People With Aphasia Research Articles

Reliability and validity of bedside version of Arabic Diagnostic Aphasia Battery (A-DAB-1) for Lebanese individuals

ABSTRACTBackground: There are several clinical aphasia assessment tools for screening and rehabilitation purposes in different languages. They are used globally to determine important aspects of language functioning in brain damaged individuals. Despite this, a valid bedside operational assessment tool is not available in Arabic to determine the level and severity of aphasia in Lebanese brain damaged patients.Aims: The aim of the present study was to develop the bedside version of Arabic Diagnostic Aphasia Battery (A-DAB-1) to measure severity of aphasia for rehabilitation purposes in Lebanese Arabic-speaking people with aphasia (PWA).Methods & Procedures: This study followed the theoretical framework of the WAB-R as well as connected speech analysis framework of P-WAB-1 developed for Persian (Persian Western Aphasia Battery). An expert native speaking panel was employed to evaluate the faithful translation of A-DAB-1 for matching the sociolinguistic properties of Arabic spoken in Lebanon using the Delphi method. The content validity ratio (CVR) was determined, and the new version of the test was administered to 60 healthy native Arabic-speaking adults living in Lebanon to obtain norms. The final version was administered to 30 Lebanese Arabic-speaking cerebrovascular accident (CVA) PWA introduced by a neurologist. The internal consistency and the test-retest were determined by reassessing ten PWA within 2–4 weeks interval.Outcomes & Results: The results of this study indicated that A-DAB-1 is a valid and reliable bedside clinical assessment tool. It achieved CVR 0.75 and an acceptable internal consistency (alpha = 0.961) and test-retest reliability (ICC = 0.988 p. Also A-DAB-1 showed a good clinical utility to differentiate between normal individuals and the performance of PWA as an operational index of severity.Conclusions: Based on the result, A-DAB-1 can be used as a valid clinical assessment tool for screening aphasia in bedside and to determine the severity of aphasia and efficacy of language intervention in Lebanese Arabic-speaking PWA.

Does communication partner training improve the conversation skills of speech-language pathology students when interacting with people with aphasia?

BackgroundAphasia is a common consequence of stroke. Despite receiving specialised training in communication, speech-language pathology students may lack confidence when communicating with People with Aphasia (PWA). This paper reports data from secondary outcome measures from a randomised controlled trial. ObjectiveThe aim of the current study was to examine the effects of communication partner training on the communication skills of speech-language pathology students during conversations with PWA. MethodThirty-eight speech-language pathology students were randomly allocated to trained and untrained groups. The first group received a lecture about communication strategies for communicating with PWA then participated in a conversation with PWA (Trained group), while the second group of students participated in a conversation with the PWA without receiving the lecture (Untrained group). The conversations between the groups were analysed according to the Measure of skill in Supported Conversation (MSC) scales, Measure of Participation in Conversation (MPC) scales, types of strategies used in conversation, and the occurrence and repair of conversation breakdowns. ResultsThe trained group received significantly higher MSC Revealing Competence scores, used significantly more props, and introduced significantly more new ideas into the conversation than the untrained group. The trained group also used more gesture and writing to facilitate the conversation, however, the difference was not significant. There was no significant difference between the groups according to MSC Acknowledging Competence scores, MPC Interaction or Transaction scores, or in the number of interruptions, minor or major conversation breakdowns, or in the success of strategies initiated to repair the conversation breakdowns. ConclusionSpeech-language pathology students may benefit from participation in communication partner training programs.

More Than the Verbal Stimulus Matters: Visual Attention in Language Assessment for People With Aphasia Using Multiple-Choice Image Displays.

Language comprehension in people with aphasia (PWA) is frequently evaluated using multiple-choice displays: PWA are asked to choose the image that best corresponds to the verbal stimulus in a display. When a nontarget image is selected, comprehension failure is assumed. However, stimulus-driven factors unrelated to linguistic comprehension may influence performance. In this study we explore the influence of physical image characteristics of multiple-choice image displays on visual attention allocation by PWA. Eye fixations of 41 PWA were recorded while they viewed 40 multiple-choice image sets presented with and without verbal stimuli. Within each display, 3 images (majority images) were the same and 1 (singleton image) differed in terms of 1 image characteristic. The mean proportion of fixation duration (PFD) allocated across majority images was compared against the PFD allocated to singleton images. PWA allocated significantly greater PFD to the singleton than to the majority images in both nonverbal and verbal conditions. Those with greater severity of comprehension deficits allocated greater PFD to nontarget singleton images in the verbal condition. When using tasks that rely on multiple-choice displays and verbal stimuli, one cannot assume that verbal stimuli will override the effect of visual-stimulus characteristics.

Cross-situational word learning in aphasia

Human learners can resolve referential ambiguity and discover the relationships between words and meanings through a cross-situational learning (CSL) strategy. Some people with aphasia (PWA) can learn word-referent pairings under referential uncertainty supported by online feedback. However, it remains unknown whether PWA can learn new words cross-situationally and if such learning ability is supported by statistical learning (SL) mechanisms. The present study examined whether PWA can learn novel word-referent mappings in a CSL task without feedback. We also studied whether CSL is related to SL in PWA and neurologically healthy individuals. We further examined whether aphasia severity, phonological processing and verbal short-term memory (STM) predict CSL in aphasia, and also whether individual differences in verbal STM modulate CSL in healthy older adults. Sixteen people with chronic aphasia underwent a CSL task that involved exposure to a series of individually ambiguous learning trials and a SL task that taps speech segmentation. Their learning ability was compared to 18 older controls and 39 young adults recruited for task validation. CSL in the aphasia group was below the older controls and young adults and took place at a slower rate. Importantly, we found a strong association between SL and CSL performance in all three groups. CSL was modulated by aphasia severity in the aphasia group, and by verbal STM capacity in the older controls. Our findings indicate that some PWA can preserve the ability to learn new word-referent associations cross-situationally. We suggest that both PWA and neurologically intact individuals may rely on SL mechanisms to achieve CSL and that verbal STM also influences CSL. These findings contribute to the ongoing debate on the cognitive mechanisms underlying this learning ability.

Part of the message comes in gesture: how people with aphasia convey information in different gesture types as compared with information in their speech

ABSTRACTBackground: Studies have shown that the gestures produced by people with aphasia (PWA) can convey information useful for their communication. However, the exact significance of the contribution to message communication via gesture remains unclear. Furthermore, it remains unclear how different gesture types and representation techniques impact message conveyance.Aims: The present study aimed to investigate the contribution of gesture to PWA’s communication. We specifically focussed on the degree to which different gesture types and representation techniques convey information absent in the speech of PWA.Methods & Procedure: We studied the gestures produced by 46 PWA and nine non-brain-damaged participants (NBDP) during semi-structured conversation. For each of the different types of gestures and representation techniques we identified whether these conveyed essential information, that is information that was absent in speech. Rather than looking at information that was either similar to information in speech or additional to information in speech, we focused on the essential gestures only.Outcomes & Results: For PWA, a fifth of their gestures were Essential. Despite individual differences between PWA, the majority produced more Essential gestures than NBDP, who produced limited amounts of Essential gestures. Essential information was mostly conveyed by specific gesture types: Pointing, Emblems and Iconic gesture. Within the group of iconic gestures, not only Handling and Enact but also Object and Shape gestures, were often Essential.Conclusions: Our findings suggest that a great proportion of gestures produced by most PWA convey information essential for understanding their communication. In their communication advice, speech language therapists could draw attention to specific gesture types to make sure that interlocutors pay more attention to these gestures when communicating with PWA.

The influence of sense-contingent argument structure frequencies on ambiguity resolution in aphasia

Verbs with multiple senses can show varying argument structure frequencies, depending on the underlying sense. When acknowledge is used to mean ‘recognise’, it takes a direct object (DO), but when it is used to mean ‘admit’ it prefers a sentence complement (SC). The purpose of this study was to investigate whether people with aphasia (PWA) can exploit such meaning-structure probabilities during the reading of temporarily ambiguous sentences, as demonstrated for neurologically healthy individuals (NHI) in a self-paced reading study (Hare et al., 2003). Eleven people with mild or moderate aphasia and eleven neurologically healthy control participants read sentences while their eyes were tracked. Using adapted materials from the study by Hare et al. target sentences containing an SC structure (e.g. He acknowledged (that) his friends would probably help him a lot) were presented following a context prime that biased either a direct object (DO-bias) or sentence complement (SC-bias) reading of the verbs. Half of the stimuli sentences did not contain that so made the post verbal noun phrase (his friends) structurally ambiguous. Both groups of participants were influenced by structural ambiguity as well as by the context bias, indicating that PWA can, like NHI, use their knowledge of a verb's sense-based argument structure frequency during online sentence reading. However, the individuals with aphasia showed delayed reading patterns and some individual differences in their sensitivity to context and ambiguity cues. These differences compared to the NHI may contribute to difficulties in sentence comprehension in aphasia.

Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study

Purpose: This pilot study aimed to evaluate the effects of an intensive hybrid service delivery model (i.e., combining face-to-face individual, computer and group therapy) on communication and well-being for people with aphasia (PWA) in the hospital setting.Materials and methods: The study explored two different intensities of the hybrid model, 4 h/week (Hybrid-4) and 8 h/week (Hybrid-8) both for 8 weeks. Participants ranging from 1 month to 5 years post-onset were allocated using matched-pair randomisation to receive either Hybrid-4 (n = 5) or Hybrid-8 (n = 4) and assessed using a comprehensive language battery by a blinded assessor, as well as selected activity, participation and well-being measures before, immediately after and 4-week post-treatment.Results: All participants in Hybrid-4 and three out of four participants in Hybrid-8 demonstrated clinically significant improvement to measures of language impairment immediately post-treatment, with the majority also demonstrating maintenance effects 4-week post-treatment. Clinically significant improvements to activity, participation and well-being measures were also observed across participants in both groups.Conclusions: Findings support the potential benefit of employing an intensive hybrid service model and suggest that both 4 and 8 h per week of impairment-based treatment for 8 weeks may result in improvements in communication and well-being for some PWA across different stages of recovery.Implications for rehabilitationThe present findings help bridge the gap between what evidence suggests is effective intensity of rehabilitation for aphasia and what can be practically delivered in real-world hospital settings.Findings support the potential clinical value of employing a hybrid service model (using computer, group and individual therapy) to deliver intensive rehabilitation to people with aphasia in the hospital setting, and suggest that clinically significant improvements to communication and well-being can result when the model is delivered at either 4 or 8 h per week.The current study highlights that people with aphasia in the early stages of aphasia recovery can potentially benefit from intensive impairment-based hybrid models of intervention.

A rational inference approach to group and individual-level sentence comprehension performance in aphasia

The rational inference, or noisy channel, account of language comprehension predicts that comprehenders are sensitive to the probabilities of different interpretations for a given sentence and adapt as these probabilities change (Gibson, Bergen & Piantadosi, 2013). This account provides an important new perspective on aphasic sentence comprehension: aphasia may increase the likelihood of sentence distortion, leading people with aphasia (PWA) to rely more on the prior probability of an interpretation and less on the form or structure of the sentence (Gibson, Sandberg, Fedorenko, Bergen & Kiran, 2015). We report the results of a sentence-picture matching experiment that tested the predictions of the rational inference account and other current models of aphasic sentence comprehension across a variety of sentence structures. Consistent with the rational inference account, PWA showed similar sensitivity to the probability of particular kinds of form distortions as age-matched controls, yet overall their interpretations relied more on prior probability and less on sentence form. As predicted by rational inference, but not by other models of sentence comprehension in aphasia, PWA's interpretations were more faithful to the form for active and passive sentences than for direct object and prepositional object sentences. However contra rational inference, there was no evidence that individual PWA's severity of syntactic or semantic impairment predicted their sensitivity to form versus the prior probability of a sentence, as cued by semantics. These findings confirm and extend previous findings that suggest the rational inference account holds promise for explaining aphasic and neurotypical comprehension, but they also raise new challenges for the account.

The confidence and knowledge of health practitioners when interacting with people with aphasia in a hospital setting

Purpose: The aim of the study was to describe and compare the confidence and knowledge of health professionals (HPs) with and without specialized speech-language training for communicating with people with aphasia (PWA) in a metropolitan hospital setting.Methods: Ninety HPs from multidisciplinary teams completed a customized survey to identify their demographic information, knowledge of aphasia, current use of supported conversation strategies and overall communication confidence when interacting with PWA using a 100 mm visual analogue scale (VAS) to rate open-ended questions. Conventional descriptive statistics were used to examine the demographic information. Descriptive statistics and the Mann–Whitney U test were used to analyse VAS confidence rating data. The responses to the open-ended survey questions were grouped into four previously identified key categories.Results: The HPs consisted of 22 (24.4%) participants who were speech-language pathologists and 68 (75.6%) participants from other disciplines (non-speech-language pathology HPs, non-SLP HPs). The non-SLP HPs reported significantly lower confidence levels (U = 159.0, p < 0.001, two-tailed) and identified fewer strategies for communicating effectively with PWA than the trained speech-language pathologists. The non-SLP HPs identified a median of two strategies identified [interquartile range (IQR) 1–3] in contrast to the speech-language pathologists who identified a median of eight strategies (IQR 7–12).Conclusion: These findings suggest that HPs, particularly those without specialized communication education, are likely to benefit from formal training to enhance their confidence, skills and ability to successfully communicate with PWA in their work environment. This may in turn increase the involvement of PWA in their health care decisions.Implications for RehabilitationInterventions to remediate health professional’s (particularly non-speech-language pathology health professionals) lower levels of confidence and ability to communicate with PWA may ultimately help ensure equal access for PWA.Promote informed collaborative decision-making, and foster patient-centred care within the health care setting.

Rehabilitation Of Stroke Aphasia: Topics Of Research

Background: Stroke may result in aphasia, an acquired language disorder which affects receptive and expressive language. The symptoms are observed in the auditory-verbal processing, oral expression, written expression and written language processing. As spoken language is the strongest tool of human communication, loss of it may cause great destructive consequences in the social and personal life of the affected individual. People with aphasia (PWA) and their carers seek rehabilitation in an effort to remove or reduce the effects. Speech-language pathologists (SLPs) are professional in offering such service. This paper aims at addressing new approaches and current research questions about the factors affecting the therapy.Main points: The issues which aphasia therapy research and reviews have addressed are the ones that are asked frequently in clinical settings and research areas. These include the intensity of treatment, the best post-onset time to start, quality of individualized treatment, efficacy of newly-introduced interventions, and the interventions based on the International Classification of Functioning, Disability and Health (ICF) model with emphasis on activity/participation.Findings: The results of studies have revealed that compact therapy in a short period of time might result in better recovery of aphasia. Studies also indicated that starting treatments very early with intensive programs leads to the best therapy results. Chronic stage is good for some intervention strategies as well; however, the effectiveness of these interventions requires further investigations. Moreover, better treatment results could be attained by tailoring the program to match with individual needs. Manipulation of word frequency, personal relevance, and considering reaction time are among important factors in tailor-made therapies. Besides, the conceptual model of ICF which incorporates impairment (body structure and function), activity and participation in the assessment and treatment of aphasia are being researched currently. This model provides a comprehensive functional communicative lookout of the patient.Conclusion: There is no prescribed intervention for different types of aphasia. Customized therapeutic programs which are tailored to the unique needs of the patients and incorporate primary impairment, functional limitations and social restrictions of the patient are needed. This therapy should be intensive enough and be administered as early as possible.

Effects of word frequency and contextual predictability on sentence reading in aphasia: an eye movement analysis

ABSTRACTBackground: Mild reading difficulties are a pervasive symptom of aphasia. While much research in aphasia has been devoted to the study of single word reading, little is known about the process of (silent) sentence reading. Reading research in the non-brain-damaged population has benefited from the use of eye-tracking methodology, allowing inferences on cognitive processing without participants making an articulatory response. This body of research identified two factors, which strongly influence reading at the sentence level: word frequency and contextual predictability (influence of context).Aims: The main aim of this study was to investigate whether word frequency and contextual predictability influence sentence reading by people with aphasia (PWA), in parallel to that of neurologically healthy individuals (NHI). A second aim was to examine whether readers with aphasia show individual differences in the effects, and whether these are related to their underlying language profile.Methods & Procedures: Seventeen PWA and associated mild reading difficulties and 20 NHI took part in this study. Individuals with aphasia completed a range of language assessments. For the eye-tracking experiment, participants silently read sentences that included target words varying in word frequency and predictability while their eye movements were recorded. Comprehension accuracy, fixation durations, and the probability of first-pass fixations and first-pass regressions were measured.Outcomes & Results: Eye movements by both groups were significantly influenced by word frequency and predictability, but the predictability effect was stronger for the PWA than the neurologically healthy participants. Additionally, effects of word frequency and predictability were independent for the NHI, but the individuals with aphasia showed a more interactive pattern. Correlational analyses revealed (i) a significant relationship between lexical-semantic impairments and the word frequency effect score and (ii) a marginally significant association between the sentence comprehension skills and the predictability effect score.Conclusions: Consistent with compensatory processing theories, these findings indicate that decreased reading efficiency may trigger a more interactive reading strategy that aims to compensate for poorer reading by putting more emphasis on a sentence context, particularly for low-frequency words. For those individuals who have difficulties applying the strategy automatically, using a sentence context could be a beneficial strategy to focus on in reading intervention.

Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia

Investigating the Efficiency of Group Therapy on Improving Conversational Skills in People with Aphasia

A preliminary Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (ANELT)

A preliminary Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (ANELT)

Intensive and modified Action Observation Therapy : Preliminary behavioral results

Intensive and modified Action Observation Therapy : Preliminary behavioral results

Aphasia and literacy-the insider's perspective.

BackgroundFew studies have investigated how people with aphasia (PWA) experience literacy skills. Taking the insider's perspective is a way to increase understanding of the individual experiences of literacy among PWA, which may have clinical implications.AimsTo describe how literacy, i.e., reading and writing, is experienced in everyday life by PWA and to gain insight into the part played by literacy skills in their lives.Methods & ProceduresA qualitative descriptive research approach was taken. In‐depth interviews were conducted with 12 PWA (six women and six men) who had all lived with aphasia for at least 6 months post‐stroke. The interviews were analysed using qualitative content analysis.Outcomes & ResultsOne overarching theme emerged from the data: literacy as an ongoing recovery process. Based on this overarching theme, two subthemes were identified: changes in conditions for literacy (experiences of reading and writing initially post‐onset compared with experiences at the time of the interview); and facing expectations about literacy (participants’ own and other people's expectations of them in terms of literacy).Conclusions & ImplicationsThe findings are important at a general level in that they indicate that PWA are able to articulate their individual experiences and thoughts about literacy, i.e., reading and writing. Specifically, PWA in this study experience literacy as playing an essential part in their lives and the findings imply that personal experiences are important in the design of reading and writing interventions in speech and language therapy.

Coreference Annotation in the Russian Clinical Pear Stories Corpus: Annotation Features and Preliminary Results

This work is devoted to the distribution of different referential devices in spoken discourse produced by healthy speakers and people with aphasia and its comparison to written discourse. We discuss some special annotation issues for the corpus of Pear film retellings (Russian CliPS) by people with aphasia (PWA), right hemisphere damage (RHD), and healthy speakers (HP for healthy people) of Russian. The study summarizes the comprehensive annotation schema developed for this task and the preliminary research of the referential choice features based on the corpus. Comparing retellings and written texts, we found a significant difference in the use of basic coreferential expressions between the two. Firstly, there is a significant difference in the distribution of basic NP types. Speakers use reduced devices such as zero anaphora or bare nouns in retellings more frequently than in written texts. There are also differences in the distribution of more granulated features such as the word order within an NP, the use of anaphoric and reduced expressions (demonstratives or zero NPs) for the first mention of an entity, and the inclusion of epistemic markers into NPs. We also found that the retellings produced by PWA and HP do not differ much in terms of the distribution of basic NP types. However, a detailed analysis within different NP types and taking into consideration various disfluencies reveals some prominent differences between the two populations. These include a difference in zero subject distribution, the frequency of non-referential NP links, the frequency of co-reference errors. While adapting the initial coreference annotation scheme we concluded that besides referential ambiguity, which is normally taken into account in spoken discourse analysis, and basic taxonomy of the referential devices (full NP vs. anaphoric pronoun vs. anaphoric zero), other features need to be considered.

Sensitivity to change and responsiveness of the Stroke and Aphasia Quality-of-Life Scale (SAQOL) in a Singapore stroke population

ABSTRACTBackground: The health-related quality of life (HRQoL) of people with aphasia (PWA) in Singapore is unknown.Aims: To compare outcomes between stroke survivors with and without aphasia in Singapore and examine the sensitivity and responsiveness to change of the Stroke and Aphasia QOL Scale (SAQOL-39g) and its Singapore (Mandarin) variant, SAQOL-CSg.Methods & Procedures: A longitudinal cohort study was conducted with stroke survivors with and without aphasia. Participants underwent a series of questionnaires at 3 and 12 months post-stroke including SAQOL-39g/SAQOL-CSg, Barthel Index, Modified Rankin Scale (MRS), Mini Mental State Examination, Frontal Assessment Battery, Center for Epidemiologic Studies Depression Scale and the EQ-5D. The following data analyses were conducted: comparison of stroke outcomes between participants with and without aphasia, computation of floor and ceiling effects, calculation of effect sizes (ESs) to determine sensitivity to change and estimation of minimally important differences (MIDs) for examining responsiveness.Outcomes & Results: A total of 78 participants (29.5% female, 29.5% PWA, mean age 64.1 years) completed all the assessments on both occasions. At 12 months post-stroke, PWA had higher levels of disability on the MRS (Mann–Whitney U = 294.5, p < 0.01) and reported significantly lower quality of life on the SAQOL-39g/SAQOL-CSg (U = 349, p < 0.01) and the EQ-5D index (U = 447, p < 0.05). In terms of sensitivity to change, the SAQOL-39g/SAQOL- 35CSg showed a small degree of improvement for the entire sample (ES, r = 0.22) but change was only significant for participants without aphasia. MID estimates for improvement were 0.21 on the SAQOL-39g/SAQOL-CSg and 0.17 on the EQ-5D index.Conclusions: PWA reported poorer HRQoL even when physical function was comparable. SAQOL-39g/SAQOL-CSg was found to have adequate sensitivity to change (i.e., reflect at least small change) up to 12 months post-stroke. MID estimates of the SAQOL-39g/SAQOL-CSg may assist in the interpretation of changes in scores in the clinical setting.

Name agreement in aphasia

ABSTRACTBackground: Images are essential materials for assessment and rehabilitation in aphasia. Psycholinguistic research has identified name agreement (the degree to which different people agree on a particular name for a particular image) to be a strong predictor of picture naming in healthy individuals in a wide variety of languages. Despite its significance in naming performance and its impact across linguistic families, studies investigating the effects of name agreement in neuropsychological populations are limited. Determining the impact of name agreement in neuropsychological populations can inform us about lexical processing, which in turn can aid in development of improved assessment and rehabilitation materials.Aims: To compare the naming accuracy and error profile in naming high versus low name agreement (HighNA and LowNA) images in people with aphasia (PWA) and in healthy Adults (HA).Methods & Procedures: Participants were 10 PWA and 21 age- and gender-matched HA. Stimuli were black-and-white line drawings of 50 HighNA images (e.g., acorn, bell) and 50 LowNA images (e.g., jacket, mitten). The image sets were closely matched on a range of image and lexical variables. Participants were instructed to name the drawings using single words. Responses were coded into exclusive categories: correct, hesitations, alternate names, visual errors, semantic errors and omissions.Outcomes and Results: HighNA images were named more accurately than LowNA images; the HA group had higher accuracy than the PWA group; there was a significant interaction in which the name agreement effect was stronger in HA than in PWA. In individual analyses, 7 of 10 PWA participants showed the group pattern of higher accuracies for HighNA, whilst 3 PWA did not. HighNA and LowNA images gave rise to more alternate names in HA than in PWA. There were also fewer visual errors, and more omissions, in PWA than in HA, but only for LowNA items.Conclusions: Name agreement produced measurable differences in naming accuracy for both HA and PWA. PWA shows a reduced effect of name agreement and exhibit a different pattern of errors, compared to healthy controls. We speculate that in picture naming tasks, lower name agreement increases competitive lexical selection, which is difficult for PWA to resolve. In preparation of clinical materials, we need to be mindful of image properties. Future research should replicate our findings in a larger population, and a broader range of pathologies, as well as determine the executive mechanisms underpinning name agreement effects.

People with aphasia using AAC: are executive functions important?

ABSTRACTBackground: Many people with aphasia (PWA) who are introduced to augmentative and alternative communication (AAC) struggle to become effective and independent users of AAC. Aims: In this article, we discuss how impairments of executive functioning (EF) might be expected to interact with ability to use AAC effectively. We also review the research literature that has investigated the relationship between EF and response to AAC treatment in aphasia. Assessment tools that may be useful in predicting successful use of AAC by PWA are also discussed.Main Contribution: Results from the few available studies are mixed with respect to the importance of EF to successful AAC use. At present, there is a paucity of research directly investigating which aspects of EF might be the best predictors for response to treatment to learn AAC, although some researchers have reported that EF tasks designed to measure cognitive flexibility (shifting) appear to have some predictive utility.Conclusions: Using terminology from two published models of EF, we suggest that executive attention, which includes working memory, as well as updating, shifting and inhibiting, are all necessary when using AAC for successful communication. This perspective is one that should receive more attention in clinical practice and when designing research on use of AAC by PWA.

Assessment of Aphasia Across the International Classification of Functioning, Disability and Health Using an iPad-Based Application.

Access2Aphasia™ is an iPad™-based aphasia assessment application that enables real-time audiovisual communication between people with aphasia (PWA) and speech-language pathologists (SLPs), and the use of supported conversation techniques. This study aimed to establish the reliability of aphasia assessment across the International Classification of Functioning, Disability and Health (ICF) using Access2Aphasia, and compare it with face-to-face (FTF) assessment. Consumer perspectives of Access2Aphasia were also examined. Thirty PWA were randomized into two conditions: online-led and FTF assessment. Participants in the online-led group were assessed remotely using Access2Aphasia™ in their own homes, while an FTF SLP scored silently simultaneously. Participants in the FTF group were assessed FTF using standard administration materials. Assessment included two subtests of the Psycholinguistic Assessment of Language Processing Activities (PALPA) and the Assessment of Living with Aphasia (ALA) to allow for outcomes to be captured across the ICF domains. Consumer perspectives on Access2Aphasia were obtained from both PWA and research SLPs in the online-led group. Kappa statistics indicated moderate to almost perfect agreement between online and FTF SLPs (k = 0.71-1.00). Intrarater and interrater reliability was excellent (ICC = 0.99-1.00) and equivalent for the online-led and FTF conditions. Both PWA and research SLPs in the online-led group reported being satisfied with the experience overall, with suggestions provided by research SLPs to improve Access2Aphasia. This study supports the provision of iPad-based aphasia assessments across the ICF in the online environment, with comparable reliability to FTF assessments. Future research is warranted to support the development of iPad-based aphasia assessment and treatment as an alternative mode of service delivery to PWA.