Anomia in left hemisphere stroke, multiple sclerosis and Parkinson's disease - a comparative study

PURPOSE

To explore quantitative and qualitative features of anomia in participants with left-hemisphere stroke, Parkinson's disease, or multiple sclerosis.

MATERIALS AND METHODS

This descriptive cross-sectional study compares signs of anomia within and across participants (n = 87), divided into four groups; moderate to severe anomia after stroke (MSAS, n = 19), mild anomia after stroke (MAS, n = 22), PD (n = 19) and MS (n = 27). Aspects analysed include naming accuracy and speed, the nature of incorrect responses, semantic and phonemic verbal fluency, information content in re-telling, and the relationship between test results and self-reports on word-finding difficulties and communicative participation.

RESULTS

All groups had impaired verbal fluency, prolonged response times and reduced information content in re-telling. The MSAS group had significantly more signs of anomia than the other groups. Results from the other groups overlapped on a MAS-PD-MS continuum. Both semantically and phonologically incorrect responses were common in the stroke groups, while semantically incorrect ones predominated in the PD and MS groups. All four groups reported a similar negative impact on self-perceived communicative participation. Correlations between self-reports and test results were inconsistent.

CONCLUSIONS

Anomia features have quantitative and qualitative similarities and differences across neurological conditions.

Implementation of communication routines facilitating person-centred care in long-term residential care: A pilot study

BACKGROUND

Specific routines such as the development of personal communication plans can improve the interaction between people with communication disorders and healthcare staff.

OBJECTIVE

This pilot study explores a model for implementing communication routines including personal communication plans in long-term residential care.

DESIGN, SETTING AND PARTICIPANTS

This multiple case study includes two residential care facilities that differ in size and the number of languages spoken. Intervention or main variables studied implementation strategies involved workshops, individual coaching and follow-up visits. Main outcome measure implementation was assessed using goal attainment measurements, and the staff's views about facilitators and barriers to implementation were explored through structured interviews using the Theoretical Domains Framework.

RESULTS

The overall implementation success rate for the facilities was moderate, and one of the facilities showed promising results related to personal communication plans. Both facilities experienced barriers to implementation, including management problems and a lack of reminders. However, the two facilities seem to have different motivations for change.

DISCUSSION AND CONCLUSIONS

Regardless of the features of the facility, successful implementation requires stable and committed leadership. Moreover, experiences with language diversity may motivate staff to implement communication routines.

PATIENT OR PUBLIC CONTRIBUTION

The content of the implementation model used (i.e., choice of specific routines and implementation strategies) was coproduced by staff, managers and the researchers involved in this project. The staff and managers were responsible for the implementation of the new routines under the supervision of the researchers.

Naming vs. non-naming treatment in aphasia in a group setting-A randomized controlled trial

INTRODUCTION

Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting.

METHODS

In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication.

RESULTS

Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group.

CONCLUSIONS

Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.

Word-finding difficulties in Parkinson's disease: Complex verbal fluency, executive functions and other influencing factors

BACKGROUND

Persons with Parkinson's disease (PD) frequently report word-finding difficulties. Many of the established tests are, however, insufficient in detecting mild cases of such symptoms. Results from earlier research have suggested that controlled oral word association tests (COWATs) with high demands on cognitive processing resources could prove helpful in detecting the more subtle (language-related) problems seen in neurological disorders such as PD.

AIMS

First, to examine whether persons with PD (PwPD) differ in performance on different types of COWATs compared with non-brain-damaged controls. Second, to investigate possible relationships between executive functions and the novel complex oral semantic fluency (COSEF) task performance scores in the PwPD group. Third, to investigate whether age, years of education, severity of motor symptoms and self-perceived severity of word-finding difficulties influenced the COSEF task results.

METHODS & PROCEDURES

A total of 17 PwPD participated in the study. Their results were compared with a matched control group (n = 17) at both group and individual levels. One phonemic and two types of semantic COWATs were used. Correlations between the COSEF task and executive function results, age, education and severity of motor symptoms were analysed in the PwPD group.

OUTCOMES & RESULTS

The PwPD group had significantly lower scores on the COSEF task compared with the control group, but not on the other COWATs. A variation in the results was seen on an individual level. In the PwPD group, large significant correlations were seen between the COSEF task and verbally based tasks measuring working memory and cognitive flexibility. Both age and education, but neither self-perceived severity of word-finding difficulties nor motor symptoms, were correlated with the COSEF task result in the group of PwPD.

CONCLUSIONS & IMPLICATIONS

The results are in line with the predictions that a relatively more cognitive demanding COWAT such as the COSEF task could prove valuable when assessing word-finding difficulties in PD in research and clinical assessment.

WHAT THIS PAPER ADDS

What is already known on the subject Varying degrees of word-finding difficulties are a common symptom in PD and may affect everyday communication. Discreet word-finding difficulties can be hard to detect with the established language assessment tools. What this paper adds to existing knowledge This study adds insights into how PwPD perform on different types of COWATs compared with a control group. It also sheds light on the relationships between a novel, more cognitive complex COWAT and executive functions in PD. What are the potential or actual clinical implications of this work? More cognitively complex COWATs can contribute significantly to the assessment of discreet word-finding difficulties, but it is important to include a thorough anamnesis regarding language and communication in PwPD.

Person-centred care in speech-language therapy research and practice for adults: A scoping review

BACKGROUND

Person-centred care (PCC) has shown positive effects in various health-care settings and therefore is desirable in clinical work. However, as PCC is still being developed, the literature reflects a heterogeneous use of both terminology and conceptualisation. This lack of consistency hinders the implementation or adaptation of PCC in general and in select fields of practice such as speech-language therapy (SLT).

AIMS

To describe how the concept of PCC manifests in current speech and language therapy research and practice for adult patients.

METHODS & PROCEDURES

Searches for published literature were conducted in five databases (PubMed, Scopus, CINAHL, Psych INFO, and Linguistics and Language Behaviour Abstracts) using search terms related to PCC and SLT. Records were included if they involved an adult population, were written in English, and focused on PCC and SLT irrespective of year of publication.

MAIN CONTRIBUTION

A total of 134 records published 1996-2020 were included in this review. Many of these records were discussion papers that described how speech-language therapists (SLTs) can or should work in a person-centred way. The search did not find any records that explore the implementation, effects, or patients' views of person-centred SLT. This literature review revealed that person-centred SLT practice mainly relates to the International Classification of Functioning, Disability, and Health framework, and the Life Participation Approach to Aphasia. Studies incorporating exploration of proposed clinical routines of PCC demonstrate specific context-dependant aspects including barriers to eliciting a patient narrative, involving patient and family members, and documenting SLT.

CONCLUSIONS & IMPLICATIONS

This study provides information that can be used to implement person-centred care in SLT education, clinical practice, and research by providing an inventory of the current knowledge and the existing gaps.

WHAT IS ALREADY KNOWN ON THE SUBJECT

PCC has shown positive effects and is currently being implemented in various health-care settings worldwide.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This study provides an account of the current state in research and practice on how PCC for adults is described, discussed, and evaluated. While related concepts such as family-centred care have mainly been explored within paediatrics, little is known about how PCC manifests in SLT for adults. Our results show that PCC is presently being discussed and valued in SLT although obstacles exist, and few studies explore whether current practice is person centred and the potential effects of such practice. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: This study provides clinicians, researchers, and policymakers' guidance on what aspects to consider when working to implement person-centred SLT for adults.

Improving medical students' knowledge and skill in communicating with people with acquired communication disorders

PURPOSE

To explore the effects of an interactive workshop on medical students' knowledge and skill in communicating with people with acquired communication disorders.

METHOD

Sixty-nine medical students received a lecture on acquired communication disorders. Thirty-six of these students also participated in a workshop where they practised using supportive strategies in interaction with a simulated patient with aphasia. All students completed a questionnaire exploring attitudes, confidence in knowledge and ability to suggest suitable supportive strategies pre- and post-lecture/workshop and 15 students were video recorded when interacting with a simulated patient pre- and post-workshop.

RESULT

The results show no change in attitude in either student group, but both groups rated their confidence in knowledge as higher post-lecture/workshop. The students' ability to suggest supportive strategies post training was significantly higher only in the workshop group. Comparing post training results regarding knowledge and ability to suggest supportive strategies between the groups, higher ratings were found for the workshop group. The analysis of video recordings indicated that the students also used new supportive strategies and used strategies more frequently after the workshop.

CONCLUSION

An interactive workshop can improve medical students' knowledge and skills in communicating with people with acquired communication disorders.

Teaching medical students about communication in speech-language disorders: Effects of a lecture and a workshop

PURPOSE

This study aims to explore the effects of an interactive workshop involving speech-language pathology students on medical students' knowledge about communication in relation to speech-language disorders.

METHOD

Fifty-nine medical students received a lecture about speech-language disorders. Twenty-six of them also participated in a workshop on communication with patients with speech-language disorders. All students completed a 12-item questionnaire exploring knowledge and attitudes towards communication before and after the lecture or the workshop. The results from the two groups' self-ratings of confidence in knowledge were compared with expert-ratings of their ability to choose suitable communicative strategies.

RESULT

Both the lecture and the workshop increased the students' confidence in knowledge about speech-language disorders and how to support communication. Only the workshop group also displayed a statistically significant increase in expert-rated ability and changed their attitude regarding responsibility for the communication in cases of speech-language disorders. There were no statistically significant correlations between the student's own confidence ratings and the experts' ratings of ability.

CONCLUSION

Increased confidence in knowledge from learning is not always reflected in actual knowledge in how to communicate. However, an interactive workshop proved to increase medical students' expert-rated ability and attitudes related to communication in cases of speech-language disorders.

Participant characteristics and observed support in conversations involving people with communication disorders

PURPOSE

Communication partner training is an increasingly common approach to improve the possibilities for people with communication disorders to participate in everyday interaction. So far, though, little is known about what conversation partner characteristics might influence the ability to be a supportive partner in conversation. The current study explored possible associations between the observed skill to support a person with communication difficulties in conversation and the following characteristics of the conversation partner; executive function, inference ability, age, education level and relationship to the person with communication disorder. The impact of the aetiology of the communication difficulties was also explored.

METHOD

Thirty-five dyads participated: 23 people with aphasia along with 18 significant others and five enrolled nurses and 12 people with Parkinson's disease along with 10 significant others and two enrolled nurses.

RESULT

Only tendencies of associations were found between observed skill to support conversation and executive function for the significant others and inference ability for the enrolled nurses.

CONCLUSION

Although type of activity involved in the conversation may be a key factor, the results indicate that executive function and ability to make mental inferences may matter for the ability to support a person with communication disorder in conversation.

On the diverse outcome of communication partner training of significant others of people with aphasia: an experimental study of six cases

BACKGROUND

Communication partner training (CPT) has been shown to improve the communicative environment of people with aphasia. Interaction-focused training is one type of training that provides an individualized intervention to participants. Although shown to be effective, outcomes have mostly been evaluated in non-experimental case studies.

AIMS

The aim of the controlled experimental intervention study was to evaluate an individualized approach in a CPT programme directed to significant others of people with aphasia. Specifically the effects on conversation partners' ability to support the person with aphasia in conversation and on the individuals with aphasias' perception of their functional communication were explored.

METHODS & PROCEDURES

Six dyads consisting of a person with aphasia and a significant other were included in a replicated single-subject design with multiple baselines across individuals. The intervention followed the interaction-focused communication training programme included in Supporting Partners of People with Aphasia in Relationships and Conversation (SPARRC). The main elements of the training consisted of supervised viewing of the couples' own video-recorded natural interaction and the formulation of individual goals for the adaptation of particular communicative strategies. Outcome was measured via blinded ratings of filmed conversational interaction obtained once a week throughout the different phases of baseline, intervention and follow-up. A rating scale to assess overall quality of conversation was used, taking into account both transfer of information and social aspects of conversation. Measures of perceived functional communication in the persons with aphasia were also collected from the individuals with aphasia and their conversation partners.

OUTCOMES & RESULTS

The results were mixed, with two of the six participants showing small improvements in ability to support their partner with aphasia in conversation. Half the participants with aphasia and half the significant others reported improvements on perceived functional communication in the person with aphasia after intervention, but no changes were statistically significant.

CONCLUSIONS & IMPLICATIONS

This study adds to the growing body of research concerning CPT by pinpointing the importance of careful consideration regarding set-up of training, suitability of participants and evaluation of outcome.

Communicative barriers and resources in nursing homes from the enrolled nurses' perspective: A qualitative interview study

BACKGROUND AND OBJECTIVES

Managing communicative disability is a pervasive issue in long-term care facilities. The aim of this study was to explore how enrolled nurses experience their everyday interactions with residents in nursing homes, particularly focusing on interactions with residents with communicative disability.

DESIGN

A qualitative exploratory design including content analysis was used.

PARTICIPANTS AND SETTING

Eight individuals working at six nursing homes in western Sweden were interviewed.

METHOD

The interviews were semi-structured with questions about the participants' experiences in communicating with residents, feelings associated with interactions involving residents with communicative disability, meaning ascribed to interactions, and factors influencing interactions. The interviews were analysed using content analysis.

RESULTS

A dynamic interplay between interpersonal relations, daily interactions and the managing of communicative disability was revealed. The enrolled nurses had good knowledge of supportive strategies and an awareness of the importance of the development of personal relationships with residents in order to facilitate interaction. However, factors in the environment presented barriers to communication.

CONCLUSIONS/IMPLICATIONS

The organisation and physical environment of nursing homes prevent the enrolled nurses from taking full advantage of the communicative resources they have in interaction with residents with communicative disability, hence affecting staff-resident relationships and the delivery of person-centred care.

Problematic topic transitions in dysarthric conversation

PURPOSE

This study examined the nature of topic transition problems associated with acquired progressive dysarthric speech in the everyday conversation of people with motor neurone disease.

METHOD

Using conversation analytic methods, a video collection of five naturally occurring problematic topic transitions was identified, transcribed and analysed. These were extracted from a main collection of over 200 other-initiated repair sequences and a sub-set of 15 problematic topic transition sequences. The sequences were analysed with reference to how the participants both identified and resolved the problems.

RESULT

Analysis revealed that topic transition by people with dysarthria can prove problematic. Conversation partners may find transitions problematic not only because of speech intelligibility but also because of a sequential disjuncture between the dysarthric speech turn and whatever topic has come prior. In addition the treatment of problematic topic transition as a complaint reveals the potential vulnerability of people with dysarthria to judgements of competence.

CONCLUSION

These findings have implications for how dysarthria is conceptualized and how specific actions in conversation, such as topic transition, might be suitable targets for clinical intervention.

Semantic trouble sources and their repair in conversations affected by Parkinson's disease

BACKGROUND

It is known that dysarthria arising from Parkinson's disease may affect intelligibility in conversational interaction. Research has also shown that Parkinson's disease may affect cognition and cause word-retrieval difficulties and pragmatic problems in the use of language. However, it is not known whether or how these problems become manifest in everyday conversations or how conversation partners handle such problems.

AIMS

To describe the pragmatic problems related to the use of words that occur in everyday conversational interaction in dyads including an individual with Parkinson's disease, and to explore how interactants in conversation handle the problems to re-establish mutual understanding.

METHODS & PROCEDURES

Twelve video-recorded everyday conversations involving three couples where one of the individuals had Parkinson's disease were included in the study. All instances of other-initiated repair following a contribution from the people with Parkinson's disease were analysed. Those instances involving a trouble source relating to the use of words were analysed with a qualitative interaction analysis based on the principles of conversation analysis.

OUTCOMES & RESULTS

In 70% of the instances of other-initiated repair the trouble source could be related to the semantic content produced by the individual with Parkinson's disease. The problematic contributions were typically characterized by more or less explicit symptoms of word search or use of atypical wording. The conversation partners completed the repair work collaboratively, but typically the non-impaired individual made a rephrasing or provided a suggestion for what the intended meaning had been.

CONCLUSIONS & IMPLICATIONS

In clinical work with people with Parkinson's disease and their conversation partners it is important to establish what type of trouble sources occur in conversations in a specific dyad. It may often be necessary to look beyond intelligibility and into aspects of pragmatics to understand more fully the impact of Parkinson's disease on everyday conversational interaction.

Communicative strategies used by spouses of individuals with communication disorders related to stroke-induced aphasia and Parkinson's disease

BACKGROUND

A communicative disability interferes with the affected person's ability to take active part in social interaction, but non-disabled communication partners may use different strategies to support communication. However, it is not known whether similar strategies can be used to compensate for different types of communicative disabilities, nor what factors contribute to the development of a particular approach by communication partners.

AIMS

To develop a set of categories to describe the strategies used by communication partners of adults who have problems expressing themselves due to neurogenic communicative disabilities. The reliability of assessment was a particular focus.

METHODS & PROCEDURES

The material explored consisted of 21 video-recorded everyday conversations involving seven couples where one spouse had a communicative disability. Three of the dyads included a person with dysarthria and anomia related to later stages of Parkinson's disease, while four of them included a person with stroke-induced aphasia involving anomia. First a qualitative interaction analysis was performed to explore the strategies used by the communication partners when their spouses had problems expressing themselves. The strategies were then categorized, the reliability of the categorizations was explored and the relative frequency of the various strategies was examined.

OUTCOMES & RESULTS

The analysis of the conversational interactions resulted in a set of nine different strategies used by the communication partners without a communicative disability. Each of these categories belonged to one of three overall themes: No participation in repair; Request for clarification or modification; and Providing candidate solutions. The reliability of the categorization was satisfactory. There were no statistically significant differences between diagnoses in the frequency of use of strategies, but the spouses of the persons with Parkinson's disease tended to use open-class initiations of repair more often than the spouses of the persons with aphasia.

CONCLUSIONS & IMPLICATIONS

The types of strategies used by spouses of persons with neurogenic communicative disabilities seem to be more strongly associated with individual characteristics of communicative ability than with the type of disorder involved. The set of categories developed in this study needs to be trialled on larger groups of participants, and modified if and as necessary, before it can be regarded as a valid system for the description of such strategies in general. Once this has been done it may become a useful instrument in the assessment of the strategies used by communication partners of individuals with communicative disabilities.

Perceived changes in communicative interaction in atypical parkinsonism

The aim of this study was to examine if atypical parkinsonism affects the communicative ability in conversational interaction. Fifteen persons close to individuals with atypical parkinsonism answered a questionnaire, “Assessment of Change in Communicative Interaction” (ACCI), estimating perceived change in interactive skills compared to before the onset of the disease. The study also examined if perceived change correlated with disease duration. The results showed that at group level, the participants experienced change in many aspects of conversational interaction, particularly regarding the affected person's speech, body communication, response latency, phrase length, word finding, and ability to make themselves understood. There was no correlation between perceived change and disease duration. In conclusion, results indicated that the communicative interaction of individuals with atypical parkinsonism is significantly affected and that information elicited from significant others can help define specific problem areas or foci of concern that need to be targeted in communicative intervention or at least considered in interaction with these persons.

Comprehension of complex discourse in different stages of Huntington's disease

BACKGROUND

Huntington's disease not only affects motor speech control, but also may have an impact on the ability to produce and understand language in communication.

AIMS

The ability to comprehend basic and complex discourse was investigated in three different stages of Huntington's disease.

METHODS & PROCEDURES

In this experimental group study, 18 patients with Huntington's disease completed a test that assessed basic language abilities as well as tests from a battery of tasks that explored the ability to comprehend more complex information. The test battery assessed the ability to comprehend logico-grammatical sentences, ambiguous information and inferred meaning on sentence and discourse levels.

OUTCOMES & RESULTS

In comparison with results from pair-matched participants in a control group, matched for gender, age and education, the group of individuals with Huntington's disease had significantly more problems with all tasks requiring more complex cognitive processing. There was a correlation, as well as tendencies towards correlations, between results in the group of individuals with Huntington's disease and stage of the disease. However, results within the stage groups were heterogeneous, and some individuals in an early stage of the disease sometimes performed as well as others in a late stage.

CONCLUSIONS & IMPLICATIONS

It is likely that, in complex discourse tasks, individual differences in cognitive capacity may contribute and override other differences related to stage of disease. These results indicate that it is important to assess comprehension even in early stages of Huntington's disease, with tests that are sensitive to subtle language disorders, to reduce communication problems for the individuals concerned and their conversational partners.

Inference in right hemisphere damaged individuals' comprehension: the role of sustained attention

The ability to make inferences for the purposes of comprehension is considered an important factor in pragmatic ability. In this experimental group study with stroke patients, the ability to make inferences and its associations with sustained attention and verbal working memory were explored. A group of 14 left-hemisphere-damaged individuals had more difficulty with tasks requiring the ability to revise inferences than a matched control group. Their results on those tasks tended to be associated with verbal working memory capacity. A group of 14 right-hemisphere-damaged (RHD) individuals also had problems in revising inferences, but their results were associated with sustained attention. In addition, the RHD subjects had problems in making inferences about characters' attitudes or motives. A lack of significant differences in results on tasks between the groups of brain damaged individuals indicate that comprehension of complex information might be impaired post stroke, irrespectively of whether the damage is to the left or right hemisphere. The results suggest that sustained attention, whilst not being a solitary sufficient factor, might somehow be involved in comprehension problems related to RHD. Implications for further research and clinical management of these sometimes subtle problems are discussed.