation(s)
- Manaswita Dutta
- Department of Speech and Hearing Sciences, Portland State University, Portland, OR, United States
| | - Bijoyaa Mohapatra
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, United States
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Cavanaugh R, Dickey MW, Hula WD, Fromm D, Golovin J, Wambaugh J, Fergadiotis G, Evans WS. Determinants of Multilevel Discourse Outcomes in Anomia Treatment for Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3094-3112. [PMID: 39146383 PMCID: PMC11427423 DOI: 10.1044/2024_jslhr-24-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE Individuals with aphasia identify discourse-level communication (i.e., language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, are poorly understood, and vary greatly among individuals with aphasia. In response, this study consisted of a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis (SFA) clinical trials. Aim 1 evaluated changes in theoretically motivated discourse outcomes representing lexical-semantic processing, lexical diversity, grammatical complexity, and discourse informativeness. Aim 2 explored the potential moderating role of nonlanguage cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes. METHOD This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for n = 60 (Aim 1) and a subset n = 44 (Aim 2). Outcome measures included lexical-semantic processing (% semantic errors), lexical diversity (moving average type-token ratio), grammatical complexity (mean utterance length), and discourse informativeness (% correct information units). Bayesian generalized mixed-effects models were used to examine changes across four study time points: enrollment, entry, exit, and 1-month follow-up. RESULTS The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after SFA when measured using standard, general-topic discourse stimuli. There was weak and inconsistent evidence that nonlanguage cognitive factors may play a role in moderating treatment response. CONCLUSIONS These findings indicate a clear need to pair theoretically informed treatments designed to facilitate generalization to discourse with intentional measurement paradigms designed to capture it. Furthermore, there is a clear need to examine how established treatments, restorative or compensatory, can better facilitate generalization to discourse-level communication. These priorities are critical for meaningfully improving everyday communication and reducing the profound communication and psychosocial consequences of aphasia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26524081.
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Affiliation(s)
- Robert Cavanaugh
- Northeastern University, Portland, ME
- University of Pittsburgh, PA
- VA Pittsburgh Healthcare System, PA
| | | | - William D Hula
- University of Pittsburgh, PA
- VA Pittsburgh Healthcare System, PA
| | | | | | | | | | - William S Evans
- University of Pittsburgh, PA
- VA Pittsburgh Healthcare System, PA
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Sather TW, Strong KA. Supporting Participation Through Project-Based Intervention: A Tutorial for Working With People With Aphasia in Individual Sessions. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-14. [PMID: 39240835 DOI: 10.1044/2024_ajslp-24-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
PURPOSE Participation is an integral focus of services to people with aphasia and is considered best practice within the scope of practice for speech-language pathology. The Life Participation Approach to Aphasia encourages meaningful participation in life for people living with aphasia. In theory, providing participation-based services to people with aphasia seems logical; however, embedding these constructs of participation into practice can be challenging for speech-language pathologists (SLPs). Project-based intervention (PBI) provides an authentic opportunity to target participation and support identity reformulation in aphasia intervention. Historically, projects have been provided primarily in group-based settings, which may be difficult for the majority of SLPs who primarily offer individual sessions due to reimbursement. This tutorial provides a framework for using PBI in individual sessions for clients with aphasia using five evidence-based components: (a) shared decision making, (b) patient-reported outcomes, (c) goal setting, (d) the project, and (e) ongoing evaluation. Evidence-based tools and a case example are provided to support each component. CONCLUSIONS Projects and PBI provide tangible means of placing participation at the center of intervention while also providing opportunities to target language impairments, identity reconstruction, and various environments in a meaningful and personalized way. Projects can be scaled to the client's needs and abilities as well as to the constraints and options of the service delivery setting.
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Affiliation(s)
- Thomas W Sather
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
| | - Katie A Strong
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
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Dutta M, Murray LL, Stark BC. The Relationship Between Executive Functioning and Narrative Language Abilities in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-24. [PMID: 39116314 DOI: 10.1044/2024_ajslp-23-00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE Although individuals with aphasia commonly exhibit challenges in executive functioning (EF) and spoken discourse, there is limited research exploring connections between these abilities within this specific population. Therefore, this study investigated the relationship between verbal and nonverbal EF and narrative productions in aphasia using a multilevel linguistic approach. METHOD Participants included 22 persons with aphasia (PWA) and 24 age- and education-matched, neurologically healthy controls (NHC). All participants completed assessments for EF and a story retelling task. Narrative samples were analyzed for microlinguistic (productivity, lexical and syntactic features, semantic content, word and sentence errors) and macrolinguistic (coherence, informational content, organization, and language use) characteristics. Correlational analyses were employed to explore the relationships among narrative variables. EF factors, extracted from principal component analysis, were used as predictive variables in hierarchical stepwise regression analyses to evaluate their role in predicting narrative performances of PWA and NHC. RESULTS Relative to NHC, PWA exhibited impaired narrative performance affecting both microlinguistic and macrolinguistic levels. Breakdowns at the structural level (i.e., reduced productivity, syntax, lexical retrieval, and diversity) correlated with impaired story completeness, organization, and connectedness; this relationship was more prominent for PWA. Three EF factors representing (1) verbal EF, (2) verbal and nonverbal fluency, and (3) nonverbal EF were extracted. Factors 1 and 2 largely predicted narrative performance, whereas Factor 3 (i.e., nonverbal EF) contributed prominently to predicting macrolinguistic discourse performance in both groups although accounting for less variance in the data. Overall, lower EF scores, particularly verbal EF variables, predicted poor narrative performance in both groups. CONCLUSIONS Our results indicate that both linguistic and extralinguistic cognitive abilities play a role in story retelling performances among PWA. Notably, both verbal and nonverbal EF skills were found to be correlated with narrative abilities. However, the extent of their contributions varied depending on the discourse levels assessed. These findings provide a significant contribution to our understanding of the cognitive factors associated with breakdowns in discourse among PWA and highlight the importance of comprehensive assessment of EF and discourse within this population. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26485627.
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Affiliation(s)
- Manaswita Dutta
- Department of Speech and Hearing Sciences, Portland State University, OR
| | - Laura L Murray
- School of Communication Sciences and Disorders, Canadian Centre for Activity and Aging, Western University, London, Ontario
| | - Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Program for Neuroscience, Cognitive Science Program, Indiana University, Bloomington
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Dipper L, Devane N, Barnard R, Botting N, Boyle M, Cockayne L, Hersh D, Magdalani C, Marshall J, Swinburn K, Cruice M. A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study. PLoS One 2024; 19:e0304385. [PMID: 38875279 PMCID: PMC11178191 DOI: 10.1371/journal.pone.0304385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/10/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. OBJECTIVES This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. METHODS This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. RESULTS The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. CONCLUSIONS Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. TRIAL REGISTRATION Clinical trials registration: NCT05847023 (clinical trials.gov).
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Affiliation(s)
- Lucy Dipper
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Niamh Devane
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rachel Barnard
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Nicola Botting
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Mary Boyle
- Montclair State University, Montclair, New Jersey, United States of America
| | - Lin Cockayne
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Australia
| | - Carla Magdalani
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Jane Marshall
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Kate Swinburn
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Madeline Cruice
- Department of Language and Communication Science, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Whitworth A. Elizabeth Usher memorial lecture. Models, mind maps, and metacognition: How theory is the true hero. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:304-316. [PMID: 38982689 DOI: 10.1080/17549507.2024.2369146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Within the educational context of identifying the critical ingredients of an effective speech-language pathologist, this paper highlights the centrality of theory in underpinning every level of our practice. A spotlight is placed on us knowing how language and communication work, what makes our interventions work, how we can make the most difference through our choices in therapy, and what makes both us and our clients respond. So, what are the critical ingredients of an effective speech-language pathologist, of an effective therapy, of an effective therapeutic alliance, and why is this so important? While there are many foundational and guiding habits upon which new graduates, early career, and experienced clinicians shape their practice, no one habit is regarded as more important than us exploring the theoretical underpinnings of what we are doing and why. To underscore the role of theory in our everyday practice, a discourse level intervention for people with aphasia is used as an exemplar to track the complex contribution of different theories to a single intervention. Discourse level interventions are relatively new on the scene in the area of acquired language disorders. Child language interventions, on the other hand, have frequently revolved around the story, aiming to bridge the oral-literate divide through the development of narrative structure. This paper will aim to weave its own story around discourse level interventions, combining the narrative genre with the everyday genres used by adults in conversation. I will highlight how this approach taps into lexical theories, sentence processing theories, discourse organisation, and the cognitive underpinnings of language, and closely examine how this multilayering of language in context may hold some of the answers to questions around generalisation, impact, and making the greatest difference to individuals.
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Affiliation(s)
- Anne Whitworth
- Speech Pathology, School of Health Sciences, University of Tasmania, Launceston, Australia
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Wong WWS. Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test (CANELT): A functional approach. PLoS One 2024; 19:e0303810. [PMID: 38787889 PMCID: PMC11125462 DOI: 10.1371/journal.pone.0303810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA). METHOD CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted. RESULTS An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [χ2 (2) = 95.2, p < .001] and NI [χ2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's α of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained. CONCLUSIONS Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed.
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Affiliation(s)
- Winsy Wing Sze Wong
- Department of Chinese & Bilingual Studies, Faculty of Humanities, Hong Kong Polytechnic University, Hong Kong SAR
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Stark BC, Dalton SG. A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38520735 DOI: 10.1111/1460-6984.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND It is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians' and researchers' desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation. AIMS To use scoping review methodology to identify transcription-less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: 'What transcription-less tools and analysis procedures are available to assess discourse in people with aphasia?' and included several sub-questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties. METHODS The scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer-reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. 'Transcription-less' analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review. MAIN CONTRIBUTION An overview of the state of transcription-less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings. CONCLUSION Transcription-less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings. WHAT THIS PAPER ADDS What is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech-language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription-less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients' desired outcomes. However, little is known about the current state of transcription-less discourse analysis, blocking progress. What this paper adds to existing knowledge This study provides an overview of currently available transcription-less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription-less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro-structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription-less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription-less procedures are lacking psychometric data including information about validity and reliability. What are the potential or actual clinical implications of this work? Transcription-less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription-less discourse analysis to better monitor clients' desired treatment outcomes.
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Affiliation(s)
- Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Sarah Grace Dalton
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, Wisconsin, USA
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Deng BM, Gao J, Liang LS, Zhao JX, Lin F, Yin MY, Zheng HQ, Hu XQ. Discourse Task Type-Specific Linguistic Characteristics in Anomic Aphasia and Healthy Controls: Evidence From Mandarin-Chinese AphasiaBank. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:937-951. [PMID: 38266215 DOI: 10.1044/2023_ajslp-23-00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE This study was designed to examine the hypothesis that discourse task types influence language performance in Mandarin Chinese-speaking people and to reveal the discourse task-specific linguistic properties of persons with anomic aphasia compared to neurotypical controls. METHOD Language samples from persons with aphasia (n = 31) and age- and education-matched controls (n = 31) across four discourse tasks (sequential-picture description, single-picture description, story narrative, and procedural discourse) were collected from Mandarin AphasiaBank. Task-specific distributions of parts of speech were analyzed using mosaic plots. The main effects of tasks in each group and the between-group differences within each task for several typical linguistic variables were evaluated, including the mean length of utterance, tokens, moving-average type-token ratio, words per minute, propositional density, noun-verb ratio, noun percentage, and verb percentage. RESULTS The results revealed an impact of discourse tasks on most language variables in both groups. In the healthy controls, story narratives yielded the highest total words and lowest verb percentage. In the aphasia group, procedural discourse elicited the fewest total words and densest expressions, whereas their single-picture descriptions had the highest noun-verb ratio. For all tasks, the aphasia group performed worse than the control group in the mean length of utterance, tokens, moving-average type-token ratio, and words per minute. For noun-verb ratio, noun percentage, and verb percentage, only one task (i.e., single-picture description) showed significant between-group differences. CONCLUSION The selection of discourse tasks should be addressed in assessments and interventions for Mandarin Chinese-speaking individuals with aphasia to obtain more accurate and feasible outcomes.
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Affiliation(s)
- Bao-Mei Deng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Gao
- School of Rehabilitation Medicine, Nanjing Medical University, Jiangsu, China
- Sir Run Run Hospital, Nanjing Medical University, Jiangsu, China
| | - Li-Si Liang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia-Xin Zhao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Feng Lin
- School of Rehabilitation Medicine, Nanjing Medical University, Jiangsu, China
| | - Ming-Yu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hai-Qing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xi-Quan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Meier EL, Sheppard SM, Sebastian R, Berube S, Goldberg EB, Shea J, Stein CM, Hillis AE. Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke. Front Neurol 2023; 14:1288801. [PMID: 38145117 PMCID: PMC10744570 DOI: 10.3389/fneur.2023.1288801] [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: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown. Methods In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task. Results Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions. Discussion These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Shauna Berube
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Shea
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Colin M. Stein
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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Wei W, Jiang Z. A bibliometrix-based visualization analysis of international studies on conversations of people with aphasia: Present and prospects. Heliyon 2023; 9:e16839. [PMID: 37346333 PMCID: PMC10279826 DOI: 10.1016/j.heliyon.2023.e16839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
In recent years, there has been a rapid increase in the number of people with aphasia due to brain lesions worldwide, which has prompted researchers to carry out in-depth studies on the pathogenesis, inducement and prognosis of aphasia from neurology, clinical medicine, psychology and other disciplines. With the deepening of research and understanding of aphasia, it is generally believed that a single discipline can no longer meet the needs of the academic community. Therefore, multidisciplinary integration has emerged and achieved fruitful results. This paper, based on the biblioshiny package run by R, conducts bibliometric analysis on the international interdisciplinary research status of conversation and aphasia, predicts its future development direction, and provides reference for relevant domestic research from international source journals. The results indicate that led by Australia, the United Kingdom, the United States and other countries, the international conversational aphasia research has formed a complete system, and formed a "descriptive study of patients with language disorders" and "applied study of rehabilitation treatment". In the future, while continuing to focus on these two categories of research, the empathy ability of conversational partners and medical staff may be taken into account, in order to better contribute to improving patients' quality of life.
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Affiliation(s)
- Wei Wei
- Graduate School, Xi'an International Studies University, School of Foreign Studies, Xi'an Medical University, Xi'an, China
| | - Zhanhao Jiang
- School of Foreign Languages, Southeast University, Nanjing, China
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12
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Gallée J, Cartwright J, Volkmer A, Whitworth A, Hersh D. "Please Don't Assess Him to Destruction": The R.A.I.S.E. Assessment Framework for Primary Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:391-410. [PMID: 36763839 DOI: 10.1044/2022_ajslp-22-00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Speech-language pathologists (SLPs) assess people with primary progressive aphasia (PPA) through measurements of speech, language, communication, and well-being, with the aims of identifying challenges and strengths, monitoring change, and informing treatment directions and supports. The purpose of this clinical focus article is to highlight the necessity for person-centered assessment specific to PPA and to conceptualize a framework that acknowledges the multifaceted nature of assessment for this population. In this framework, the unique challenges posed by a diagnosis of PPA are addressed with the aim to provide practical guidance for clinicians and to support reflection on current practices. METHOD In clinical and research practice, assessment of people with PPA requires an ever-evolving approach that is centered on the client. In this clinical focus article, a discussion-based consensus process was used to synthesize authentic longitudinal experiences of people with PPA to explore assessment approaches, tools, and philosophies. RESULTS This analysis of person-centered assessment identifies seven essential components of assessment in PPA that set the foundation for the five steps of the R.A.I.S.E. Assessment framework. These components each contribute to a clear definition of assessment that reveals clients' competencies with a strengths-based focus; prioritizes the reciprocity of benefits; promotes dynamic assessment; and recognizes the complexity, evolution of assessment over time, and advocacy. CONCLUSIONS This clinical focus article takes a novel look at assessment in PPA by stepping away from assessment practices that focus on revealing deficits and decline and, instead, provides practical recommendations through the conceptualization of a PPA-specific assessment framework. The R.A.I.S.E. Assessment framework is grounded in principles of uplifting clients through person-centered assessment, keeps pace with best practice in PPA intervention, and contributes to a supportive experience for clients and families in the face of a progressive diagnosis over time.
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Affiliation(s)
- Jeanne Gallée
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Evergreen Speech & Hearing Clinic, Redmond, WA
| | - Jade Cartwright
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, United Kingdom
| | - Anne Whitworth
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Deborah Hersh
- Speech Pathology, School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Speech Pathology, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Allied Health Sciences and Practice, Adelaide University, South Australia, Australia
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Baker C, Foster AM, D'Souza S, Godecke E, Shiggins C, Lamborn E, Lanyon L, Kneebone I, Rose ML. Management of communication disability in the first 90 days after stroke: a scoping review. Disabil Rehabil 2022; 44:8524-8538. [PMID: 34919449 DOI: 10.1080/09638288.2021.2012843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. PURPOSE To explore the scope of literature for the management of communication disability in the first 90 days after stroke. MATERIALS AND METHODS A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). RESULTS A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). CONCLUSION A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.IMPLICATIONS FOR REHABILITATIONInterdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).
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Affiliation(s)
- Caroline Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia
| | - Abby M Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia.,School of Primary & Allied Health Care, Monash University, Melbourne, Australia
| | - Sarah D'Souza
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Health Sciences, University of East Anglia, Norwich, UK
| | - Edwina Lamborn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lucette Lanyon
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Ian Kneebone
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadlands, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Salis C, DeDe G. Sentence Production in a Discourse Context in Latent Aphasia: A Real-Time Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1284-1296. [PMID: 35363996 DOI: 10.1044/2022_ajslp-21-00232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to improve our understanding as to which factors determine online, spoken sentence production abilities of adults with latent aphasia in a discourse context. METHOD Discourse samples of the story of Cinderella elicited from AphasiaBank were analyzed with speech analysis software. Participants comprised people with latent and anomic aphasia as well as neurotypical controls (10 per group). Durations of pauses (silent and filled) were analyzed according to (a) the location they occurred (between or within sentences), (b) the syntactic complexity of sentences (simple, complex), and (c) sentence length (number of words). Statistical comparisons were conducted using mixed-effect models. RESULTS The two clinical groups (latent and anomic) differed from controls in the duration of pauses, both between and within sentences. Syntactic complexity did not exert an effect on either of the two clinical groups as compared with controls. As compared with controls, both clinical groups paused more before long in comparison with short sentences. CONCLUSION Reduction in processing speed, which affects the ability to simultaneously maintain multiple linguistic and other cognitive demands associated with planning and monitoring of utterances, is a major factor that compromises sentence production in spoken discourse in latent aphasia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19448726.
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Affiliation(s)
- Christos Salis
- Speech & Language Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gayle DeDe
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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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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Editorial: New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia. Brain Sci 2021; 11:brainsci11111508. [PMID: 34827507 PMCID: PMC8615359 DOI: 10.3390/brainsci11111508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023] Open
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