People With Aphasia Research Articles

Can machines classify picture naming errors? Evidence from Dell’s model

Can machines classify picture naming errors? Evidence from Dell’s model

Script Training Using Telepractice with Two Adults With Chronic Non-fluent Aphasia

Two male participants with chronic (> 2 years), non-fluent aphasia and their family members participated in script training using videoconferencing. Functional scripts were developed by people with aphasia (PWA) and their family members. Accuracy of scripts was measured by total target words produced per turn. Participant 1 with Broca’s aphasia produced scripts with 0% accuracy pre-treatment and 87.5% accuracy post-treatment. Participant 2 with Transcortical Motor aphasia produced scripts with 20.2% accuracy pre-treatment and 63.5% accuracy post-treatment. Pre- and post-questionnaires for communication effectiveness and the use of telepractice for speech therapy indicated improvements in answering yes/no questions, participating in conversations with strangers, and increasing confidence and satisfaction with technology delivered treatment. The use of videoconferencing to deliver script training appears beneficial for individuals with chronic aphasia.

Modifying and Validating a Measure of Chronic Stress for People With Aphasia.

Chronic stress is likely a common experience among people with the language impairment of aphasia. Importantly, chronic stress reportedly alters the neural networks central to learning and memory-essential ingredients of aphasia rehabilitation. Before we can explore the influence of chronic stress on rehabilitation outcomes, we must be able to measure chronic stress in this population. The purpose of this study was to (a) modify a widely used measure of chronic stress (Perceived Stress Scale [PSS]; Cohen & Janicki-Deverts, 2012) to fit the communication needs of people with aphasia (PWA) and (b) validate the modified PSS (mPSS) with PWA. Following systematic modification of the PSS (with permission), 72 PWA completed the validation portion of the study. Each participant completed the mPSS, measures of depression, anxiety, and resilience, and provided a sample of the stress hormone cortisol extracted from the hair. Pearson's product-moment correlations were used to examine associations between mPSS scores and these measures. Approximately 30% of participants completed the mPSS 1 week later to establish test-retest reliability, analyzed using an interclass correlation coefficient. Significant positive correlations were evident between the reports of chronic stress and depression and anxiety. In addition, a significant inverse correlation was found between reports of chronic stress and resilience. The mPSS also showed evidence of test-retest reliability. No association was found between mPSS score and cortisol level. Although questions remain about the biological correlates of chronic stress in people with poststroke aphasia, significant associations between chronic stress and several psychosocial variables provide evidence of validity of this emerging measure of chronic stress.

Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

ABSTRACTBackground: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia.Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures.Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis.Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia.Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway.

A concise patient reported outcome measure for people with aphasia: the aphasia impact questionnaire 21

ABSTRACTBackground: There are many validated and widely used assessments within aphasiology. Few, however, describe language and life with aphasia from the perspective of the person with aphasia. Across healthcare, patient experience and user involvement are increasingly acknowledged as fundamental to person-centred care. As part of this movement, Patient Reported Outcome Measures (PROMs) are being used in service evaluation and planning.Aims: This paper reports the quantitative aspects of a mixed methods study that developed and validated a concise PROM, the Aphasia Impact Questionnaire (AIQ), co-produced with People with Aphasia (PWA).Methods & Procedures: The AIQ was developed within the social model of disability and all stages of the development of the AIQ were performed in partnership with PWA. It was adapted from a pre-existing and lengthier PROM for PWA, the Communication Disability Profile. The first iterations of the AIQ focused on domains of communication, participation and well-being/emotional state. Subsequently the AIQ was extended to include additional items relating to reading and writing (AIQ-21). The research design was iterative. Initially, concurrent validity, internal consistency, and sensitivity of the AIQ-prototype were obtained. The AIQ-prototype was modified to become the AIQ-21. Statistical testing with a new group of PWA was performed, investigating internal consistency and concurrent validity of the AIQ-21.Outcomes & Results: Results for both the AIQ-prototype and AIQ-21 showed statistically significant concurrent validity and good internal consistency. Repeated measurement using the AIQ-prototype demonstrated statistically significant change after PWA accessed a community intervention.Conclusions: The AIQ-21 is a PROM that has great potential to be one of the core set of aphasia tests for clinical and research use. Results can be used alongside language assessment to enable person-centred goal setting and partnership working for people with aphasia.

Effects of phonomotor treatment on discourse production

ABSTRACTBackground: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with all people with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse.Aims: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment (PMT), on discourse production.Methods & Procedures: Twenty-six PWA participated in 60 h of PMT, which focuses on building a person’s ability to recognize, produce, and manipulate phonemes in progressively longer nonword and real-word contexts. Language samples were collected prior to, immediately after, and 3 months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated.Outcomes & Results: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and 3 months later, as well as significantly improved percent CIUs, relative to baseline, 3 months following treatment.Conclusions: PMT, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production.

Communication access: is there some common ground between the experiences of people with aphasia and speakers of English as an additional language?

ABSTRACTBackground: Creating communication accessible environments is an essential component to facilitating the social inclusion and well-being of people with communication support needs (CSN). However, in Australia, this has yet to translate into legislation, which may be partly due to the relatively small numbers of people if CSN only considers people with a communication disability. Including people from a culturally and linguistically diverse background, significantly increases the size of the cohort that may benefit from communication access legislation.Aims: This study explores whether the face to face experiences of service encounters of people with aphasia (PWA) were similar to speakers of English as an additional language (EAL) in an attempt to highlight the need for government policy to address the needs of a larger cohort of people with a wide range of CSN.Methods & Procedures: Using a qualitative description approach, semi-structured, in-depth interviews were conducted with five PWA and five EAL speakers about their experiences within service interactions. Using this approach, the study explored the key features which were perceived as enabling or constraining communication access. Results are explored against the backdrop of a sociological theoretical conceptual model, drawing from the theories of Pierre Bourdieu and Erving Goffman, to consider a deeper nuanced understanding of the connections between communication access, social capital and social inclusion.Outcome and results: This study suggests that there are shared experiences for PWA and speakers of EAL within service interactions. Although both groups describe many positive experiences, findings indicate that even subtle negative reactions by service providers, in particular non-verbal behaviours, are conceptualised as having a considerable impact on their negotiation of social capital and ultimately social inclusion. This study highlights that a sociological framework, underpinned by the theories of Bourdieu and Goffman appears to be a useful template for researchers to consider when studying the interactions of people with CSN.Conclusion: A wider cohort of people could benefit significantly from policy development which promotes communication access in everyday service encounters. People with disability are being encouraged to have a voice and people from different cultures are being encouraged to settle into Australian society, so it is essential to understand the everyday experience of communication access. This study has facilitated a more in–depth theoretical understanding of the multidimensional concept of communication access and the significant implications for well-being, social integration and social inclusion currently under recognised within government legislation.

Home-based, early rehabilitation after stroke: the perspectives of people with aphasia and healthcare professionals

Background: Currently, people with aphasia (PWA) in the UK receive stroke rehabilitation in a variety of care settings, including Early Supported Discharge (ESD) (home-based rehabilitation). Stroke...

Features of semantic content expressed via gesture by people with aphasia

Background: People with aphasia (PWA) use different gesture types spontaneously, including iconic gestures and pantomimes (Sekine & Rose, 2013). Iconic gestures are speech-accompanying gestures, re...

Reading of everyday texts by people with aphasia: do advance organisers help?

Background: Many people with aphasia (PWA) experience difficulty reading and report a preference for texts accompanied with pictures (Knollman-Porter, Wallace, Hux, Brown, & Long, 2015). Pictures, ...

What do we measure when we assess communication-related quality of life in people with aphasia?

Background: People with aphasia (PWA) face significant changes of their communicative functioning that can lead to reduced activities and participation in everyday life (Howe, Worrall, & Hickson, 2...

Quality of life in leaders and members of peer-led aphasia support groups – preliminary results of a systematic approach

Background: People with aphasia (PWA) often experience reduced quality of life (QoL) with diminished autonomy and challenges in maintaining strong social relationships (Hilari & Northcott, 2016). S...

Sensorimotor strategies for the improvement of naming abilities in aphasia: Neural and behavioural correlates of personalized observation, execution, and mental imagery therapy (POEM)

Anomia is the most frequent and pervasive symptom for people with aphasia (PWA) and can affect all grammatical categories. Research has long focused on name retrieval, while therapies targeting verb anomia remain scarce. Single word retrieval therapy for verbs is effective across different approaches. Nevertheless, the impact of sensorimotor strategies on aphasia recovery has been rarely explored. This study reports on the efficacy of Personalized Observation, Execution, and Mental Imagery therapy (POEM), a new therapy approach designed to integrate sensorimotor and language based strategies to treat verb anomia. Two participants with chronic aphasia and verb anomia were followed-up in a pre-post therapy fMRI study. Tests of language and cognitive functions were completed. A personalized set of stimuli was built based on the naming performance on baseline controlled for linguistic variables. POEM therapy was administered in a massed stimulation schedule: three 60-minutes sessions per week for 5 weeks. The results show a significant improvement in both participants, with trained and untrained items. Changes in fMRI patterns following POEM reflect a reduction in the number of recruited areas supporting recovered naming, and the recruitment of brain areas, part of language and mirror neuron systems. This study originally contributes to the research on verb anomia treatment with an innovative structured combination of sensorimotor strategies allowing PWAs to retrieve more precisely and quickly treated and untreated verbs. Changes in fMRI patterns following POEM reflect a reduction in the number of recruited areas supporting recovered naming, and the recruitment of brain areas, part of language and mirror neuron systems. Future studies with a larger sample of participants are required to further explore this avenue.

Delivering storytelling intervention in the virtual world of EVA Park

Background: Sharing stories are a powerful way of connecting with each other. People with aphasia (PWA) struggle to produce stories: producing shorter, less complex, more effortful narratives (Andr...

Modeling confrontation naming and discourse informativeness using structural equation modeling

ABSTRACTBackground: People with aphasia (PWA) and their families identify as their priority the ability to use language at the discourse level in order to meet their daily communicative needs. However, measuring connected speech can be a challenging task due to the complex and multidimensional nature of discourse. As a result, professionals often depend on confrontation naming tests to identify and measure impaired underlying cognitive mechanisms that are also hypothesized to be important for discourse production.Aims: In the current study, we investigated the validity of making inferences about discourse performance based on scores from confrontation naming tests. Specifically, we investigated the strength of the relationship between word retrieval abilities, and the ability to convey information during discourse production.Method & Procedures: Data from 118 monolingual PWA were retrieved from AphasiaBank and analyzed using structural equation modeling. Performance in confrontation naming tests was modeled as a latent variable based on the Boston Naming Test, the Western Aphasia Battery – R Naming Subtest, and the Verb Naming Test. Performance at the discourse level was modeled based on indices of informativeness in three discourse tasks (free speech, eventcasts, and story re-tell). Informativeness was quantified using the percentage of Correct Information Units.Outcomes and Results: Based on the fit statistics, the model exhibited adequate fit, indicating that the relationship between confrontation picture naming and informativeness was adequately reflected in the model. We found a strong relationship between confrontation naming test performance and discourse informativeness (standardized regression coefficient between the two latent factors = .79).Conclusions: Performance on confrontation naming tests was a strong predictor of the amount of information PWA communicated during discourse production. However, our results also highlight that performance on the latter cannot be predicted solely from the former, as evidenced by the large proportion of unexplained variance in the informativeness latent variable.

“I definitely think it’s a feasible and worthwhile option”: perspectives of speech-language pathologists providing online aphasia group therapy

ABSTRACTBackground: Speech-language pathologists (SLPs) have begun to incorporate telepractice methods into clinical service delivery and online intervention for aphasia is recognised as an appropriate alternative to face-to-face services. However, little is known about the SLP experience of telepractice with no known study exploring the provision of aphasia group therapy online. The purpose of this study was to describe the experience of SLPs who provided the online aphasia group therapy, Telerehabilitation Group Aphasia Intervention and Networking (TeleGAIN), to people with aphasia (PWA) and their perceptions regarding the outcomes of intervention and feasibility of implementation into clinical practice.Aims: The aim of this study was to describe the experience of SLPs who provide TeleGAIN to people with aphasia including the perceived outcomes of the intervention and treatment procedures.Methods & Procedures: Three SLPs with experience in aphasia rehabilitation delivered at least one 12 week block of TeleGAIN – an aphasia group intervention purposefully developed for delivery via telepractice. Prior to TeleGAIN, SLPs were trained in using the technology required and the goals, activities, and constructs of TeleGAIN. The goals of TeleGAIN for PWA were to 1) create opportunities for communicative success, 2) share personal life history, and 3) provide support for living successfully with aphasia through networking with others. The SLPs provided this intervention to 21 PWA across six groups. Following completion of all treatment blocks, each SLP participated in a semi-structured interview exploring their perceptions of TeleGAIN and the potential for implementation. Interviews were analysed using qualitative content analysis and key categories were identified.Outcomes & Results: SLPs enjoyed providing the online aphasia group therapy TeleGAIN, and considered the intervention to be feasible and worthwhile. SLPs developed a range of strategies to manage the barriers to implementing the online group successfully and promoted those factors that facilitated more efficient and effective group sessions. In addition, benefits for individuals with aphasia, SLPs and SLP services were recognised despite challenges with technology and group dynamics experienced during TeleGAIN.Conclusions: The results from this study suggested that although SLPs may take time to improve their skills and confidence in telepractice, they were successfully able to provide online group aphasia therapy to PWA. The experience of the SLPs in this study suggested that commonly cited barriers to telepractice such as rapport building and technology issues were able to be overcome. SLPs perceived that TeleGAIN offered PWA many communication and psychosocial benefits and may improve SLP service provision. Findings support investigation of the implementation of TeleGAIN into clinical services.

‘I've got to get something out of it. And so do they’: experiences of people with aphasia and university students participating in a communication partner training programme for healthcare professionals

Communication partner training (CPT) has been used to support communication partners to interact successfully with people with aphasia (PWA). Through successful CPT interaction PWA's accessibility to healthcare is notably improved. The present study sought to build on prior studies by investigating the experiences of individuals with aphasia and healthcare providers to ascertain what they deemed to be beneficial from CPT and what could be refined or improved, dependent on the setting and skill set of those participating. To gain an understanding of the experiences of PWA involved in the provision of CPT to health professional (HP) students. Also to investigate the experiences of HP students who participated in the CPT programme. Eight PWA and 77 HP students who had completed a CPT programme participated in a focus group/semi-structured interview (PWA) and feedback session (HP students) moderated by two speech-language pathologists (SLPs). These sessions were recorded (audio and video), transcribed verbatim, including non-verbal communication, and analyzed using qualitative content analysis. Overall, the study sought to understand experiences of the training. Both the PWA and HP students reported positive experiences of CPT. PWA discussed their perception that CPT improved HPs and HP students' understanding and interactions conversing with them and emphasized the need for training and education for all health related professions. HP students enjoyed the opportunity to experience interacting with PWA, without being 'assessed' and felt it consolidated their learning based on lecture content. Inclusive and accessible healthcare is paramount to ensure the engagement of patients and providers. Based on the experiences and feedback of the participants in this current study, CPT offers a salient and practical training method with potential to improve practice. Participants perceived CPT to be beneficial and validated the need for the training to support PWA accessing healthcare.

Aphasia education: speech-language pathologists’ perspectives regarding current and optimal practice

ABSTRACTBackground: People with aphasia (PWA) and their families (PWA-F) have conveyed that the receipt of information and education is a key component of rehabilitation which supports access to services and participation in healthcare decision-making. Best practice recommendations state that education about aphasia should be tailored, aphasia-friendly, and provided on multiple occasions and in a variety of formats. To date, there has been little research examining the current practices of speech-language pathologists (SLPs) in the provision of education or their perspectives on barriers and facilitators to achieving optimal aphasia education practices.Aims: The aim of this study was to explore current and optimal aphasia education practices from the perspective of Australian SLPs.Methods and Procedures: This study used a cross-sectional survey design, comprising both quantitative and qualitative questions. An online survey was distributed to Australian SLPs via professional networks. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis.Outcomes and Results: This study reports data from 130 Australian SLPs. The majority of SLPs (>70%) reported that they provided information to both PWA and PWA-F about (1) the definition of aphasia, (2) characteristics of aphasia, (3) causes of aphasia, (4) aphasia recovery, (5) strategies to assist communication, and (6) coping strategies. However, the majority of SLPs reported that they did not provide information to friends on any of the presented topics. Many SLPs (>95%) provided both face-to-face and written aphasia information, and approximately half (55%) provided aphasia education that could be accessed via the Internet. All but one SLP reported using pre-prepared written information and less than half (45%) considered those materials to be formatted in an aphasia-friendly way. The majority of SLPs (65%) reported that they did not have a systematic approach to providing aphasia education, they (82%) did not evaluate the effectiveness of aphasia education, and they (92%) did not provide optimal aphasia education. SLPs reported that greater access to aphasia-friendly formatted information (94%) and written information for family members (92%) would assist in optimising aphasia education. Furthermore, 82% of SLPs indicated that they would support an Australia-wide move to use the term aphasia, rather than dysphasia.Conclusions: The majority of SLPs reported providing information to PWA and PWA-F in a variety of formats; however, information provision did not commonly extend to friends. Increased tailoring of information and access to aphasia-friendly information would assist SLPs in meeting best practice recommendations for aphasia education.

Spirituality as a coping mechanism for family caregivers of persons with aphasia

This study sought to describe spirituality resourcing of family caregivers for people with aphasia (PWA). A purposive sample of 14 female family caregivers of PWA from a historically disadvantaged South African community were participants (married = 42%; age range 21 to 65 years). They completed interviews regarding the spiritual support that they received when caring for their family member with aphasia. Thematic analysis of the data yielded findings to suggest spiritual interpretation of their experiences, importance of prayer as a source of hope and healing, and significance of social support from church fellowship. Spirituality is a resource for coping with the carer-role among community women with responsibility over family members with aphasia.

An investigation of hospitality industry students’ awareness and knowledge of aphasia

ABSTRACTBackground: Previous studies highlight a lack of awareness of aphasia among the general public. To date, no research has investigated awareness of aphasia among those working in the hospitality service industry. A lack of awareness of aphasia can exacerbate reduced participation in society for people with aphasia (PWA); as lack of awareness has been identified as a core barrier to participation by PWA themselves. Reduced social participation is a central theme which impacts on negative quality of life for PWA. Education on the nature and impact of aphasia has been identified as a precursor to facilitating participation for PWA. However, before education of aphasia can be provided, we must first ascertain the current level of awareness and knowledge of aphasia among this population working in the hospitality service industry.Aims: To investigate the awareness and level of knowledge of aphasia among hospitality industry students in Ireland and identify strategies to improve awareness.Methods & Procedures: The participants, recruited from four third-level institutions in Ireland, completed a validated survey which was adapted for use with the target population. Descriptive and inferential statistics were used to analyse responses. Open-ended questions were first analysed using content analysis, followed by descriptive statistical analysis.Outcomes & Results: One hundred and fifty-five hospitality industry students participated in this study. 9.68% of participants were aware of aphasia, whereas 3.23% of participants were found to have adequate knowledge of aphasia. Suggested strategies to improve awareness of aphasia were campaigning, education in college and advertising using print, broadcast, and social media.Conclusions: This study highlights a distinct lack of awareness and knowledge of aphasia among hospitality students. This can have a negative impact on PWA who have reported this as a barrier to their social participation. By raising awareness of aphasia among hospitality students, they will be better equipped to facilitate communication with PWA. This would break down the existing barrier to participation for PWA. All methods identified by participants can be used to raise awareness and, in particular, it is recommended that undergraduate education of aphasia be incorporated into the college curriculum at a policy level. As this is the first study of its kind on this population, further research in this area is warranted, particularly in the area of how best to raise awareness and knowledge of aphasia among this specific population.