People With Aphasia Research Articles

Gavel Club for people with aphasia: communication confidence and quality of communication life

ABSTRACTBackground: Many factors that contribute to successful living with aphasia intersect with the benefits one can get from attending an aphasia group. Affiliated with Toastmasters International, Gavel Clubs (GCs) for people with aphasia (PWA) provide a range of communication activities that promote public speaking and leadership skills. The constructs of communication confidence and quality of communication life (QCL) were introduced over a decade ago but have not been widely investigated.Aims: This study aims to investigate the association between weekly participation in GC public speaking activities for PWA and the constructs of QCL and communication confidence. In addition, the study aims to explore the association between the severity of aphasia, QCL and communication confidence.Methods & Procedures: Eight members of a GC for PWA, who attended 31–33 weekly GC meetings per year between 2012 and 2016, participated in assessments of their QCL (using the ASHA Quality of Communication Life (ASHA QCL)), communication confidence (using the Communication Confidence Rating Scale for Aphasia (CCRSA)), and aphasia severity (using the Western Aphasia Battery-Revised (WAB-R)). A link was sought between severity of aphasia and the constructs of QCL and communication confidence.Outcomes & Results: QCL improved significantly over four years of participation in the GC (Z = 2.103, n = 8, p = .035, r = .74). Communication confidence also improved significantly (Z = 1.973, p = .049, r = .70). No associations were found between the two scales or between the scales and severity of aphasia.Conclusions: Weekly participation in GC group activities was associated with improved QCL, as measured by the ASHA QCL, and improved communication confidence as measured by the CCRSA. Decision-making (measured by the CCRSA) and the Roles and Responsibilities domain (in the ASHA QCL) also improved. More research is needed to verify these findings using a study design that includes a control group, to identify the links between the various psychosocial aspects at play in the life of PWA and to conceptualise how the gains achieved with GC participation can be applied more broadly to successful living with aphasia.

How do speakers with and without aphasia use syntax and semantics across two discourse genres?

ABSTRACTBackground: Discourse is an increasing focus of assessment in clinical and research settings because it reflects everyday communication. Everyday communication is likely to include a range of different discourse genres, e.g., describing a scene, or reflecting on life experiences. It is likely that speakers use verbs differently in these different discourse genres, but very little is known about this.Aims: To explore whether there were differences in how two groups of speakers (with and without a communication impairment) used verbs in two different discourse genres, in terms of syntax and semantics.Methods & Procedures: Data from people with aphasia (PWA) were taken from an earlier study, and neurologically healthy people were recruited for the current study. Participants produced discourses from two genres: a picture description (the Western Aphasia Battery “Picnic Scene”) and personal narrative (reflective responses to quality of life [QoL] questions). Discourses were analysed using measures of argument structure (mean predicate argument structure score), verb weight (% heavy verbs), and verb semantic category (% mental and relational verbs). Comparisons were made for each measure between genre and group using a series of two mixed two-way ANOVAs.Outcomes & Results: Data from 26 PWA and 27 neurologically healthy people were analysed. For predicate argument structure, there was a main effect of genre, significant interaction between group and genre, and main effect of group. For the semantic measures, there was a main effect of genre for % mental verbs but no effects or interactions for % heavy and % relational verbs. Post hoc correlations explored associations between the variables.Conclusions: Genre exerts no demonstrable impact on semantic weight, in either speaker group, but does exert influence on the semantic category of verbs used because, for both speaker groups, the picture description genre elicited a smaller percentage of mental verbs than the personal narratives produced in response to QoL questions. For PWA only, genre also exerted an influence on argument structure, with QoL narratives eliciting significantly less complex argument structures. This has implications for clinical assessment. Discourses of different genres should be sampled to fully assess a speaker’s syntactic and lexico-semantic skills; and the genre of discourse used for assessment and therapy materials should align with the client’s communication goals.

Response Time Inconsistencies in Object and Action Naming in Anomic Aphasia

The effect of repeated naming on both object and action picture naming in individuals with anomic aphasia is explored. We asked whether repeatedly naming the same items leads to improved accuracy and reduced response latency. Ten individuals with anomic aphasia and 6 healthy adults, 3 young and 3 old, named a set of 27 object pictures and a set of 27 action pictures presented 1 at a time on a computer screen. We examined accuracy and response times (RTs) across the 2 blocks of 10 repeated trials. Results demonstrated higher accuracy and faster RTs for object than for action naming for all participants, with lower accuracy rates and slower RTs for the people with aphasia (PWA) compared with the healthy individuals, and diverging patterns of change across trials. Unlike the healthy participants, whose RTs decreased across trials, PWA continued to demonstrate variability in response latencies across the trials. Our preliminary results suggest that measuring RT may be useful in characterizing retrieval difficulty in anomic aphasia and that the retrieval processes in PWA, even in those who experience mild anomia, may be less efficient or different from those processes in neurologically healthy individuals.

Lexical overlap increases syntactic priming in aphasia independently of short-term memory abilities: Evidence against the explicit memory account of the lexical boost

Abstract Speakers show syntactic priming – that is, a tendency to repeat syntactic constructions they have recently comprehended or produced – and this tendency is even stronger when adjacent utterances share the same main verb, termed the lexical boost. Some have suggested that abstract syntactic priming (i.e., with no lexical overlap) derives from implicit learning, whereas the lexical boost derives from explicit short-term memory (STM) for the prime (e.g., Chang, Dell, & Bock, 2006). To address this issue, we assessed twelve people with aphasia (PWA) with varying degrees of STM and language deficits and eleven age-matched healthy control speakers in a syntactic priming experiment. Despite the PWA's difficulty in maintaining phonological, semantic, and structural information, as evidenced by various STM and sentence repetition measures, they showed lexical boost effects comparable to those of healthy speakers. Moreover, the size of the lexical boost was unrelated to the degree of STM deficit, suggesting that the lexical boost does not rely on explicit memory. Alternative explanations for the differing patterns for syntactic priming with and without lexical overlap are discussed.

Enjoyment in a recreational sing-along group for people with aphasia and their caregivers

ABSTRACTBackground: Literature exists documenting connections between music, health, and well-being. Group singing involving people with aphasia (PwA) and caregivers may be an enjoyable, leisure activity contributing to a successful life that includes aphasia. However, the benefits of group singing are only achieved if programming is sustainable. Little has been published about aspects of such programs that result in greater enjoyment, and by potential extension, reduced attrition.Aims: To explore the feasibility of a recreational sing-along group for PwA and their caregivers that results in enjoyment.Methods and Procedures: Study participants included five PwA, each accompanied by one caregiver. Prior to initiating the study, PwA were asked about their musical experience and their perceived relationship with their caregiver. Caregivers answered questions about their perceived levels of stress/burden. After participation in 10 group sing-along sessions, post-participation information was gathered so that the sing-along program could be modified if necessary to meet the interests of the participants. Post-participation information included questionnaires and interviews including ratings of song preferences (worded, non-worded, familiar, novel), environmental aspects of the sing-along, group dynamics, and the impact on caregiver stress/burden. Field notes maintained by the authors were used to support findings.Outcomes and Results: Participants (PwA and caregivers) believed a public setting with meetings once every two weeks for at least 90 min would be more enjoyable than shorter weekly sessions. PwA with less musical experience rated the sing-along experience as more enjoyable than those with more experience. Both PwA and their caregivers expressed interest in singing worded songs, even when they found them less enjoyable, explaining that they believed it might have a positive impact on word finding skills for the PwA. Familiar music was more enjoyable to sing than novel songs. PwA enjoyed having their caregivers participate in the sing-along sessions rather than singing without them. Caregivers enjoyed singing with the group, but also welcomed the opportunity to have unstructured free time away from their partner with aphasia. Caregivers agreed the sing-along experience lowered their stress to a small degree.Conclusions: The musical background of participants and song repertoire appear to play an important role in singing enjoyment. Overall, the sing-along group was perceived by the participants as an enjoyable social activity for both PwA and their caregivers. Notably, however, participation motivation was partially influenced by an underlying belief in the therapeutic speech-language potential of the activity.

Cognitive effort during a short-term memory (STM) task in individuals with aphasia

Abstract People with aphasia (PWA) have been shown to demonstrate limited short-term memory (STM) span capacity, but little is known about the degree of cognitive effort PWA expend when completing STM tasks. For decades, researchers have used task-evoked pupillary responses (TEPRs) to infer cognitive effort; pupil size increases as the difficulty of a task increases. The purpose of this study was to examine TEPRs while PWA and healthy control participants completed a STM picture span task. Sixteen PWA and 16 demographically matched control participants completed paper-based and computer-based versions of a picture span task. Measures of pupil size were collected using an eye-tracking system during the computer-based task. Both PWA and control participants demonstrated increased pupil size as STM demands increased. The two groups did not differ in pupil size across different span levels; however, PWA performed significantly poorer than matched controls in terms of behavioural accuracy scores. This suggests that although PWA exerted similar amounts of effort to control participants as task demands increased, they did not show a corresponding increase in accuracy. These data provide support for the feasibility of using TEPRs to investigate cognitive effort in PWA. In conjunction with behavioural performance measures, measures of cognitive effort may provide a holistic picture of cognitive and linguistic functioning in PWA.

What happens when they think they are right? Error awareness analysis of sentence comprehension deficits in aphasia

ABSTRACTBackground: Comprehension of non-canonical sentences is frequently characterised by chance level performance in people with aphasia (PWA). Chance level performance has been interpreted as guessing, but online data does not support this rendering. It is still not clear whether the incorrect sentence processing is guided by the compensatory strategies that PWA might employ to overcome linguistic difficulties.Aims: We aim to study to what extent people with non-fluent aphasia are aware of their sentence comprehension deficits.Methods & Procedures: This study combined offline and online data to investigate the effect of word order and error-awareness on sentence comprehension in a group of PWA and non-brain damaged (NBD) participants. The offline tasks involved auditory sentence picture-matching immediately followed by a confidence rating (CR). Participants were asked to judge the perceived correctness of their previous answer. Online data consisted of eye-tracking.Outcomes & Results: Replicating previous findings, PWA had significantly worse comprehension of Theme-Agent order compared to Agent-Theme order sentences. Controls showed ceiling level sentence comprehension. CR was a poor predictor of response accuracy in PWA, but moderate-good in NBD. A total of 6.8% of judgements were classified as “guessing” by PWA. Post hoc gaze data analysis indicated that CR was a predictor of the fixation pattern during the presentation of the linguistic stimuli.Conclusions: Results suggest that PWA were mostly unaware of their sentence comprehension errors and did not consciously employ strategies to compensate for their difficulties.

Application of automatic speech recognition (ASR) techniques for automatic speech assessment in people with aphasia

Application of automatic speech recognition (ASR) techniques for automatic speech assessment in people with aphasia

Meta-analysis of Treatment of Underlying Forms: dosage-related and person-level predictors of acquisition and generalization response

Meta-analysis of Treatment of Underlying Forms: dosage-related and person-level predictors of acquisition and generalization response

Measuring Life Participation, Communicative Confidence, Language, and Cognition in People With Aphasia

This study investigated change in life participation in people with aphasia (PWA) before and after a stroke from their perspectives. Language, cognitive, and communicative confidence factors that m...

Naming Light Verb Constructions in Persian Speakers with Aphasia: A Linear Mixed Effects Model

Poster Session 2: Syntax/Pragmatics; Word Production; Written Language; Cognitive Processes Syntax/ Pragmatics

Sensorimotor Strategies for the Improvement of Naming Abilities in Aphasia: Neural and Behavioral Correlates of POEM – Personalized Observation, Execution, and Mental Imagery Therapy in two participants with verb anomia

Sensorimotor Strategies for the Improvement of Naming Abilities in Aphasia: Neural and Behavioral Correlates of POEM – Personalized Observation, Execution, and Mental Imagery Therapy in two participants with verb anomia

Speak along without the song: what promotes fluency in people with aphasia?

ABSTRACTBackground: Melodic intonation therapy (MIT) is a widely used treatment for nonfluent aphasia that builds upon a number of musical elements in order to ultimately improve generative language. These include intoning syllables on different pitches, using a metrically regular speech rhythm, and the clinician and patient producing phrases in unison. Studies have investigated which of these musical elements might be the most clinically facilitating, but important differences in methodology and results across studies leave some questions unanswered. In particular, the relative roles of intoning and unison production remain unclear.Aims: The present study examined these elements in isolation and in combination.Methods & Procedures: Twelve people with aphasia (PWA) and 10 control participants sang and rhythmically spoke unfamiliar song lyrics in unison with a recording and by themselves. A subset of eight of the PWA returned for post-hoc testing to evaluate singing familiar lyrics from memory, and propositional speech. Across all tasks, productions were evaluated for syllable accuracy.Outcomes & Results: On average, PWA benefited from unison over solo production and from rhythmic speech over singing when repeating unfamiliar lyrics. They did show a benefit of singing when producing familiar lyrics from memory, but this post-hoc task did not control for syllable duration or task order. Within-group correlations indicated that those with more severe apraxia of speech, worse single-word auditory comprehension, and poorer repetition ability benefited the most from unison production. Those with better sentence-level auditory comprehension and poorer performance on a perceptual rhythm test tended to benefit more from singing compared to rhythmically speaking unfamiliar lyrics.Conclusions: Unison production is an important element for promoting fluency in many PWA, and perhaps especially for those for whom MIT is considered an appropriate treatment option. However, some candidates for MIT are hindered by the inclusion of even moderately complex melodic information, indicating that this factor should be considered when customizing or adapting the therapy. Finally, PWA who show a striking improvement in fluency when singing familiar songs will not necessarily benefit from singing when the aim is to produce new lyrics or propositional content.

Integrity and function of gestures in aphasia

ABSTRACTBackground: Gestures can provide an excellent natural alternative to verbal communication in people with aphasia (PWA). However, despite numerous studies focusing on gesture production in aphasia, it is still a matter of debate whether the gesture system remains intact after language impairment and how PWA use gestures to improve communication. A likely source for the contradicting results is that many studies were conducted on individual cases or in heterogeneous groups of individuals with additional cognitive deficits such as conceptual impairment and comorbid conditions such as limb apraxia.Aims: The goal of the current study was to evaluate the integrity and function of gestures in PWA in light of cognitive theories of language–gesture relationship. Since all such theories presuppose the integrity of the conceptual system, and the absence of comorbid conditions that selectively impair gesturing (i.e., limb apraxia), our sample was selected to fulfill these assumptions.Methods & Procedures: We examined gesture production in eight PWA with preserved auditory comprehension, no comorbidities, and various degrees of expressive deficit, as well as 11 age- and education-matched controls, while they described events in 20 normed video clips. Both speech and gesture data were coded for quantitative measures of informativeness, and gestures were grouped into several functional categories (matching, complementary, compensatory, social cueing, and facilitating lexical retrieval) based on correspondence to the accompanying speech. Using rigorous group analyses, individual-case analyses, and analyses of individual differences, we provide converging evidence for the integrity and type of function(s) served by gesturing in PWA.Outcomes & Results: Our results indicate that the gesture system can remain functional even when language production is severely impaired. Our PWA heavily relied on iconic gestures to compensate for their language impairment, and the degree of such compensation was correlated with the extent of language impairment. In addition, we found evidence that producing iconic gestures was related to higher success rates in resolving lexical retrieval difficulties.Conclusions: When comprehension and comorbidities are controlled for, impairment of language and gesture systems is dissociable. In PWA with good comprehension, gesturing can provide an excellent means to both compensate for the impaired language and act as a retrieval cue. Implications for cognitive theories of language–gesture relationship and therapy are discussed.

Experiencing EVA Park, a Multi-User Virtual World for People with Aphasia

Virtual worlds are used in wide-ranging ways by many people with long-term health conditions, but their use by people with aphasia (PWA) has been limited. In contrast, this article reports the use of EVA Park, a multi-user virtual world designed for PWA to practice conversations, focusing on people's emotional, social, and conversational experiences. An analysis of observation and interview data collected from 20 people with aphasia who participated in a 5-week therapy intervention revealed key themes related to user experience. The themes offer a rich insight into aspects of the virtual world experience for PWA that go beyond therapeutic outcomes. They are as follows: affect (positive and negative); types of conversation, miscommunication, and misunderstanding; immersion in the virtual world; social presence and initiative and flow. Overall, the study showed that participants experienced positive emotional and social outcomes. We argue that this was achieved as a consequence of EVA Park being not only accessible but also a varied and entertaining environment within which PWA experienced both the realistic and the quirky while engaging with others and having fun.

The efficacy of an inter-disciplinary community aphasia group for living well with aphasia

ABSTRACTBackground: Community aphasia groups (CAGs) are argued to have various benefits for people with chronic aphasia. However, there is a paucity of evidence regarding the feasibility of conducting an interdisciplinary programme with content and outcome measures encompassing ICF domains, making it difficult to ascertain the full potential of this service option. As another key population living with aphasia, family members have received little attention in CAG research to date.Aim: To determine potential efficacy of a speech-language pathologist- and social worker-led CAG model for four people with aphasia (PWA) and their spouses on living well with aphasia within a proof-of-concept trial.Methods & Procedures: Informed by extensive study of the existing CAG literature, we developed a comprehensive 12-week interdisciplinary CAG model and trial protocol (the InterD-CAG). We used a Phase I pre-post design with a follow-up phase. The group was co-facilitated by a speech-language pathologist and social worker with support from aide staff. The group met at a university clinic for 2 h per week over 12 consecutive weeks. The protocol comprised a combination of communication therapy; conversation practice; social, peer, and psychological support; stroke and aphasia information; and participation in meaningful and accessible activities. Group session time was split into two formats: (1) concurrent sessions dedicated to members with aphasia alone/spouses alone and (2) mixed sessions with both members with aphasia and spouses together. The Therapeutic Factors Inventory was administered at regular intervals during the programme to ascertain participants’ perceptions of group process. Pre, post, and follow-up outcome measures spanned all WHO ICF domains for PWA, with measures for spouses addressing supported conversation skills, psychological health, and carer burden.Outcomes & Results: Both PWA and spouses perceived the presence of therapeutic factors to be medium or high by Week 12 in the programme. Our hypotheses for significant improvement for PWA in quality of life, aphasia impairment, activity & participation, and contextual factors were partially supported and maintenance of gains was observed in some cases. No clear changes were evident for spouses.Conclusions: This study contributes preliminary evidence for the efficacy of the InterD-CAG model for people with chronic aphasia. Larger-scale studies with comparison groups are required to build on the present findings with specific attention to spouse support needs.

Individual variability in attention and language performance in aphasia: a study using Conner’s Continuous Performance Test

ABSTRACTBackground: Individual variability in attention in aphasia is important because moment-to-moment fluctuations in attention could might influence language performance.Aims: Moment-to-moment variability in performance has been considered a feature of aphasia. The aim of the current work is to study the possible relationship between moment-to-moment intraindividual fluctuations in attention and their possible relationship with language disorders in people with aphasia (PWA).Methods & Procedures: 24 controls and 21 PWA matched by age and sex took part in the study. Language assessment included phonological processing (phonological discrimination, word and pseudoword repetition), lexical access (auditory lexical decision, spoken word-to-picture matching and naming), and semantic association (object–action association, semantic association, and odd-one-out). Attention assessment employed a comprehensive test of basic attention functions (Conner’s Continuous Performance Test II). We studied the association between indices of intraindividual variability in response time in Conner’s Continuous Performance Test and linguistic performance in both groups.Outcomes & Results: PWA showed increased response times and also increased intraindividual variability in response speed. Moreover, only in this group, response speed variability was significantly associated with speech discrimination and with performance in semantic association tasks. Indices of intraindividual variability predicted performance in linguistic tasks in PWA, even after accounting for language performance in related tasks.Conclusion: The current results provide additional support to evidence suggesting a relationship between attention skills and some aspects of linguistic performance in PWA, and draw attention to the putative importance of processing speed instability.

An analysis of topics and vocabulary in Chinese oral narratives by normal speakers and speakers with fluent aphasia

ABSTRACTThis study analysed the topic and vocabulary of Chinese speakers based on language samples of personal recounts in a large spoken Chinese database recently made available in the public domain, i.e. Cantonese AphasiaBank (http://www.speech.hku.hk/caphbank/search/). The goal of the analysis is to offer clinicians a rich source for selecting ecologically valid training materials for rehabilitating Chinese-speaking people with aphasia (PWA) in the design and planning of culturally and linguistically appropriate treatments. Discourse production of 65 Chinese-speaking PWA of fluent types (henceforth, PWFA) and their non-aphasic controls narrating an important event in their life were extracted from Cantonese AphasiaBank. Analyses of topics and vocabularies in terms of part-of-speech, word frequency, lexical semantics, and diversity were conducted. There was significant overlap in topics between the two groups. While the vocabulary was larger for controls than that of PWFA as expected, they were similar in distribution across parts-of-speech, frequency of occurrence, and the ratio of concrete to abstract items in major open word classes. Moreover, proportionately more different verbs than nouns were employed at the individual level for both speaker groups. The findings provide important implications for guiding directions of aphasia rehabilitation not only of fluent but also non-fluent Chinese aphasic speakers.

The comprehensibility of pantomimes produced by people with aphasia.

People with aphasia (PWA) use pantomime, gesture in absence of speech, differently from non-brain-damaged people (NBDP). To evaluate through an exploratory study the comprehensibility of PWA's pantomimes and to find out whether they can compensate for information PWA are unable to convey in speech. A total of 273 naïve observers participated in one of two judgement tasks: forced-choice and open-ended questions. These were used to determine the comprehensibility of pantomimes produced to depict objects by PWA as compared with NBDP. Furthermore, we compared the information conveyed in pantomime with the information in speech. We looked into factors influencing pantomime's comprehensibility: individual factors, manner of depiction and information needed to be depicted. Although comprehensibility scores for PWA's pantomimes were lower than for those produced by NBDP, all PWA were able to convey information in pantomime that they could not convey in speech. Comprehensibility of pantomimes was predicted by apraxia. The inability to use the right hand related to slightly lower comprehensibility scores. Objects for which individuals depicted its use were best understood. Our findings highlight the potential benefit of pantomime for clinical practice. Pantomimes, even though sometimes impaired, can convey information that PWA cannot convey in speech. Clinical implications are discussed.

Eye-tracking the effect of word order in sentence comprehension in aphasia: evidence from Basque, a free word order ergative language

ABSTRACTAgrammatic speakers of languages with overt grammatical case show impaired use of the morphological cues to establish theta-role relations in sentences presented in non-canonical word orders. We analysed the effect of word order on the sentence comprehension of aphasic speakers of Basque, an ergative, free word order and head-final (SOV) language. Ergative languages such as Basque establish a one-to-one mapping of the thematic role and the case marker. We collected behavioural and gaze-fixation data while agrammatic speakers performed a picture-matching task with auditorily presented sentences with different word orders. We found that people with aphasia (PWA) had difficulties in assigning theta-roles in Theme-Agent order. This result is in line with processing accounts. Contrary to previous findings, our data do not suggest a systematic delay in the integration of morphological information in the PWA group, but strong reliance on the ergative case morphology and difficulties assigning thematic roles into the determiner phrases.