ABSTRACT Background Aphasia is a language disorder resulting from brain damage that disrupts language comprehension and production, emphasizing the need for effective diagnostic and therapeutic tools. Aims This narrative review examines how eye-tracking technology has been used to investigate language production deficits in people with aphasia (PWA). It seeks to identify emerging research trends, assess the contributions of eye-tracking to understanding language production processes, and explore the technology’s potential clinical relevance in aphasiology. Methods and Procedures A comprehensive search of four databases was conducted using the key terms “aphasia”, “eye-tracking”, and “language production”, as well as their combinations, covering the period from January 2015 to January 2025. The initial search yielded 95 articles. After screening titles and abstracts according to predefined inclusion and exclusion criteria, 20 papers were selected for further review. A subsequent full-text review excluded articles not explicitly focused on language production in PWA, resulting in six studies for detailed appraisal. These studies specifically explored the application of eye-tracking to language production processes in PWA. Outcomes and Results The reviewed studies demonstrate that eye-tracking can elucidate the linguistic mechanisms underlying language production deficits in PWA. Eye movement and eye fixation patterns in PWA offer insight into how aphasia disrupts various stages of language production. Conclusions Our findings suggest that eye-tracking provides valuable insights into the complex processes disrupted by aphasia. Thus, eye-tracking device can represent a promising avenue for enhancing diagnostic accuracy and informing therapeutic interventions for PWA. This review also underscores the need for further research to expand our understanding and application of eye-tracking technology in aphasiology, paving the way for advancements in both theoretical knowledge and clinical practice.

ABSTRACT Background Intensive comprehensive rehabilitation is recommended as an effective way to improve speech and language in individuals with aphasia. However, there is limited research on patients’ experiences, especially for modified Intensive Comprehensive Aphasia Programmes (mICAPs) in regular healthcare settings. Aim This study aimed to explore the acceptability, feasibility, and engagement of individuals with aphasia with and without co-occurring apraxia of speech (AOS), when participating in an mICAP in regular healthcare settings. Methods & Procedures In this multicentre intervention study across 13 Swedish clinics, quantitative data from 23 responses to questionnaires and qualitative data from semi structured interviews with five patients were analysed with a mixed method convergent design. Outcomes & Results Quantitative findings indicated high satisfaction with the mICAP. Patients found it effective, recommendable to others, and noted speech-language improvements. They felt involved in goal setting, were highly motivated, and expressed a need for more therapy. The timing of the mICAP is a previously overlooked aspect of participant experience, with a clear preference for the chronic phase, followed by the sub-acute phase. Challenges included tiredness, transportation, and time constraints. Five themes from the qualitative interviews were generated: (1) improvements in speech-language functions and daily activities; (2) the mICAP was enjoyable and effective, and the Speech-Language Pathologist (SLP) played an important role; (3) highly motivated for continued and more challenging rehab; (4) can be tiring at the start, but stamina improves; and (5) transportation and physical limitations can be barriers. Mixed-methods analysis revealed that qualitative data provided crucial nuances to the quantitative findings. Although the questionnaire respondents reported tiredness as a problem, the interviewed patients described an initial fatigue that was short-lived and replaced by increasing stamina. Similarly, although a preference for individual sessions was reported in the questionnaires, interview patients described the comprehensive format as more effective. And while goal setting involvement had high ratings in the questionnaires, interview responses indicated that both the goal setting process and the goals were unclear. Conclusions Participants with aphasia, with or without co-occurring AOS, found the mICAP acceptable and feasible when introduced across multiple sites in regular Swedish healthcare. They showed high engagement, described the mICAP as enjoyable and effective, and valued their contact with the SLP greatly. Although the intensive format can be initially tiring, the participants remained highly motivated for longer and even more demanding rehabilitation.

ABSTRACT Background Despite the importance of grammatical skills for participation in daily life, treatments for sentence–level abilities in aphasia are comparatively scarce. The psycholinguistic paradigm of syntactic priming has recently been advanced as a potential assessment and treatment for grammatical skills, and existing evidence on priming in aphasia is highly promising. Nevertheless, a comprehensive analysis of the strength of priming effects in aphasia, as well as treatment components which might amplify these effects, has not been reported. This meta–analysis synthesizes existing findings on syntactic priming in aphasia, aiming to provide a comprehensive picture of priming effects and their potential application for treatment. Method A comprehensive search of reported syntactic priming studies including persons with aphasia was conducted, yielding 27 experiments. Standardized mean differences (SMD) were computed from each experiment to account for inter –study heterogeneity. Studies were then weighted by participant numbers. An omnibus meta–analysis model was fitted to evaluate standardized differences associated with priming, followed by meta–regression analyses assessing possible treatment components. Results A large, robust effect of syntactic priming was discovered (SMD = 1.37). All but one reported studies found positive priming effects, though substantial heterogeneity was found between included experiments. Meta–regression analyses found no effects of lexical overlap between primes and targets (lexical boost), the presence of a confederate in experiments, or oral repetition of prime sentences. Conclusions This study strongly supports the development of syntactic priming as a sentence–level treatment in aphasia, and suggests high adaptability of priming to different formats and settings. Lexical overlap may not be effective in facilitating priming–induced gains. Future studies of priming in aphasia should include larger samples of participants and should investigate how lexical information interacts with syntactic priming.

ABSTRACT Background People with aphasia (PWA) often struggle to determine who/what pronouns refer to. However, spontaneous speech studies on non-fluent PWA have revealed a disparity: one cluster of PWA tends to omit pronouns, while another cluster tends to overuse them. This study improves our current knowledge of pronoun processing by presenting how aphasia impacts pronoun production in Turkish. Aims This study addresses three questions: (i) whether Turkish-speaking PWA show impairments in producing pronouns in spontaneous speech, either through omission or overproduction; (ii) whether their production of personal pronouns is selectively affected; and (iii) whether theyexhibit difficulties in producing deictic and/or non-personal pronominal elements, including demonstratives, indefinites, and possessives. Methods & Procedures Spontaneous speech samples from 10 PWA speaking Turkish and 10 matched healthy controls were analysed. Three groups of pronoun variables were quantified: (i) general characteristics of pronoun uses including total number of pronominal elements, and pronoun-to-noun ratios, (ii) total and null personal pronouns in subject and object positions, and (iii) other types of pronouns including demonstrative, indefinite, and possessive pronouns. Outcomes & Results The Turkish-speaking PWA were above the control norms in total number of pronominal elements, and pronoun-to-noun and pronoun-to-word ratios, but they showed reduced lexical diversity in noun usage. They produced more first-person (deictic) than third person (anaphoric) pronouns while this difference was not significant in the controls. The PWA exhibit overuses in null subjects and objects, demonstratives and indefinite pronouns. Conclusions Turkish-speaking PWA overproduce pronouns; however, this overuse does not represent a uniform pattern. Overuses caused mostly by deictic elements such as demonstratives and indefinite pronouns, in the context of reduced lexical diversity in nouns. While the overuse of pronouns likely reflects a communicative strategy, the extent and nature of this strategy seem to vary across individuals.

ABSTRACT Background Stroke is a leading cause of aphasia, a language disorder that can affect speaking, understanding, reading, and writing. Aphasia exists in varying types and severity levels. Severe aphasia is often associated with minimal or absence of verbal production, making everyday communication extremely challenging. Persons with severe aphasia (PWSA) may benefit from augmentative and alternative communication (AAC) strategies, which offer alternative means to express needs, thoughts, and emotions, thereby supporting participation and quality of life. Aims This study aimed to explore (a) the PWSA ’s perception about their communication, (b) caregivers’ experience communicating with the PWSA, and (c) the perception of PWSA and caregivers about the use of AAC to support communication. Methods and Procedures This two-phased study was conducted in Jordan and involved 10 stroke persons with severe aphasia. In Phase 1, structured interviews were conducted with the PWSA using an aphasia-friendly guide to obtain information about how they communicated. In Phase 2, their caregivers were interviewed to delve into how they communicated with the PWSA. All participants were also asked about their perceptions of AAC. Outcomes & Results The PWSA in this study reported struggling to communicate with those around them and mainly used gestures and body movement. They reported feelings of isolation and frustration due to their communication difficulties. They communicated mostly with family members and were eager to learn other forms of communication. Caregiver’s express challenges communicating with the PWSA, and most of them have a strong interest in learning about AAC, recognizing its potential to enhance communication for the PWSA. However, they highlighted certain barriers, including insufficient training in AAC use, lack of accessible resources, and resistance rooted in cultural attitudes and stigma. There were some caregivers, however, who were reluctant to use AAC with PWSA. Conclusions The study highlights that while AAC tools have the potential to enhance communication outcomes for PWSA in Jordan, there is a need for comprehensive caregiver education, culturally sensitive advocacy for AAC adoption, and the establishment of support systems to bridge the gaps in implementation.

ABSTRACT Aim This study aimed to examine the benefits of combining spoken and written approaches in treating naming deficits in Chinese-speaking people with aphasia (C-PwA). Specifically, it examined whether participants’ naming accuracy would be improved by three different approaches – repetition approach (REP), repetition + written Chinese characters approach (REP+WC), and repetition + written Chinese Pinyin approach (REP+WP). Method & Procedures A single-subject experimental design was conducted with four post-stroke aphasia participants. 72 items were allocated across three treatment conditions and one control condition (18 items each). Each participant received 10 sessions per treatment condition, delivered five times weekly in randomized order. Treatment effects were analyzed using the contrastive dual-criteria method and effect size calculations. Outcomes & Results Visual analyses revealed naming improvements across all participants and treatment conditions. Effect size analysis showed meaningful improvements for all participants overall, with differential patterns across approaches. REP+WC demonstrated effectiveness in all four participants, while REP was effective in three participants and REP+WP in two participants. The control condition showed no meaningful effects except for one participant. Conclusions Chinese character writing combined with repetition (REP+WC) produced better outcomes compared to repetition alone or combined with Pinyin writing. These findings suggest the therapeutic value of orthographic processing in Chinese character writing for improving spoken naming in C-PwA, suggesting that REP+WC represents a viable clinical intervention for addressing naming deficits in this population.

ABSTRACT This paper reviews prominent assessments of grammatical deficits in sentence production among individuals with aphasia. The first aim is to examine existing methods for assessing sentence production deficits and to evaluate the strengths and limitations of these approaches. Assessment methods are categorized into unconstrained and constrained types, and the review also examines three standardized constrained tests, all of which were developed in English. Unconstrained methods, such as discourse-based tasks, allow individuals to produce sentences freely in naturalistic contexts. While these tasks reflect everyday communication, they have limitations, most notably, the tendency for individuals to avoid complex syntactic structures, which may obscure specific deficits. In contrast, constrained tasks, such as single-picture descriptions, provide more controlled assessments of targeted syntactic structures but often rely on instructions and metalinguistic prompts that may increase cognitive load. The second goal of the review is to explore how agrammatic and paragrammatic speech – two prominent patterns of sentence-level impairment – are assessed through both constrained and unconstrained methods, as well as in three formal tests commonly used in the aphasia literature. The review concludes by emphasizing the need for novel assessment tools that integrate the strengths of both constrained and unconstrained approaches to more comprehensively capture sentence production deficits in aphasia.

ABSTRACT Introduction The purpose of the study was to examine the efficacy of a modified semantic feature analysis (SFA) – working memory (WM) approach on a group of people with aphasia (PwA), representing a variety of aphasia subtypes. Self-reported quality of life measures were also obtained. Method Nine individuals with Broca’s, conduction, Wernicke’s, and anomic aphasia participated in the study. Pre- and post-treatment assessments of language function, WM abilities, and perceived quality of life were carried out. The treatment protocol, based on a previous pilot study (Hashimoto, 2023), incorporated WM and linguistic tasks to improve naming accuracy across two treatment lists. A single-subject multiple-baseline across behaviors design was employed. Maintenance effects were examined one-month following treatment. Treatment effect sizes (Beeson & Robey, 2006), modified t-tests (Crawford & Howell, 1998), and Wilcoxon Signed Ranks test was carried out to examine the effects of treatment on overall language functions, as well as on naming and WM performance. Results Seven of nine participants demonstrated a range of small to large ESs on the treated lists. Post-treatment improvements were also obtained on various language and WM assessments for all participants. Group analyses revealed significantly improved post-treatment scores on measures of overall language function and on overall self-reported quality of life. Conclusions These findings revealed that the modified SFA – WM approach can be used successfully to treat anomia across a wider variety of aphasia types. Given the significant impact of cognitive functions on linguistic performance in PwA, this approach represents a viable treatment option for practicing clinicians.

ABSTRACT Background The use of icons in conjunction with other aphasia-friendly principles is known to enhance reading comprehension in persons with aphasia-based alexia. However, whether the type of icon (noun or verb) is an important variable in comprehension is unknown. Further, previous research suggests that persons with aphasia-based alexia are dissatisfied with their reading skills. Aims The current study investigated the influence noun or verb icons have on reading comprehension of short stories in persons with aphasia-based alexia. Additionally, we explored the participants’ self-perceived satisfaction of their current reading abilities. Methods An adapted alternating treatment design across multiple baselines was employed to examine the impact of noun versus verb icons on reading comprehension in aphasia-friendly short stories in persons with aphasia-based alexia. Multiple baselines across three participants were randomized, and the study had predetermined points in time. Each participant read short stories about American history; five included verb icons, and five included noun icons. Reading comprehension was evaluated by the identification of key story elements. Self-perceived satisfaction of reading abilities was measured with subtests of the Comprehensive Assessment of Reading in Aphasia prior to reading the stories. Outcomes & Results Visual inspection and statistical analyses of the data revealed that two of the three participants demonstrated increased comprehension compared to baseline when icons were introduced to the text. Two of the three participants displayed separation between the two alternating treatments: noun and verb, with the use of nouns showing higher reading comprehension than verbs. The participants with aphasia-based alexia self-reported feelings towards their reading skills were significantly lower than the reported average for people with aphasia. Conclusions These results provide preliminary evidence that noun icons improved reading comprehension more so than the use of verbs in two of the three participants. All participants benefited from the presence of icons, aligning with existing literature. Clinicians and researchers should provide pictorial reading supports while considering the person’s feelings regarding reading abilities.

ABSTRACT Background Friendship is vital for the well-being and social integration of people with aphasia (PWA) post-stroke. The impact of chronic aphasia on the friendships and social engagement of PWA is often overlooked by rehabilitation clinicians. Aim: To co-create the Functional Rating of Interaction Engagement Needs and Difficulties Scale (FRIENDS), a self-report aphasia-friendly tool, in collaboration with PWA, and test its psychometric properties. Methods A Patient and Public Involvement approach was adopted, involving 3 PWA and a caregiver as research partners across eight co-design meetings. FRIENDS’ psychometric properties were evaluated with reliability and validity measures. The psychometric study involved 166 participants: 62 PWA, 50 people with stroke without aphasia, and 54 healthy controls. Results FRIENDS demonstrated excellent internal consistency (Cronbach’s α > 0.960) and high test – retest reliability (ICC ≥0.99). The results demonstrated a significant difference amongst the three groups (p < 0.001), which verified known-groups validity. Significant correlations between FRIENDS and measures of aphasia severity, functional communication, and quality of life supported the tool’s convergent validity. Results derived from analyzing the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) report supported its content validity. Conclusion FRIENDS is a psychometrically sound, patient-reported outcome measure, developed to rate changes in the friendships of PWA. Co-created with PWA, FRIENDS offers a broad view of chronic aphasia’s impact on friendships, aiding clinicians in co-developing functional intervention plans, enabling person-centered care, and improving the social life of PWA.