Auditory Verbal Comprehension Research Articles

Feasibility of remote assessment of language and cognition in healthy subjects with heterogeneous educational levels

AbstractBackgroundThe COVID‐19 pandemic is accelerating the use of telemedicine in the management of chronic neurological diseases. However, studies on the feasibility of assessing language and cognition are still scarce, especially in developing countries in which education is very heterogeneous. This pilot study evaluated the feasibility of using telemedicine for linguistic‐cognitive assessment, by comparing the performance of healthy adults in face‐to‐face and online assessments in a Brazilian sample. We also verified the influence of age and education on the two assessment forms.MethodThe sample consisted of 15 cognitively healthy subjects, aged between 57‐70 years (M = 63.2; SD = 4.6) and between 8‐22 years of education (M = 14.7; SD = 4.3). The Western Aphasia Battery‐Revised (WAB‐R) (Kertesz, 2007; Neves et al., 2014) was used for language assessment, with subtests for spontaneous speech, auditory verbal comprehension, repetition, naming, reading, and writing. The Addenbrooke’s Cognitive Examination‐revised version (ACE‐R) (Mioshi et al., 2006; Carvalho e Caramelli, 2007) was used for a brief cognitive screening and is composed of five subscales assessing attention and orientation, memory, fluency, language, and visuospatial skills. Subjects were randomly evaluated both face‐to face and online, with an interval of 1‐6 months.ResultNo differences were found in both WAB‐R and ACE‐R scores obtained in a face‐to‐face versus online environment. However, performance was associated with different sociodemographic variables in the two different evaluation contexts. In face‐to‐face assessment, there was a positive correlation between education and writing subtests (Spearman r = 0.878; p = 0.004). In the remote form of evaluation, there was a negative correlation between age and auditory verbal comprehension (Spearman r = ‐0.722; p = 0.043), and a positive correlation between education and spontaneous speech (Spearman r = 0.871; p = 0.004), auditory verbal comprehension (Spearman r = 0,768; p = 0,025), writing (Spearman r = 0.727; p = 0.040) and Aphasia Coefficient score (Spearman r = 0.736; p = 0.037).ConclusionThe absence of statistical difference between the two forms of evaluation demonstrated the viability of remote assessment of language and cognition in healthy subjects, despite the more significant influence of education in this evaluation form. Further studies will be conduct to verify the feasibility of remote assessment in individuals with mild cognitive impairment and dementia.

Theory and Application of Neuropsychological Underpinnings of Adjudicative Competency.

In their article, Aveson and colleagues postulate a model for understanding the neurocognitive underpinnings of competence to stand trial, and they present evidence to support that model for two specific facets: social intelligence and auditory verbal (episodic) memory. This commentary attempts to extend those findings by outlining specific interventions and assessment methods in the inpatient restoration setting that focus on strengthening these capacities and connecting them to the psycho legal context. It echoes the work of Aveson et al. that court is a transactional, social context heavily dependent on auditory processing and verbal comprehension and expression and suggests that restoration programs ought to incorporate interventions and assessment tools that address such faculties. Further refinement of our understanding of competence and its constituent components will enable us to better allocate scarce resources throughout the system, to tailor restoration programming to the needs of each individual defendant, and to aid defendants through restoration programming to develop the skills to take a more involved, collaborative role in the process.

The Severity-Calibrated Aphasia Naming Test.

We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension. We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT. The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead. We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores. https://doi.org/10.23641/asha.21476871.

Remote cortical atrophy and language outcomes after chronic left subcortical stroke with aphasia.

ObjectiveSubcortical stroke can cause a variety of language deficits. However, the neural mechanisms underlying subcortical aphasia after stroke remain incompletely elucidated. We aimed to determine the effects of distant cortical structures on aphasia outcomes and examine the correlation of cortical thickness measures with connecting tracts integrity after chronic left subcortical stroke.MethodsThirty-two patients and 30 healthy control subjects underwent MRI scanning and language assessment with the Western Aphasia Battery-Revised (WAB-R) subtests. Among patients, the cortical thickness in brain regions that related to language performance were assessed by the FreeSurfer software. Fiber tracts connecting the identified cortical regions to stroke lesions were reconstructed to determine its correlations with the cortical thickness measures across individual patient.ResultsCortical thickness in different parts of the left fronto-temporo-parietal (FTP) regions were positively related to auditory-verbal comprehension, spontaneous speech and naming/word finding abilities when controlling for key demographic variables and lesion size. Cortical thickness decline in the identified cortical regions was positively correlated with integrity loss of fiber tracts connected to stroke lesions. Additionally, no significant difference in cortical thickness was found across the left hemisphere between the subgroup of patients with hypoperfusion (HP) and those without HP at stroke onset.ConclusionsThese findings suggest that remote cortical atrophy independently predicts language outcomes in patients with chronic left subcortical stroke and aphasia and that cortical thinning in these regions might relate to integrity loss of fiber tracts connected to stroke lesions.

Effectiveness of Atomoxetine (Strattera) for the Treatment of Poststroke Aphasia Combined With Cognitive Impairment.

In this study, we aimed for the first time to evaluate the effectiveness of atomoxetine (Strattera) in the treatment of cognitive impairment and aphasia after stroke in a large sample. We reviewed the data of 106 patients with poststroke aphasia and cognitive impairment (atomoxetine treatment group = 55 patients vs control group = 51 patients), including scores of the Korean version of the Mini-Mental State Examination (K-MMSE) and the Korean version of the Western Aphasia Battery. Wilcoxon signed-rank tests were used to compare the initial and follow-up K-MMSE and Korean version of the Western Aphasia Battery scores. Mann-Whitney U tests were used to compare the degree of improvement in K-MMSE and Aphasia Quotient (AQ) scores between the atomoxetine and control groups. Baseline characteristics including age, years of education, and scores of the initial Functional Independence Measure, Korean version of the Modified Barthel Index, Hamilton Depression Rating Scale, K-MMSE, and AQ did not differ significantly between the 2 groups. Follow-up K-MMSE and AQ scores were significantly better than the initial scores in both the treatment and control groups. However, improvements in K-MMSE scores were significantly greater in the treatment group than in the control group. In addition, the atomoxetine group had significantly higher AQ scores than the control group, especially for auditory verbal comprehension and naming. Atomoxetine has been shown to significantly improve cognitive function and language in patients with poststroke aphasia. It is also the first study to report improvement in auditory comprehension and naming by administration of atomoxetine.

The Reliability of Telepractice Administration of the Western Aphasia Battery-Revised in Persons With Primary Progressive Aphasia.

The use of telepractice in the field of communication disorders offers an opportunity to provide care for those with primary progressive aphasia (PPA). The Western Aphasia Battery-Revised (WAB-R) is used for differential diagnosis, to assess severity of aphasia, and to identify a language profile of strengths and challenges. Telehealth administration of the WAB-R is supported for those with chronic aphasia due to stroke but has not yet been systematically explored in neurodegenerative dementia syndromes. To fill this gap, in-person and telehealth performance on the WAB-R from participants with mild to moderate PPA was compared. Nineteen participants with mild to moderate PPA were administered the WAB-R in person and over videoconferencing. Videoconferencing administration included modifications to the testing protocol to ensure smooth completion of the assessment. Subtest and Aphasia Quotient (WAB-AQ) summary scores were compared using concordance coefficients to measure the relationship between the administration modes. In-person and telehealth scores showed strong concordance for the WAB-AQ, Auditory Verbal Comprehension subtest, and Naming & Word Finding subtest. The Spontaneous Speech test summary score had slightly lower concordance, indicating the need for caution when comparing these scores across administration modes. These findings support extending the use of telehealth administration of the WAB-R via videoconferencing to those with mild to moderate PPA given appropriate modifications to testing protocol.

Disrupted Functional Connectivity Within and Between Resting-State Networks in the Subacute Stage of Post-stroke Aphasia.

Background: Post-stroke aphasia (PSA) results from brain network disorders caused by focal stroke lesions. However, it still remains largely unclear whether the impairment is present in intra- and internetwork functional connectivity (FC) within each resting-state network (RSN) and between RSNs in the subacute stage of PSA.Objectives: This study aimed to investigate the resting-state FC within and between RSNs in patients with PSA and observe the relationships between FC alterations and Western Aphasia Battery (WAB) measures.Methods: A total of 20 individuals with subacute PSA and 20 healthy controls (HCs) were recruited for functional MRI (fMRI) scanning, and only patients with PSA underwent WAB assessment. Independent component analysis was carried out to identify RSNs. Two-sample t-tests were used to calculate intra- and internetwork FC differences between patients with PSA and HCs. The results were corrected for multiple comparisons using the false discovery rate (FDR correction, p < 0.05). Partial correlation analysis was performed to observe the relationship between FC and WAB scores with age, gender, mean framewise displacement, and lesion volume as covariates (p < 0.05).Results: Compared to HCs, patients with PSA showed a significant increase in intranetwork FC in the salience network (SN). For internetwork FC analysis, patients showed a significantly increased coupling between left frontoparietal network (lFPN) and SN and decreased coupling between lFPN and right frontoparietal network (rFPN) as well as between lFPN and posterior default mode network (pDMN) (FDR correction, p < 0.05). Finally, a significant positive correlation was found between the intergroup difference of FC (lFPN-rFPN) and auditory-verbal comprehension (p < 0.05).Conclusion: Altered FC was revealed within and between multiple RSNs in patients with PSA at the subacute stage. Reduced FC between lFPN and rFPN was the key element participating in language destruction. These findings proved that PSA is a brain network disorder caused by focal lesions; besides, it may improve our understanding of the pathophysiological mechanisms of patients with PSA at the subacute stage.

Independent contributions of structural and functional connectivity: Evidence from a stroke model.

Altered functional connectivity is related to severity of language impairment in poststroke aphasia. However, it is not clear whether this finding specifically reflects loss of functional coherence, or more generally, is related to decreased structural connectivity due to cortical necrosis. The aim of the current study was to investigate this issue by factoring out structural connectivity from functional connectivity measures and then relating the residual data to language performance poststroke. Ninety-seven participants with a history of stroke were assessed using language impairment measures (Auditory Verbal Comprehension and Spontaneous Speech scores from the Western Aphasia Battery–Revised) and MRI (structural, diffusion tensor imaging, and resting-state functional connectivity). We analyzed the association between functional connectivity and language and controlled for multiple potential neuroanatomical confounders, namely structural connectivity. We identified functional connections within the left hemisphere ventral stream where decreased functional connectivity, independent of structural connectivity, was associated with speech comprehension impairment. These connections exist in frontotemporal and temporoparietal regions. Our results suggest poor speech comprehension in aphasia is at least partially caused by loss of cortical synchrony in a left hemisphere ventral stream network and is not only reflective of localized necrosis or structural connectivity.

Changes in Electrical Brain Activity Due to tDCS in Post-Stroke Chronic Aphasia: a Double-Blind Randomized Controlled Study

<h3>Research Objectives</h3> To better understand changes in brain activity related to transcranial direct current stimulation (tDCS) in post-stroke chronic aphasia. <h3>Design</h3> Double-blind randomized placebo controlled study design. <h3>Setting</h3> Casa Colina Research Institute. <h3>Participants</h3> Forty three post-stroke outpatients with chronic aphasia (32 males; age: 61±13y; 0.9-18years post-injury; 32 ischemic stroke; 19 non-fluent aphasia). Twenty patients were in the tDCS group. <h3>Interventions</h3> Participants were randomly assigned either to the tDCS group (cathode on Broca, left side) or to the sham/placebo group. Both groups had five consecutive days of 20 minutes session, using a FDA approved tDCS device (soterixmedical.com). Resting state electrophysiological recordings (5 minutes) and behavioral assessments were performed the week before/after tDCS/sham intervention. <h3>Main Outcome Measures</h3> 1) EEG data: power spectrum as well as coherence in delta, theta, alpha and beta frequencies in fronto-temporal electrodes; 2) Behavioral data: the Western Aphasia Battery-Revised (WAB-R total scores and subscores). <h3>Results</h3> For the behavioral data, groups differed, pre/post intervention, on the WAB-R total score (F=5.22; p=0.028) as well as for the Auditory-Verbal Comprehension (F=4.657; p=0.038) and Repetition (F=4.56; p=0.04) subscores. For the EEG, groups also differed, pre/post intervention, when looking at changes in coherence between Broca and Wernicke on the contralateral side (F8T4, alpha and beta) as well as between Broca area on bilateral sides (F7F8, beta) and other fronto-temporal electrodes (F3T3, beta; FzT5, alpha; F4T5, beta). Post-hoc analyses revealed a significant increase in coherence for the tDCS group (but not for the sham group) for the following electrodes: F8T4 (alpha), F3T3 (beta) and F4T5 (beta). <h3>Conclusions</h3> In this double-blind randomized placebo controlled trial, our findings show a higher improvement in language functions (for both receptive and expressive language skills) in response to treatment as compared to sham. These improvements seem related to an increase in coherence not only in ipsilateral but also contralateral fronto-temporal electrodes, suggesting a higher functional connectivity within the language network due to tDCS in post-stroke chronic aphasia. <h3>Author(s) Disclosures</h3> The authors have nothing to declare.

Abstract P200: Transcranial Direct Current Stimulation in Post-Stroke Chronic Aphasia: A Double Blind Randomized Controlled Study

Background: There is growing evidence even amongst those with chronic aphasia that transcranial direct current stimulation (tDCS) combined with behavioral speech therapy could boost language. However, current findings do not allow making strong recommendations for using tDCS in order to improve language in post-stroke aphasia. The efficacy of tDCS therefore still needs to be established using double-blind controlled randomized trials in large samples. Intervention: In this ongoing double-blind randomized placebo controlled trial study, participants were randomly assigned either to the tDCS group or to the sham group. Both groups had five consecutive days of 20 minutes session, using a FDA approved tDCS device (soterixmedical.com). Behavioral and neuroimaging data were performed the week before/after tDCS/sham intervention and again 3 months following treatment. Participants: 42 post-stroke patients with chronic aphasia (32 males; age: 61±11y; 0.9-18years post-injury; 32 ischemic stroke; 19 non-fluent aphasia). Eighteen patients were in the tDCS group. Main Outcome Measures: The Western Aphasia Battery-Revised (WAB-R), Communication Outcomes after Stroke, patient and family report (COAST). MRI Diffusion Tensor Imaging data (64 dir) were also collected. Statistical Analyses: Anova with repeated measures was used on the behavioral outcome measures with aphasia severity, age and time since injury as covariates in SPSS. The average fractional anisotropy (FA) and mean diffusivity (MD) were extracted per ROI from each participant and timepoint. Main Results: a) Behavioral. Groups differed, pre/post intervention, on the WAB-R total score, for the Auditory-Verbal Comprehension and Repetition subscores; b) Neuroimaging. Change in Spontaneous Speech and Auditory Verbal Comprehension negatively correlated with change in mean MD and FA, respectively, in Superior Cerebellar Peduncle for tDCS, but not sham. Conclusion: Our preliminary findings show a higher improvement in language functions (for both receptive and expressive language skills) in response to treatment (vs. sham). Neuroplasticity was observed in superior cerebellar peduncle in response to tDCS mediated language improvement.

Prediction of Aphasia Severity in Patients with Stroke Using Diffusion Tensor Imaging.

This study classified the severity of aphasia through the Western Aphasia Battery and determined the optimal cut-off value for each Language-Related White Matter fiber and their combinations, we further examined the correlations between Language-Related White Matter and Western Aphasia Battery subscores. This retrospective study recruited 64 patients with aphasia. Mild/moderate and severe aphasia were classified according to cut-off Aphasia Quotient score of 51 points. Diffusion tensor imaging and fractional anisotropy reconstructed Language-Related White Matter in multiple fasciculi. We determined the area under the covariate-adjusted receiver operating characteristic curve to evaluate the accuracy of predicting aphasia severity. The optimal fractional-anisotropy cut-off values for the individual fibers of the Language-Related White Matter and their combinations were determined. Their correlations with Western Aphasia Battery subscores were analyzed. The arcuate and superior longitudinal fasciculi showed fair accuracy, the inferior frontal occipital fasciculus poor accuracy, and their combinations fair accuracy. Correlations between Language-Related White Matter parameters and Western Aphasia Battery subscores were found between the arcuate, superior longitudinal, and inferior frontal occipital fasciculi and spontaneous speech, auditory verbal comprehension, repetition, and naming. Diffusion-tensor-imaging-based language-Related White Matter analysis may help predict the severity of language impairment in patients with aphasia following stroke.

EFFECT OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON POST STROKE-DYSPHASIA

Background: Aphasia is characterized as language impairment. The bulk of stroke-induced cerebrovascular disease leads to its prevalence. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and painless method of altering the excitability of the cerebral cortex by inducing or enhancing neuroplasticity in brain. Objective: The goal of this research to assess the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on improving post-stroke dysphasia. Patients and methods: Our studies were conducted on sixty (60) patients suffering from post-cerebrovascular stroke dysphasia and were randomly divided into two groups. Group A (case group): Forty patients received stimulatory session’s high frequency) of rTMS (10Hz, 90 % of motor threshold) over the dominant language areas, and Group B (sham group): Twenty patients received sham rTMS on dominant language areas. Patients were selected from the Department of Neurology at Al-Azhar University Hospitals, and follow up was performed at outpatient clinics at (Bab Al-Shaaria and Al-Hussien university hospitals). Results: There were a significant changes in fluency, auditory verbal (AV) comprehension, sequential commands and aphasia qutions (AQ) before and after rTMS therapy in group A (P <0.05). There was significant difference in auditory verbal (AV) comprehension, sequential commands before and after shamTMS therapy in group B (P <0.05). Conclusion: Significant changes were found in fluency, auditory verbal comprehension, sequential commands and aphasia qutions between before and after TMS therapy in group A (case group).High frequency rTMS was beneficial for rehabilitating patients with post stroke aphasia.

Dysfunction of the left angular gyrus may be associated with writing errors in ALS

Background: Language dysfunction is a feature of cognitive impairment in amyotrophic lateral sclerosis (ALS) that may compromise communication. Objective: To elucidate language dysfunction in patients with ALS and its relationship with other neuropsychological tests and to identify the brain regions associated with this dysfunction using perfusion image. Methods: Overall, 37 patients with ALS were included in this study. Their neuropsychological function was investigated using the Western Aphasia Battery (WAB), Frontal Assessment Battery and Behavioral Assessment of the Dysexecutive Syndrome. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography was used to examine regional cerebral blood flow and its relationship with WAB scores was investigated using multiple regression analyses, controlled for age, sex and years of education. Results: Frequency of language abnormality in ALS was 8.5% for spontaneous speech, 25.7% for auditory verbal comprehension, 8.8% for repetition, 14.7% for naming, 17.6% for reading and 51.4% for writing. The writing error was mainly omission and substitution of kana letters. Executive tests were correlated with naming (r > 0.5, p < 0.001) and reading (r > 0.4, p < 0.01) scores. With respect to the writing sub-test, positive perfusional relationship was only detected in the left angular gyrus. Conclusions: The left angular gyrus is the region associated with the writing errors observed in ALS.

Clinical utility of transcranial direct current stimulation and online language training in semantic dementia

AbstractBackgroundSemantic dementia (SD) is a variant of primary progressive aphasia (PPA) which is characterised by impaired confrontation naming, single word comprehension and object recognition with preserved fluency and syntax. Similar to many other neurodegenerative dementias, there is currently no effective treatment for semantic dementia. Neuromodulatory interventions like transcranial direct current stimulation(tDCS) and repetitive transcranial magnetic stimulation(rTMS) along with language training is emerging as a potential treatment strategy for Primary progressive aphasia. Aim: Four patients with semantic dementia were administered concomitant online language training with tDCS to study the feasibility and clinical outcome.MethodFour patients (2 males) aged between 50‐63 years, diagnosed with semantic dementia after a comprehensive clinical assessment and Addenbrooke’s cognitive examination and Clinical Dementia Rating(CDR) scale by an experienced geriatric Psychiatrist were included in the case series. Detailed assessment of neurolinguistic skills was done using Western Aphasia Battery (WAB‐Kannada/Hindi) before and after 5‐days of tDCS by qualified speech pathologist. Daily tDCS sessions were delivered using 2mA current with anode over the left dorsolateral prefrontal cortex and cathode over right supraorbital area for 30 minutes, except one female patient with moderate dementia who received 2 session daily at an interval of 3 hours. Online cognitive‐linguistic intervention was provided by the speech pathologist during tDCS sessions. Adverse effects were monitored using structured questionnaire.ResultThree Patients had mild dementia and one had moderate dementia as per CDR. tDCS was tolerated well except for burning sensation in two sessions in one patient and all were able to attend the linguistic training. All subjects improved in the domains of Spontaneous speech, Auditory verbal comprehension, repetition and naming on the WAB.ConclusiontDCS can be a potential therapeutic modality in semantic dementia. Randomized Sham Controlled Clinical trials are required to establish the efficacy of tDCS and language training in the treatment of semantic dementia.

Relative Weight Analysis of the Western Aphasia Battery

ABSTRACT Background: The Western Aphasia Battery (WAB) is one of the most widely used batteries for assessing people with aphasia. Despite longstanding use, it is unclear how the individual components of the battery contribute to the aphasia quotient (AQ), which profiles aphasia severity. Objectives: The primary objective of this study was to explore the individual contributions of the four major components (Spontaneous Speech, Auditory Verbal Comprehension, Repetition, Naming) and the 10 subtests of the WAB to the WAB AQ using relative weight analysis (RWA). The second objective was to evaluate whether the contributions that these components and subtests make to the WAB AQ are influenced by aphasia type (fluent vs non-fluent). Methods & Procedures: Data for 288 persons with aphasia obtained from the AphasiaBank were analyzed in this study. RWA was performed with the R relaimpo package 2.2–3 using WAB AQ scores, scores from the major components, and scores from the10 subtests that are used to calculate the AQ. A second RWA was completed to examine whether the relative weights for these measures vary as a function of aphasia type (fluent vs non-fluent). Outcomes & Results: Results of RWA for the four major components of the AQ indicated that Spontaneous Speech contributes ~30%, Auditory Verbal Comprehension 20%, Repetition 25%, and Naming/Word Finding 25% to the AQ. RWA for the 10 WAB subtests revealed the major contributors to be Fluency (14.4%), Repetition (14.1%), Information Content (13.1%), and Object Naming (10.5%). In comparisons of the four major areas between individuals with fluent vs non-fluent aphasia, only the contribution of Spontaneous Speech differed between the two groups with this area contributing 31% to the AQ in those individuals with fluent aphasia and 28% in those with non-fluent aphasia. Conclusions: RWA demonstrated that the major components of the WAB do not contribute equally to the AQ but that the contribution of Spontaneous Speech is less than has been suggested previously. The strongest contributors to the AQ are primarily measures of expressive language. This greater influence of the expressive language measures on the AQ should be considered carefully when interpreting the AQ and aphasia severity.

Storybook selection criteria used by teachers of d/Deaf and hard-of-hearing prereaders communicating in English

ABSTRACT For d/Deaf and hard-of-hearing prereaders who communicate predominately in spoken and/or signed English (DHH-English), Teachers of the d/Deaf (TODs) read books aloud to increase English skills, auditory-verbal comprehension, sequencing skills, verbal reasoning, background knowledge, and sight word recognition. Teachers struggle to select appropriate books for read alouds. Unfortunately, the only available book selection system for TODs serving DHH-English was developed for a different purpose than identifying storybooks to increase English skills and was based on a methodology difficult to evaluate. To help teachers select books, we created an empirically-derived difficulty-level system based on the judgments of 69 experienced TODs serving DHH-English preschoolers and kindergartener across the United States. We used 14 storybooks and asked the TODs to group these books and order these groups based on how difficult the storybooks would be for DHH-English prereaders to understand when the books were read aloud. Additionally, TODs described the groups they created and why they assigned the books in their groups. We used these descriptions in a content analysis to derive a glossary of book characteristics. Finally, we analysed these results with a multivariate technique that simultaneously analysed the glossary and ranking data to create a difficulty-level scale and to identify exemplar books. The book selection system includes a two-tiered glossary, a six-point difficulty-level scale and exemplar books for each scale level. We discuss how this empirically-derived book selection system for read alouds with DHH-English prereaders can be paired with the three existing evidence-based read-aloud interventions designed to increase oral language skills.

Interhemispheric interactions during sentence comprehension in patients with aphasia

Right-hemisphere involvement in language processing following left-hemisphere damage may reflect either compensatory processes, or a release from homotopic transcallosal inhibition, resulting in excessive right-to-left suppression that is maladaptive for language performance. Using fMRI, we assessed inter-hemispheric effective connectivity in fifteen patients with post-stroke aphasia, along with age-matched and younger controls during a sentence comprehension task. Dynamic Causal Modeling was used with four bilateral regions including inferior frontal gyri (IFG) and primary auditory cortices (A1). Despite the presence of lesions, satisfactory model fit was obtained in 9/15 patients. In young controls, the only significant homotopic connection (RA1-LA1), was excitatory, while inhibitory connections emanated from LIFG to both left and right A1's. Interestingly, these connections were also correlated with language comprehension scores in patients. The results for homotopic connections show that excitatory connectivity from RA1-to-LA1 and inhibitory connectivity from LA1-to-RA1 are associated with general auditory verbal comprehension. Moreover, negative correlations were found between sentence comprehension and top-down coupling for both heterotopic (LIFG-to-RA1) and intra-hemispheric (LIFG-to-LA1) connections. These results do not show an emergence of a new compensatory right to left excitation in patients nor do they support the existence of left to right transcallosal suppression in controls. Nevertheless, the correlations with performance in patients are consistent with some aspects of both the compensation model, and the transcallosal suppression account for the role of the RH. Altogether our results suggest that changes to both excitatory and inhibitory homotopic and heterotopic connections due to LH damage may be maladaptive, as they disrupt the normal inter-hemispheric coordination and communication.

Psychometric properties of discourse measures in aphasia: acceptability, reliability, and validity.

Discourse in adults with aphasia is increasingly the focus of assessment and therapy research. A broad range of measures is available to describe discourse, but very limited information is available on their psychometric properties. As a result, the quality of these measures is unknown, and there is very little evidence to motivate the choice of one measure over another. To explore the quality of a range of discourse measures, targeting sentence structure, coherence, story structure and cohesion. Quality was evaluated in terms of the psychometric properties of acceptability (data completeness and skewness), reliability (inter- and intra-rater), and validity (content, convergent, discriminant and known groups). Participants with chronic mild-to-moderate aphasia were recruited from community groups. They produced a range of discourses which were grouped into Cinderella and everyday discourses. Discourses were then transcribed orthographically and analyzed using macro- and microlinguistic measures (Story Grammar, Topic Coherence, Local Coherence, Reference Chains and Predicate Argument Structure-PAS). Data were evaluated against standard predetermined criteria to ascertain the psychometric quality of the measures. A total of 17 participants took part in the study. All measures had high levels of acceptability, inter- and intra-rater reliability, and had good content validity, as they could be related to a level of the theoretical model of discourse production. For convergent validity, as expected, 8/10 measures correlated with the Western Aphasia Battery-Revised (WAB-R) spontaneous speech scores, and 7/10 measures correlated with the Kissing and Dancing Test (KDT) scores (r ≥ 0.3), giving an overall positive rating for construct validity. For discriminant validity, as predicted, all measures had low correlations with Raven's Coloured Progressive Matrices (RCPM) and WAB-R Auditory Verbal Comprehension scores (r < 0.3), giving an overall positive rating for construct validity. Finally, for known groups validity, all measures indicated a difference between speakers with mild and moderate aphasia except for the Local Coherence measures. Overall, Story Grammar, Topic Coherence, Reference Chains and PAS emerged as the strongest measures in the current study because they achieved the predetermined thresholds for quality in terms of each of the psychometric parameters profiled. The current study is the first to psychometrically profile measures of discourse in aphasia. It contributes to the field by identifying Story Grammar, Topic Coherence, Reference Chains and PAS as the most psychometrically robust discourse measures yet profiled with speakers with aphasia. Until further data are available indicating the strength of other discourse measures, caution should be applied when using them.

Neuropsychological performance in patients with asymptomatic HIV-1 infection

ABSTRACTHuman immunodeficiency virus (HIV-1) infection and acquired immunodeficiency syndrome (AIDS) lead to neurocognitive disorders; however, there is still much knowledge to be gained regarding HIV-associated neurocognitive disorders. The purpose of this study was to assess the cognitive performance, instrumental activities of daily living, depression, and anxiety in patients with asymptomatic HIV-1 infections compared with seronegative participants without neurocognitive impairment. We studied a sample consisted of 60 patients with asymptomatic HIV-1 infections and 60 seronegative participants without neurocognitive impairment from the city of Barranquilla, Colombia, with a mean age of 36.07 years. A protocol of neuropsychological and psychopathological tests was applied to the participants. The group of patients with asymptomatic HIV infections significantly underperformed on tasks that assessed global cognitive screening, attention span, learning, phonemic verbal fluency, auditory-verbal comprehension, information processing speed, cognitive flexibility, and motor skills compared to the group of seronegative participants. No significant differences were found in memory, visual confrontation naming, vocabulary, inhibition, and instrumental activities of daily living. Additionally, the patients with asymptomatic HIV-1 infection had a higher anxiety index than the seronegative participants, but no significant difference was found in depression. A correlation was found between depression and anxiety. In conclusion, the patients with asymptomatic HIV-1 infection had lower cognitive performances than the seronegative participants in the cognitive functions mentioned above and more anxiety but still performed the instrumental activities of daily living.

Inhibitory or excitatory connections between hemispheres? Evidence from sentence comprehension in patients with aphasia

Inhibitory or excitatory connections between hemispheres? Evidence from sentence comprehension in patients with aphasia