People With Aphasia Research Articles

Discourse-Level Communication Success in Aphasia: Unveiling Its Significance through Observer's Ratings.

Audrey Holland (1982) compared test scores to observers' ratings of conversational communicative success in people with aphasia (PWA). This springboarded a body of evidence employing observers to rate discourse. We review the utility of those ratings for assessing PWA's communication success. A traditional literature review identified 16 articles involving naive or trained raters assessing PWAs' communicative success across discourse genres. Another 10 articles reported ratings over time. Collectively, these studies evaluated 349 PWAs. Four studies utilized observers to rate the success of PWA's conversations. Eight studies that reported observers' ratings on other discourse genres found that multimodal communication and facilitative contexts improved success, and ratings of informativeness and comfort related to objective discourse analysis measures. Nine of 10 studies examining treatment effects found that communicative success ratings captured improvements. Observers' ratings provide social validity by reliably assessing the discourse-level communicative success of PWA. Ratings correlated with standardized diagnostic and objective discourse metrics but provided a window into factors that affect communicative success, including the degree to which communication is interactive, multimodal, and contextual. Integrating observers' ratings of discourse success at pretreatment may help identify supports or barriers to successful communication, facilitate individualization of treatments, and offer social validity of change.

Time reference in French-speaking people with fluent and non-fluent aphasia (part II): a cluster analysis

ABSTRACT Background Tense production is often impaired in people with aphasia (PWA). Interestingly, the literature suggests that not all tenses are affected in the same way, although the pattern of dissociation is still debated in the literature. The heterogeneity of tense production deficits in PWA might partly explain this lack of consensus in the literature. While this heterogeneity has been demonstrated by descriptive statistics or double dissociations in several studies, no study has used cluster analyses to highlight the main patterns of tense dissociation. Furthermore, the factors underlying this heterogeneity have been little explored. Aims Our study aimed to use cluster analyses on tense production performance to (1) identify the main patterns of dissociation between tenses in PWA and (2) explore the clinical (aphasia type and severity) and cognitive (executive disorders and temporality) factors that may underlie these patterns. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia completed a verb inflection production task, as well as language and cognitive tests. Cluster analyses were performed on the differences in performance between the tenses on the verb inflection production task. Generalized linear mixed models and nonparametric statistics were used to analyze the effect of tense and its interaction with the clusters, and to compare the clusters on the clinical and cognitive variables. Outcomes & results Cluster analyses revealed two main clusters, one with worse performances in the past and future than in the present (PWA_1 – 70% of the PWA), and the other with worse performances in the past and present than in the future (PWA_2 – 30%). The type and severity of aphasia, and cognitive test performance did not differ between the two clusters. On the other hand, the PWA_2 cluster had a longer time post-onset than the PWA_1 cluster. Conclusions Our results confirm the heterogeneity of verb inflection deficits in PWA. They suggest that most PWA would have difficulties with past and future tenses, questioning the presence of discourse linking in these two tenses. However, a minority of PWA, who are clinically and cognitively indistinguishable from the others, do not follow this pattern. Adopting the strategy of producing a morphologically simple tense in French – future – could explain the high performance in the future tense and the errors in substituting other tenses with the future in this subgroup. Finally, the clinical and research implications of this heterogeneity, in relation to therapies and the lack of consensus in the literature, are discussed.

Sentence comprehension in Malay-speaking adults with aphasia: the role of affix integration

ABSTRACT Background One of the impairments in comprehension mostly reported for aphasia is that in reversible passive sentences, where a systematic asymmetry with reversible active sentences has been attested across languages. In several accounts, this selective impairment has been proposed to be the result of the specific syntax of passive sentences. However, some results particularly from flexible word order languages suggest that a pattern where both active and passive sentences are impaired also exists. Aims In this study, we examined the actives and passives in the comprehension of a flexible word order language, namely standard Malay, in people with aphasia (PWA), aiming to confirm that the predominant pattern in this language is one of generalised impairment across reversible sentences (active and passive), and not an asymmetrical one. The role of fluency in determining the pattern of impairment was also explored. Methods & procedures Fourteen healthy adults and 20 PWA, 14 with fluent aphasia and 6 with non-fluent aphasia, took part in a comprehension study in standard Malay. Standard Malay is a flexible word order language that relies on the parsing of the voice affix on the verb to correctly interpret both active and passive sentences. Participants were tested on a sentence-picture matching task on comprehension of active and passive reversible clauses. Outcomes and results The study revealed that PWA were overall less accurate than healthy speakers in comprehension of reversible active and passive sentences, and non-fluent PWA were less accurate than fluent PWA with no effect of sentence type (active/passive). While not predominant, an asymmetric pattern was present in some participants. We propose that an impairment in thematic role assignment leads to a generalised impairment in comprehension of reversible sentences, while preserved thematic role mapping and impaired syntax lead to an asymmetric impairment. Conclusions The study confirmed that speakers of Malay mostly show a generalised impairment in both active and passive sentences. Given the nature of the language, we propose that this suggests that impairment in Malay is predominantly shown on affix integration, first in mapping of thematic roles, and then in the full syntactic processing.

Picture Naming Properties of Turkish People with Fluent and Non-Fluent Aphasia

Objectives: People with aphasia (PWA) have naming problems. During naming activities, they produce paraphasias. However, there is no significant association between paraphasia and aphasia types. This study aimed to identify the relationship between paraphasia and aphasia type, as well as the effect of cueing on naming performance. Materials and Methods: The study comprised 37 Turkish PWA who were divided into two groups: fluent and non-fluent aphasia. Participants were presented with 40 pictures and asked to name them. Cues were given in case they did not answer correctly. The participants' answers, the types of paraphasias, and how they responded to the cues were all recorded. Results: Participants in both groups significantly increased their naming performance for all words when cues were given. A total of 181 paraphasias were observed in the fluent aphasia group: Phonemic paraphasias were the most common (41.4%), followed by semantic paraphasias with 32.1%. There were 270 paraphasias in the non-fluent aphasia group, with phonemic paraphasia being the most common (60.7%). Conclusion: Phonemic and neologistic paraphasias were significantly higher in the non-fluent group. Phonemic and neologistic paraphasia is more common in those with non-fluent aphasia. This study found that the cueing method had a favourable influence on PWAs' naming performance, which is consistent with prior research.

What do people with aphasia want in rehabilitation? Designing diagnostic materials that occupational therapists can use to assess the needs, values and preferences of people with aphasia

ABSTRACT Background Client-centred care and shared decision making are prevailing principles in healthcare. For people with aphasia (PWA) this is difficult. There is a need for diagnostic instruments that are accessible for PWA and capture their needs, values and preferences (NV&P) for rehabilitation. Aims This paper reports on a collaboration between occupational therapists (OTs), PWA and speech language therapists that aimed to investigate current barriers and facilitators that OTs experience in assessing the client’s NV&P and create and evaluate supportive tools to enable OTs to help PWA in formulating their NV&P. Methods The research consisted of two phases. Phase one: qualitative research was conducted with semi-structured interviews with OTs about their current approach and their needs in assessing clients’ NV&P. The interviews were transcribed, coded and themes were identified. Phase two: tools for the in-patient setting were developed together with PWA, based on the analysis from the first phase. These tools were piloted, and feedback groups were held, in order to further refine the materials. Results Results from interviews showed that there is a need for instruments to assess the clients’ NV&P for in-patient and out-patient settings. The clinical phase focusses on activities of daily living. In the out-patient phase the focus is on daily activities. For the clinical phase, a set of 55 photos in 8 categories was developed, with which the patient’s NV&P can be determined. Conclusion OTs need tools to support their conversation with PWA about their NV&P. In collaboration with OTs and PWA tools were developed.

Cognitive assessment of post-stroke patients with and without aphasia: The Hebrew version of the Cognitive Assessment for Stroke Patients (CASP) vs. the Montreal Cognitive Assessment (MoCA)

Cognitive screening assessments for neurological deficits are critical to the initial assessment of post-stroke patients. However, most measures are not designed for post-stroke patients and in particular not for people with aphasia (PWA), because they rely on language functions. The Cognitive Assessment for Stroke Patients (CASP) is a screening test that can also be administered to PWA, and was recently adapted into Hebrew. The current study aimed to compare the performance of post-stroke patients on the Hebrew versions of the CASP and the Montreal Cognitive Assessment (MoCA). Forty medical records of post-stroke patients were retrospectively examined: Twenty participants without aphasia and 20 PWA. The data included demographics, total CASP and MoCA scores, and scores in specific cognitive domains. Correlations were found between total CASP and MoCA scores, for all participants as well as for each group separately. Comparisons between groups revealed significantly higher performance of the participants without aphasia on the MoCA, but not on the CASP. Clinically, these findings suggest that the Hebrew version of the CASP can be implemented as a formal cognitive screening test for post-stroke patients, including PWA. It can help identifying PWA’s cognitive state and differentiate between language and cognitive impairments, hence, contributing in planning targeted treatment.

Interplay of Semantic Plausibility and Word Order Canonicity in Sentence Processing of People With Aphasia Using a Verb-Final Language.

The Western Aphasia Battery is widely used to assess people with aphasia (PWA). Sequential Commands (SC) is one of the most challenging subtests for PWA. However, test items confound linguistic factors that make sentences difficult for PWA. The current study systematically manipulated semantic plausibility and word order in sentences like those in SC to examine how these factors affect comprehension deficits in aphasia. Fifty Korean speakers (25 PWA and 25 controls) completed a sentence-picture matching task that manipulated word order (canonical vs. noncanonical) and semantic plausibility (plausible vs. less plausible). Analyses focused on accuracy and aimed to identify sentence types that best discriminate the groups. Additionally, we explored which sentence type serves as the best predictor of aphasia severity. PWA demonstrated greater difficulties in processing less plausible sentences than plausible ones compared to the controls. Across the groups, noncanonical and less plausible sentences elicited lower accuracy than canonical and plausible sentences. Notably, the accuracy of PWA and control groups differed in noncanonical and less plausible sentences. Additionally, aphasia severity significantly correlated with less plausible sentences. Even in languages with flexible word order, PWA find it challenging to process sentences with noncanonical syntactic structures and less plausible semantic roles.

The Adaptation of the Communicative Effectiveness Index (CETI) into Greek: A Reliability and Validity Study.

The Communicative Effectiveness Index (CETI) is an informant rating scale designed to measure changes in functional communication in people with aphasia (PWA) from the carer's perspective. It offers a comprehensive view of aphasia's impact on everyday communication situations, aiding clinicians in designing personalized intervention plans. The aim of this study was to translate and adapt the CETI into Greek (CETI-GR) and validate its psychometric properties. The CETI-GR was translated into Greek using back-translation. A pilot and a content validity study ensured its acceptability. The study involved 30 people with aphasia and 30 carers. The CETI-GR's psychometric properties were evaluated, including internal consistency, test-retest reliability, inter-rater reliability, and validity measures. The CETI-GR demonstrated excellent internal consistency (Cronbach's α > 0.95) and excellent inter-rater reliability (ICC ≥ 0.93). Excellent consistency was revealed when testing the CETI responses given only by PWA (α = 0.91) versus their carers (α = 0.97). Test-retest reliability was high (ICC = 0.88). Significant correlations between the CETI-GR and measures of language severity, functional communication, and quality of life supported convergent validity. The CETI-GR is a reliable tool for assessing functional communication in chronic aphasia. Its Greek adaptation enhances aphasia rehabilitation, enabling person-centered care and improving the quality of life for people with aphasia and carers.

Listening to self-advocacy scripts produced by speakers with Broca’s aphasia and apraxia of speech: thoughts and emotions reported by unfamiliar communication partners

ABSTRACT Background Self-advocacy scripts are brief, scripted narratives that people with aphasia (PWA) use to self-disclose their aphasia, explain what it is, and request supportive communicative behaviors from communication partners (CPs). In previous research, PWA have reported that self-advocacy statements, including self-advocacy scripts, facilitate their interactions with unfamiliar CPs. To understand the benefits of self-advocacy scripts, it is important to directly investigate how unfamiliar CPs respond to them. Aims The aim of this study was to characterize the thoughts and emotions reported by unfamiliar adults after listening to self-advocacy scripts produced by speakers with Broca’s aphasia and apraxia of speech. Methods & Procedures This experimental study included 238 adult research participants without aphasia. Each participant was randomly assigned to listen to one script produced by a speaker with Broca’s aphasia and apraxia of speech: either a self-advocacy script or a control script about the weather that does not mention the speaker’s aphasia. Then, they answered one open-ended question (analyzed using a codebook approach) and eight rating scale questions (analyzed using Bayesian linear regression) about the thoughts and emotions they experienced while listening to the speaker. Outcomes & Results Compared to the control script, the self-advocacy script improved listeners’ knowledge about the speakers’ condition, their perception of the speakers’ intelligence, and their patience and empathy for the speakers. Conclusions Aphasia self-advocacy scripts can have powerful, positive effects on unfamiliar listeners. The present results highlight the importance of providing support in clinical practice for collaborative development of self-advocacy scripts between people with aphasia and their clinicians.

The development of a novel, standardized, norm-referenced Arabic Discourse Assessment Tool (ADAT), including an examination of psychometric properties of discourse measures in aphasia.

People with aphasia (PWA) typically exhibit deficits in spoken discourse. Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, the available discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use and limited evidence of the psychometric properties of published discourse measurements. (1) To develop a standardized, norm-referenced, culturally and linguistically appropriate Arabic Discourse Assessment Tool (ADAT); and (2) to examine the psychometric properties of content and construct validity and interrater reliability of different discourse measures elicited using three discourse genres (descriptive, narrative and procedural) in neurotypical control adults and matched PWA. Discourse samples were collected using three novel discourse stimuli that are sensitive to the Arabic language and culture from 70 neurotypical control adults and a matched group of 50 PWA. Transcription agreement was assessed. A standard approach was used to evaluate construct validity and interrater reliability for 16 discourse measures that assess fluency, language productivity, information content, lexical-semantics, lexical diversity, grammatical category, grammatical structure and syntactic complexity. Strong measures were identified based on their psychometric properties, and normative data were established on these measures. Discourse performance of PWA was then examined using the newly developed tool (ADAT). Transcription agreement was extremely high for all discourse stimuli in both groups. Eight discourse measures were proven to have consistently very high construct validity and consistently very good to excellent reliability across the three stimuli in both neurotypical control and aphasia groups: lexical information units, content information units, words per minute, discourse duration, number of different words, number of complete sentences and proportion of open and closed class words. Norms were established on these measures, and cut-off scores of impairments were determined. Other measures showed low construct validity and variable or poor reliability across the two groups. The newly developed, standardized, and norm-referenced tool(ADAT) consist of three discourse stimuli and eight high-quality discourse measures that assess multiple aspects of spoken discourse and were able to differentiate PWA from neurotypical adults consistently. ADAT also includes normative data and cut-off impairment scores. The tool has great potential to enhance clinical practice and research with Arabic speakers. Evidence was provided that not all discourse measures are of high quality, as some are vulnerable to differences between raters, discourse stimuli and groups. Clinicians and researchers can use ADAT for accurate aphasia assessments, better management plans and to monitor therapy effectiveness. ADAT can be further validated in other clinical populations with language impairments. What is already known on the subject Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, existing discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use in aphasia, and limited evidence of the psychometric properties of published discourse measurements. What this paper adds to existing knowledge A novel, standardized, norm-referenced Arabic Discourse Assessment Tool (ADAT) was developed and validated in this study. ADAT was further validated among PWA. The study provides evidence that not all discourse measures are of high quality and thus should not be used with confidence. Specific measures are vulnerable to the type of stimuli, the rater and/or the tested group. On the other hand, eight discourse measures were identified to be reliable between different raters and across different stimuli for the two groups, and they were able to differentiate the discourse performance of PWA from neurotypical control adults. Normative data derived from neurotypical control adults were established on these strong measures, and the performance of PWA was classified as impaired based on these norms. What are the potential or actual clinical implications of this work? The present study provides a novel, standardized, norm-referenced, validated discourse assessment tool that is culturally and linguistically appropriate for use by Arabic speakers (ADAT). ADAT holds immense potential to enhance clinical practice and research with Arabic speakers. The study also identified strong discourse measures that can be used to assess language productivity, information content, lexical-semantics, lexical diversity, grammatical category, and syntactic complexity for accurate and comprehensive assessments. This will lead to better rehabilitation management by guiding the development of tailored client-centred interventions. ADAT can be utilized in clinical and research settings in PWA and has the potential to be further validated with other clinical populations.

“You’ll find most people who got involved with the Café couldn’t do without it now” – Socialising in an online versus in-person Aphasia Café

BACKGROUND: People with Aphasia (PwA) experience detrimental consequences post-stroke which can result in limited opportunities for social engagement and poor psychosocial ramifications. Peer support can improve psychosocial outcomes. Unfortunately, Covid-19 related social restrictions resulted in the closure of social outlets for PwA, further exacerbating social isolation. Some social networks transitioned online during this period. One such network was the Aphasia Café, a social group for PwA, supported by Speech and Language Therapy students (SLTS). OBJECTIVE: This study aimed to investigate the experiences, knowledge, attitudes, and beliefs about the Aphasia Café (in-person and online), within the context of pandemic-related social restrictions, from the perspectives of PwA and the SLTS who support them. METHODS: 16 SLTS participated in one of five focus groups. Six PwA were individually interviewed. Semi-structured questionnaires facilitated inductive and deductive data collection which were analysed using Framework Analysis. RESULTS: Observed themes related to the in-person and online Aphasia Café will be reported in this paper. Overarching themes observed from both SLTS and PwA include: ‘Socialising changes during Covid-19 pandemic’, ‘Awareness and Purpose of the Aphasia Café’, ‘Perceptions of an Online and In-Person Aphasia Café” (subthemes –accessibility, technology, time/timing, non-verbal communication, and social environment), and ‘Optimal Aphasia Café’ (PwA only). CONCLUSIONS: This study provides a unique perspective on the delivery of a supported informal conversation group from both PwA and the SLTS who facilitate it. Both online and in-person social spaces were considered to enhance the quality of life for PwA and give valuable experience for SLTS.

Limitations during processing of variable reflexive anaphors and overt/null object pronouns in Turkish aphasia revealed by eye-tracking during listening studies

This study investigated how reflexives and object pronouns in Turkish are processed in aphasia as compared to a group of unimpaired controls. We aimed to understand (i) the moment-by-moment time course of processing reflexive forms, and (ii) and overt/null object pronouns in Turkish people with aphasia (PWA). We administered two eye-movement-monitoring during-listening experiments exploring resolution of reflexive variables (Experiment 1) and object pronouns (Experiment 2) in 6 PWA and their controls (n=26). Our findings showed that interpretation of reflexive anaphors in Turkish is variable, and PWA are employing a non-local interpretation of reflexive anaphors to tackle down referential ambiguity in the absence of an ability to integrate contextual cues. Furthermore, PWA inappropriately considered inaccessible local antecedents for object pronouns, and they encountered limitations processing discourse antecedents. We argue that anaphoric processing profiles in aphasia face strong limitations by variable interpretability of pronominal reference and PWA’s inability to integrate contextual cues to disambiguate the intended antecedents.

Validity and satisfaction in telehealth aphasia assessment: videoconference administration of the Comprehensive Aphasia Test-Hungarian

ABSTRACT Background The demand for telehealth aphasia assessment is increasing, yet only a limited number of instruments’ validity and feasibility in telehealth have been evaluated. The Comprehensive Aphasia Test (CAT) is a widely available language test with established psychometric properties in several languages, including Hungarian. Aims The current study aimed to evaluate the validity of administering the Hungarian version of the CAT (CAT-H) via videoconference and explore the satisfaction of people with aphasia (PWA) with videoconference assessment compared to in-person assessment. Methods & Procedures Twelve PWA with left hemisphere stroke (mean age = 50.83 years, mean post-onset = 19 months), exhibiting mild-to-moderate aphasia, completed both in-person and videoconference assessments using the CAT-H Language Battery. The study used a comparison design, incorporating elements of counterbalancing and blinding. The assessments were conducted by speech-language pathologists (SLPs), with one person leading the in-person assessment and another leading the videoconference assessment for each participant. The order of administration (in-person or videoconference) was counterbalanced across participants. SLPs leading the second assessments were blind to the results of the first assessments. One key adjustment for the videoconference assessment was the utilisation of the screen sharing and/or control sharing features within the videoconferencing software. Participants also filled out a satisfaction questionnaire after each assessment and expressed their preference between the two assessment methods at the end of the study. Intraclass correlation coefficients (ICCs) were calculated to compare the CAT-H modality summary scores and the CAT-H language battery score between in-person and videoconference assessments. Outcomes & Results There was good-to-excellent agreement between in-person and videoconference assessments, with ICCs ranging from 0.80 to 0.96 (p < 0.001) for the CAT-H modalities and an ICC of 0.97 for the CAT-H language battery score. At the individual level, minor inconsistencies were observed in the language battery score between the two assessments. Participants reported high satisfaction with both assessment methods, with satisfaction levels for the videoconference assessment being comparable to those for the in-person assessment. While the majority of participants did not exhibit a preference between the two methods in terms of understanding the clinician, approximately half of them favoured the in-person assessment for expressing themselves and comfort. Conclusions Obtained results suggest that the CAT-H can be effectively administered via videoconference, offering a viable alternative to in-person assessment when necessary. Future studies should replicate these findings with a larger and more diverse study sample, involving participants with moderately severe and severe aphasia.

“It’s not a normal relationship, and it won’t be”: The impact of aphasia on spouses

ABSTRACT Background Aphasia has far-reaching effects on both the affected individuals and their surroundings. In 2001, the World Health Organization (WHO) introduced the International Classification of Functioning (ICF) model, which includes the concept of “third-party disability”, highlighting the challenges faced by healthy partners when their significant others have a medical condition. Despite family members expressing a willingness to engage in rehabilitation, healthcare professionals often overlook their negative emotions. Aim & Methods This study explores the impact of aphasia on spouses of people with aphasia (PWA). Using mixed methods, it involved 30 spouses who completed the Family Aphasia Measure of Life Impact questionnaire (FAMLI. Grawburg et al. 2019), assessing the healthy partner’s functioning concerning the PWA. Additionally, 12 spouses from the same group participated in in-depth interviews about their lives before the stroke, their experiences during it, and life alongside aphasia. Results The FAMLI questionnaire revealed notably low scores in four of five categories: health and daily life, helping others, communication and emotion and outside influences and interactions. However, the attitudes and personal life category yielded a positive score. The communication and emotion category had the most pronounced negative impact, a finding supported and enhanced by the interviews. Challenges included an overwhelming sense of burden and profound loss within marital relationships. Conclusion Spouses of PWA face an emotionally taxing journey, with communication impairment reshaping marital dynamics. Speech-language pathologists should play a role in restoring effective communication. Addressing spouses’ unique needs should be a research and clinical priority.

Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test (CANELT): A functional approach.

The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA). CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted. An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [χ2 (2) = 95.2, p < .001] and NI [χ2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's α of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained. Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed.

Safety-Seeking Behaviors and Anxiety Maintenance in People With Aphasia: A Viewpoint.

People with aphasia (PWA) often experience higher levels of anxiety and social isolation than people without aphasia. Although the presence of anxiety is appreciated in PWA, literature examining the etiology and persistent nature of anxiety in PWA is underdeveloped. Safety-seeking behaviors, or maladaptive acts used by individuals to decrease anxiety from a feared outcome, have been reported as key facilitators of long-term anxiety toward feared situations across a variety of clinical populations. The purpose of this viewpoint is to explore the concept of safety-seeking behaviors and discuss their potential relevance to the maintenance of anxiety in PWA. We further discuss the distinction between maladaptive (i.e., safety seeking) and adaptive (i.e., coping) behaviors and how this knowledge may improve the quality of clinical services for PWA. The present review advocates for further exploration of the safety-seeking behaviors that are used by PWA. Until critical attention is given to this subject, clinicians may remain ill-equipped to identify and depict whether a self-management strategy is facilitative or inhibitive to PWA's communicative participation goals. Critically, a behavior that may be "maladaptive" for one individual may be "adaptive" for another. Future research should seek to identify common behavioral and cognitive strategies that PWA implement to reduce acute perceptions of anxiety. This knowledge may help facilitate holistic aphasia rehabilitation by allowing clinicians to foster conversations around behaviors that inhibit or promote successful communicative participation.

Self-initiated self-repairs of connected speech and novel vocabulary learning during the first year of recovery from aphasia: four longitudinal case studies

ABSTRACT Background Self-initiated self-repair of problems in speech production has been suggested to be associated with aphasia treatment gains and recovery, but the topic has been little studied. Similarly, the ability to learn novel words has been associated with anomia treatment benefits, although longitudinal data on such learning is lacking. Aims The present study’s aim was to examine whether and how self-initiated self-repairs in connected speech and the ability to learn novel vocabulary reflected recovery from aphasia as measured with cognitive-linguistic tests. Additionally, our aim was to explore whether self-initiated repair and novel word learning changed in parallel during recovery. Methods & Procedures Four people with aphasia (PWA) (2 anomic, 1 Wernicke, and 1 global aphasia) were tested in the subacute (11 to 68 days post stroke) and chronic (12 months post stroke) phases of recovery with cognitive-linguistic tests, connected speech tasks, and a computerized learning task. In the learning task, PWA associated 6 pseudowords with 6 unfamiliar referents. The associations were learned from an ambiguous setup with feedback. At both time points, learning was measured as correct immediate recognition of the items and recognition maintenance one week post-training. The proportion of self-initiated self-repairs and the proportion of unrepaired problems in connected speech were used as measures of self-repair behavior. Outcomes & Results All participants initiated self-repairs both in the subacute and chronic phases, and their self-repairs were most often related to aphasic difficulties in speech production. Between the subacute and chronic phases, self-repairs changed both in quality and quantity. The proportion of self-repair elements decreased in 4/4 participants and the proportion of unrepaired problem segments decreased in 3/4 participants. Of the participants, 3/4 showed significant novel word learning and/or maintenance already in the subacute phase and 4 /4 in the chronic phase. Conclusion Reduction in self-initiated self-repairs of speech reflected recovery from aphasia. Novel word learning improved during aphasia recovery from the subacute to the chronic phase. Novel word learning was possible even in subacute, severe aphasia and even in an ambiguous task set-up with no explicitly provided word-referent connections. Novel word learning and self-initiated self-repairs did not change in a clearly parallel manner; however, these findings need to be tested with a larger sample.

Understanding experiences, unmet needs and priorities related to post-stroke aphasia care: stage one of an experience-based co-design project

ObjectivePeople with post-stroke aphasia (language/communication impairment) and their supporters report mixed satisfaction with stroke and aphasia care. To date, however, their journey of care and the key service interactions that...

Experiences of People with Aphasia Receiving Enhanced Community-Based Speech-Language Pathology Provided by Speech-Language Pathology Students

Introduction: Treatment intensity for people with aphasia (PWA) is a significant factor in enhancing recovery. Personal factors such as fatigue, physical endurance, and motivation as well as clinician availability have been described as barriers to increased intensity. The use of student therapists has been shown to assist with addressing service gaps. Methods: The aim of the study was to explore the experiences of PWA who received enhanced community-based treatment delivered by speech-language pathology (SLP) students. Enhanced community-based treatment was defined as three or more treatment sessions per week targeting communication. Semi-structured interviews were conducted with 10 PWA living in New Zealand. Interview data were analysed with reflexive thematic analysis. Results: Two themes and six sub-themes were developed. Theme 1 related to intensity and included more treatment is better than less (sub-theme 1), there’s a “right time” for more intensive treatment (sub-theme 2), the hard work is worth the effort (sub-theme 3). Theme 2 related to working with SLP students; it didn’t feel like they were students (sub-theme 4), we just got on so well (sub-theme 5), and they listened to what I wanted (sub-theme 6). Conclusions: The findings confirm that PWA value access to more intensive treatment and desire involvement in decisions about flexible treatment schedules. PWA have positive experiences when treatment is provided by SLP students. Implications for clinical practice and future research directions are discussed.

Visual Attention to Semantic and Orthographic Associations in Fluent Aphasia: Evidence from Eye-Tracking.

We examined the allocation of visual attention in an association task by both neurotypical participants (n = 11) and adults with fluent aphasia (n = 12). Participants were presented with a picture (e.g., a basket) followed by a semantically related association (i.e., "strawberry") and an orthographically related association (i.e., "b," the first letter of "basket"). An eye tracker recorded their eye movements for three areas of interest (AOI): the picture, the semantic associate, and the orthographic associate, over 1396 observations. Results showed that both neurotypical participants and participants with aphasia looked longer at the semantic associate than at the picture, and this difference was more pronounced for neurotypicals than for people with aphasia (PWA). Neurotypicals also looked longer than the PWA group at the orthographic associate than at the prior picture. Regarding eye fixation counts, both participant groups looked more frequently at the semantic associate than at either the picture or the orthographic associate. Notably, this pattern was more pronounced among neurotypical participants than PWA. Our findings emphasize the importance of semantic associations in fluent aphasia and suggest a potential rehabilitative approach in speech and language therapy.