Discourse Impairment Research Articles

Insights From Important Event Recounts Told by People With Traumatic Brain Injury.

Communication can be chronically impacted by severe traumatic brain injury (TBI), yet there is a critical lack of research investigating communication recovery beyond 12 months postinjury with discourse measures. This longitudinal study aimed to investigate quantitative and qualitative changes in important event recounts produced by a group of people with severe TBI up to 2 years postinjury. A prospective observational design with an inception cohort was adopted. Thirty-four participants with severe TBI were asked to produce an important event recount at 6, 12, and 24 months postinjury. A mixed-methods approach comprised a quantitative analysis of microlinguistic and macrostructural measures, using the automated discourse command EVAL in Computerized Language Analysis (CLAN) and the CLAN Collaborative Commentary tool, respectively. Statistical analysis included a repeated-measures analysis of variance and the Friedman test. An independent qualitative content analysis was also conducted. The measures revealed significant differences between 6 and 24 months, indicating a protracted recovery trajectory. The microlinguistic analysis showed increased use of revision and repetition over time. The macrostructural analysis indicated changes with orientation to recount characters, evaluative comments, and the number of events or complexity of the recount. The content analysis revealed categories of (a) childhood events, (b) family and relationships, (c) career and education, and (d) grief and loss. Topics at 6 months focused on childhood events and holidays, whereas career and education predominated at 24 months. This is the first study to explore important event recounts told by people with severe TBI as they recovered. Participants showed discourse recovery beyond 12 months, highlighting the need for equivalent timing of service provision. The important event recount shows good potential as an ecologically valid assessment tool to evaluate communication recovery that can also be integrated with advances in computerized analysis. Analyses additionally provided insights into potential therapy targets and content categories for chronic discourse impairments. https://doi.org/10.23641/asha.26499271.

Assessment and theoretical interpretation of spoken discourse and cognitive skills in two adolescents with acquired brain injury

Purpose Although discourse assessment is recommended, few tools exist for adolescent acquired brain injury (ABI) and few theories describe the contribution of cognition to discourse impairment. This study explored whether a novel discourse protocol can identify difficulties following ABI and whether a discourse processing model provides a useful account of impairment. Method Using a case-control design, two adolescent males with moderate ABI (12 and 14 years) were compared to a neurotypical sample on a range of language and cognitive assessments. Patterns in performance were interpreted using a theoretical model. Participants completed a standardised omnibus language assessment, discourse assessment, and battery of cognitive tasks. Result Analyses revealed significant differences in discourse and cognition between adolescents with and without ABI. No impairment was detected on a standardised language assessment. Patterns in discourse and cognition aligned with a contemporary model of discourse processing. Conclusion Participants with ABI demonstrated discourse deficits relative to the neurotypical reference sample. The findings demonstrate the value of discourse sampling across multiple genres and analysis of microlinguistic to superstructural features. A structure-building framework (SBF) model, originating in schizophrenia, provides a promising theory with which to interpret discourse impairment and has the potential to inform intervention for discourse in ABI.

Verbal expressive language minimally affected in non-demented people living with amyotrophic lateral sclerosis

Objective: Language dysfunction is one of the most common cognitive impairments in amyotrophic lateral sclerosis (ALS). Although discourse capacities are essential for daily functioning, verbal expressive language has not been widely investigated in ALS. The existing research available suggests that discourse impairments are prevalent. This study investigates verbal expressive language in people living with ALS (plwALS) in contrast to healthy controls (HC). Methods: 64 plwALS and 49 age, gender and education-matched healthy controls were ask to describe the Cookie Theft Picture Task. The recordings were analyzed for discourse productivity, discourse content, syntactic complexity, speech fluency and verb processing. We applied the Bayesian hypothesis-testing framework, incorporating the effects of dysarthria, cognitive impairment status (CIS), and premorbid crystalline verbal IQ. Results: Compared to HC, plwALS only showed a single impairment: speech dysfluency. Discourse productivity, discourse content, syntactic complexity and verb processing were not impaired. Cognition and dysarthria exceeded the influence of verbal IQ for total words spoken and content density. Cognition alone seemed to explain dysfluency. Body-agent verbs were produced at even higher rates than other verb types. For the remaining outcomes, verbal IQ was the most decisive factor. Conclusions: In contrast to existing research, our data demonstrates no discernible impairment in verbal expressive language in ALS. What our findings show to be decisive is accounting for the influence of dysarthria, cognitive impairment status, and verbal IQ as variables on spontaneous verbal expressive language. Minor impairments in verbal expressive language appear to be influenced to a greater degree by executive dysfunctioning and dysarthria than by language impairment.

A qualitative exploration of speech-language pathologists' approaches in treating spoken discourse post-traumatic brain injury.

Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech-language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. To explore the under-researched area of clinical practice for spoken discourse interventions with adults post-TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi-structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight-building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client-specific factors and rationales prioritized tailored, context-sensitive and goal-directed treatment. This study provided insight into a previously under-researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post-TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post-TBI, from initial assessment to outcome measurement, may help inform clinical decision-making and the transfer of research to practice. What is already known on the subject Spoken discourse impairments occur in dialogic and monologic productions post-TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision-making for discourse interventions post-TBI are limited. What this paper adds to existing knowledge This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post-TBI. It details the factors that influence clinical decision-making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work? This study identifies the broad and complex considerations required to deliver context-sensitive discourse intervention post-TBI. It indicates the need for an in-depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience.

Interaction of discourse processing impairments, communicative participation, and verbal executive functions in people with chronic traumatic brain injury.

IntroductionEspecially in the chronic phase, individuals with traumatic brain injury (TBI) (IwTBI) may still have impairments at the discourse level, even if these remain undetected by conventional aphasia tests. As a consequence, IwTBI may be impaired in conversational behavior and disadvantaged in their socio-communicative participation. Even though handling discourse is thought to be a basic requirement for participation and quality of life, only a handful of test procedures assessing discourse disorders have been developed so far. The MAKRO Screening is a recently developed screening tool designed to assess discourse impairments. The test construction is based on psycholinguistic frameworks and the concept of macro-rules, which refer to cognitive functions responsible for organizing and reducing complex information (e.g., propositional content) in discourse.AimThe aim of our study was to investigate discourse processing in IwTBI in different tasks and to assess problems in communicative participation in the post-acute and chronic phase. In this context, we also aimed to analyze the influence of the severity of the initial impairment and the verbal executive abilities on the discourse performance. Additionally, the impact of macrolinguistic discourse impairments and verbal fluency on perceived communicative participation was targeted in our analysis.MethodsData from 23 IwTBI (moderate to severe) and 23 healthy control subjects have been analyzed. They completed two subtests of the MAKRO screening: Text production and Inferences. Discourse performance was examined in relation to measures of semantic fluency and verbal task-switching. Socio-communicative problems were evaluated with the German version of the La Trobe Communication Questionnaire (LCQ).ResultsIwTBI showed lower test results than the control group in the two subtests of the MAKRO-Screening. Difficulties in picture-based narrative text production also indicated greater perceived difficulties in communicative participation (LCQ). We also found that the subject’s performance on the MAKRO-Screening subtests can partly be explained by underlying dysexecutive symptoms (in terms of verbal fluency and verbal task switching) and the severity of their injury. The preliminary results of our study show that cognitive-linguistic symptoms in IwTBI are also evident in the chronic phase. These can be detected with procedures referring to the discourse level, such as the MAKRO-Screening. The assessment of discourse performance should be an integral part in the rehabilitation of IwTBI in order to detect cognitive-linguistic communication disorders and to evaluate their impact on socio-communicative participation.

The MAKRO Screening – an assessment tool for discourse deficits in adults with dysexecutive symptoms following TBI

ABSTRACT Introduction Discourse impairments are common sequelae following TBI. Even though handling discourse is thought to be a basic requirement for social participation and quality of life, few test procedures to assess discourse disorders have been developed so far. Objective The main aim of this prospective cohort study was to evaluate the use of the MAKRO Screening for detecting deficits in discourse production and reception in a group of participants with TBI in the post-acute and chronic phase and their relation to executive functions (EF) and severity of brain injury. Method Twenty individuals with TBI and a control group of healthy speakers performed on the MAKRO and on tests of EF (Regensburger Verbal Fluency Test; Tower of London; WAIS-IV digit span index). Group performance was evaluated on the basis of a scoring system and qualitative discourse analysis with focus on main concepts and coherence. Further, MAKRO scores were correlated with measures of EF. Outcomes Individuals with TBI demonstrated significantly poorer performance within all MAKRO subtests. Discourse analysis revealed fewer main concepts and more frequent use of thematically inappropriate utterances. Performance can be partly explained by severity of initial injury and executive disorders. MAKRO presents a reliable and functional measure for discourse impairments.

A pilot study of AID-COMp: An innovative speech-language intervention for patients with early-stage major neurocognitive disorder.

Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties. This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication-For Persons Who Live with MND (AID-COMp). We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively. For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND's communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs. We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences. What is already known on the subject MND affects cognition and communication, which are crucial to a good relationship between a carer and a person with MND. Interventions involving only PwMND have been shown to be effective, but do not address all the communication impairments in the mild stage of MND. These interventions may require many therapy sessions. Generally, SLT interventions do not examine the potential effects of an intervention on carers. What this paper adds to existing knowledge AID-COMp, an intensive intervention of 10 sessions over 1 month, was provided to people living with MND in the community. It included training the person with MND in using a memory notebook combined with semantic and phonological therapy, a new discourse therapy and PACE therapy, addressing several communication deficits. After a control period of 2 months without intervention and a 1-month intensive intervention, the results showed significant improvement in naming, cognition and communication, and PwMND well-being. Moreover, the carers witnessed the impacts of therapy in their everyday life interactions with the PwMND. What are the potential or actual clinical implications of this work AID-COMp can provide communication support for PwMND that has further benefits reported by both PwMND and carers. We described AID-COMp in detail to inspire clinicians in providing SLT for unserved PwMND. Future research studies should use controlled designs, more participants and a qualitative component.

Pearls: How (and Why) to Use Participatory Language When Communicating with Patients About Osteoarthritis.

Pearls: How (and Why) to Use Participatory Language When Communicating with Patients About Osteoarthritis.

Creating a Theoretical Framework to Underpin Discourse Assessment and Intervention in Aphasia.

Discourse (a unit of language longer than a single sentence) is fundamental to everyday communication. People with aphasia (a language impairment occurring most frequently after stroke, or other brain damage) have communication difficulties which lead to less complete, less coherent, and less complex discourse. Although there are multiple reviews of discourse assessment and an emerging evidence base for discourse intervention, there is no unified theoretical framework to underpin this research. Instead, disparate theories are recruited to explain different aspects of discourse impairment, or symptoms are reported without a hypothesis about the cause. What is needed is a theoretical framework that would clarify the specific linguistic skills that create completeness, coherence, and complexity (i.e., richness) in discourse, and illuminate both the processes involved in discourse production and the reasons for breakdown. This paper reports a review and synthesis of the theoretical literature relevant to spoken discourse in aphasia discourse, and we propose a novel theoretical framework which unites these disparate sources. This framework is currently being tested as the foundation for Linguistic Underpinnings of Narrative in Aphasia (LUNA) treatment research. In this paper, we outline the novel framework and exemplify how it might be used to guide clinical practice and research. Future collaborative research is needed to develop this framework into a processing model for spoken discourse.

Narrative Discourse Intervention After Traumatic Brain Injury

Purpose: Narrative discourse (e.g., telling anecdotes or relating personal events) comprises a key part of social interaction and is commonly affected after traumatic brain injury (TBI). Research over the past decades has enabled improved characterization of discourse impairment after TBI, but a critical lack of research into discourse intervention approaches remains. Methods: This systematic review examined empirical research on narrative discourse intervention after TBI. Searches were conducted on EMBASE, CINAHL, PsycINFO, and PubMed for original research on spoken narrative discourse treatment, where at least 50% of the study participants were adults with TBI. Results: Of 519 screened articles, six studies met criteria: three single case studies and three case series studies. Interventions incorporated metacognitive and metalinguistic theoretic principles, with a focus on understanding the structure and elements of narratives. Active components of treatments are discussed and compared in relation to existing narrative discourse treatment programs for other neurological communication disorders. Conclusions: Although all studies reported gains on some measures for treated narratives following intervention, there were mixed results for effect generalization and/or maintenance. The INCOG guidelines recommend that interventions after TBI should be contextualized and involve personally relevant materials, and this was not evident in the reviewed intervention approaches. Directions are suggested for clinical practice and future research in treating narratives.

Patterns of narrative discourse in early recovery following severe Traumatic Brain Injury

ABSTRACTPrimary Objective: To investigate the nature and patterns of narrative discourse impairment in people with severe Traumatic Brain Injury (TBI) during early recovery.Methods and Procedures: A single image picture description task was administered to 42 participants with severe TBI at 3 and 6-months post-injury. The same task was administered to 37 control participants. Discourse samples were analyzed with measures of productivity, informativeness and story organization. The performance of people with TBI was compared with the control group at both 3 and 6 months, and the performance of the participants with TBI was also compared across the two time points. Individual patterns of performance were also examined.Results: Inferential analyses revealed significant differences between the control group and the group with TBI on informativeness at both time points and number of complete episodes at 3 months, but no significant differences for productivity measures. There was no significant change for the group with TBI between 3 and 6 months. However, individual improvement over time was observed.Conclusions: People with TBI have discourse difficulties early post TBI that are also present at 6-months post-injury. In order to understand longer-term discourse recovery, it is necessary to examine participant patterns over further time points on this narrative task.

Narrative discourse in Persian-speaking patients with mild Alzheimer's disease.

ABSTRACT.Despite the significance of discourse impairments, they have not been thoroughly investigated in Persian-speaking patients with Alzheimer’s disease (AD).Objective:the aim of this study was to perform a multi-level analysis of narrative discourse in Persian-speaking patients with mild AD and to compare them with healthy elderly.Methods:the study included 14 older adults with mild AD and a matched group of 14 healthy elderly. Using a storytelling task based on serial pictures, both macro- and micro-linguistic aspects of narrative discourse were assessed. Cohesion ratio and coherence were investigated as macrolinguistic dimensions of discourse. The studied microlinguistic features included syntactic complexity and verbal errors (mostly involving phonological and semantic paraphasias and mazes). Severity of AD was determined using the Cognitive Dementia Rating (CDR).Results:there were significant differences between the groups regarding cohesion ratio (0.9 ± 0.34 vs. 1.29 ± 0.45, p = 0.02) and coherence scores (2.43 ± 0.41 vs. 3.02 ± 0.81, p = 0.03). Verbal errors and syntactic complexity did not differ significantly between the groups.Conclusion:Persian-speaking patients with mild AD show macrolinguistic impairments in producing discourses based on picture description. Therefore, intervention protocols should focus on the ability to organize information on a specific subject and also to connect sentences produced using appropriate cohesive ties.

Discourse recovery after severe traumatic brain injury: exploring the first year

ABSTRACTObjectives: Although much is known about discourse impairment, little is known about discourse recovery after severe traumatic brain injury (TBI). This paper explores discourse recovery across the critical first year, controlling for pre-injury, injury and post-injury variables. Design and methods: An inception cohort comprising 57 participants with severe TBI was examined at 3, 6, 9 and 12 months post-injury and compared to a cross-section of matched healthy control participants. A narrative discourse task was analyzed with main concept analysis (MCA). A mixed linear model approach was used to track recovery controlling for pre-injury, injury and post-injury variables. Results: An upward trajectory of recovery was observed, with peak periods of improvement between 3–6 and 9–12 months and all time points were significantly below controls. Years of education and PTA duration were significant covariates in the recovery model. Presence of aphasia also influenced the recovery model. Conclusions: Individuals with TBI typically improve over the first year, however many will continue to have discourse deficits at 12 months. Years of education, PTA duration and aphasia should be considered when planning services. The 3–6- and 9–12-month periods may offer optimal periods for discourse recovery and increased supports may be beneficial between 6-9 months.

Discourse and cognition in speakers with acquired brain injury (ABI): a systematic review.

Cognitive impairment, particularly of executive functioning, has been implicated in deficits in spoken discourse production following acquired brain injury (ABI). However, due to variation in the methodologies and heterogeneity of findings across studies, the nature and extent of this association is not well understood. This review aims to synthesize the literature investigating associations between cognitive deficits and discourse impairment after ABI. It is reported in accordance with guidelines of The Preferred Reporting Items of Systematic Reviews and Meta-Analyses. Searches were conducted of a variety of databases including Medline, PsycINFO, EMBASE, CINAHL, ProQuest, Cochrane and ERIC. Additional studies were identified via reference harvesting. Studies were included if they reported data on participants with ABI, assessed spoken discourse production and cognitive function, and performed statistical analyses to determine the association between discourse and cognitive variables. This review excluded non-English sources and those not published in peer-reviewed journals. Meta-analyses were not conducted due to variability across tools and terminology used to describe participant injury- and non-injury-related characteristics and outcomes. Twenty-five observational studies were included in the review. Findings revealed significant associations between multiple cognitive functions and discourse across micro-linguistic to super-structural measures. Methodological and terminological inconsistencies were identified across studies, which limited systematic comparison of the results. This review revealed present, yet heterogeneous, relationships between cognitive and discourse deficits in speakers with ABI. Associations were interpreted in light of a well-established model of discourse processing. Greater comparison across studies would have been facilitated by a standard nomenclature in relation to cognitive constructs and standardized discourse assessment. Future research should explore the influence of injury- and participant-related factors on discourse-cognitive relationships. The lack of information on conversational discourse and paediatric ABI limits the generalizability of this review to daily interaction following ABI. While applicable across the lifespan, in-depth investigation of discourse following ABI in childhood and adolescence is a priority due to complex changes in language and cognition, and the potential for impairments profoundly impact social, emotional and academic progression into adulthood. Given the centrality of remediating cognitive-communication difficulties in ABI, the interrelationships between discourse and cognition should retain a critical focus of research. This will inform clinical management and future research with this population. Findings have implications for our theoretical understanding of discourse and the nature of its breakdown in ABI.

Taking words to a new level: a preliminary investigation of discourse intervention in primary progressive aphasia

ABSTRACTBackground: Despite a growing literature characterising connected speech and discourse impairments associated with primary progressive aphasia (PPA), intervention in PPA has focused predominantly on lexical retrieval and picture-naming treatments, with limited generalisation of therapy gains reported. Recent developments in the post-stroke aphasia literature with discourse-level approaches have provided highly promising findings for the generalisation of language gains to everyday communication, and an opportunity to investigate whether the same benefits may be found in the PPA population.Aims: This study evaluated the effectiveness of a discourse intervention in two individuals with PPA to determine whether significant improvements were seen in word retrieval and discourse organisation in everyday discourse.Methods & Procedures: KW, a 54-year-old man, who presented with semantic variant PPA, and AS, a 59-year-old woman, presenting with logopenic variant PPA, completed the NARNIA intervention programme (Whitworth, Leitão et al., 2015) in 20 sessions over a 10-week period. Discourse performance was sampled prior to intervention across 10 tasks involving four different genres, at one time point, and compared to performance immediately and four weeks post intervention. The multilevel intervention protocol aimed to increase awareness of word retrieval, sentence structure, and macrostructure of a range of discourse genre.Outcomes & Results: Both participants made significant gains in discourse production immediately after intervention and when reassessed four weeks later, in the absence of change on naming tasks and in the context of stable overall cognitive performance. Significant gains were seen in the amount of overall output, noun and verb usage, and the number of body elements in macrostructure in everyday discourse in topics that were not trained in treatment. Further to the findings of the original NARNIA study in post-stroke aphasia, significant gains were also seen in narrative discourse across lexical categories for both participants. Informativeness and efficiency of communication also improved significantly for KW across all genres. Both participants reported significant gains in measures of social communication and participation.Conclusions: The study suggests that improvements in everyday discourse may be possible when the discourse level is directly targeted, that lexical access can improve in the absence of targeting lexical items, and that discourse-level interventions have the potential to impact real-life communication in individuals with PPA. As the first known study to trial a multilevel intervention in the context of PPA, the findings may be of clinical and theoretical significance, and warrant further investigation.

Beyond Sentences: Using the Expression, Reception, and Recall of Narratives Instrument to Assess Communication in School-Aged Children With Autism Spectrum Disorder.

Impairments in the social use of language are universal in autism spectrum disorder (ASD), but few standardized measures evaluate communication skills above the level of individual words or sentences. This study evaluated the Expression, Reception, and Recall of Narrative Instrument (ERRNI; Bishop, 2004) to determine its contribution to assessing language and communicative impairment beyond the sentence level in children with ASD. A battery of assessments, including measures of cognition, language, pragmatics, severity of autism symptoms, and adaptive functioning, was administered to 74 8- to 9-year-old intellectually able children with ASD. Average performance on the ERRNI was significantly poorer than on the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). In addition, ERRNI scores reflecting the number and quality of relevant story components included in the participants' narratives were significantly positively related to scores on measures of nonverbal cognitive skill, language, and everyday adaptive communication, and significantly negatively correlated with the severity of affective autism symptoms. Results suggest that the ERRNI reveals discourse impairments that may not be identified by measures that focus on individual words and sentences. Overall, the ERRNI provides a useful measure of communicative skill beyond the sentence level in school-aged children with ASD.

Discourse Characteristics in Aphasia Beyond the Western Aphasia Battery Cutoff.

This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia. Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density. Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia. Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.

Pauses During Autobiographical Discourse Reflect Episodic Memory Processes in Early Alzheimer's Disease.

There is a large body of research on discourse production in Alzheimer’s disease (AD). Some studies have focused on pause production, revealing that patients make extensive use of pauses during speech. This has been attributed to lexical retrieval difficulties, but pausing may also reflect other forms of cognitive impairment as it increases with cognitive load. The aim of the present study was to analyze autobiographical discourse impairment in AD from a broad perspective, looking at pausing behavior (frequency, duration, and location). Our first objective was to characterize discourse changes in mild cognitive impairment (MCI) due to AD. Our second objective was to determine the cognitive and neuroanatomical correlates of these changes. Fifteen patients with MCI due to AD and 15 matched cognitively normal controls underwent an ecological episodic memory task, a full neuropsychological assessment, and a 3D T1-weighted MRI scans. Autobiographical discourse collected from the ecological episodic memory task was recorded, transcribed, and analyzed, focusing on pausing. Intergroup comparisons showed that although patients did not produce more pauses than controls overall, they did make more between-utterance pauses. The number of these specific pauses was positively correlated with patients’ episodic memory performance. Furthermore, neuroimaging analysis showed that, in the patient group, their use was negatively correlated with frontopolar area (BA 10) grey matter density. This region may therefore play an important role in the planning of autobiographical discourse production. These findings demonstrate that pauses in early AD may reflect a compensatory mechanism for improving mental time travel and memory retrieval.

Propositional analysis of discourse produced by Chinese speakers with traumatic brain injury

Propositional analysis of discourse produced by Chinese speakers with traumatic brain injury

Understandying the right hemisphere’s role in communication abilities: A study in temporal lobe epilepsy patients

Objective: Language research in epilepsy has previously been focused on dominant hemisphere processing. Although communication skills that enable social functioning and in which the right hemisphere has a central role, have remained unexplored. The purpose of this study was to investigate communication abilities in patients with right lateralized medial temporal lobe epilepsy (TLE).Methods: 60 patients with TLE and hippocampal sclerosis candidates for surgical treatment were evaluated: 28 with a right epileptic zone (EZ) (RTLE) and 32 with a left EZ (LTLE). Subjects were underwent a battery to measure: conversational and narrative discourse; prosody; social inference, pragmatic comprehension; verbal fluency; naming and logic-temporal sequencing. Disease related variables and general neuropsychological data were evaluated.Results: RTLE compared to LTLE patients, showed interictal conversational and narrative discourse impairments, a tendency to tangential and disintegrated speech, lack of hierarchical and categorized codification, and misinterpretation of social intention. RTLE showed lower performance in conversational discourse, narrative comprehension retelling and production, idiom expressions’ and indirect speech’s comprehension, social meaning inference, emotional prosody, strategies for lexical and categorization. Otherwise, LTLE group showed lower performance in logical temporal sequencing.Significance: RTLE patients showed deficits which are similar to what has been described in right hemisphere damaged patients, and may be important to evaluate these skills in RTLE patients to detect potential impairments. Medial and anterior temporal lobe structures seem to have a key role in discourse processing as a link between semantic, world knowledge, and social cognition associated areas to construct a contextually related coherent meaning. Objective: Language research in epilepsy has previously been focused on dominant hemisphere processing. Although communication skills that enable social functioning and in which the right hemisphere has a central role, have remained unexplored. The purpose of this study was to investigate communication abilities in patients with right lateralized medial temporal lobe epilepsy (TLE). Methods: 60 patients with TLE and hippocampal sclerosis candidates for surgical treatment were evaluated: 28 with a right epileptic zone (EZ) (RTLE) and 32 with a left EZ (LTLE). Subjects were underwent a battery to measure: conversational and narrative discourse; prosody; social inference, pragmatic comprehension; verbal fluency; naming and logic-temporal sequencing. Disease related variables and general neuropsychological data were evaluated. Results: RTLE compared to LTLE patients, showed interictal conversational and narrative discourse impairments, a tendency to tangential and disintegrated speech, lack of hierarchical and categorized codification, and misinterpretation of social intention. RTLE showed lower performance in conversational discourse, narrative comprehension retelling and production, idiom expressions’ and indirect speech’s comprehension, social meaning inference, emotional prosody, strategies for lexical and categorization. Otherwise, LTLE group showed lower performance in logical temporal sequencing. Significance: RTLE patients showed deficits which are similar to what has been described in right hemisphere damaged patients, and may be important to evaluate these skills in RTLE patients to detect potential impairments. Medial and anterior temporal lobe structures seem to have a key role in discourse processing as a link between semantic, world knowledge, and social cognition associated areas to construct a contextually related coherent meaning.