Prosodic perception in aphasia: a meta-analysis across functions, domains, and acoustic cues

ABSTRACTBackground: Images are essential materials for assessment and rehabilitation in aphasia. Psycholinguistic research has identified name agreement (the degree to which different people agree on a particular name for a particular image) to be a strong predictor of picture naming in healthy individuals in a wide variety of languages. Despite its significance in naming performance and its impact across linguistic families, studies investigating the effects of name agreement in neuropsychological populations are limited. Determining the impact of name agreement in neuropsychological populations can inform us about lexical processing, which in turn can aid in development of improved assessment and rehabilitation materials.Aims: To compare the naming accuracy and error profile in naming high versus low name agreement (HighNA and LowNA) images in people with aphasia (PWA) and in healthy Adults (HA).Methods & Procedures: Participants were 10 PWA and 21 age- and gender-matched HA. Stimuli were black-and-white line drawings of 50 HighNA images (e.g., acorn, bell) and 50 LowNA images (e.g., jacket, mitten). The image sets were closely matched on a range of image and lexical variables. Participants were instructed to name the drawings using single words. Responses were coded into exclusive categories: correct, hesitations, alternate names, visual errors, semantic errors and omissions.Outcomes and Results: HighNA images were named more accurately than LowNA images; the HA group had higher accuracy than the PWA group; there was a significant interaction in which the name agreement effect was stronger in HA than in PWA. In individual analyses, 7 of 10 PWA participants showed the group pattern of higher accuracies for HighNA, whilst 3 PWA did not. HighNA and LowNA images gave rise to more alternate names in HA than in PWA. There were also fewer visual errors, and more omissions, in PWA than in HA, but only for LowNA items.Conclusions: Name agreement produced measurable differences in naming accuracy for both HA and PWA. PWA shows a reduced effect of name agreement and exhibit a different pattern of errors, compared to healthy controls. We speculate that in picture naming tasks, lower name agreement increases competitive lexical selection, which is difficult for PWA to resolve. In preparation of clinical materials, we need to be mindful of image properties. Future research should replicate our findings in a larger population, and a broader range of pathologies, as well as determine the executive mechanisms underpinning name agreement effects.

Communication partner training delivered face-to-face and via telepractice with health professionals, health professional students and people with aphasia

Background Clinicians such as speech-language pathologists (SLPs) and neuropsychologists play a central role in the rehabilitation process of people with aphasia (PWA). Some studies, mostly from the Global North, have reported training, assessment, and treatment practices, as well as facilitators and barriers faced by clinicians working with PWA. However, less is known about these topics from the perspectives of clinicians working with PWA in the Global South. Understanding clinical practices in these countries can help to identify gaps in aphasia rehabilitation services and guide tailored implementation strategies to improve aphasia care in the Global South. This pilot study aims to contribute to this broader understanding by focusing on the experiences and perspectives of clinicians working with PWA in Colombia. Aims The current pilot study had three aims, to: 1) describe the aphasia training received and the training needs perceived by SLPs and neuropsychologists working with PWA in Colombia; 2) report the assessment and treatment practices used when working with PWA in Colombia; and 3) outline the main facilitators and barriers to providing rehabilitation services to PWA in Colombia Methods and Procedures Five SLPs and five neuropsychologists working with PWA in Colombia participated in this study. In-depth interviews were conducted to explore participants’ training, assessment, treatment practices, and perceived facilitators and barriers to aphasia care. A thematic analysis was employed to identify key themes emerging from the interviews Outcomes and Results Eleven key themes emerged from the thematic analysis. These themes were organized into four groups: training characteristics and resources, usual clinical practice characteristics in aphasia, facilitators of clinical practice, and barriers to clinical practice. Overall, clinicians perceived aphasia training to be insufficient. Perceived barriers included a lack of assessments and treatments adapted to the Colombian context, and Spanish-speaking patients. There were also barriers associated with the Colombian healthcare system, where some administrative processes hindered access and continuous rehabilitation services for PWA. Facilitators included some features of the universal healthcare system in Colombia and the ample number of qualified clinicians who could potentially work with aphasia. Conclusions Our findings underscore the need to expand aphasia research in the Global South. Describing the training, assessment, and treatment practices, as well as systemic facilitators and barriers perceived by clinicians working with PWA in Colombia, is the first step toward understanding what implementation targets and strategies could meaningfully improve aphasia care in the country

People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real-life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy. To develop, validate and pilot a wide-ranging, aphasia-friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy. To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric-style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia-friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform. The FNA23 demonstrated acceptable internal consistency reliability (KR-20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls. The FNA23 is a wide-ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys. What is already known on this subject Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work? The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties.

Assessing spoken discourse during aphasia clinical examination is crucial for diagnostic and rehabilitation purposes. Recent approaches have been developed to quantify content word fluency (CWF) and informativeness of spoken discourse without the need to perform time-consuming transcription and coding. However, the accuracy of these approaches has not been examined in real-time clinical settings, and they have been developed and validated mainly in English and thus cannot be applied to other languages. For the first time: (i) to create and validate CWF checklists and main concept (MC) lists in Arabic; (ii) to examine the application of these two approaches in real-time clinical settings with people with aphasia (PWA) while they are performing the task; and (iii) to investigate whether these two approaches can differentiate discourse responses produced by PWA versus neurotypical adults. The Arabic Discourse Assessment Tool (ADAT) was used to collect discourse responses on three tasks (composite picture description, storytelling narrative, and procedural discourse) from 70 neurotypical control adults and 50 PWA matched to the control group in age and education. The discourse samples were transcribed, and analysed. For each task, CWF checklists and MC lists were developed and validated using discourse reponses from the control group. Afterwards, the application of these two approaches in real-time clinical settings was examined with the aphasia groups. The psychometric properties of CWF and MC approches were examined. Novel Arabic CWF checklists and MC lists were successfully developed, validated, and applied clinically for three discourse tasks. The analysis showed significant high accuracy between CWF scores obtained in real-time clinical settings and those identified using the traditional approach of transcribing and analysing discourse samples across all three discourse tasks (ICC = 0.88 to 0.94). Furthermore, significant excellent reliability (ICC = 0.917 to 0.994) were found for the three tasks in both groups. Most of the MCs were produced accurately and completely by neurotypical control adults, whereas they were mostly absent in PWA. CWF checklists and MC lists showed significant high validity in distinguishing spoken discourse produced by PWA from those produced by neurotypical adults at p < 0.001. This is the first study to develop and validate novel Arabic CWF checklists and MC lists. Furthermore, this study demonstrated that the CWF approach and main concept analysis (MCA) can be applied clinically in real-time with PWA. These transcription-less approaches can be used as part of the routine aphasia clinical examination to provide quick but accurate assessments of CWF (microlinguistics) and informativeness (macrolinguistics) of spoken discourse in PWA. These approaches also provide a significant resource for Arabic speakers with aphasia, that will lead to accurate aphasia assessments and better clinical management. What is already known on the subject Conversations between people rely heavily on producing relevant and informative spoken discourse. Thus, there has been increased interest in the application of discourse tasks in clinical practice to enable a comprehensive assessment of expressive language and functional communication. However, utilising discourse tasks in clinical settings is impractical because their administration and scoring are time-consuming, labour-heavy, and must be completed after the session has ended. Therefore, transcription-less, efficient, and accurate approaches to analyse discourse responses have been developed and validated in English. However, no study has investigated the application of these approaches in real-time clinical settings with people with aphasia (PWA). What this study adds To our knowledge, this is the first study to (i) develop and validate content word fluency (CWF) checklists and main concept (MC) lists in Arabic. These were created for three discourse tasks (composite picture description, storytelling narratives, and procedural discourse) using discourse responses from a neurotypical control group; and (ii) examine the application of these valid, transcription-less, efficient, and accurate approaches to assess CWF and informativeness of spoken discourse in PWA in real-time clinical settings. What are the potential or actual clinical implications of this work? The transcription-less, efficient, and accurate discourse assessment approaches that have been developed and validated in this study allow clinicians to objectively assess discourse responses produced by Arabic speakers with aphasia during clinical examinations while the person is speaking without the need for offline transcription, analyses, and scoring. The reliable application of these approaches in real-time clinical settings encourages clinicians to incorporate discourse tasks as part of their routine clinical examination with PWA to be used (i) for a comprehensive assessment of expressive language skills beyond words and sentences, (ii) to guide the development of personalised therapy goals and strategies to improve functional communication, and (iii) as outcome measurements to monitor spontaneous recovery and changes in response to interventions.

Background Tense production is often impaired in people with aphasia (PWA). Interestingly, the literature suggests that not all tenses are affected in the same way, although the pattern of dissociation is still debated in the literature. The heterogeneity of tense production deficits in PWA might partly explain this lack of consensus in the literature. While this heterogeneity has been demonstrated by descriptive statistics or double dissociations in several studies, no study has used cluster analyses to highlight the main patterns of tense dissociation. Furthermore, the factors underlying this heterogeneity have been little explored. Aims Our study aimed to use cluster analyses on tense production performance to (1) identify the main patterns of dissociation between tenses in PWA and (2) explore the clinical (aphasia type and severity) and cognitive (executive disorders and temporality) factors that may underlie these patterns. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia completed a verb inflection production task, as well as language and cognitive tests. Cluster analyses were performed on the differences in performance between the tenses on the verb inflection production task. Generalized linear mixed models and nonparametric statistics were used to analyze the effect of tense and its interaction with the clusters, and to compare the clusters on the clinical and cognitive variables. Outcomes & results Cluster analyses revealed two main clusters, one with worse performances in the past and future than in the present (PWA_1 – 70% of the PWA), and the other with worse performances in the past and present than in the future (PWA_2 – 30%). The type and severity of aphasia, and cognitive test performance did not differ between the two clusters. On the other hand, the PWA_2 cluster had a longer time post-onset than the PWA_1 cluster. Conclusions Our results confirm the heterogeneity of verb inflection deficits in PWA. They suggest that most PWA would have difficulties with past and future tenses, questioning the presence of discourse linking in these two tenses. However, a minority of PWA, who are clinically and cognitively indistinguishable from the others, do not follow this pattern. Adopting the strategy of producing a morphologically simple tense in French – future – could explain the high performance in the future tense and the errors in substituting other tenses with the future in this subgroup. Finally, the clinical and research implications of this heterogeneity, in relation to therapies and the lack of consensus in the literature, are discussed.

Event Abstract Back to Event Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia Yael Neumann-Werth1* 1 Queens College (CUNY), United States Group therapy provides a naturalistic setting to enhance functional communication skills, e.g., conversational abilities, in people with aphasia (PWA). The Life Participation Approach to Aphasia (LPAA) supports the view of treating PWA as members of a social unit with his/her conversational partner(s). Therefore, group aphasia therapy is a highly beneficial approach to achieving this goal as it provides a natural forum for supporting conversational practice. There are numerous studies that have looked at various contributors to group therapy outcomes, namely, transactional and interactional assessment, in addition to linguistic, functional/social, quality of life, psychological, and cognitive/executive functioning measures. However, these variables have not been studied collectively in one in-depth study. This project intends to enhance our understanding of the effectiveness of group therapy on conversation skills using a multitude of measurement outcomes. Findings from this pilot study will then be used to develop a comprehensive standardized tool for eventual professional use in various rehabilitation settings. The participant in this study was a non-fluent aphasic due to a unilateral cerebrovascular accident. He was 2-year post-onset, had no symptoms of dementia, adequate hearing and vision, used English as his primary language, and had adequate communicative abilities to engage in conversation. The subject participated in a group therapy which consisted of three other members with a variety of different types of aphasia. The subject was tested on an array of standardized tests and functional rating scales to study conversational changes pre-and post-group therapy. This included assessment of: transactional analysis, conversational analysis, interactional aspects in conversations (Measure of Interaction in Communication - MIC), language abilities using the Boston Diagnostic Aphasia Examination (BDAE-Short Form), comprehension through the use of the Token Test (Short Version), linguistic and executive functions by using Word Fluency, functional communication skills using the Communication Activities in Daily-Living (CADL-2), quality of life (Stroke and Aphasia Quality of Life Scale -SAQOL-39), psychological well-being (Geriatric Depression Scale - GDS), and executive function skills like planning, impulse inhibition, and the ability to shift cognitive focus (Delis-Kaplan Executive Function System). The group therapy was run once a week for 45 minutes over the course of 12 weeks. The sessions focused on discussing current event topics and group games with the overall goal of creating a social, supportive, and therapeutic community. Therapeutic principles were largely taken from Promoting Aphasic’s Communicative Effectiveness (PACE; Davis, 2005) where the conversational partner and the study participant took equal turns in the exchange of information, shared novel information, and were encouraged to use multi-modalities in communication, e.g. using gestures, pointing, an ABC board, writing. Pre-testing results indicate the participant’s performance was generally mild. Transactional success measured the participant’s ability to yield information regarding three short clips played from the Mr. Bean television show. We identified the main ideas for each clip and determined target words for the structure of the main ideas. On average, the subject was able to identify at least one target component from each main idea, however his overall performance level was low. When assessing interactional success, we observed the participant interact with a conversational partner. In this testing, the participant received a higher score for his interactional skills than his transactional skills. He did not demonstrate a verbal/vocal attempt to engage his communication partner or respond to interactional attempts; however, he scored much higher in his nonverbal communication (i.e. gesture, writing, drawing, etc.) attempt where he showed full and appropriate participation. While observing his transactional skills with a communicative partner, he scored the same on verbal/vocal and nonverbal communication; he exhibited adequate participation. With regards to his language abilities, he scored high in auditory comprehension with the Token test – SF. Other tests where the subject received a low score on were in the quality of life and geriatric depression scale. Initial analyses of post-therapy findings are currently being analyzed and will be completed prior to the conference date. References American Speech-Language-Hearing Association. (1998). The role of speech-language pathologists in identification, diagnosis, and treatment of individuals with cognitive-communication impairments. ASHA, 30, 79. Cruice, M., Worrall, L., Hickson, L., & Murison, R. (2003). Finding a focus for quality of life with aphasia: Social and emotional health, and psychological well-being. Aphasiology, 17(4), 333-353. Damico, J.S., Oelschlaeger, M., & Simmons-Mackie, N. (1999). Qualitative methods in aphasia research: Conversation analysis. Aphasiology, 13(9–11), 667–680. Davis, G. A. (2005). PACE revisited. Aphasiology, 19, 21-38. Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis – Kaplan Executive Function System (D-KEFS). San Antonio, TX: The Psychological Corporation. De Renzi, E., & Vignolo, LA. (1962). The Token test: A sensitive test to detect receptive disturbances in aphasia. Brain, 85, 665–678. Frattali, C.M., Thompson, C.K., Holland, A.L., Wohl, C.B., & Ferketic, M.M. (1995). Functional Assessment of Communication Skills for Adults: Manual. Rockville, MD: American Speech- Language-Hearing Association. Goodglass, H., Kaplan, E., & Barresi, B. (2001). The assessment of aphasia and related disorders. Lippincott Williams & Wilkins. Hilari, K., & Byng, S. (2001). Measuring quality of life in people with aphasia: the Stroke Specific Quality of Life Scale. International Journal of Language & Communication Disorders, 36(1), 86-91. Hilari, K., Wiggins, R., Roy, P., Byng, S., & Smith, S. (2003). Predictors of health-related quality of life (HRQL) in people with chronic aphasia. Aphasiology, 17(4), 365-381. Holland, A., Frattali, C., & Fromm, D. (1999). Communication Activities of Daily Living (2nd ed.). Austin, TX: Pro-Ed. Kagan, A. (1998). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12,9, 816-830. Pound C, Parr S, Lindsay J, Woolf C. Beyond aphasia: Therapies for Living with Communication Disability. Bicester, UK: Speechmark; 2000. Ramsberger, G. (2005). Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach. Aphasiology, 19, 1066–1073. Ramsberger, G., and Rende, B. (2002). Measuring transactional success in the conversation of people with aphasia. Aphasiology, 16(3), 337-353. Saldert, C., Backman, E., and Hartelius, L. (2013). Conversation partner training with spouses of persons with aphasia: A pilot study using a protocol to trace relevant characteristics. Aphasiology, 27,3, 271-292. Schegloff, E.A. (1988) . Discourse as an interactional achievement II: An exercise in conversation analysis. In D. Tanner (Ed.), Linguistics in context: Connecting observation and understanding (pp. 135–158). Norwood, NJ: Ablex. World Health Organization. (2001). International classification of functioning, disability, and health. Retrieved April 30, 2003, from http://www.who.int/gb/EB_WHA/PDF/WHA54/ea5418.pdf Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey,M., & Leirer, V. O. (1983).Development and validation of a geriatric depression rating scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. Keywords: Aphasia, Group Therapy, Conversational skills, adults population, aphasia therapy Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster presentation Topic: General Submission Citation: Neumann-Werth Y (2019). Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00043 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 03 May 2017; Published Online: 25 Jan 2019. * Correspondence: Dr. Yael Neumann-Werth, Queens College (CUNY), Queens, United States, rodriguez.janice88@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. 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Background In recent years, artificial intelligence (AI) has become commonplace in our daily lives, making its way into many different settings, including health and rehabilitation. While there is an increase in research on AI use in different sectors, information is sparse regarding whether and how AI is used in aphasia rehabilitation. Aims The objective of this scoping review was to describe and understand how AI is currently being used in the rehabilitation of people with aphasia (PWA). Our secondary goal was to determine if and how AI is being integrated into Augmentative and alternative communication (AAC) devices or applications for aphasia rehabilitation. Methods Using the Arksey and O’Malley (2005) Levac and colleagues (2010) frameworks, we identified the research question: In what way is artificial intelligence (AI) used in language rehabilitation for people with aphasia (PWA)? We then selected search terms and searched six databases which resulted in the identification of 663 studies. Based on the inclusion criteria, 28 suitable studies were retained. We then charted, collated and summarised the data in order to generate four main themes: (1) AI used for the classification or diagnosis of aphasia/aphasic syndromes or for the classification or diagnosis of primary progressive aphasia (PPA)/PPA variants; (2) AI used for aphasia therapy; (3) AI used to create models of lexicalization; and (4) AI used to classify paraphasic errors. Results None of the articles retained incorporated AI in AAC devices or applications in the context of aphasia rehabilitation. The majority of articles (n=17) used AI to classify aphasic syndromes or to differentiate PWA from healthy controls or persons with dementia. Another subset of articles (n=7) used AI in the attempt to augment an aphasia therapy intervention. Finally, two articles used AI to create a model of lexicalization and another two used AI to classify different types of paraphasias in the utterances of PWA. Conclusion Regarding performance accuracy of the diagnosis tools, results show that, regardless the type of AI approach used, models were able to differentiate between aphasic syndromes with a relatively high level of accuracy. Although significant advancements in AI and more interaction between the fields of aphasia rehabilitation and AI are required before AI can be integrated in aphasia rehabilitation, it nevertheless has the potential to be a central component of novel AAC devices or applications and be incorporated into innovative methods for aphasia assessment and therapy. However, for a transition to the clinic, new technologies or interventions using AI will need to be assessed to determine their efficacy and acceptance by both speech-language pathologists and PWA.

Research has found that people with aphasia (PWA) may experience psychosocial benefits from participating in communication partner training (CPT). It is unknown whether similar benefits are found if components of the CPT are delivered via telepractice. This pilot study aimed to explore PWAs’ perceptions of: (a) their communication confidence and self-esteem after communicating with speech-language pathology (SLP) students via telepractice as part of a CPT programme; (b) whether it is important for SLP students to converse with PWA; and (c) the suitability of using telepractice to facilitate these conversations. Five adults with aphasia participated. A single group, pre-test post-test design was utilised. Standardised measures were used to capture changes in the participants’ self-reported communication confidence and self-esteem. A verbal questionnaire was used to obtain participants’ perceptions of the programme. Post-CPT, a significant decrease occurred on one confidence item. Non-significant improvement was noted on other items. All five participants believed it was important for SLP students to converse with PWA. Content analysis of the participants’ responses revealed two categories: (a) aphasia being a chronic communication difficulty and (b) conversing with PWA can be scary and different from conversing with adults without aphasia. Four out of five participants thought that telepractice was suitable for conversing with students. Results suggest that PWA may experience psychosocial benefits from conversing with students via telepractice. Confirmation of these findings from a larger scale study would have implications not only for PWA, but also for SLPs providing clinical services to PWA and for educators of SLP students.

People with aphasia (PWA) typically exhibit deficits in spoken discourse. Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, the available discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use and limited evidence of the psychometric properties of published discourse measurements. (1) To develop a standardized, norm-referenced, culturally and linguistically appropriate Arabic Discourse Assessment Tool (ADAT); and (2) to examine the psychometric properties of content and construct validity and interrater reliability of different discourse measures elicited using three discourse genres (descriptive, narrative and procedural) in neurotypical control adults and matched PWA. Discourse samples were collected using three novel discourse stimuli that are sensitive to the Arabic language and culture from 70 neurotypical control adults and a matched group of 50 PWA. Transcription agreement was assessed. A standard approach was used to evaluate construct validity and interrater reliability for 16 discourse measures that assess fluency, language productivity, information content, lexical-semantics, lexical diversity, grammatical category, grammatical structure and syntactic complexity. Strong measures were identified based on their psychometric properties, and normative data were established on these measures. Discourse performance of PWA was then examined using the newly developed tool (ADAT). Transcription agreement was extremely high for all discourse stimuli in both groups. Eight discourse measures were proven to have consistently very high construct validity and consistently very good to excellent reliability across the three stimuli in both neurotypical control and aphasia groups: lexical information units, content information units, words per minute, discourse duration, number of different words, number of complete sentences and proportion of open and closed class words. Norms were established on these measures, and cut-off scores of impairments were determined. Other measures showed low construct validity and variable or poor reliability across the two groups. The newly developed, standardized, and norm-referenced tool(ADAT) consist of three discourse stimuli and eight high-quality discourse measures that assess multiple aspects of spoken discourse and were able to differentiate PWA from neurotypical adults consistently. ADAT also includes normative data and cut-off impairment scores. The tool has great potential to enhance clinical practice and research with Arabic speakers. Evidence was provided that not all discourse measures are of high quality, as some are vulnerable to differences between raters, discourse stimuli and groups. Clinicians and researchers can use ADAT for accurate aphasia assessments, better management plans and to monitor therapy effectiveness. ADAT can be further validated in other clinical populations with language impairments. What is already known on the subject Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, existing discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use in aphasia, and limited evidence of the psychometric properties of published discourse measurements. What this paper adds to existing knowledge A novel, standardized, norm-referenced Arabic Discourse Assessment Tool (ADAT) was developed and validated in this study. ADAT was further validated among PWA. The study provides evidence that not all discourse measures are of high quality and thus should not be used with confidence. Specific measures are vulnerable to the type of stimuli, the rater and/or the tested group. On the other hand, eight discourse measures were identified to be reliable between different raters and across different stimuli for the two groups, and they were able to differentiate the discourse performance of PWA from neurotypical control adults. Normative data derived from neurotypical control adults were established on these strong measures, and the performance of PWA was classified as impaired based on these norms. What are the potential or actual clinical implications of this work? The present study provides a novel, standardized, norm-referenced, validated discourse assessment tool that is culturally and linguistically appropriate for use by Arabic speakers (ADAT). ADAT holds immense potential to enhance clinical practice and research with Arabic speakers. The study also identified strong discourse measures that can be used to assess language productivity, information content, lexical-semantics, lexical diversity, grammatical category, and syntactic complexity for accurate and comprehensive assessments. This will lead to better rehabilitation management by guiding the development of tailored client-centred interventions. ADAT can be utilized in clinical and research settings in PWA and has the potential to be further validated with other clinical populations.

Event Abstract Back to Event Face-to-Face Communication in Aphasia: An Experimental Approach to Everyday Communication Willemijn Doedens1*, Arpita Bose1 and Lotte Meteyard1 1 University of Reading, United Kingdom Introduction. In aphasia, functional communication is an important outcome measure for speech and language therapy (SLT; Brady, Godwin, Enderby, Kelly, & Campbell, 2016). Historically, aphasiology has relied heavily on decontextualized psycholinguistic measures such as picture naming and repetition to describe different aphasia types. These measures give a linguistically well-defined profile of impairment, but research shows that they do not fully predict how People With Aphasia (PWA) use language in everyday life (Holland, 1982). The literature shows a lack of consensus over what everyday communication is and how it should be measured (Brady, Godwin, Enderby, Kelly, & Campbell, 2016; Wallace, et al., 2018). In this project we use an experimental approach that is well known from studies on communication with neurologically unimpaired subjects to investigate (1) the influence of speaker familiarity on communication for PWA and (2) which measures are meaningful in objectively defining communicative ability in PWA. Methods. The experimental design consists of a collaborative, referential communication task (Clark & Krych, 2004) that allows pairs to interact and communicate freely, replicating a real-life face-to-face communicative setting. Pairs sit across from each other, in front of identical playmobile rooms, while the view of the other’s room is blocked by a low barrier. Five high-frequency items are placed in one room (instructor), and outside the other with an additional distractor item (follower). Pairs are asked to discuss the items in the instructor’s room with the aim of replicating the setup in the follower’s room. Each pair repeats the game six times: first with a familiar partner, then with an unfamiliar partner (the partner of a different PWA with a similar aphasia profile). For each trial, roles (instructor/follower) are swapped. Six different setups are used across trials, the order is randomized for each pair. 20 PWA are included along with someone they speak with often. 20 pairs of neurologically unimpaired subjects (age and education matched) complete the task to give normative data for comparison. Familiarity of the conversation partner varied on a personal level (i.e. having shared experiences) and on knowledge of aphasia (i.e. what it is and how to support communication). The full method is pre-registered at http://osf.io/9xwm7. Results. Preliminary results of the experiment will compare communicative efficiency (i.e. accuracy, time taken to complete) between groups (PWA and HC) and conditions (familiar vs unfamiliar), and between trials (first game vs last game). These variables will be related to measures of linguistic impairment, executive control, and a standardized measure of everyday communication. Plans for further analyses will be presented: error detection, self- and other-monitoring, and measures taken from Conversation Analysis such as repairs and patterns of sequence construction. Discussion. This experiment is the first step in a systematic, theoretically founded, experimental approach to the study of everyday communication in PWA. Improving our understanding of everyday communication in aphasia and its underlying mechanisms will help us understand the relationship between traditional linguistic measures, intervention and communication in everyday life. Acknowledgements This project was conducted as part of a doctoral research project funded by the Magdalen Vernon Studentship provided by the School of Psychology and Clinical Language Sciences at the University of Reading, UK. References Brady, M. C., Godwin, J., Enderby, P., Kelly, H., & Campbell, P. (2016). Speech and Language Therapy for Aphasia After Stroke: An Updated Systematic Review and Meta-Analyses. Stroke, 47, E236-E237. doi:10.1161/Strokeaha.116.014439 Clark, H. H. (1996). Using Language. Cambridge: Cambridge University Press. Clark, H. H., & Krych, M. A. (2004). Speaking while monitoring addressees for understanding. Journal of Memory and Language, 50, 62-81. doi:10.1016/j.jml.2003.08.004 Holland, A. (1982). Observing functional communication of aphasic adults. Journal of Speech and Hearing Disorders, 47, 50–56. Wallace, S., Worrall, L., Rose, T., Le Dorze, G., Breitenstein, C., Enderby, P., Bose, A., Brady, M., Cruice, M., Copland, D., Hersh, D., Cherney, L., Babbitt, E., Rochon, E., Pearl, G., Hilari, K., Marshall, J., Webster, J., Kelly, H., Howe, T., Kiran, S., Nicholas, M., Rose, M., Sage, K., Laska, A. C., Patterson, J. and Small, S. (2018). A core outcome set for aphasia treatment research: Consensus statement. International Journal of Stroke. doi: 10.1177/1747493018806200 Keywords: Aphasia, multimodal, Functional communication, Interaction, common ground Conference: Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019. Presentation Type: Poster presentation Topic: Eligible for student award Citation: Doedens W, Bose A and Meteyard L (2019). Face-to-Face Communication in Aphasia: An Experimental Approach to Everyday Communication. Front. Hum. Neurosci. Conference Abstract: Academy of Aphasia 57th Annual Meeting. doi: 10.3389/conf.fnhum.2019.01.00103 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Apr 2019; Published Online: 09 Oct 2019. * Correspondence: Ms. Willemijn Doedens, University of Reading, Reading, United Kingdom, w.j.doedens@pgr.reading.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Willemijn Doedens Arpita Bose Lotte Meteyard Google Willemijn Doedens Arpita Bose Lotte Meteyard Google Scholar Willemijn Doedens Arpita Bose Lotte Meteyard PubMed Willemijn Doedens Arpita Bose Lotte Meteyard Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

People with aphasia (PWA) present with language deficits including word retrieval difficulties after brain damage. Language learning is an essential life-long human capacity that may support treatment-induced language recovery after brain insult. This prospect has motivated a growing interest in the study of language learning in PWA during the last few decades. Here, we critically review the current literature on language learning ability in aphasia. The existing studies in this area indicate that (i) language learning can remain functional in some PWA, (ii) inter-individual variability in learning performance is large in PWA, (iii) language processing, short-term memory and lesion site are associated with learning ability, (iv) preliminary evidence suggests a relationship between learning ability and treatment outcomes in this population. Based on the reviewed evidence, we propose a potential account for the interplay between language and memory/learning systems to explain spared/impaired language learning and its relationship to language therapy in PWA. Finally, we indicate potential avenues for future research that may promote more cross-talk between cognitive neuroscience and aphasia rehabilitation.

Non-fluent aphasia is characterized by frequent word search and a much slower speech rate than non-aphasic speech. For patients with this type of aphasia, communication with those around them is therefore made difficult and is often severely impaired. One of the therapeutic proposals to improve the quality of life of these patients is to re-educate them with more multimodal alternatives. This of course assumes that gestures represent possible alternative means of communication for patients, and that their gestures are not affected in the same way as their speech. This article therefore proposes to study the gestures of 4 aphasic people and to compare them to the gestures performed by non-aphasic people, but also to establish correspondences between those gestures, intonation contours and the way people with aphasia develop their discourse. Results show that although gesture rate is not different in the two groups of participants, the gesture-to-speech ratio is higher for people with aphasia (PWA) than for non-aphasic people (NAP). Considering the fact that PWA also gesture more than NAP during silent pauses, which are longer but not more frequent than in NAP’s speech, and the fact that their gestures coincide less often with a lexical word, we believe that PWA use their gestures as compensation strategies for deficient speech. Yet, their speech impairment is also reflected in their gesturing: more gestures are prepared but abandoned before the stroke in this group and pre-stroke holds are longer, which means that PWA hold their gestures in the hope that they will better coincide with the word they are supposed to accompany and which takes more time to be uttered than in non-pathological speech. Their gestures are also less linked to each other than in the NAP group which goes hand in hand with the fact that they tend to utter independent syntactic phrases with no cohesive marker between them. This is also reflected in their less frequent use of flat and rising tones in intonation, which generally indicate that two sentence parts are dependent one upon the other, as well as their less frequent use of gestures showing discourse organization. In terms of gesture types, the PWA in this study perform many rhythmic beats and rely much on conventional gestures to compensate for their speech impairment rather than on their own creativity. Globally, this means that if multimodal therapies may benefit PWA to improve their communication with other people, speech therapists nevertheless need to be aware that life-long habits of gesture-speech alignment and synchronization may not be so easy to overcome for patients.

Reading and listening comprehension abilities in Cantonese-speaking people with aphasia and people with right hemisphere damage

Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA). PWA indexed within AphasiaBank-a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information-were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results. PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression. These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.