People With Aphasia Research Articles

Perspectives of working-age adults with aphasia regarding social participation.

BackgroundWorking-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa.ObjectivesDescribe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident.MethodSemi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants’ perspectives of social participation.ResultsSeven themes were identified pertaining to participants’ perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate.ConclusionSuccessful social participation was dependent on the PWA’s perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA’s communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.

Mental capacity assessment with people with aphasia: understanding the role of the speech and language therapist

ABSTRACT Background The law is leading a cultural shift away from medical paternalism towards shared decision-making with patients. A person’s ability to make decisions about their care and treatment is regulated through mental capacity law in the UK. A verbal interview is used to judge a person’s capacity. People with aphasia (PwA) may retain the cognitive ability to make decisions but have difficulty understanding information and expressing their wishes. PwA are at risk of having their capacity status misidentified without the support of skilled communication partners such as Speech and Language Therapists (SLTs). Currently, little is known about the SLTs’ role in capacity assessment for PwA in the UK. Aims This research aimed to explore UK SLTs’ experience of mental capacity assessment in PwA, focusing on the principal challenges and facilitators and the role SLTs play in the assessment process and within the multidisciplinary team (MDT). Methods A qualitative approach was taken using semi-structured interviews to explore SLTs’ perspectives. 13 interviews were conducted with SLTs from England and Scotland. Data were analysed thematically. Results Participants reported that facilitators were routine decision types, patients without complex co-morbidities, availability of time, close collaborative teams where the role of the SLT was valued, and trust existed in the relationship with the PwA and their carers. Challenges to the process were infrequent decision types, patients with complex cognitive/communication impairments, lack of time, conflict with carers and the MDT, and lack of access to team support. SLTs inhabited a variety of roles in the process of mental capacity assessment. They were morally motivated to adopt supportive roles but were equivocal towards adopting assessor roles. Across the data set an ambiguous interpretation of terminology, processes and level of specialisation required emerged. Conclusion SLTs’ play a unique role in supporting PwA to exercise their right to autonomy. This study is the first to explore SLTs’ experience of mental capacity assessment across different UK jurisdictions. SLTs’ confidence in their role in capacity assessment is growing although the complexity of the process continues to present challenges. Broader training in legal and conceptual aspects of mental capacity would support a clearer understanding of assessment procedures and facilitate SLTs to promote their role more broadly with their colleagues.

Linguistic analysis in public speaking: evidence from a Gavel Club for people with aphasia

ABSTRACT Public speaking has been described as one of the most daunting tasks one can engage in, even more so for people with aphasia (PWA). Gavel Clubs (affiliated with Toastmasters International) were established over 20 years ago for those who want to engage in public speaking but do not meet the eligibility criteria for Toastmasters membership. This study is the first of its kind to systematically evaluate changes in the speeches of PWA attending a weekly Gavel Club. The aims were to compare Table Topics (TT) and Prepared Speeches (PS) which are two different tasks regularly performed in a Gavel Club; to measure linguistic change over time in the two speech types; and to determine the feasibility of a discourse measure for analysing public speeches. Thirty-six speeches (four each from nine PWA) were audio-recorded, transcribed and analysed using the Linguistic Communication Measure (LCM). The nine participants represented a wide range of aphasia severity. Analysis revealed that engaging in weekly speaking activities in the GC was associated with an improvement in conveying content and in grammaticality through an increase in total number of words and number of correct words produced. The LCM is a comprehensive analysis tool but proved to be challenging in its speed and utility when measuring linguistic change in public speeches of PWA. Regular GC participation appears to facilitate improved language abilities, but we have yet to find the best tool to demonstrate this.

Are People with Aphasia (PWA) Involved in the Creation of Quality of Life and Aphasia Impact-Related Questionnaires? A Scoping Review.

Background: Quality of Life (QoL) questionnaires are used to describe the impact of aphasia on stroke survivors’ life. People with aphasia (PWA) are traditionally excluded from research, potentially leading to a mismatch between the factors chosen in the tools and the realistic needs of PWA. The purpose of this review was to determine the direct involvement of PWA in the creation of QoL and aphasia impact-related questionnaires (AIR-Qs). Methods: A scoping review methodology was conducted by an expert librarian and two independent reviewers on health sciences based on the Preferred Reporting Items for Systematic Reviews and Metanalyses extension for Scoping Reviews (PRISMA-ScR) protocol, through a literature search in five databases: Medline Complete, PubMed, PsychINFO, Scopus, and Google Scholar. Search terms included ‘stroke’, ‘people with aphasia’, ‘communication’, ‘well-being’, and ‘quality of life’. Results: Of 952 results, 20 studies met the eligibility criteria. Of these, only four AIR-Qs studies (20%) were found reporting the direct involvement of PWA, while no QoL tools did so. Evidence showed involvement in the creation phase of AIR-Q, mainly in a consultation role. Conclusions: There is an absence of a framework for conducting and reporting the involvement of PWA in qualitative participatory research studies, which limits effectiveness to promote equitable best practice in aphasia rehabilitation.

Variables and Mechanisms Affecting Response to Language Treatment in Multilingual People with Aphasia.

Background: Despite substantial literature exploring language treatment effects in multilingual people with aphasia (PWA), inconsistent results reported across studies make it difficult to draw firm conclusions. Methods: We highlight and illustrate variables that have been implicated in affecting cross-language treatment effects in multilingual PWA. Main contribution: We argue that opposing effects of activation and inhibition across languages, influenced by pertinent variables, such as age of language acquisition, patterns of language use, and treatment-related factors, contribute to the complex picture that has emerged from current studies of treatment in multilingual PWA. We propose a new integrated model—Treatment Effects in Aphasia in Multilingual people (the TEAM model)—to capture this complexity.

Prevalence of Verb and Sentence Impairment in Aphasia as Demonstrated by Cluster Analysis

ABSTRACT Background: Verb and sentence processing impairments are frequently observed in people with aphasia (PWA). However, patterns of impairment (i.e. combinations of deficits that are revealed by arrays of tasks) are usually investigated at the group level, by selecting groups of patients with specific aphasia types (e.g., non-fluent variants with signs of agrammatism), or in case-series with relatively small samples. Aims: We aimed to explore patterns of impairment in verb and sentence processing in a large (N = 54) group of PWA with various aphasia types, using methods that do not require a priori aphasia-type information. Methods & Procedures: To assess verb and sentence processing impairments in production and comprehension, we used the Verb and Sentence Test (VAST) adapted to Russian (VAST-Ru). As our main method, we used k-means cluster analysis to group individuals based on their scores on different tasks of the VAST-Ru. We then compared cluster allocations to aphasia types (according to Alexander Luria’s classification) established by a standard clinical evaluation procedure. As a follow up, we investigated performance of each person with aphasia on each task by comparing their individual scores to the control group. Outcomes & Results: The k-means analysis grouped the PWA into two clusters. The main difference between the clusters was the severity of impairment across most of the tasks, both at the single verb and at the sentence level, both in production and in comprehension. All participants with efferent motor aphasia (roughly corresponding to Broca’s aphasia) and most of the participants with acoustic-mnestic aphasia (roughly corresponding to anomic aphasia) were in the less-impaired cluster. Complex aphasia types (complex motor and complex temporal aphasia) pertained to the more-impaired cluster, while other aphasia types (dynamic aphasia, corresponding to transcortical motor, and sensory, corresponding to Wernicke’s aphasia) were more or less evenly distributed over two clusters. Individual-level analysis revealed heterogeneous patterns of impairment in both clusters and across different aphasia types. Conclusions: These results demonstrate that verb and sentence impairments are prevalent in aphasia, irrespective of the aphasia type. They also indicate that aphasia severity mediates verb and sentence impairment in aphasia. We could not find a clear correspondence between individual patterns of impairment and aphasia type at this stage. The clinical implications are discussed.

Aphasia and acquired reading impairments: What are the high-tech alternatives to compensate for reading deficits?

People with aphasia (PWA) frequently present impairments in reading comprehension. Such impairments can be particularly debilitating due to the limitations and constraints they impose on everyday life. Recent technological advancements in the field of information and communication technologies offer many compensative tools for PWA. However, most technological tools are designed for patients with speech production impairments. Instruments addressing reading impairments associated with aphasia remain scarce and underrepresented in the scientific literature. To conduct a state-of-the-art review of the technologies currently available to PWA and acquired reading impairments. In particular, this review covers (1) research on technologies explicitly developed to compensate for reading difficulties associated with aphasia; and (2) research into which accessibility features included in mainstream high-tech systems are helpful for PWA when trying to access written material. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) international standard, the authors conducted a systematic review from 2009 to 2019. The databases inspected were Scopus, Web of Science, PubMed, the Cochrane collection, IEEE Xplore, ScienceDirect and SpringerLink. Other research papers were included after checking the references of the selected papers. The review reveals that research on compensative devices for reading impairments largely neglects tools for individuals with aphasia and acquired reading difficulties. Most of the studies in this field are qualitative investigations of how patients with literacy difficulties tackle everyday tasks with the help of mainstream technology (e.g., smartphone applications). Therefore, this paper highlights the scarce high-tech alternatives that support text comprehension in PWA and acquired reading impairments, and suggests further work on the development of customized software for smartphones and personal computers. High-tech reading tools may help PWA to regain reading autonomy. PWA and acquired reading impairments employ a wide array of devices to overcome reading difficulties, which underlines the importance of reading in everyday life. However, the supports currently available are not yet flexible and accurate enough to answer their day-to-day needs. Thus, further work is necessary to enhance the compensative devices available to them. For instance, existing new technologies in the area of natural language processing (such as automatic text simplification) could potentially be used in compensative devices. What this paper adds What is already known on the subject Most research on high-tech compensative reading tools is focused on investigating how patients with aphasia and acquired reading impairments cope with their reading difficulties in everyday life by resorting to different types of technology. Yet, we still lack specific research on compensative reading technology for PWA. What this paper adds to existing knowledge This review shows that PWA with acquired reading impairments are offered limited options for accessing written content easily and autonomously-and those few resources that are available are not specifically designed for PWA. What are the potential or actual clinical implications of this work? Both aphasia and acquired reading impairments can vary in terms of both their severity and the associated typology of cognitive impairments. Therefore, it might be interesting to investigate flexible and highly adaptable reading support designed for them-and innovations in the field of information and communication technology might prove particularly fruitful.

Implicit-statistical learning in aphasia and its relation to lesion location

BackgroundImplicit-statistical learning (ISL) research investigates whether domain-general mechanisms are recruited in the linguistic processes that require manipulation of patterned regularities (e.g. syntax). Aphasia is a language disorder caused by focal brain damage in the left fronto-temporal-parietal network. Research shows that people with aphasia (PWA) with frontal lobe lesions manifest convergent deficits in syntax and ISL mechanisms. So far, ISL mechanisms in PWA with temporal or parietal lobe lesions have not been systematically investigated. AimsWe investigated two complementary hypotheses: 1) the anatomical hypothesis, that PWA with frontal lesions display more severely impaired ISL abilities than PWA with posterior lesions and 2) the behavioural hypothesis, that the magnitude of impairment in ISL mechanisms correlates to syntactic deficits in aphasia. MethodsWe tested 13 PWA, 5 with frontal lesions and 8 with posterior lesions, and 11 non-brain-damaged controls on a visual statistical learning (VSL) task. In addition, all PWA completed several linguistic tasks. Reaction times, obtained in the VSL task, were analyzed using linear mixed-effects model. Correlational statistics were used to assess the relationship between VSL task performance and linguistic measures. Results and DiscussionWe did not find support for the anatomical hypothesis as patients with spared frontal regions also manifested impaired ISL mechanisms. This is attributed to a) ISL mechanisms being vulnerable to other cognitive dysfunctions and/or b) ISL mechanisms anatomically extending to the posterior brain regions. Notably, ISL mechanisms were impaired, but not absent in aphasia. With regards to the behavioural hypothesis, we provide empirical evidence of correlation between ISL mechanisms and syntactic, but not lexical impairment in aphasia. We discuss both the theoretical contributions to the debate of domain-independence of ISL mechanisms and clinical implications for implicit language therapy.

Comparing language samples of Bangla speakers using a colour photograph and a black-and-white line drawing.

A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black-and-white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP). To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black-and-white LD from neurologically healthy native Bangla speakers. A total of 30 participants (mean age = 36.03 years) were recruited based on self-reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black-and-white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM). Of the four measures, only MLU showed a statistically significant difference between the CP and the black-and-white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM. This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples. What this paper adds What is already known on the subject There are studies on neurologically healthy individuals as well as on PWA that identified the impact of using different visuographic variables (colour and photograph) separately, which enhanced the picture comprehension and improved performances on associated language production tasks. To our knowledge, no studies have identified the combined impact of these two visuographic variables on spontaneous language production. Therefore, this initial study on neurologically healthy Bangla adults reports the impact of using a CP as a stimulus item for a PDT task to elicit spontaneous language samples. What this paper adds to existing knowledge This study reports that using a culturally appropriate CP for a PDT enhances the grammatical complexity of spontaneous language production of neurologically healthy adults. To our knowledge, this is the first study in Bangla that used the MLU as a measurement variable to analyse adults' spontaneous language production. What are the potential or actual clinical implications of this work? The development of future aphasia assessments should consider incorporating CPs as stimuli for PDTs, which may guide speech-language pathologists to provide accurate diagnoses for aphasia and related language disorders.

The Impact of Cognition and Communication on Participation for Individuals with Aphasia Poststroke

Abstract Date Presented 03/28/20 This study examines the impact of cognition and communication on participation for people with aphasia (PWA). For participation in communication and cognitive-intensive activities among PWA, a modest amount of variance is accounted for by cognition and communication ability. Cognition is a significant independent predictor of participation in communication and cognitive-intensive activities for PWA. To facilitate community re-integration for PWA, OTs must consider internal and external factors. Primary Author and Speaker: Madelyn Girardi Additional Authors and Speakers: Lisa Tabor Connor Contributing Authors: Marjorie Nicholas

Social Support Mediates the Relationship Between Communication Abilities and Social Participation Post-Stroke Only for People With Aphasia (PWA)

Abstract Date Presented 03/28/20 This study examines relationships among self-perception of social support, communication, and social participation in PWA and people without aphasia (PWOA) poststroke. Results show that social support for PWA mitigates the negative impact of communication deficits on social participation. For PWOA, support facilitates social participation to a lesser degree. This indicates that OT practitioners should consider PWA’s social supports to facilitate reintegration into community living. Primary Author and Speaker: Katrina Fritz Additional Authors and Speakers: Lisa Tabor Connor Contributing Authors: Majorie Nicholas

Do caregivers' personality and emotional intelligence modify their perception of relationship and communication with people with aphasia?

There is a wide agreement that family and friends of people with aphasia (PWA) can play a crucial role in the rehabilitation of interpersonal communication. Therefore, speech and language therapists (SLTs) should include family and friends in the process of therapy. However, little has been said about the role of caregivers of severely disabled PWA in the rehabilitation of communication functions. To examine how caregivers of severely disabled PWA perceive their relationship and communication with PWA, how they facilitate communication with PWA, and whether the caregiver's personality and emotional intelligence modify the abovementioned processes. The study involved 123 caregivers of severely disabled stroke survivors with aphasia. Participants took part in a structured interview based on a structured interview guide created for the purpose of this study. The standardized psychological questionnaires NEO Five-Factor Inventory (NEO-FFI) and Schutte Emotional Intelligence Scale (SEIS) were used. The caregiver's positive attitude towards the PWA correlated with the active facilitation of communication. The personality traits of caregivers and their level of emotional intelligence were associated with the tendency to use certain techniques to facilitate communication with PWA. Caregivers' positive attitude towards PWA is beneficial for the rehabilitation of communicative functions. Personality traits and emotional intelligence could modify the caregiver's strategy of coping with aphasia-related challenges and should be taken into consideration when providing support. What this paper adds What is already known on the subject Interpersonal communication must by definition involve at least two people. Therefore, there are a lot of approaches in SLT where support is given not only to the PWA but also to the communication partners. The most important group is significant others, which is usually understood as family members and friends. There is an increasing recognition that SLTs should include them in therapy. What this paper adds to existing knowledge For those PWA who need constant care, caregivers may have a significant influence on the quality of communication. Their positive attitude towards PWA corresponds with more active facilitation of communication and can make rehabilitation more efficacious. Caregivers should be educated on the cognitive and behavioural aspects of aphasia and encouraged to look actively for a PWA's positive characteristics. Caregivers' personality traits play a role in facilitating communication. For example, caregivers with high agreeableness are more likely to enjoy providing care, while those with higher conscientiousness declare using more techniques to facilitate communication with the PWA. What are the potential or actual clinical implications of this work? Caregivers' personality traits play a role in caring. Their positive attitude towards PWA corresponds to more active facilitation of communication, which can lead to more effective rehabilitation. This should be taken into account when training caregivers. Training programmes should include cognitive and behavioural aspects of aphasia as well as emphasize the need to maximize the PWA's abilities.

Decision Making by People With Aphasia: A Comparison of Linguistic and Nonlinguistic Measures.

Purpose Decision making involves multiple cognitive and linguistic processes. The extent to which these processes are involved depends, in part, on the conditions under which decision making is assessed. Because people with aphasia (PWA) have impaired language abilities and may also present with cognitive deficits, they may have difficulty during decision-making tasks. Yet little research exists on the decision-making abilities of PWA. Thus, the purposes of this study were to investigate the performance of PWA on linguistic and nonlinguistic decision-making measures and to explore the relationship between decision making and cognitive test performance. Method A quasi-experimental design was used to compare the performance of PWA (n = 16) and age- and education-matched control participants (n = 16) on three decision-making tasks: Making a Decision subtest from the Functional Assessment of Verbal Reasoning and Executive Strategies (linguistic decision-making task), Iowa Gambling Task (nonlinguistic decision-making task with ambiguity), and Game of Dice Task (nonlinguistic decision-making task without ambiguity). Participants also completed assessments of language, working memory, and executive functions. Scores on the three decision-making tasks were compared between groups, and cognitive influences on decision-making performance were examined using correlation analyses. Results PWA differed significantly from control participants on linguistic decision making, particularly when required to verbalize their rationale for making their decision. PWA and control participants did not differ significantly on measures of nonlinguistic decision making. Performance on multiple cognitive measures was correlated with performance on the linguistic reasoning task, as well as one of the nonlinguistic tasks (Game of Dice Task). Conclusions Decision-making tasks that are heavily dependent on language, such as those used in capacity assessments, may disadvantage PWA. Assessments of decision-making capacity should include communication supports for people with acquired communication disorders; further investigation in the areas of decision making and aphasia is needed.

Supporting people with post-stroke aphasia to live well: A cross-sectional survey of Speech & Language Therapists in Ireland.

Living well with post-stroke aphasia is supported by responsive, collaborative heath and related services, aphasia information and training for people with aphasia (PWA) and their social networks, and opportunities to contribute and participate autonomously in their communities. Several international surveys indicate shortcomings in the provision of long-term support and, in Ireland, while there is a lack of data around service provision for PWA, there is evidence that post-acute stroke services are fragmented and under-resourced. The aim of this study was to survey Speech & Language Therapists (SLTs), due to their unique role in aphasia management, to understand what SLT and related support services and aphasia information and training are currently available to support living well with aphasia in Ireland. We developed and piloted a self-administered, web-based cross-sectional survey with questions informed by a systematic review and qualitative evidence synthesis around living well with aphasia, and with input from a Public and Patient Involvement aphasia advisory group. Data from 95 SLTs working with PWA were analysed using descriptive statistics. Although SLT was generally available for PWA, the results highlight access barriers and evidence-practice gaps in terms of the amount, intensity and timing of SLT to be maximally effective and there was a lack of PWA input into service design and evaluation. Access to other relevant supports such as mental health services was inconsistent and there was a lack of community support for families. There were shortcomings in access to aphasia information/training for PWA, families, friends and other healthcare professionals. There is a need for a coordinated and standardised approach to supporting PWA across Ireland. This study addresses an evidence gap around the provision of stroke services for PWA and is part of a larger project aiming to produce recommendations for improving person-centred support to facilitate living well with aphasia.

The effects of digital symbol format on the naming, identification, and sentence production incorporating verbs for individuals with aphasia

ABSTRACT Purpose: To investigate the effects of symbol format and verb argument structure on the naming, identification, and sentence generation in people with aphasia (PWA). Methods: A 2 × 2 randomized, mixed factorial design was used. Symbol format was the between-subjects variable with a photograph condition and a video condition. Verb argument structure was the within-subjects variable and included two- and three-argument verbs. Twenty-one participants were recruited and randomly assigned into either the photograph condition (n = 9) or the video condition (n = 12). Independent t-tests determined if any differences between the groups were present with respect to their standard language scores in Western Aphasia Battery-Revised (WAB-R) and the Northwestern Assessment of Verbs and Sentences (NAVS). A MANOVA was conducted to determine the effects of symbol format and argument structure on the three experimental tasks, including verb naming task, identification task, and sentence generation task. Results: No significant differences were found between groups on the WAB-R or the NAVS. A significant multivariate and univariate effect was found for argument structure on all three experimental tasks. Two- argument verbs were easier to name, identify, and use in a sentence when compared to three-argument verbs. While there was no multivariate or univariate effect for symbol format, there was a medium effect size. The participants accurately named more verbs in the video condition when compared to the photograph condition. Conclusion: These findings add support to the Argument Structure Complexity Principle. The effect of symbol format requires further research with respect to sentence generation, but videos may be used to support naming in PWA.

Fluent or nonfluent? Part A. Underlying contributors to categorical classifications of fluency in aphasia

ABSTRACT Background The concept of fluency is widely used to dichotomously classify aphasia syndromes in both research and clinical practice. Despite its ubiquity, reliability of fluency measurement is reduced due to its multi-dimensional nature and the variety of methods used to measure it. Aims The primary aim of the study was to determine what factors contribute to judgements of fluency in aphasia, identifying methodological and linguistic sources of disagreement. Methods & Procedures We compared fluency classifications generated according to fluency scores on the revised Western Aphasia Battery (WAB-R) to clinical impressions of fluency for 254 English-speaking people with aphasia (PwA) from the AphasiaBank database. To determine what contributed to fluency classifications, we examined syndrome diagnoses and measured the predictive strength of 18 spontaneous speech variables extracted from retellings of the Cinderella story. The variables were selected to represent three dimensions predicted to underlie fluency: grammatical competence, lexical retrieval, and the facility of speech production. Outcomes & Results WAB-R fluency classifications agreed with 83% of clinician classifications, although agreement was much greater for fluent than nonfluent classifications. The majority of mismatches were diagnosed with anomic or conduction aphasia by the WAB-R but Broca’s aphasia by clinicians. Modifying the WAB-R scale improved the extent to which WAB-R fluency categories matched clinical impressions. Fluency classifications were predicted by a combination of variables, including aspects of grammaticality, lexical retrieval and speech production. However, fluency classification by WAB-R was largely predicted by severity, whereas the presence or absence of apraxia of speech was the largest predictor of fluency classifications by clinicians. Conclusions Fluency judgements according to WAB-R scoring and those according to clinical impression showed some common influences, but also some differences that contributed to mismatches in fluency categorization. We propose that, rather than using dichotomous fluency categories, which can mask sources of disagreement, fluency should be explicitly identified relative to the underlying deficits (word-finding, grammatical formulation, speech production, or a combination) contributing to each individual PwA’s fluency profile. Identifying what contributes to fluency disruptions is likely to generate more reliable diagnoses and provide more concrete guidance regarding therapy, avenues we are pursuing in ongoing research.

An End-to-End Approach to Automatic Speech Assessment for Cantonese-speaking People with Aphasia

Conventional automatic assessment of pathological speech usually follows two main steps: (1) extraction of pathology-specific features; (2) classification or regression on extracted features. Given the great variety of speech and language disorders, feature design is never a straightforward task, and yet it is most crucial to the performance of assessment. This paper presents an end-to-end approach to automatic speech assessment for Cantonese-speaking People With Aphasia (PWA). The assessment is formulated as a binary classification task to discriminate PWA with high scores of subjective assessment from those with low scores. The 2-layer Gated Recurrent Unit (GRU) and Convolutional Neural Network (CNN) models are applied to realize the end-to-end mapping from basic speech features to the classification outcome. The pathology-specific features used for assessment are learned implicitly by the neural network model. The Class Activation Mapping (CAM) method is utilized to visualize how the learned features contribute to the assessment result. Experimental results show that the end-to-end approach can achieve comparable performance to the conventional two-step approach in the classification task, and the CNN model is able to learn impairment-related features that are similar to the hand-crafted features. The experimental results also indicate that CNN model performs better than 2-layer GRU model in this specific task.

Do caregiver proxy reports and congruence of client-proxy activity participation goals relate to quality of life in people with aphasia?

Achieving activity participation goals is a key factor in quality of life (QOL) for people with aphasia (PWA), but expressing participation goals can be difficult for many of them. Proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, and discrepancies in these goals between PWA and their caregivers may affect QOL, based on the assumption that caregivers' awareness of their loved ones' unique participation goals may be important to increasing PWA activity participation. To examine everyday activities valued by PWA using the Life Interests and Values (LIV) Cards; to measure congruence between PWA and their caregivers on life participation goals; and to measure how congruence of PWA-caregiver participation goals related to QOL. A convenience sample of 25 PWA completed the LIV Card assessment and the Stroke Aphasia Quality of Life Scale-39 to assess participation goals and QOL. Participation goals were also evaluated with respect to age, time post-onset and aphasia severity. A total of 12 caregivers were administered the LIV Cards to calculate agreement between PWA-proxy activity reports and the relationship between agreement and QOL. PWA endorsed wanting to participate more in a wide range of activities, with common interests in walking/running, going to the beach and eating out, among others. PWA-caregiver activity agreement was fair to moderate with point-to-point agreement averaging 70%. However, no relationship between degree of congruence in PWA-proxy pairs and QOL was found. PWA have a variety of activity participation goals that can be integrated into intervention plans. Dependence on proxy respondents should be reduced as much as possible to support self-determination for PWA. What this paper adds What is already known on the subject Achieving activity participation goals is a key factor in QOL for PWA, but communicating about participation goals can be difficult for many of them. Because proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, this study examined how both PWA and their caregivers responded to an aphasia-friendly assessment for determining participation goals, and then compared level of agreement about these goals to QOL. Because activity participation is known to be an important factor in QOL, the reason for investigating how agreement relates to QOL is that caregivers' awareness of their loved ones' unique participation goals likely facilitates increased participation by PWA in their ongoing desired activities. The relationship between PWA-caregiver agreement regarding participation goals and QOL in PWA had not yet been investigated before this study. What this paper adds to existing knowledge This study adds additional as well as confirmatory information to the existing literature about life participation goals of community-dwelling individuals with chronic aphasia. Top activities endorsed by a group of 25 PWA are reported within four activity domains (home and community activities, creative and relaxing activities, physical activities, and social activities). Results indicated that agreement between PWA and their caregiver proxies on PWA's most desired activities was < 50%. However, the level of agreement between caregivers and proxies on participation goals was not significantly related to QOL in this sample. What are the potential or actual clinical implications of this work? PWA have a variety of participation goals that can be integrated into intervention plans to be carried out with clinicians, caregivers and family members. The use of proxy respondents when determining participation goals should be reduced as much as possible to support self-determination for PWA. Use of the LIV Cards, a picture-based sorting-task assessment, reduces the need for proxy responders and guesswork about the specific participation goals of PWA.

How Responsiveness From a Communication Partner Affects Story Retell in Aphasia: Quantitative and Qualitative Findings.

Purpose Because people with aphasia (PWA) frequently interact with partners who are unresponsive to their communicative attempts, we investigated how partner responsiveness affects quantitative measures of spoken language and subjective reactions during story retell. Method A quantitative study and a qualitative study were conducted. In Study 1, participants with aphasia and controls retold short stories to a communication partner who indicated interest through supportive backchannel responses (responsive) and another who indicated disinterest through unsupportive backchannel responses (unresponsive). Story retell accuracy, delivery speed, and ratings of psychological stress were measured and compared. In Study 2, participants completed semistructured interviews about their story retell experience, which were recorded, transcribed, and coded using qualitative analysis software. Results Quantitative results revealed increased psychological stress and decreased delivery speed across all participant groups during the unresponsive partner condition. Effects on delivery speed were more consistent for controls than participants with aphasia. Qualitative results revealed that participants with aphasia were more attuned to unresponsive partner behaviors than controls and reported stronger and more frequent emotional reactions. Partner responsiveness also affected how PWA perceived and coped with the communication experience. Conclusions Combined quantitative and qualitative findings suggest that, while unresponsive communication partners may not have robust effects on spoken language, they elicit strong emotional reactions from PWA and affect their communication experience. These findings support the need for communication partner training and suggest that training PWA on emotion regulation or relaxation techniques may help assuage their anxiety during socially challenging everyday communication and increase social participation. Supplemental Material https://doi.org/10.23641/asha.11368028.

Exploring the outcomes and perceptions of people with aphasia who conversed with speech pathology students via telepractice: a pilot study

ABSTRACT Research has found that people with aphasia (PWA) may experience psychosocial benefits from participating in communication partner training (CPT). It is unknown whether similar benefits are found if components of the CPT are delivered via telepractice. This pilot study aimed to explore PWAs’ perceptions of: (a) their communication confidence and self-esteem after communicating with speech-language pathology (SLP) students via telepractice as part of a CPT programme; (b) whether it is important for SLP students to converse with PWA; and (c) the suitability of using telepractice to facilitate these conversations. Five adults with aphasia participated. A single group, pre-test post-test design was utilised. Standardised measures were used to capture changes in the participants’ self-reported communication confidence and self-esteem. A verbal questionnaire was used to obtain participants’ perceptions of the programme. Post-CPT, a significant decrease occurred on one confidence item. Non-significant improvement was noted on other items. All five participants believed it was important for SLP students to converse with PWA. Content analysis of the participants’ responses revealed two categories: (a) aphasia being a chronic communication difficulty and (b) conversing with PWA can be scary and different from conversing with adults without aphasia. Four out of five participants thought that telepractice was suitable for conversing with students. Results suggest that PWA may experience psychosocial benefits from conversing with students via telepractice. Confirmation of these findings from a larger scale study would have implications not only for PWA, but also for SLPs providing clinical services to PWA and for educators of SLP students.