Neurogenic Communication Disorders Research Articles

Effect of Age and Education on Discourse Cohesion

ABSTRACT Background Several studies have proven the presence of cohesion difficulties in neurogenic communication disorders. However, we still have very little information about discourse cohesion in the intact adult population and the factors that influence it. The aim of the present study is to provide additional information on this topic and to assess the effect of age and education on discourse cohesion. Methods One hundred and eighty-two healthy Slovak-speaking adult participants were divided into three age groups and three education groups were asked to tell Cinderella's story. The cohesion of the obtained discourse samples was evaluated. Results Our study indicates no significant effect of age. However, an increasing tendency of the occurrence of cohesive tie errors with increasing age was described. Education, on the other hand, turned out to be a statistically significant factor and had an impact on the overall use of cohesive ties as well as the use of referential pronouns. Conclusion Our findings suggest that monitoring the influence of education when creating normative data for discourse cohesion is more important than monitoring the effect of age.

Animal-assisted services for adults with acquired neurogenic communication disorders: A scoping review.

There is increasing interest in the incorporation of animal-assisted services (AAS) in therapy for adults with acquired neurogenic communication disorders. AAS have the potential to enhance speech and language therapy engagement and outcomes. However, a greater understanding of the nature and potential benefits of these interventions is needed. To describe the existing evidence for the incorporation of AAS in therapy with adults with acquired neurogenic communication disorders and to identify areas for future research. A scoping review was conducted and reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist extension for scoping reviews (PRISMA-ScR). Seven databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane, Scopus, Web of Science) and grey literature (Google) were searched. Two reviewers independently screened titles, abstracts and full texts against eligibility criteria using Covidence software. The Template for Intervention Description and Replication (TIDieR) checklist guided extraction of intervention data. A total of 17 studies with adults with aphasia, apraxia of speech and cognitive-communication disorders were included. While terminology varied, most interventions met the definition of animal-assisted therapy or animal-assisted activity and used therapy dogs. Across studies, a range of outcomes were targeted, and positive benefits were reported for participant mood, emotions, motivation and satisfaction. There were mixed, but mostly positive, benefits on social behaviour, communication and participation. AAS has been incorporated in therapy for adults with acquired neurogenic communication disorders, predominately with people with dementia. Across studies, communication impairments and AAS interventions were insufficiently or inconsistently described. Improved reporting would assist understanding of the potential benefits of AAS as an adjunct therapy. A quality appraisal of existing studies, and meta-analysis of findings, is needed to draw conclusions about the effectiveness of AAS as a complementary therapy for people with acquired neurogenic communication disorders. What is already known on this subject There is increasing interest and research in AAS as an adjunct to traditional speech and language therapy. Several clinical populations have been shown to benefit from the incorporation of AAS as a complementary therapy approach, including adults with acquired neurogenic communication disorders. To date there has not been a comprehensive review of literature in the area. What this paper adds to the existing knowledge This review aimed to describe what is known about AAS as an adjunct intervention for adults with acquired neurogenic communication disorders. A total of 17 studies were identified, the majority conducted with people living with dementia. Overall, consistent positive benefits of AAS were reported on participant mood, positive emotions, motivation, and satisfaction. There were mixed, but mostly positive, benefits of AAS on social behaviour, including both verbal and non-verbal communication outcomes, and participation. What are the practical and clinical implications of this work? These results suggest a potential therapeutic benefit for the inclusion of AAS into traditional modalities used by speech-language therapists with people with acquired neurogenic communication disorders. However, clinicians should view these findings with caution. Studies were often insufficiently or inconsistently reported, and a quality appraisal and meta-analysis of existing studies would be needed to draw clear conclusions on the effectiveness of AAS as a complementary approach for people with acquired neurogenic communication disorders.

Modifications to consent documentation with adults with communication disorders following brain injury: An exploratory study.

Consent documentation for research studies is often inaccessible to people with neurogenic communication disorders following brain injury and there is limited literature on specific modifications for informed consent. This exploratory study aimed to identify effective strategies and modifications to consent processes for adults with brain injury. Using a fictitious research study, we developed a set of Participant Information Sheets (PISs) varying in complexity, presentation format, and communication modality. Evaluations were conducted with eight participants. Findings indicated diverse participant preferences for PIS modifications, suggesting simplified vocabulary, reduced text, carefully selected images, and an interactive presentation modality as helpful strategies. Building on previous literature, we present refined guidelines for consent modifications for adults with neurogenic communication disorder after brain injury. These guidelines can promote more appropriate inclusion of communicatively impaired populations in research and assist ethics committees and researchers in preparing modified consent documents.

Inner speech in the daily lives of people with aphasia.

This exploratory, preliminary, feasibility study evaluated the extent to which adults with chronic aphasia (N = 23) report experiencing inner speech in their daily lives by leveraging experience sampling and survey methodology. The presence of inner speech was assessed at 30 time-points and themes of inner speech at three time-points, over the course of three weeks. The relationship of inner speech to aphasia severity, demographic information (age, sex, years post-stroke), and insight into language impairment was evaluated. There was low attrition (<8%) and high compliance (>94%) for the study procedures, and inner speech was experienced in most sampled instances (>78%). The most common themes of inner speech experience across the weeks were 'when remembering', 'to plan', and 'to motivate oneself'. There was no significant relationship identified between inner speech and aphasia severity, insight into language impairment, or demographic information. In conclusion, adults with aphasia tend to report experiencing inner speech often, with some shared themes (e.g., remembering, planning), and use inner speech to explore themes that are uncommon in young adults in other studies (e.g., to talk to themselves about health). High compliance and low attrition suggest design feasibility, and results emphasize the importance of collecting data in age-similar, non-brain-damaged peers as well as in adults with other neurogenic communication disorders to fully understand the experience and use of inner speech in daily life. Clinical implications and future directions are discussed.

Written discourse in diagnosis for acquired neurogenic communication disorders: current evidence and future directions.

We aimed to perform the first review of research focusing on written discourse performance in people with acquired neurogenic communication disorders. In studies from 2000 onward, we specifically sought to determine: (1) the differences between patient populations and control groups, (2) the differences between different patient populations, (3) longitudinal differences between patient populations, and (4) modality differences between spoken and written discourse performance. We completed a thorough search on MEDLINE, Embase, Cochrane, APAPsycinfo, Web of Science, and Scopus databases. We identified studies that focus on written discourse performance in people with aphasia, primary progressive aphasia, mild cognitive impairment, and Alzheimer's disease. Nineteen studies were identified from the review of literature, some of which addressed more than one of our review questions. Fifteen studies included a comparison between clinical populations and controls. Six studies compared different characteristics of patient populations. Three studies reported changes over time in progressive disorders. Six studies targeted different modalities of discourse. Differences in linguistic features by patient populations are not yet clear due to the limited number of studies and different measures and tasks used across the studies. Nevertheless, there is substantial evidence of numerous linguistic features in acquired neurogenic communication disorders that depart from those of healthy controls. Compared to the controls, people with aphasia tend to produce fewer words, and syntactically simpler utterances compared to the controls. People with Alzheimer's disease produce less information content, and this feature increases over time, as reported in longitudinal studies. Our review imparts additional information that written and spoken discourse provide unique insights into the cognitive and linguistic deficits experienced by people with aphasia, Alzheimer's disease, mild cognitive impairment and primary progressive aphasia and provide targets for treatment to improve written communication in these groups.

Digital participation of brain tumour patients in the assessment and treatment of communication disorders.

Communication deficits have a severe impact on our social interactions and health-related quality of life. Subtle communication deficits are frequently overlooked or neglected in brain tumour patients, due to insufficient diagnostics. Digital tools may represent a valuable adjunct to the conventional assessment or therapy setting but might not be readily suitable for every patient. This article summarises results of three surveys on the readiness for telemedicine among (a) patients diagnosed with high-grade glioma, (b) matched controls, and (c) speech and language therapists. The respective surveys assessed the motivation for participation in telemedical assessments and supposed influencing factors, and the use potential of digital assessment and therapy technologies in daily routine, with a spotlight on brain tumour patients and the future prospects of respective telemedical interventions. Respondents included 56 high-grade glioma patients (age median: 59 years; 48% males), 73 propensity-score matched neurologically healthy controls who were instructed to imagine themselves with a severe disease, and 23 speech and language therapists (61% <35 years; all females). The vast majority of the interviewed high-grade glioma (HGG) patients was open to digitisation, felt well-equipped and sufficiently skilled. The factorial analysis showed that digital offers would be of particular interest for patients in reduced general health condition (p = 0.03) and those who live far from specialised treatment services (p = 0.03). The particular motivation of these subgroups seemed to outweigh the effects of age, equipment and internet skills, which were only significant in the control cohort. The therapists' survey demonstrated a broad consensus on the need for improving the therapy access of brain tumour patients (64%) and strengthening their respective digital participation (78%), although digitisation seems to have yet hardly entered the therapists' daily practise. In summary, the combined results of the surveys call for a joint effort to enhance the prerequisites for digital participation of patients with neurogenic communication disorders, particularly in the context of heavily burdened HGG patients with limited mobility.

Remote Testing of Adult Neurogenic Tests: Implications and Recommendations for Speech-Language Pathologists

Purpose: One purpose of this preliminary case report was to document the challenges that can arise when giving adult neurogenic tests via telepractice. Another purpose was to develop recommendations on adaptations that can be made when speech-language pathologists give the tests employed in this report. Though one test was adapted by its authors to be given remotely, the other two tests have little or no published adaptations regarding remote administration.Methods: A 33 year old female and a 51 year old male, both of whom have acquired neurogenic communicative disorders, were given the Apraxia Battery for Adults-2nd edition, the Ross Information Processing Assessment-2nd edition, and the Quick Aphasia Battery-Remote via telepractice across 2-3 sessions per participant. The female participant used an iPad during remote testing, while the male participant used a Chromebook.Results: All three tests had some challenges when given remotely. Though slight technical issues were encountered, the research team needed to make various test adaptations, such as putting pictures into a Google presentation so that patients could adequately see the target picture. In other instances, wording to questions were changed slightly while still retaining the general integrity of the original item.Conclusions: Recommended adaptations to the three tests used in this study are included. Though issues may arise during telepractice, these suggestions should aid clinicians who want to use these tests with their telepractice clients.

Rehabilitation Supported by Immersive Virtual Reality for Adults With Communication Disorders: Semistructured Interviews and Usability Survey Study.

Individuals who have acquired communication disorders often struggle to transfer the skills they learn during therapy sessions to real-life situations. Immersive virtual reality (VR) technology has the potential to create realistic communication environments that can be used both in clinical settings and for practice at home by individuals with communication disorders. This research aims to enhance our understanding of the acceptance, usefulness, and usability of a VR application (SIM:Kitchen), designed for communication rehabilitation. Additionally, this research aims to identify the perceived barriers and benefits of using VR technology from the perspective of individuals with acquired communication disorders. Semistructured interviews and usability surveys were conducted with 10 individuals with acquired neurogenic communication disorders aged 46-81 (mean 58, SD 9.57) years after trialing an immersive VR application. The audio-recorded interviews were transcribed and analyzed to identify themes. The quantitative data regarding the usability of the system associated with participants' immersion experience in the VR application were promising. Findings from semistructured interviews are discussed across five key thematic areas including (1) participant's attitude toward VR, (2) perceived usefulness of the VR system, (3) perceived ease of use of the VR system, (4) their willingness to continue using VR, and (5) the factors they perceived as challenges or facilitators to adopting this VR technology. Overall, participants in this study found the VR experience to be enjoyable and were impressed by the realism of the VR application designed for communication rehabilitation. This study highlighted personally relevant, immersive VR interventions with different levels of task difficulty that could enhance technology uptake in the context of communication rehabilitation. However, it is essential that VR hand controller technology is refined to be more naturalistic in movement and able to accommodate user capabilities.

Collaborative Commentary for Understanding Communication Disorders.

The goal of the Collaborative Commentary (CC) system is to make the TalkBank adult clinical databases-including AphasiaBank, DementiaBank, RHDBank, and TBIBank-open to commentary and analysis from the full community of researchers, instructors, students, and clinicians. CC allows a group leader to establish a commentary group and invite colleagues or students to join as members of the group. Members can then browse through the transcript database using the TalkBank Browser. When they wish to insert a comment, they click on the utterance line number or drag the cursor across a range of utterances and a window opens to receive the comment. The comment can include open text along with codes selected from a predefined set of codes created by that commentary group. CC was released for public use in August 2022. It is being used currently in five research projects and eight classes. An important feature of CC is its ability to evaluate the reliability of coding systems and to sharpen analytic categories. By familiarizing instructors and researchers with the capabilities of CC, we expect to see an increasing usage of CC for a variety of clinical and research applications. CC can contribute to a better understanding of connected speech features in aphasia, dementia, right hemisphere disorder, and traumatic brain injury. CC represents an extreme innovation not only for the study of adult neurogenic communication disorders but also for the study of spoken language generally.

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States.

This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Singing for the Rehabilitation of Acquired Neurogenic Communication Disorders: Continuing the Evidence Dialogue with a Survey of Current Practices in Speech-Language Pathology.

Therapeutic applications of singing (e.g., melodic intonation therapy) for acquired neurogenic communication disorders (ANCD) such as post-stroke aphasia, dysarthria, or neurodegenerative diseases have emerged from innovations by clinical speech-language pathologists (SLPs). However, these specialists have never been systematically consulted about the use of singing in their practices. We report a survey of 395 SLPs in France using an online questionnaire (September 2018–January 2019). Most (98%) knew that singing could be a therapeutic tool. A wide variety of uses emerged in our data. Some practices (e.g., song games) have not yet been investigated in research settings. Melodic therapy, which is supported by scientific evidence, is familiar to clinicians (90%), but they lack training and rarely follow a full protocol. Over half of respondents (62%) recognize group singing for various benefits, but do not often use it, mainly due to the lack of adapted or welcoming choirs in their area. These results provide key information for continued dialogue between researchers, clinicians, and the community. Considering the aging population and the associated increase in the prevalence of ANCD, access to group singing in particular could be facilitated for these patients from a social prescription perspective with further research evidence.

Best practice guidelines for reporting spoken discourse in aphasia and neurogenic communication disorders

ABSTRACT Background Spoken discourse is a fundamental form of communication, yet often disrupted in persons with aphasia and other neurogenic communication disorders. It follows that discourse analysis is important for understanding language, its impairments, and language recovery in these populations. Being a highly interdisciplinary field, discourse analysis would benefit from a set of guidelines (best practices) that help streamline reporting and discussion of discourse specific to populations with neurogenic communication disorders. This would enhance the overall quality of ongoing research by improving replicability, allowing meta-analysis, and supporting implementation in clinical practice. Aims To establish clear reporting guidelines for studies that use spoken discourse analysis in aphasia. Methods & Procedures An e-Delphi survey methodology was used. We identified aphasia and neurogenic communication disorder experts using Boolean search criteria and author consensus, then invited these individuals to participate in an online, three-round survey. The three rounds took place between November 2020 and June 2021. In each round, participants were asked to rank necessity of items on a scale of 1 (“not at all necessary”) to 5 (“extremely necessary”). Participants were instructed to rate based on whether the item was necessary to inform the creation of a minimum reporting guideline. Only participants who responded in the prior round were invited to participate in subsequent rounds. Items that met predetermined consensus criteria for ratings greater than “necessary” were brought forward to each subsequent round. New items were added to each round based on qualitative information collected from participants. Outcomes & Results Items that were rated by ≥ 70% of the participants as “highly necessary” or “extremely necessary” in Round 3 were those deemed as “necessary” to be reported in research, whereas items rated < 70% in Round 3 were deemed as “recommended” to be reported in research. Following Round 3, 16 items were deemed “necessary” to report in research. A further five items were “recommended”. Conclusions Consensus by leading researchers in the field established that 20 reporting items were “necessary” or “recommended” as the minimum information reported across all spoken discourse studies. These items included information about sampling, transcription, and analysis. Adherence to rigorously developed reporting guidelines is important for improving the overall quality and replicability of research in the field. We have archived the current recommendations on the Open Science Framework, which is where updates to the recommendations will also be located (https://osf.io/y48n9/).

The Incidence of Aphasia, Cognitive Deficits, Apraxia, Dysarthria, and Dysphagia in Acute Post Stroke Persian Speaking Adults.

Stroke is a major cause of serious disabilities in adults. While communication deficits post stroke are prevalent and disabling, early detection of them is important during acute phase. There is limited data published on the incidence of communication disorders in Persian speaking adults following post stroke to our knowledge. The present study aims to determine the incidence and associated factors of aphasia, cognitive deficits, motor speech disorders (apraxia and dysarthria) as well as dysphagia following acute post stroke in Persian speaking adults. 100 stroke patients were assessed using P-WAB, MMSE, Oral Apraxia test, Informal Dysarthria assessment, and MASA. The data was collected from 2 hospitals in Tehran using convenient sampling for the duration of 1year. Based on our findings, the incidence of aphasia, cognitive deficits, oral apraxia, dysarthria, and dysphagia was in respectively 61.8%, 76%, 30%, 61%, and 39% of stroke patients during the acute phase. Patients with aphasia were significantly older (mean age, 59.29 vs. 64.95), and had fewer education years (9.21 vs. 5.45) compared to individuals without aphasia (p < .05). Co-occurrence of aphasia and dysarthria, dysphasia, cognitive deficits, and apraxia was in respectively 40%, 31%, 55%, and 25%. Due to the high incidence of neurogenic communication disorders and dysphagia during the acute post stroke, especially in the elderly and the less educated patients, prompt and rapid detection of these deficits and rehabilitation is essential to ameliorate patients' quality of life and social participation, and reduce the comorbidities risk.

Interprofessional Collaboration Between Audiologists, SLPs

Interprofessional Collaboration Between Audiologists, SLPs

Exploring Animal-Assisted Therapy for Creating Rich Communicative Environments and Targeting Communication Goals in Subacute Rehabilitation.

This study continues our research examining the use of animal-assisted therapy (AAT) for patients with acquired neurogenic communication disorders. AAT pairs an animal/handler team with a licensed therapist during sessions to target discipline-specific goals. Our original study focused on dog/handler teams paired with occupational and physical therapists during inpatient rehabilitation sessions. We documented multiple ways that AAT enriched the communicative environment, increasing the amount, complexity, and voluntariness of patient participation. This study focuses on speech-language pathology sessions, comparing communicative environments during AAT and traditional sessions. We also examined the speech-language pathologists' (SLPs') experiences in learning to plan for and target communication goals for patients during AAT sessions. This interpretive design combines ethnographic methods with participatory action research. We recruited 10 patients from an inpatient rehabilitation unit and two SLPs. We video-recorded 20 speech-language pathology sessions (one AAT and one traditional for each patient) and conducted 26 interviews. We consulted with SLPs on how to incorporate AAT into their treatment during their preparation time and used self-report measures to track changes in their planning time and confidence across the 6-week study. Across participants, AAT sessions provided richer communicative environments than traditional speech-language pathology sessions as measured by participant talk time, mean length of turns, and use of interactional discourse resources such as narrative use and playful language. The SLPs were rapidly able to adapt their clinical practice to incorporate AAT and displayed rapid and marked decreases in their initial planning time and increases in confidence. AAT sessions created meaningful, rich, and complex communicative environments in a clinical space for participants to align with others around a shared interest.

Moving Toward Accurate Assessment of Working Memory in Adults With Neurogenically Based Communication Disorders.

Purpose This article presents a viewpoint highlighting concerns regarding currently available assessments of working memory in adults with neurogenic communication disorders. Additionally, we provide recommendations for improving working memory assessment in this population. Method This viewpoint includes a critique of clinical and experimental working memory tests relevant to speech-language pathologists. We consider the terminology used to describe memory, as well as discuss language demands and test construction. Results Clinical and experimental testing of working memory in adults with neurogenic communication disorders is challenged due to theoretical, methodological, and practical limitations. The major limitations are characterized as linguistic and task demands, presentation and response modality effects, test administration, and scoring parameters. Taking these limitations into consideration, several modifications to working memory testing and their relevance to neurogenic populations are discussed. Conclusions The recommendations provided in this article can better guide clinicians and researchers to advocate for improved tests of working memory in adults with neurogenic communication disorders. Future research should continue to address these concerns and consider our recommendations.

Methodological Considerations for Incorporating Clinical Data Into a Network Model of Retrieval Failures.

Difficulty retrieving information (e.g., words) from memory is prevalent in neurogenic communication disorders (e.g., aphasia and dementia). Theoretical modeling of retrieval failures often relies on clinical data, despite methodological limitations (e.g., locus of retrieval failure, heterogeneity of individuals, and progression of disorder/disease). Techniques from network science are naturally capable of handling these limitations. This paper reviews recent work using a multiplex lexical network to account for word retrieval failures and highlights how network science can address the limitations of clinical data. Critically, any model we employ could impact clinical practice and patient lives, harkening the need for theoretically well-informed network models.

A Comparison of Manual Versus Automated Quantitative Production Analysis of Connected Speech.

Purpose Analysis of connected speech in the field of adult neurogenic communication disorders is essential for research and clinical purposes, yet time and expertise are often cited as limiting factors. The purpose of this project was to create and evaluate an automated program to score and compute the measures from the Quantitative Production Analysis (QPA), an objective and systematic approach for measuring morphological and structural features of connected speech. Method The QPA was used to analyze transcripts of Cinderella stories from 109 individuals with acute-subacute left hemisphere stroke. Regression slopes and residuals were used to compare the results of manual scoring and automated scoring using the newly developed C-QPA command in CLAN, a set of programs for automatic analysis of language samples. Results The C-QPA command produced two spreadsheet outputs: an analysis spreadsheet with scores for each utterance in the language sample, and a summary spreadsheet with 18 score totals from the analysis spreadsheet and an additional 15 measures derived from those totals. Linear regression analysis revealed that 32 of the 33 measures had good agreement; auxiliary complexity index was the one score that did not have good agreement. Conclusions The C-QPA command can be used to perform automated analyses of language transcripts, saving time and training and providing reliable and valid quantification of connected speech. Transcribing in CHAT, the CLAN editor, also streamlined the process of transcript preparation for QPA and allowed for precise linking of media files to language transcripts for temporal analyses.

Augmenting Communicative Environments for People With Acquired Neurogenic Disorders

This theoretical review article describes situated discourse analysis (SDA) and explores its implications for communication sciences and disorders. Drawing on situated theories of cognition and communication, SDA aims to understand real-time communicative processes of people engaging in complex sociocultural activities in specific sociomaterial environments. For SDA, discourse points first to the multimodal processes, not the products, of communicative interactions people engage in, and recognizes that these processes are fundamentally complex, distributed, and emergent. The article begins by defining SDA and describing four theoretical principles that guide this approach. We illustrate ways SDA might alter and advance theory, research, and clinical practice by considering its application to understanding the use of augmentative and alternative communication (AAC) technologies by adults with neurogenic communication disorders and their routine partners. We then explore empirical evidence from a methodologically diverse set of cases. The first considers Mialet's (2012) ethnographic study of Stephen Hawking and his use of AAC technologies, which highlights the complex, distributed, and emergent nature of situated discourse. We turn then to our clinical experiences, reflecting on what we have learned from our clients who have creatively repurposed technologies to remediate their activities and to mediate successful interactions and situated learning. Finally, we discuss a participatory design research project that used SDA as a guide for the innovative design of PIMs, pseudo-intelligent mediators (i.e., devices that sense the environment and act as active agents to mediate interactions). We conclude the article with a discussion of ways SDA contributes to and advances our research and clinical practice.

From the Editors

Discourse analysis, thus, is essentially a contribution to the study of language “in use.” —Teun A. van Dijk (1985) In this issue of Topics in Language Disorders, Issue Editor Dr. Davida Fromm has invited authors to provide information about advances in discourse analysis related to neurogenic communication disorders. The study of discourse is critical because as van Dijk (1985) states, examining various facets of discourse allows researchers and clinicians to best capture functional production of spoken (and written) language. First, DeDe and Hoover (2021) use case studies of individuals with aphasia to illustrate the importance of selecting appropriate discourse measures using a person-centered approach. Next, Hengst and Sherrill (2021) discuss discourse analysis for people with complex communication needs who use augmentative and alternative communication within a theory of situated discourse analysis. Then, Steel et al. (2021) summarize the literature related to narrative discourse interventions for people with posttraumatic brain injury. Roberts et al. (2021) share findings from their large database of people with cerebrovascular disease related to a sequenced picture description task. Finally, to complete this well-rounded issue, Minga et al. (2021) provide an introduction to the RHDBank, which is a shared database that includes discourse samples of individuals with communication impairments following right hemisphere damage. In summary, Davida Fromm and the authors of this issue provide guidance to researchers and clinicians wishing to expand their knowledge and use of a wide variety of discourse analysis approaches. These contributions will move the field toward an improved understanding of language in use. —Sarah E. Wallace, PhD, CCC-SLP —Gary A. Troia, PhD, CCC-SLP Co-Editors