Clinical Aphasiology Conference Research Articles

Moving Toward Anti-Ableist Practices in Aphasia Rehabilitation and Research: A Viewpoint.

Ableism is a pervasive set of beliefs that regard nondisabled bodies and minds as ideal and necessary to live a full life. Ableism manifests for people with aphasia as stigma and discrimination based on their language ability. We assert that ableism contributes to decreased quality of life for people with aphasia and should be actively challenged and disrupted by clinicians and researchers in the field. We applied the Health Stigma and Discrimination Framework (HSDF) to outline how stigma and discrimination are perpetuated against people with aphasia on the basis of language ability and their downstream health and social consequences. We presented this framework at the Clinical Aphasiology Conference in 2023 and share themes and challenges that arose from this discussion and from our ongoing learning. Applying the HSDF to aphasia outlined potential sequelae of ableism. We identified preliminary foci of future initiatives aimed at challenging ableist beliefs and practices and means to monitor the effectiveness of such interventions. Furthermore, we draw attention to the seeming tension between anti-ableist practices and traditional language rehabilitation goals. We assert that this tension may be a catalyst for fruitful discourse on how clinicians and researchers can resist ableism while honoring the lived experiences of people with aphasia and their goals for language rehabilitation. These discussions may be facilitated by existing models in disability studies (e.g., the political/relational model). Clinicians and researchers are well positioned to challenge ableism and minimize the resultant health and social impacts for people living with aphasia. Anti-ableist practices are not antithetical to aphasia rehabilitation and can be thoughtfully integrated into rehabilitation practices and discourse.

Introduction to the Special Issue for the 50th Clinical Aphasiology Conference.

Introduction to the Special Issue for the 50th Clinical Aphasiology Conference.

THE 52nd CLINICAL APHASIOLOGY CONFERENCE

THE 52nd CLINICAL APHASIOLOGY CONFERENCE

Maintenance and Generalization of Lexical Items in Primary Progressive Aphasia: Reflections From the Roundtable Discussion at the 2021 Clinical Aphasiology Conference.

Our capacity to engage in society and maintain meaningful relationships is dependent on intact communication skills. They are compromised in a neurodegenerative language disorder termed primary progressive aphasia (PPA). Behavioral interventions for PPA are sparse and often limited to impairment-based approaches or communication skills training, although various functional interventions have been also described. The slow but relentless language decline does not naturally support maintenance and/or generalization of treatment gains, which should be the ultimate goal of any therapy. However, in some cases and under certain conditions, maintenance and generalization may be accomplished. While each type of intervention has much to offer to the PPA population, the clinical and research realms can benefit from a collective professional discussion on aspects of intervention conducive to maintenance and/or generalization of treatment gains in PPA. Such a discussion took place at the 2021 Clinical Aphasiology Conference during two roundtable sessions. The aims of the sessions were to review the premises of successful treatment approaches in PPA and to discuss factors fostering or inhibiting maintenance and generalization in PPA. Current literature delivers, albeit in small doses, encouraging evidence for clinicians providing language intervention to patients with PPA. Although PPA is a progressive disorder, both the immediate treatment effects and, in many cases, evidence of maintenance and generalization demonstrate that improvements may be long lasting and transferrable. Several factors may enhance maintenance and generalization effects, including repeated practice, working with multiple exemplars of treatment items, booster sessions, group programs with built-in individual sessions, spared semantics, and personal relevance, to name a few. With this evidence in hand, we need to become more diligent about measuring and reporting clinical outcomes and delivering interventions that support maintenance and generalization of therapeutic gains beyond the clinician's office. https://doi.org/10.23641/asha.19836370.

The 51st Clinical Aphasiology Conference

The annual Clinical Aphasiology Conference (CAC) provides a forum for clinicians and researchers engaged in the study and clinical management of persons with acquired neurologic language disorders ...

Introduction to the Special Issue for the 49th Clinical Aphasiology Conference.

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The 50th annual clinical Aphasiology conference

The 50th annual clinical Aphasiology conference

The 2017 Clinical Aphasiology Conference: A Letter From the Editor.

The 2017 Clinical Aphasiology Conference: A Letter From the Editor.

Using Images With Individuals With Aphasia: Current Research and Clinical Trends

Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia. The aim of this review-resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference-was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice. Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices. Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).

From the Editors

Without opportunities to communicate, improved language is a trivial accomplishment. Nina Simmons-Mackie (2008, p. 304) We selected these words to introduce this issue because, with them, Dr. Nina Simmons-Mackie (2008), speech–language pathologist and ethnographic researcher, conveyed its essential message. Simmons-Mackie's words are quoted in the Foreword for Volume 37, Issue 1, of Topics in Language Disorders by the Issue Editors Tami Howe and Robyn O'Halloran (2017). Howe and O'Halloran titled the issue, “A Turning Point for Inclusion” of Adults With Aphasia: Removing Barriers and Implementing Facilitators. We point readers to their issue editors' Foreword for a more detailed overview of the articles and their contributions to the topic. Briefly, Issue Editors Howe and O'Halloran conceptualized this issue as a collection of articles that could illuminate facilitators and barriers to participation for people with aphasia for whom communication difficulty is a defining feature. They invited contributors to describe recent developments about inclusion and participation for people with aphasia from around the globe. First, Menger, Morris, and Salis (2017) review a method of using the International Classification of Functioning, Disability, and Health (World Health Organization, 2001) to evaluate Internet use in people with aphasia. Next, Sather, Howe, Nelson, and Lagerwey (2017) describe the concept of flow as it is experienced by people with aphasia. Third, Howe (2017) provides a closer look at the impact of environmental factors affecting participation of people with aphasia through an exploration of found opportunities for social participation. Fourth, Solarsh and Johnson (2017) provide an overview of a program designed to increase communication access throughout the community. Fifth, Pearl and Cruice (2017) describe methods and provide examples of ways in which researchers may include people with aphasia in research studies. Finally, O'Halloran, Carragher, and Foster (2017) describe the use of two conceptual models as a framework for understanding environmental factors that affect people with aphasia. Overall, we think that readers will agree that the articles in this issue provide an important overview of issues that affect the ability of people with aphasia to participate in their lives in meaningful and desired ways. Although many questions remain about how to improve outcomes, gaining a deeper understanding of the issues using a variety of methods from the perspectives of participants in multiple countries is a solid place to start. The articles in this issue echo a call from another aphasiology pioneer, Audrey Holland. Dr. Holland used her remarks during the 1982 Clinical Aphasiology Conference to encourage clinicians and researchers to employ natural observation as a powerful tool to understand aphasia's impact on people's lives. These current articles further the notion that participation is a complex and multifaceted concept that requires immediate attention by aphasiologists. —Sarah E. Wallace, PhD Associate Editor —Nickola Wolf Nelson, PhD Editor-in-Chief

Attentive Reading with Constrained Summarization-Written (ARCS-W), a treatment to improve written and spoken discourse in people with mild aphasia.

Attentive Reading with Constrained Summarization-Written (ARCS-W), a treatment to improve written and spoken discourse in people with mild aphasia.

Thresholds of visibility for masked lexical, non-lexical, and non-linguistic items in aphasia

Thresholds of visibility for masked lexical, non-lexical, and non-linguistic items in aphasia

Back From the Brink

Back From the Brink

Executive dysfunction as an explanatory basis for conversation symptoms of aphasia: A pilot study

Background: Lack of communicative success for people with aphasia is no longer seen as purely a linguistic deficit. Instead, the integrity of the executive functions (EF) is thought to be at least partly responsible for successful communication, particularly during conversation. In order to inform clinicians regarding both conversation and EF, a merging of two paradigms—conversational and neuropsychological approaches—is proposed. This paper was presented at the Clinical Aphasiology Conference, Ghent, Belgium, May 2006. Aims: First, we explore the relevance of both neuropsychological and conversational approaches to the assessment of aphasia. Second, we present the executive battery that was designed and administered to a single participant (MS) to assess various aspects of EF. The results of a Conversation Analysis (CA) undertaken on an excerpt of MS's conversation are given. Results of the EF analysis are presented with the CA in order to highlight proposed relationships that may impact on conversational strengths and difficulties. Methods and Procedures: The executive battery was designed to assess the following constructs: attention, verbal and nonverbal working memory, memory, planning, generation, and concept formation. The participant was video‐recorded in conversation with a familiar interlocutor. Transcriptions were derived and subjected to Conversation Analysis. A discussion of conversational features is presented in conjunction with results from the executive battery. Outcomes and Results: Several areas including simple sustained attention, interference control, memory, and planning appeared to be preserved. This profile occurred together with the ability to maintain concentration and track meaning during interactions with one interlocutor. Memory for previously stated information was preserved as well as the ability to think and plan ahead. These strengths also co‐occurred with intact turn taking and topic management. However MS's performance also indicated difficulty with shifting attention, verbal and nonverbal working memory, generation, and concept formation. The latter two especially appeared to be mediated by the effects of perseveration, which resulted from a reduced ability to shift focus. In terms of conversation, MS reported difficulty in multi‐party settings. In addition, conversational repair was affected by poor generation and selection of strategies as well as an inability to shift away from current ineffectual forms of expression to more effective, flexible, and potentially successful forms of communication. Conclusions: The notion of merging two distinct and historically separate paradigms presents unique and valuable opportunities for creative and effective treatment of individuals with aphasia who have reached plateaus or who, as in this case, present with relatively intact linguistic skills on formal testing but experience daily frustration during conversation.

Adding meaning to measurement: Initial Rasch analysis of the ASHA FACS Social Communication Subtest

Background: The American Speech‐Language‐Hearing Association Functional Assessment of Communication Skills (ASHA FACS) has established validity and reliability for individuals with aphasia. However, subtest scores are summed and averaged across subtests, making it difficult to describe individuals' communication behaviours. Item‐response theory provides a methodology to assess the measurement properties of established assessments by transforming ordinal data into interval data, calibrated for both person ability measures and item difficulty on the same linear scale. The result is that behaviours can be ordered and described in ways that are more informative and useful than reporting raw scores. This study was funded by the VA Associated Health Rehabilitation Research Predoctoral Fellowship, the Office of Research and Development, Rehabilitation R&D Services, Department of Veterans Affairs and NIH NIDCD P50 Grant #DC003888‐04. We wish to acknowledge the support of Leslie Gonzalez Rothi, Director of the Brain Rehabilitation Research Center (BRRC) on this project. We also acknowledge the staff of the Outcome Core of the BRRC for collection and organisation of the data used in this study. Travel to present this paper at the 35th Clinical Aphasiology Conference was funded through an NIH NIDCD Travel Fellowship. The authors have no conflicts of interest. Aims: The study aimed to use Rasch analysis to determine the psychometric properties of the ASHA FACS Social Communication Subtest (SCS) and to demonstrate how the Key form (a visual representation of the measure that results from the Rasch analysis) could add meaning to scoring and tracking progress. Methods & Procedures: A total of 130 caregivers (76% female, 24% male) rated the performance of individuals with aphasia on the ASHA FACS SCS (21 items rated on a 7‐unit scale). Participants' ages ranged from 31 to 88 years (M = 60.5, SD = 12.4). Rasch analysis was done by WINSTEP computer software. Results: The ASHA FACS SCS demonstrated good measurement characteristics with two exceptions. First, three of seven units of the rating scale were used with such low probability that they were not useful to the measure. The data were re‐analysed using the four‐unit scale. The new rating scale covered the full range of sample abilities (2.94 statistically distinct levels). Second, the principal components analysis (an analysis of unidimensionality) found negative factor‐item loading of easier items (“understanding”) and positive factor‐item loading of harder items (“conversing”), indicating that the scale contained two constructs rather than one. Fit statistics showed all 21 items within the established criteria (.6 < Mean Square < 1.4, ZStd < 2.0). The person separation reliability (analogous to Cronbach's alpha) was high at .90. The Key form linked the measure of item difficulty (logits) and rating scale with the item hierarchy. Conclusions: Through Rasch analysis of the ASHA FACS SCS we demonstrated that: caregivers were reliable respondents (adding another use for the scale); the rating scale could be simplified; and the Key form could be used to demonstrate treatment progress. Future investigation could include: (1) analysis of the measurement properties of all subtests based on a large sample of caregivers; (2) item development for two constructs of social communication (e.g., understanding and conversing); and (3) test–retest reliability of respondents.

Evidence‐based practice: What evidence is missing?

Background: Evidence‐based practice (EBP) is defined as “an approach in which current, high‐quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions“ (ASHA, 2005). Evidence‐based practice has gained significant momentum around the world. Many professional healthcare organisations, including those associated with speech‐language pathology, have recommended that clinicians incorporate EBP into everyday clinical practice. Aims: An approach such as EBP relies on the practitioner being able to locate high‐quality research in order to provide data that informs his/her clinical decision making. The present paper lists at least five possible sources of bias that serve to reduce available evidence within EPB: funding bias, publication bias, consumer/researcher mismatch, reduced clinical applicability, and over‐reliance on randomised controlled trials. Main Contribution: Possible sources of bias within the EPB process, resulting in “missing” evidence are outlined and illustrated. Specific examples are provided from various healthcare fields. Conclusions: It is suggested that discussion of sources of bias within EBP may help to maximise its potential. Audience suggestions provided at the 2005 Clinical Aphasiology Conference regarding possible directions for future work in this are appended.

Long-Term Care Approaches to Aphasia Treatment and Management

Long-Term Care Approaches to Aphasia Treatment and Management

A Brief History of the Clinical Aphasiology Conference and Its Publications

Provides a brief history of the Clinical Aphasiology Conference and its publications through 1995.

Introduction to AJSLP Clinical Aphasiology Conference Supplement

Introduction to <i>AJSLP</i> Clinical Aphasiology Conference Supplement