Correct Information Units Research Articles

Clinical efficacy and therapeutic mechanism of active ‘five-tone’ speech therapy compared with conventional speech-language therapy for treatment of post-stroke aphasia: protocol for a randomised controlled trial

IntroductionAphasia is a common dysfunction among patients with stroke that can severely affect daily life. Listening to the ‘five-tone’ melodies of traditional Chinese medicine can improve some of the language...

Determinants of Multilevel Discourse Outcomes in Anomia Treatment for Aphasia.

Individuals with aphasia identify discourse-level communication (i.e., language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, are poorly understood, and vary greatly among individuals with aphasia. In response, this study consisted of a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis (SFA) clinical trials. Aim 1 evaluated changes in theoretically motivated discourse outcomes representing lexical-semantic processing, lexical diversity, grammatical complexity, and discourse informativeness. Aim 2 explored the potential moderating role of nonlanguage cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes. This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for n = 60 (Aim 1) and a subset n = 44 (Aim 2). Outcome measures included lexical-semantic processing (% semantic errors), lexical diversity (moving average type-token ratio), grammatical complexity (mean utterance length), and discourse informativeness (% correct information units). Bayesian generalized mixed-effects models were used to examine changes across four study time points: enrollment, entry, exit, and 1-month follow-up. The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after SFA when measured using standard, general-topic discourse stimuli. There was weak and inconsistent evidence that nonlanguage cognitive factors may play a role in moderating treatment response. These findings indicate a clear need to pair theoretically informed treatments designed to facilitate generalization to discourse with intentional measurement paradigms designed to capture it. Furthermore, there is a clear need to examine how established treatments, restorative or compensatory, can better facilitate generalization to discourse-level communication. These priorities are critical for meaningfully improving everyday communication and reducing the profound communication and psychosocial consequences of aphasia. https://doi.org/10.23641/asha.26524081.

Exploring the use of co-speech hand gestures as treatment outcome measures for aphasia

ABSTRACT Background Research on aphasia treatments that directly target conversation skills have been on the rise in the recent past. Despite the ubiquitous nature of gestures in everyday conversations and their possible compensatory and/or supportive functions for adults with aphasia, the conversational treatment outcome measures continue to rely on spoken language alone. Aims We aimed to explore the feasibility of using co-speech hand gestures as a treatment outcome measure in Clyde, an individual with chronic and severe Wernicke’s aphasia. Methods & Procedures Using a multiple-probe single-case experimental research, we examined data from one participant with aphasia (Clyde) who was a part of a larger study involving 3 people with aphasia (Devanga, 2020). 10-minute conversations between Clyde and clinician, and Clyde and his spouse, were completed during 3 baseline probes, 3 treatment probes and 3 maintenance probes. Clyde also completed a 15-session Collaborative Referencing Intervention (CRI; Devanga etal., 2021) with the clinician. The 18 conversation samples were videorecorded, transcribed, and analysed. Outcomes & Results The outcomes analysed included overall gesture frequency and type (i.e., referential vs. non-referential) across sessions (baseline – treatment – maintenance) and partner familiarity (clinician – spouse). We also compared the gesture outcomes with the spoken language measure, CIUconv (Correct Information Units). Overall gesture frequency was higher with the clinician than the spouse, and the frequency of referential gestures were higher than the non-referential gestures with both partners. With the onset of treatment, we found that overall gesture frequency decreased and #CIUconv increased with the clinician, however there were minimal variations across phases with the spouse. Additionally, with the onset of treatment, referential gestures decreased, and non-referential gestures increased with both partners. Conclusions Findings from this exploratory study provide preliminary support to using co-speech hand gestures as treatment outcome measures for aphasia. Clinical implications including comparisons of gestural outcomes with spoken language outcomes and their implementation are discussed. Further research on differences in gesture use among aphasia types and severities and patterns of change in gesture use with aphasia treatment is warranted.

Assessing informativeness in Spanish-speaking individuals with primary progressive aphasia

ABSTRACT Background Primary progressive aphasia (PPA) is a neurodegenerative disorder associated with atrophy of the frontotemporal region. It is primarily characterized by language impairments that become accentuated over time, often leading to isolation and social exclusion. There are three main subtypes, the semantic (svPPA), non-fluent (nfvPPA), and logopenic (lvPPA) variants, each presenting distinct language deficits, as captured by standard assessment batteries. However, such assessments often fail to adequately identify functional communication (dis)abilities in everyday life, which is crucial for effective diagnosis and treatment. One understudied aspect of communication is informativeness, the conveyance of an appropriate amount of information in an efficient fashion. Aim This study aimed to identify the unique features of each variant of PPA that distinguish it from healthy controls, and the dissimilarity across PPA groups, in terms of the effectiveness and efficiency with which Spanish-speaking individuals with PPA conveyed information. Methods and procedures Thirty-two Spanish-speaking patients with one of the three variants of PPA and 11 healthy individuals were audio-recorded performing a picture description task. The resulting recordings were transcribed, and the contents labelled according to whether they constituted relevant or off-topic content, each type of content being further divided into subcategories. In total, 51 parameters related to the (1) overall amount of speech and number of correct information units, (2) amount of relevant content, (3) completeness of the content, and (4) off-topic information were considered. Nonparametric analyses were conducted to assess the divergence from heathy controls of each PPA group, and the dissimilarity across PPA groups. Outcomes and results Results revealed disruptions in informativeness in all PPA variants compared to controls, with lvPPA characterized by inadequate content and a high concentration of off-topic elements, nfvPPA by inadequate content but efficient delivery, and svPPA by inadequate content delivered inefficiently. Conclusions This study revealed that all three variants of PPA are characterized by reduced informativeness, although each exhibits unique patterns in communicative efficiency and the presence of off-topic information. By assessing the total amount of relevant speech, efficiency in conveying content, and the presence of off-topic elements, this research enhances our understanding of the distinct communication impairments characterizing lvPPA, nfvPPA, and svPPA, and provides valuable insights that can be applied to developing tailored remedial strategies.

Secondary language impairment in posterior cortical atrophy: insights from sentence repetition.

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by progressive impairment in visuospatial and perceptual function linked to atrophy of the occipito-parietal cortex. Besides the salient visual impairment, several studies have documented subtle changes in language may also be present. Sentence repetition is a highly constrained linguistic task involving multiple linguistic and cognitive processes and have been shown to be impaired in other AD spectrum disorders, with little consensus on its relevance in PCA. This aim of this study was to further delineate the linguistic and cognitive features of impaired language in PCA using a sentence repetition task. Seven PCA patients and 16 healthy controls verbally repeated 16 sentences from the Boston Diagnostic Aphasia Examination. Responses were transcribed orthographically and coded for accuracy (percentage accuracy; percentage Correct Information Units; Levenshtein Distance) and for temporal characteristics (preparation duration (ms); utterance duration (ms); silent pause duration (ms); speech duration (ms); dysfluency duration (ms)). The potential modulating effects of attentional control and working memory capacity were explored. PCA patients showed lower overall accuracy with retained semantic content of the sentences, and lower phonological accuracy. Temporal measures revealed longer preparation and utterance duration for PCA patients compared to controls, alongside longer speech duration but comparable dysfluency duration. PCA patients also showed comparable silent pause duration to controls. Attentional control, measured using the Hayling sentence completion task, predicted accuracy of sentence repetition. The findings suggest that sentence repetition is impaired in PCA and is characterized by phonological, response planning and execution difficulties, underpinned in part by attentional control mechanisms. The emerging profile of language impairment in PCA suggests vulnerability of similar cognitive systems to other Alzheimer's syndromes, with subtle differences in clinical presentation.

Core Lexicon analysis of spoken discourse production by Mandarin Chinese speakers with Aphasia

ABSTRACT Background Spoken discourse production has been increasingly recognised as an important source for assessing language competence of persons with aphasia (PWA). Most linguistic measures rely on transcripts of spoken discourse, so they have seldom been used in clinical practice. Thus, there is a need for standardized and norm-referenced measures that can be easily applied in clinical settings. Aims The present study aims to develop core lexicon lists for Mandarin Chinese PWA using AphasiaBank data elicited with different discourse production tasks and test their validity in detecting language deficiency. Methods & Procedures We selected seven semispontaneous discourse tasks within three major task types, i.e., picture descriptions, procedural discourse and story narrative, for core lexicon list development and for examining task type effects. Transcripts from 61 control speakers were split into two sets with age – and education matched: one set (n = 43) as a normative sample used to generate the core lexicon lists and the other (n = 18) as a healthy control group served as a baseline for comparison with PWA productions. Transcripts of 18 age- and education- matched PWA were retrieved from the AphasiaBank database. We selected the top 30 words with the widest distribution in the normative sample to generate core lexicon lists. Then for both PWA and control groups, we calculated agreement percentage as core lexicon scores. Outcomes & Results Core lexicon scores of PWA were significantly lower than the control group participants for all seven tasks and positively correlated with aphasia severity for two story narrative tasks, suggesting that story narrative tasks were more effective in assessing discourse productions compared with picture and procedural descriptions. In addition, core lexicon scores also correlated with lexical diversity (R scores) and discourse informativeness (Correct Information Units) for all seven tasks. Conclusions & Implications Core lexicon scores can effectively distinguish discourse production by Mandarin PWA and healthy controls and they reflect lexical diversity and informativeness of discourse. Our findings, thus, have clinical implications in that these lists could serve as an alternative transcription-less approach in quick Mandarin PWA discourse production assessment.

Discourse Production Across the Adult Lifespan: Microlinguistic Processes.

Successful spoken discourse requires aspeaker to be informative to deliver a coherent, meaningful message. The informativeness of discourse can be conveyed by the variety of vocabularyproduced(i.e., lexical diversity [LD]), the typicality of vocabulary items used (i.e., core lexicon [CL]), and the amount of relevant content produced (i.e., information units).Yet, it is well documented that older adults produce less informative content compared to younger adults despite relatively subtle changes to LD. The typicalityof core lexicalitems has not been assessed in healthy aging.Paradoxically, these results indicate that some aspects of discourse informativeness remain stable or even improve across the adult lifespan, while other aspects decline. The purpose of the current studyisto understand howmicrolinguisticprocesses of informativeness change across the adultlifespan.The cross-sectional study included narrative language samples fromtwowordless picture books collected from420 healthy participants between 20 and 89 years old. LD and percent of correct information units (%CIUs) were analyzed, as well as CL nouns and verbs.The results indicate that %CIUs and CL nounsdemonstratea quadratic decline starting around the ages of 40and 60, respectively. LD showsa slight linear decline as afunction of age. CL verbs areresistant to age-related changes but are influenced greater by education. The differing findings across the microlinguistic measures can be explained by the weakened connections within the language system and the differential characteristics of the measures. The findings contribute to the aging literature bysystematically identifyingthe trajectory of how variables ofinformativenesschangewith age.

A preliminary investigation on core lexicon analysis in dementia of the Alzheimer's type.

Core lexicon (CL) analysis is a time efficient and possibly reliable measure that captures discourse production abilities. For people with aphasia, CL scores have demonstrated correlations with aphasia severity, as well as other discourse and linguistic measures. It was also found to be clinician-friendly and clinically sensitive enough to capture longitudinal changes in aphasia. To our knowledge, CL has never been investigated in individuals with neurologically progressive disease. As a preliminary investigation, we sought to investigate (1) whether CL scores correlate with dementia severity, (2) whether CL scores correlate with measures of discourse quality, and (3) whether CL scores correlate with other measures of lexical/semantic access. Twelve participants with a cognitive impairment associated with dementia of the Alzheimer's type (DAT) completed several measures of language and cognitive ability, as well as provide a language sample from the wordless picture book, Picnic. Results are informative, as they provide insight into characteristics of CL and provide support for potential use of CL in individuals with neurologically progressive disease. The results indicated that CL scores do correlate with dementia severity and several measures of language ability, indicating they may provide a useful measure of language abilities in DAT, but more research is needed. What is already known on the subject Core lexicon (CL) analysis is an assessment measure of discourse ability, most closely related to informativeness or productivity, used in aphasiology that is easier to use and less time consuming than previous measures of informativeness, such as correct information units or type-token ratio (TTR). For people with aphasia, CL analysis correlates with aphasia severity, measures of informativeness, as well as other measures of discourse quality. It has also been shown to be faster and more reliable between scorers than other informativeness measures. What this study adds Core lexicon analysis is a new simple and online method for assessing the informativeness of a discourse sample without the need to record or transcribe the language sample. CL is receiving a lot of attention in aphasia, correlating with everything from aphasia severity to measures of productivity and lexical access, as well as measures of informativeness. Unfortunately, no one has investigated CL analysis in dementia. The study demonstrates the first evidence that CL analysis may be a useful measure for determining dementia severity and language quality in people with dementia. What are the clinical implications of this work? Core lexicon analysis may provide clinicians and researchers with an easy method for assessing the discourse of people with a cognitive impairment associated with dementia of the Alzheimer's type. This will improve initial assessment, as well as improve ongoing language assessment that may provide clues into their functional ability to communicate effectively.

Handwritten and Typed Discourse in People With Aphasia: Reference Data for Sequential Picture Description and Comparison of Performance Across Modality.

Writing can be completed by hand or by typing. Increasingly, functional and social activities are completed in the virtual domain, which often requires discourse level writing. Yet, there is a shortage of research on discourse writing in aphasia. The purpose of this study was to provide preliminary reference data for a sequential picture description task in writing by hand and typing for people with aphasia. Additionally, we examined individual modality differences when comparing handwritten and typed discourse. Fifteen people with mild-moderate aphasia participated in this study. They completed a sequential picture description task in handwriting and in typing. Discourse samples were coded for Correct Information Units (CIUs) and Complete Utterances. Measures of productivity were also evaluated (e.g., Total Words, Total Utterances). Participants completed a computer use questionnaire regarding their current and premorbid typing and computer use. Preliminary reference data are reported. No significant differences were found at the group level for the measures evaluated. At the individual level, there was evidence of a modality effect for seven participants who demonstrated differences in the proportion of CIUs. Although preliminary, these findings suggest that, at the group level, the handwritten and typed discourse produced by people with mild-moderate aphasia is similar. However, at the individual level, there is potential for modality differences. Consistent patterns of premorbid computer use, difficulty ratings, and individual differences in writing modes were not identified for the participants who demonstrated a modality effect. However, there was preliminary evidence that poststroke handedness may contribute to modality differences exhibited by some participants, which should be explored in future research. Additionally, these reference data are preliminary and further research is required from a more heterogeneous group of people with aphasia and to better establish assessment practices for discourse writing.

Functional Magnetic Resonance Imaging Activation During Unscripted Discourse in People With Poststroke Aphasia.

The purpose of this project was to determine the feasibility of employing a functional magnetic resonance imaging (fMRI) task that captured activation associated with overt, unscripted (or free) discourse of people with aphasia (PWA), using a continuous scan paradigm. Seven participants (six females, ages 48-70 years) with chronic poststroke aphasia underwent two fMRI scanning sessions that included a discourse fMRI paradigm that consisted of five 1-min picture description tasks, using personally relevant photographs, interspersed with two 30-s control periods where participants looked at a fixation cross. Audio during the continuous fMRI scan was collected and marked with speaking times and coded for correct information units. Activation maps from the fMRI data were generated for the contrast between speaking and control conditions. In order to show the effects of the multi-echo data analysis, we compared it to a single-echo analysis by using only the middle echo (echo time of 30 ms). Through the implementation of the free discourse fMRI task, we were able to elicit activation that included bilateral regions in the planum polare, central opercular cortex, precentral gyrus, superior temporal gyrus, middle temporal gyrus, superior temporal gyrus, Crus I of the cerebellum, as well as bilateral occipital regions. We describe a new tool for assessing discourse recovery in PWA. By demonstrating the feasibility of a natural language paradigm in patients with chronic, poststroke aphasia, we open a new area for future research.

Telling Stories in Noise: The Impact of Background Noises on Spoken Language for People With Aphasia.

The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task. Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions. Background noise resulted in higher fundamental frequency (fo) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise. Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise. https://doi.org/10.23641/asha.23681703.

The Outcomes of Remote Administration of Combined Aphasia and Apraxia of Speech Treatment: A Single-Subject Experimental Design Study.

This study was designed to examine the outcomes of Combined Aphasia and Apraxia of Speech Treatment (CAAST) administered remotely in terms of acquisition and generalization effects and to compare these effects to previous in-person CAAST studies and Response Elaboration Training (RET)/Modified-Response Elaboration Training (M-RET) benchmarks. Multiple probe designs across participants and behaviors were employed with three speakers with chronic aphasia and apraxia of speech. Correct information units (CIUs) were the primary outcome measure to measure changes in language production. Percent consonants correct (PCC) was used as the secondary outcome measure to evaluate changes in speech sound accuracy. Production of CIUs was compared with existing benchmarks from Bunker et al.'s (2019) meta-analysis of previous RET/M-RET studies. In addition, both CIUs and PCC were compared with the most recent CAAST in-person studies. All participants demonstrated substantial increases in CIUs for treated and untreated picture sets, comparable to outcomes of in-person CAAST administration. These language changes were maintained at posttreatment intervals for all participants. PCC also improved for all participants, with gains in articulatory accuracy being maintained posttreatment. Improvements in CIU production and PCC for all three participants were in keeping with results from Wambaugh et al. (2017). These findings provide additional support for the efficacy of CAAST and indicate that remote administration may be a viable alternative to in-person application. https://doi.org/10.23641/asha.23418635.

Test-Retest Reliability of Microlinguistic Information Derived From Spoken Discourse in Persons With Chronic Aphasia.

The purpose of this study was to characterize test-retest reliability of discourse measures across a battery of common tasks in individuals with aphasia and prospectively matched adults without brain damage. We collected spoken discourse during five monologue tasks at two timepoints (test and retest; within 2 weeks apart) in an aphasia group (n = 23) and a peer group with no brain damage (n = 24). We evaluated test-retest reliability for percentage of correct information units, correct information units per minute, mean length of utterance, verbs per utterance, noun/verb ratio, open/closed class word ratio, tokens, sample duration (seconds), propositional idea density, type-token ratio, and words per minute. We explored reliability's relationship with sample length and aphasia severity. Rater reliability was excellent. Across tasks, both groups demonstrated discourse measures with poor, moderate, and good reliability, with the aphasia group having measures demonstrating excellent test-retest reliability. When evaluating measures within each task, test-retest reliability again ranged from poor to excellent for both groups. Across groups and task, measures that appeared most reliable appeared to reflect lexical, informativeness, or fluency information. Sample length and aphasia severity impacted reliability, and this differed across and by task. We identified several discourse measures that were reliable across and within tasks. Test-retest statistics are intimately linked to the specific sample, emphasizing the importance of multiple baseline studies. Task itself should be considered an important variable, and it should not be assumed that discourse measures found to be reliable across several tasks (averaged) are likewise reliable for a single task. https://doi.org/10.23641/asha.23298032.

Informative and semantic language features of people with dementia displayed during reminiscence therapy.

Communication is essential for people with dementia (PWD) to independently perform activities of daily living. While cognitive training could improve communication abilities in PWD, there is limited evidence of the effect of reminiscence therapy (RT) on communication. Therefore, this study examines this effect, focusing on language features. This study used data from randomised controlled trials applying RT to women with dementia registered in a day-care center. RT using digital material or storytelling was conducted with PWD for 4 weeks. Outcome measures included general characteristics and communicative ability, such as the number of correct information units (CIUs, a measure of informativeness in discourse), the Holden Communication Scale (HCS) score, and verbal engagement. Repeated-measures multivariate analysis of variance and the paired t-test were performed to confirm the effect of RT on communicative ability. There was a significant change over time in the ratio of CIUs (F=4.35, P=0.016). In the first 2 weeks of the intervention, there were significant differences in the ratio of CIUs (t=-3.00, P=0.005), total HCS score (t=2.28, P=0.028), and conversation score (HCS subdomain) (t=2.44, P=0.019) between two measurement time points (T0, T1), while the number of syllables did not significantly change (t=-1.60, P=0.117). Informative/semantic linguistic ability was significantly increased in PWD, while the amount of discourse did not change after RT. This result may be helpful to improve effective communication with PWD and train healthcare staff working with PWD.

Exploring high-technology augmentative and alternative communication interfaces: the effect of age and technology experience

Purpose Many people with aphasia have inadequate language skills for functional communication thereby necessitating well-designed augmentative and alternative communication (AAC) interfaces. Using both a grid and a VSD interface with single word hotspots by neurologically healthy adults, across ages and with different technology experiences, this study examines the utility of these interfaces prior to investigating their use with people with aphasia in future studies. Method Participants include 18 young adults, 24 older adults with technology experience, and 20 older adults with limited technology experience. The older adult groups were matched for mean age and for sex. Participants described pictures with each interface, and performance was measured based on four dependent variables: (a) the total number of correct information units (CIUs), (b) the percentage of CIUs, (c) CIUs per minute, and (d) preferred interface. Results There was a significant difference between older adults and the young adult group for the total number of CIUs (p < 0.001) and CIUs per minute (p < 0.001). Despite the changes in technology experience between the two older groups, there was no significant difference in performance. Additionally, there was no significant difference in performance across the two interfaces in any of the groups. Conclusion Findings suggest age does impact performance on AAC. However, the difference in technology experience in older adult groups did not affect performance. Furthermore, both interfaces used in the current study were equally beneficial when describing pictures by healthy adults. Implications for Rehabilitation Augmentative and alternative communication (AAC) systems involve various interface designs. Consequently, the comparative utility of these interfaces must be examined across populations and communicative functions. Advancement in technology has given rise to numerous high-tech AAC interface designs. However, older adults with acquired language difficulties whose technology experience is limited may become reluctant to use high-tech AAC. Hence, the influence of technology experience on high-tech AAC performance should be investigated. Prior to examining interfaces with individuals with acquired language difficulties, the current study examined the use of a) grid display and b) visual scene display (VSD) with single word hotspots, by healthy adults of different ages and technology experiences. The study revealed that older adults with limited technology experience were equally competent in using high-tech AAC interfaces, as those with technology experience. Hence, an individual’s technology experience should not be considered a deterrent to using high-tech AAC interfaces. Additionally, the study found no differences in performance between the two interfaces, making it essential to consider user's personal preference when adopting AAC interface designs.

The Effects of Using Video-Clip Stimuli in Response Elaboration Training in Persian Speakers with Chronic Broca’s Aphasia

ABSTRACT Background The use of pictographic images to elicit spoken language productions is common in aphasia therapy. However, investigations on the treatment effects of using video stimuli are limited. People with aphasia are likely to want to be able to communicate better about content depicted in video-clip segments, especially with the growing popularity of video sharing between friends and family on social media. Aims The aim of this study was to examine the effects of utilising video-clip segments in the provision of Response Elaboration Training (RET; Kearns, 1985) in the Persian language. Specifically, the study addressed four questions: (1) Will the provision of RET with video-clips as the treatment stimuli increase the number of correct information units (CIUs; Nicholas and Brookshire, 1993) Persian speakers with aphasia produce in response to trained stimuli? (2) Will there be an increase in the number of CIUs participants produce in response to untrained stimuli? (3) Will treatment gains be maintained over time? (4) Will the participants exhibit improved scores on the Persian Western Aphasia Battery (Nilipour et al., 2014) from pre- to posttreatment? Methods & Procedures Two participants with moderately severe chronic Broca’s aphasia due to a left-hemisphere stroke received treatment three times a week. A single-case multiple-probe design consisting of two consecutive treatment phases, periodic generalisation probes, and three posttreatment follow-up probes (one-week, three-weeks, and six-weeks) was used. Treatment sessions consisted of two rounds of RET applied to 10 video-clip stimuli. Outcomes & Results Participant 1 reached the treatment termination criteria after six therapy sessions in the first phase of treatment and after seven treatment sessions in the second phase. Participant 2 reached the termination criteria for the first and second treatment phases after 12 and eight treatment sessions, respectively. Large positive treatment effects were found for the participants for trained items. Treatment effects were maintained above baseline performance for trained items on all follow-up measures. Generalisation to untrained items was limited. Both participants exhibited an Aphasia Quotient increase posttreatment on the Persian Western Aphasia Battery, with the largest improvement identified on the spontaneous speech subtest. Conclusion Although preliminary, this study provides support for the use of video stimuli in the provision of RET in the Persian language to individuals with chronic Broca’s aphasia. The study encourages further exploration on the topic and discusses clinical implications of the research.

Non-transcription analysis of connected speech in mild cognitive impairment using an information unit scoring system

The purpose of the current study was (1) to compare the performance of individuals with mild cognitive impairment (MCI) and cognitively healthy adults (CHA) on story retelling tasks consisting of familiar and novel stories, and (2) to examine potential utility of information unit scoring by demonstrating concurrent validity of the measure. Fifteen individuals with MCI and 15 age- and education-matched CHA who are monolingual, Korean speakers participated in this study. The task consisted of two different stories: (1) familiar story and (2) novel story. Each story was presented auditorily with sequential pictures. All participants were required to retell as much of the story as they could remember after listening to recorded audio files. Language samples were quantified using Information Unit (IU) checklists. Concurrent validity was computed by correlating IU measures (percent of information units [%IU] and percent of information units per minute [%IU/Min] and other linguistic measures (e.g., correct information units [CIU]). There were greater differences between the two groups in the familiar story than the novel story. Correlations for IU measures in the familiar story were significant and moderate to high, ranging from 0.644 to 893 for the MCI group and from .582 to .745 for the CHA group. In the novel story, one moderate correlation was found between the %IU/Min to %CIU/Min. This evidence supports that the IU scoring system serves as a valid and efficient tool to analyze connected speech in clinical settings.

A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia.

Evidence has shown that group conversation treatment may improve communication and reduce social isolation for people with aphasia. However, little is known about the impact of conversation group treatment on measures of discourse. This project explored the impact of conversation treatment on measures of monologic discourse. In this randomized controlled trial, 48 participants with chronic aphasia were randomly assigned to dyadic, large group, or control conditions. Conversation group treatment was provided for 1 hr, twice per week, for 10 weeks. Discourse samples were collected and coded at pretreatment, posttreatment, and 6-week maintenance. There were three narrative tasks: (a) Comprehensive Aphasia Test (CAT) picture description, (b) Cat Rescue Picture, and (c) Cinderella retell. All narratives were coded using the percent correct information units (percent CIUs), the CAT standardized narrative analysis method, and the complete utterance (CU) method. No significant changes were observed on percent CIU, which was the primary outcome measure. The treated groups demonstrated improvement on aspects of the CU method following treatment, whereas the control group did not. Significant changes were observed for other CIU measures and the CAT standardized narrative analysis in both the treated and control groups. The results suggest that the CU measures were more sensitive to the effects of conversation treatment in monologic discourse compared to CIU and CAT measures. Changes were more common in absolute rather than relative values, suggesting that conversation treatment impacts the overall amount of language produced rather than efficiency of production.

Assessing Language in Unstructured Conversation in People With Aphasia: Methods, Psychometric Integrity, Normative Data, and Comparison to a Structured Narrative Task.

Purpose This study evaluated interrater reliability (IRR) and test-retest stability (TRTS) of seven linguistic measures (percent correct information units, relevance, subject-verb-[object], complete utterance, grammaticality, referential cohesion, global coherence), and communicative success in unstructured conversation and in a story narrative monologue (SNM) in persons with aphasia (PWAs) and matched participants without aphasia (M-PWoAs). Furthermore, the relationship of language in unstructured conversation and SNM was investigated for these measures. Methods Twenty PWAs and 20 M-PWoAs participated in two unstructured conversations on different days with different speech-language pathologists trained as social conversation partners. An 8- to 12-min segment of each conversation was analyzed. Additionally, a wordless picture book was used to elicit an SNM sample at each visit. Correlational analyses were conducted to address the primary research questions. Normative range and minimal detectable change data were also calculated for the measures in both conditions. Results IRR and TRTS were moderate to good for parametric measures and moderate to excellent for nonparametric measures for both groups, except for TRTS for referential cohesion for the PWAs in conversation. Furthermore, in PWAs, a strong correlation was demonstrated for three of eight measures across conditions. Moderate or weaker correlations were demonstrated for three of eight measures, and correlations for two of eight measures were not significant. An ancillary finding was no significant differences occurred for sample-to-sample variability between the two conditions for any measure. Conclusions This study replicates previous research demonstrating the feasibility to reliably measure language in unstructured conversation in PWAs. Furthermore, this study provides preliminary evidence that language production varies for some measures between unstructured conversation and SNM, contributing to a literature base that demonstrates language variation between different types of monologue. Thus, these findings suggest that inclusion of the specific types of discourse of interest to the PWA may be important for comprehensive assessment of aphasia. Supplemental Material https://doi.org/10.23641/asha.16569360.

Evaluation of treatment effects of semantic feature analysis on mild anomia in multiple sclerosis

ABSTRACT Background : Multiple sclerosis (MS) commonly includes anomia and other communicative deficits that affect communicative participation and quality of life. Anomia treatment in MS is currently unexplored. Owing to the degenerative nature of MS, compensatory treatment might be preferable to restorative treatment. Semantic feature analysis (SFA) has been reported to have a treatment effect in aphasia and traumatic brain injury, and it can also be used as a compensatory word-finding strategy. SFA might therefore be effective on anomia in MS. Aims : The aim of this study was to evaluate the treatment effects of SFA on mild anomia in MS. Hypotheses were that, if used as a strategy, SFA may improve word-retrieval ability in connected speech, reduce self-perceived word-finding difficulties and increase communicative participation. Methods & Procedures : Two participants (one with relapsing-remitting MS, one with progressive MS) experiencing anomia and reduced communicative participation took part in this early-phase study with a single-case experimental design (SCED). Outcome measures included accuracy and speed in confrontation naming of treated items, correct information units (CIUs) in a re-telling task, self-reported strategy use in everyday communication, self-reported occurrence of anomia and related nuisance, and self-reported communicative participation. Measurements were carried out before treatment, at the beginning of every third treatment session, once directly after treatment, repeatedly during a maintenance phase, and once at a follow-up session ten weeks after treatment. Outcomes & Results : No treatment effects on confrontation-naming ability, re-telling ability or self-reported measures were evident in either participant after treatment with SFA. Effects of repeated measures appeared as reduced response time in confrontation naming. Conclusions : SFA as the sole element of treatment may not be sufficient to obtain treatment effects on mild anomia in MS. Further research is warranted.