Persons With Aphasia Research Articles

Quality of Communication Life in People with Aphasia: Implications for Intervention.

Background and Aims:The main goals were to determine the effectiveness of two commonly used communication-related Quality of Life (QoCL) measures, and the impact of aphasia-related factors on quality of life (QoL) and QoCL in persons with aphasia (PWAs).Method:Twenty-one PWAs ranging from 47 to 91 years of age with post-onset periods of 2 months to 14 years were tested using standardized and criterion-measure tools to assess their language and cognitive functions, QoL, and QoCL. Additionally, participants completed a demographics questionnaire, which also included information on their stroke and the kinds of therapies they had received. Assessments were conducted over two sessions with randomized order of test administrations to control fatigue and order effects.Results and Discussions:Correlation-matrix was used to determine the strength of relations between test measures. The impact of QoL related factors (viz., aphasia severity, cognitive functioning, time post-onset, and therapy received) on QoCL was examined using ANOVAs. The ASHA Quality of Communication Life Scale (ASHA-QCL) had more significant correlations with other QoL measures than the ASHA-Functional Assessment of Communication Skills (ASHA-FACS). Aphasia severity, cognitive deficits, and therapy received contributed significantly to QoL and QoCL in PWAs.Conclusions:Evaluating overall QoL may not fully reveal the QoCL in PWAs. Measuring QoCL specifically is crucial in aphasia interventions, and it is equally important to use sensitive tools that can capture the QoCL effectively. ASHA-QCL was more effective than ASHA-FACS in capturing the QoCL. QoCL must be considered even when working with PWAs with severe aphasias and/or mild cognitive deficits.

Effect of Distance between Marker Agreement Dependencies on Sentence Comprehension in Persons with Aphasia.

Background:Rules and regularities are embedded in all the language structures. Extracting these helps in speech-language acquisition and processing. Sentence processing relies on transitional probability of the dependencies and its distance which are present within the sentence.Aim:To investigate the effect of distance between marker agreement dependencies on sentence comprehension in Persons with Aphasia (PWA) and Neuro- Typical Individuals (NTI).Methods:Ten PWA and Ten NTI were recruited for the study. Participants whose native language was Kannada (a South Indian Language) and received formal education of minimum 10th grade were selected.Materials:A total of 60 Kannada sentences were used and grouped into three categories i.e., short sentence (had short distance between dependencies) (SSD); Longer sentences (had long distance between dependencies) (LLD) and longer sentences (had short distance between dependencies) (LSD). The agreement markers in the sentence were manipulated w.r.t distance among them and grouped it as adjacent (short distance) and non-adjacent (long distance) type of sentences.Procedure:The participants were instructed to read the sentence and judge whether it is grammatically correct or not by pressing the key corresponding to 'yes' or 'no' on the keyboard. In addition, modified N-back task was administered.Results and Discussion:Accuracy and reaction time measures were derived for each sentence types. NTI showed better performance than PWA in sentence judgment task. Both the groups, performed poorly on LSD type of sentence when compared to other sentence types. LSD type was more complex due to the syntactic demands placed by the antecedent preposition, pronoun and adverb placed nearer to the verb and also longer distance between subject agreement to the verb.

Conversational Therapy through Semi-Immersive Virtual Reality Environments for Language Recovery and Psychological Well-Being in Post Stroke Aphasia

Aphasia is a highly disabling acquired language disorder generally caused by a left-lateralized brain damage. Even if traditional therapies have been shown to induce an adequate clinical improvement, a large percentage of patients are left with some degree of language impairments. Therefore, new approaches to common speech therapies are urgently needed in order to maximize the recovery from aphasia. The recent application of virtual reality (VR) to aphasia rehabilitation has already evidenced its usefulness in promoting a more pragmatically oriented treatment than conventional therapies (CT). In the present study, thirty-six chronic persons with aphasia (PWA) were randomly assigned to two groups. The VR group underwent conversational therapy during VR everyday life setting observation, while the control group was trained in a conventional setting without VR support. All patients were extensively tested through a neuropsychological battery which included not only measures for language skills and communication efficacy but also self-esteem and quality of life questionnairies. All patients were trained through a conversational approach by a speech therapist twice a week for six months (total 48 sessions). After the treatment, no significant differences among groups were found in the different measures. However, the amount of improvement in the different areas was distributed over far more cognitive and psychological aspects in the VR group than in the control group. Indeed, the within-group comparisons showed a significant enhancement in different language tasks (i.e., oral comprehension, repetition, and written language) only in the VR group. Significant gains, after the treatment, were also found, in the VR group, in different psychological dimensions (i.e., self-esteem and emotional and mood state). Given the importance of these aspects for aphasia recovery, we believe that our results add to previous evidence which points to the ecological validity and feasibility of VR treatment for language recovery and psychosocial well-being.

Assessment of alerting, orienting, and executive control in persons with aphasia using the Attention Network Test

ABSTRACT Background Attention deficits frequently accompany language impairments in aphasia. Most research on attention in aphasia focuses on selective attention measured by executive control tasks such as the color-word Stroop or Erickson flanker. This is despite ample evidence in neurotypical adults indicating the existence of multiple, distinct attention subtypes. Thus, there is a disconnect between the documented attention impairments in persons with aphasia (PWA) and the literature in neurotypical adults indicating that multiple attention components independently modulate an individual’s interactions with the world. Aims This study aimed to use the well-studied Attention Network Test (ANT) to quantify three subtypes of attention (alerting, orienting, and executive control) in PWA and matched controls. It was hypothesized that significant effects of alerting, orienting, and executive control would be observed in both groups; however, the effects would be reduced in PWA compared to the neurotypical controls. It was additionally expected that alerting, orienting, and executive control would not be correlated with one another in either group. Methods & Procedures Twenty-two PWA along with 20 age, gender, and education-matched controls completed the ANT. Briefly, the ANT consists of a cued-flanker task where the cues provide information about when and where the flanker executive control task will be presented. The combination of cues and flanker targets embedded within the ANT provides measures of alerting, orienting, and executive control. Participants are expected to respond faster and more accurately to the flanker task when cued as to when and where the task will be presented. Outcomes & Results In line with previous work, the control group demonstrated significant effects of alerting, orienting, and executive control. However, we only find significant orienting and executive control effects in the aphasia group. Between-group differences were only identified within orienting attention: the control group benefitted more from the orienting cue than the aphasia group. Additionally, alerting, orienting, and executive control were not correlated in the control group, yet, a relationship between orienting and executive control was observed in the aphasia group. Conclusions Overall, our findings demonstrate that attention differs between PWA and controls, and that the ANT may provide a more complete picture of attention in aphasia; this may be particularly important when characterizing the relationship between attention and language in aphasia.

How fluent? Part B. Underlying contributors to continuous measures of fluency in aphasia

ABSTRACT Background While persons with aphasia (PwA) are often dichotomised as fluent or nonfluent, agreement that fluency is not an all-or-nothing construct has led to the use of continuous variables as a way to quantify fluency, such as multi-dimensional rating scales, speech rate, and utterance length. Though these measures are often used in research, they provide little information about the underlying fluency deficit. Aim The aim of the study was to identify how well commonly used continuous measures of fluency capture variability in spontaneous speech variables at lexical, grammatical, and speech production levels. Methods & Procedures Speech samples of 254 English-speaking PwA from the AphasiaBank database were analyzed to examine the distributions of four continuous measures of fluency: the WAB-R fluency scale, utterance length, retracing, and speech rate. Linear regression was used to identify spontaneous speech predictors contributing to each fluency outcome measure. Outcomes & Results All the outcome measures reflected the influence of multiple underlying dimensions, although the predictors varied. The WAB-R fluency scale, speech rate, and retracing were influenced by measures of grammatical competence, lexical retrieval, and speech production, whereas utterance length was influenced only by measures of grammatical competence and lexical retrieval. The strongest predictor of WAB-R fluency was aphasia severity, whereas the strongest predictor for all other fluency proxy measures was grammatical complexity. Conclusions Continuous measures allow a variety of ways to objectively quantify speech fluency; however, they reflect superficial manifestations of fluency that may be affected by multiple underlying deficits. Furthermore, the deficits underlying different measures vary, which may reduce the reliability of fluency diagnoses. Capturing these differences at the individual level is critical to accurate diagnosis and appropriately targeted therapy.

Written text production and its relationship to writing processes and spelling ability in persons with post-stroke aphasia

ABSTRACT Background: Writing ability is of increasing importance in our computerised societies, yet research into functional text writing in persons with aphasia (PWA) remains scarce. Knowledge is limited of how different aspects of the writing process interact during writing. Spelling ability has commonly been investigated using dictation tests, but it is not known to what extent those results relate to spelling or editing in text writing. Aims: To compare text writing in the production of narrative texts in persons with and without aphasia and to interrelate measures from the narrative output. Furthermore, to investigate how performance in dictation tasks related to spelling and editing in text. Methods & Procedures: Fifteen participants with mild to moderate aphasia and 26 participants without aphasia in a reference group wrote two types of narratives in a keystroke-logging program and were tested with dictation tests. Writing process measures and characteristics from the texts were compared between groups. Writing process measures were interrelated for both groups. Spelling test results were correlated to spelling and editing in text for the group with aphasia. Outcomes & Results: Significant differences between the two groups were found on all writing process measures; the PWA typed more slowly in the copytask, produced fewer words per minute and deleted a larger proportion of their texts while editing in two narrative tasks. There were also significant differences in text length and the amount of spelling errors in the picture-elicited narrative – but not in the free narrative. There were significant correlations between productivity and editing in both narrative tasks for the group with aphasia, but no such relation was found for the reference group, showing that for the PWA their productivity in text writing aligned with the amount of editing undertaken. A strong correlation between scores on the real-word dictation task and the amount of spelling errors in a picture-elicited text was found, but no correlation was found between scores on the real-word dictation task and spelling errors in the free narrative. Conclusion: All aspects of productivity in text writing were affected in this group of participants with mild to moderate aphasia. There was a relation between editing and production rate for the persons with aphasia, but not for the reference group. Scores on real-word spelling tests cannot predict spelling in free texts for PWA. Editing of writing is time-consuming and problematic for PWA and is worthy of specific focus within assessment and therapy for writing difficulty.

Effect of semantic cueing for verbs and its thematic role approach on priming of verbs and its thematic roles in persons with aphasia

Introduction: SCVTr stands for: semantic cueing for verbs and its thematic role. (SCVTr) is a therapy approach that aims to improve word retrieval in persons with aphasia (PWAs). It uses verbs and thematic roles (agent and patient) to facilitate word retrieval in PWA. Aim: The present study was conducted to analyze the effect of priming of verbs and their thematic roles in PWA. Methods: A total of five PWAs were recruited for the study, and the participants in the study initially received SCVTr therapy (Phase 1). Further, the study comprised two experiments (phase 2). In experiment 1, verb (prime) and agent (target) were presented. In experiment 2, verb (prime) and patient (target) were presented using PsychoPy software. These experiments were presented to glean reaction time and accuracy scores, during pre- and posttherapy measures, across the trained related, untrained related, and untrained unrelated conditions. Results: Researchers discerned improved reaction time and increased accuracy scores at posttherapy compare pretherapy conditions in four PWAs. In addition, researchers noted no difference in reaction time and accuracy scores across all the participants between experiment 1 versus experiment 2. Conclusions: This study throws light on the importance of thematic role during sentence processing and its relationship with verbs. Thus, this, in turn, might aid PWAs to retrieve the words with ease.

Conversational Therapy in Aphasia: From Behavioral Intervention to Neuromodulation.

This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to set up a condition of communicative exchange with the PWA using his/her own available communicative resources. Indeed, although language represents the most powerful behavior that humans use for communicating, within the conversational approach any intentional action (i.e., gestures, body movements, facial expression, drawing) can be used to communicate. For this reason, its application is particularly suitable for severe PWAs whose damage has compromised all the modalities of language (i.e., production, comprehension, reading, and writing). In this perspective, the speech-language pathologist's (SLP's) goal is not necessarily focused on restoring the damaged linguistic functions, still today pursued by the cognitive approach, but to ameliorate the use of language by teaching the PWA compensatory, productive strategies, and strengthening his/her residual communicative abilities. In this review, the fundamental principles of the conversational approach together with its modalities of treatment, which emphasize the importance of an active interaction between the SLP and the PWA, are reported. A brief summary of recent experimental evidence which combines conversational therapy with a noninvasive brain stimulation technique, transcranial direct current stimulation, is also included.

Book talk and aphasia: the power of a book.

Reading is most often affected in aphasia and this has an impact on most aspects of everyday life. Being able to read makes a significant difference to how well a person can participate in society. In this study, people with aphasia recount their experiences of being in a book club. This small scale, exploratory study employs a qualitative approach to investigate how persons with aphasia (PWA) and a librarian experience participating in a book club. The aim was to explore their overall experiences of participation, including their views regarding the design of the book club. The research questions were: How did participants experience participating in a book club? How did participants experience the structure and the content of the book club? Three men and one woman with aphasia took part in a book club, which was led by a librarian and met once a week for 9 weeks. The group read a book that had been adapted to suit adults who are not very skilled readers or who have a poor knowledge of the Swedish language; it was also available in an audio version. Data were collected through observations, interviews and field notes, and were analysed thematically to find patterns across data and across participants. The analysis showed that, despite their language difficulties, the participants experienced the book club as highly rewarding, possibly because the focus was on the content of the book and not on each individual's reading ability. The overarching theme identified in the data was 'Empowerment through a joint reading experience'. This encompassed three sub-themes: 'Structure and flexibility', 'Enjoyment of reading' and 'Fruitful discussions'. The PWA experienced the activity as positive and encouraging despite their language difficulties. What yielded the positive experience were the joint literary discussions. The project also showed that a dedicated group leader (here the librarian) and a flexible structure based on the situation and abilities of each individual were crucial for the encouraging findings.

Concurrent Validity and Reliability of the Core Lexicon Measure as a Measure of Word Retrieval Ability in Aphasia Narratives

Purpose General agreement exists in the literature that clinicians struggle with quantifying discourse-level performance in clinical settings. Core lexicon analysis has gained recent attention as an alternative tool that may address difficulties that clinicians face. Although previous studies have demonstrated that core lexicon measures are an efficient means of assessing discourse in persons with aphasia (PWAs), the psychometric properties of core lexicon measures have yet to be investigated. The purpose of this study was (a) to examine the concurrent validity by using microlinguistic and macrolinguistic measures and (b) to demonstrate interrater reliability without transcription by raters with minimal training. Method Eleven language samples collected from PWAs were used in this study. Concurrent validity was assessed by correlating performance on the core lexicon measure with microlinguistic and macrolinguistic measures. For interrater reliability, 4 raters used the core lexicon checklists to score audio-recorded discourse samples from 10 PWAs. Results The core lexicon measures significantly correlated with microlinguistic and macrolinguistic measures. Acceptable interrater reliability was obtained among the 4 raters. Conclusions Core lexicon analysis is potentially useful for measuring word retrieval impairments at the discourse level. It may also be a feasible solution because it reduces the amount of preparatory work for discourse assessment.

PARTicipate: Art as Self-Expression for Persons with Aphasia

Background
 Aphasia is an acquired communication disorder resulting from a stroke or traumatic brain injury. Persons with Aphasia (PWA) have deficits in language comprehension and expression. Loss of communicative functions can be isolating for PWA as they may face barriers to accessing community-based leisure programs. Aphasia-friendly materials, visuals and simple written or oral instructions, can reduce such barriers and support communicative access.
 Objective 
 The pARTicipate project is a student-initiated art group that was piloted with the aim of encouraging PWA to trial an art class in a communicatively accessible and low-risk environment, as part of an outpatient rehabilitation program. By using a life participation approach for aphasia, this project aimed to promote participants’ discovery, or rediscovery, of a hobby. 
 Methods
 Four PWA completed six art projects over 9 weeks. Communicative access was enhanced by using aphasia-friendly instructions and demonstrations to teach the projects. Participants showcased their projects and taught their skills to family and community members on the final “Share Day”. 
 Results
 Qualitative and quantitative data was gathered from satisfaction surveys. One hundred percent of the participants indicated that they enjoyed sharing their art with the community, and that they would join the group again if it was offered. Additionally, all participants indicated they would be likely to continue exploring art in the future. 
 Conclusions
 It is expected that the skills learned by PWAs in pARTicipate may help increase their confidence about participating in other community-based art classes. As well, continuing to use these skills may help participants develop a sense of belonging to the artistic community. By learning to incorporate personal symbols, PWA can be deliberate in their use of art for self-expression in the future. Finally, PWA were empowered to assume a leadership role during “Share Day”. Having the opportunity to teach newly acquired artistic skills to their family and community members promoted positive feelings about the self and served to reveal their cometencies. 

Increased Functional Connectivity Within Intrinsic Neural Networks in Chronic Stroke Following Treatment with Red/Near-Infrared Transcranial Photobiomodulation: Case Series with Improved Naming in Aphasia.

Objective: To examine effects of four different transcranial, red/near-infrared (NIR), light-emitting diode (tLED) protocols on naming ability in persons with aphasia (PWA) due to left hemisphere (LH) stroke. This is the first study to report beneficial effects from tLED therapy in chronic stroke, and parallel changes on functional magnetic resonance imaging (fMRI). Materials and methods: Six PWA, 2-18 years poststroke, in whom 18 tLED treatments were applied (3 × /week, 6 weeks) using LED cluster heads: 500 mW, red (633 nm) and NIR (870 nm), 22.48 cm2, 22.2 mW/cm2. Results: After Protocol A with bilateral LED placements, including midline, at scalp vertex over left and right supplementary motor areas (L and R SMAs), picture naming was not improved. P1 underwent pre-/postovert, picture-naming task-fMRI scans; P2 could not. After Protocol A, P1 showed increased activation in LH and right hemisphere, including L and R SMAs. After Protocol B with LEDs only on ipsilesional, LH side, naming ability significantly improved for P1 and P2; the fMRI scans for P1 then showed activation only on the ipsilesional LH side. After Protocol C with LED placements on ipsilesional LH side, plus one midline placement over mesial prefrontal cortex (mPFC) at front hairline, a cortical node of the default mode network (DMN), P3 and P4 had only moderate/poor response, and no increase in functional connectivity on resting-state functional-connectivity MRI. After Protocol D, however, with LED placements on ipsilesional LH side, plus over two midline nodes of DMN, mPFC, and precuneus (high parietal) simultaneously, P5 and P6 each had good response with significant increase in functional connectivity within DMN, p < 0.0005; salience network, p < 0.0005; and central executive network, p < 0.05. Conclusions: NIR photons can affect surface brain cortex areas subjacent to where LEDs are applied on the scalp. Improved naming ability was present with optimal Protocol D. Transcranial photobiomodulation may be an additional noninvasive therapy for stroke.

Persian Verb and Sentence Production Protocol (PVSP) and its efficacy on Persian-speaking agrammatic non-fluent persons with aphasia

ABSTRACT Background: The semantic/syntactic representation of the verb is directly correspondent with the information required for generating well-constructed messages. Although various verb and sentence impairment therapies for persons with aphasia (PWA) are presented, there has been no published study of Persian verb treatment protocol for linguistic and cross-linguistic purposes. Aims: This study was aimed at introducing a verb treatment protocol founded upon the Persian syntax, teaching to link the key thematic information of verbs, and targeting treatment at the word and sentence level. Methods & Procedures: A single-subject study with multiple baselines design across participants was conducted. The efficacy of Persian Verb and Sentence Production Protocol (PVSP) on three agrammatic non-fluent patients was examined. Verb production skills at the word and sentence level were examined. The Mean Sentence Length (MSL) and sentence production across different tasks were measured at baseline and daily treatment probes. Outcome and Results: Three participants notably improved in verb percent production at the word level in experimental items (from 3.3% to 88% for participant 1, from 1.17% to 27.6% for participant 2 and from 3.75% to 58.6% for participant 3). Generalisation to control items were observed (from 10% to 81.2% for participant 1, from 24.9% to 52.98% for participant 2, from 19.7% to 60.89% for participant 3). All participants also enhanced in verb percent production at the sentence level in experimental items (from 13.3% to 67% for participant 1, from 16.6% to 40% for participant 2, and from 5.7% to 55% for participant 3). Generalisation to control items was noted (from 20% to 57% for participant 1, from 23.3% to 43.5% for participant 2, from 5% to 61% for participant 3). The results of the maintenance and follow-up phases were subsequently remarkable. Pre-post measures of MSL in connected speech (free speech) were improved outstandingly (from 1 to 4.3 for participant 1, from 3.5 to 8 for participant 2, from 0 to 5.2 for participant 3). Conclusions : PVSP seems to be beneficial to various degrees for Persian-speaking agrammatic non-fluent patients, enhancing their verb retrieval and sentence making skills.

Effect of lexical accessibility on syntactic production in aphasia: an eyetracking study

ABSTRACTBackground & Aims: Healthy speakers use both word-level and structure-level information to ease sentence production processes. Structural priming facilitates message-structure mapping in aphasia. However, it remains unclear if and how word-level information affects off-line and on-line sentence production in persons with aphasia (PWA). This eyetracking-while-speaking study examined the effect of lexical priming on production of syntactic (active/passive) structures in PWA.Methods: Eleven PWA and twenty healthy older adults (HOA) described transitive actions (woman pulling horse) following lexical priming, wherein the relative ease of lexical retrieval for the Agent or Theme was manipulated via an auditory probe (what is happening with the woman/horse?). It was examined whether or not PWA produce the sentence structure that allows earlier production of the primed word (e.g., passives when Theme was primed). Participants’ eye fixation times to each character (Agent, Theme) were also monitored to examine if PWA show priming-induced preferential looks to one character from the earliest stage of production, consistent with word-driven planning.Results: HOA showed increased production of passives over actives in the Theme vs. Agent prime condition. In eye fixation data, HOA showed priming-induced Theme advantage from the earliest time window (picture onset-400 milliseconds). PWA also showed a significant priming effect in off-line sentence production, with this priming effect being greater for the individuals whose syntactic processing is better preserved. In eye fixation data, however, PWA showed preferential fixations to the primed character at a later stage of sentence planning (400–800 milliseconds), following equal fixation time to Agent and Theme during the earliest time window.Conclusion: HOA showed word-driven production in both off-line and real-time (eye fixations) production. Lexical accessibility effectively drove off-line syntactic production in PWA, especially for those whose syntactic capacity remains relatively preserved. However, PWA showed advanced processing of both characters in earliest eye fixation data, suggesting that successful word-driven off-line syntactic production was associated with atypical real-time sentence planning in aphasia.

"By the Way"… How People With Aphasia and Their Communication Partners Initiate New Topics of Conversation.

Purpose The ability to initiate new topics of conversation is a basic skill integral to communicative independence and agency that is susceptible to breakdown in aphasia (Barnes, Candlin, & Ferguson, 2013), yet this discourse skill has received little research attention. Healthy adults (HAs) follow 3 established patterns of structural organization to cue the conversation partner when an utterance is intended to initiate a new topic (Schegloff & Sacks, 1973; Svennevig, 1999). In addition, speakers have the option to use these mechanisms of topic initiation (TI) individually or in conjunction with one another. Occasionally, speakers do not follow these conversational macrostructure expectations, in which case TI occurs abruptly, referred to as a noncoherent TI (NC-TI; Mentis & Prutting, 1991). Understanding how TI is disrupted by aphasia requires foundational knowledge regarding the relative use/combined use of TI mechanisms and NC-TI in HAs and persons with aphasia (PWAs). The purpose of this study is to investigate how PWAs and their conversation partners initiate new topics of conversation and to determine the relationship between the number of TI methods used and communicative success (CS) in persons with mild aphasia (PWA-Mild) and persons with moderate and severe aphasia (PWA-Mod/Sev). Method Six PWA-Mild and 4 PWA-Mod/Sev engaged in 15-min unstructured conversations with different HA partners. Utterances were coded for types of TI used by both partners and were evaluated for CS using a 4-point scale (Leaman & Edmonds, 2019) for PWAs. Results/Implications PWAs used NC-TI with a much greater frequency than HAs who never used NC-TI. The rate of NC-TI was associated with increased severity of aphasia. HAs and PWA-Mild used cohesion most often as the method for TI, while PWA-Mod/Sev used it least often. CS was moderately positively correlated with the number of methods of TI used in PWA-Mod/Sev. However, no such correlation existed for PWA-Mild; this group achieved a high degree of CS on TI utterances, independent of the number of methods of TI used. Findings include the clinical implication suggesting PWA-Mod/Sev may benefit from simultaneous use of TI mechanisms to achieve better CS during conversation. Supplemental Material https://doi.org/10.23641/asha.9765164.

Gender differences in aphasia outcomes: evidence from the AphasiaBank.

Stroke is one of the leading causes of death in the United States. Aphasia is a language impairment which results as a consequence of stroke. Gender differences are reported in underlying mechanisms of stroke, however, gender differences in aphasia type and severity remain unclear. To examine gender differences in aphasia impairment based on data from AphasiaBank, a research repository of data obtained from studies of aphasia. The data were collected from AphasiaBank for 294 persons with aphasia (PWA) (172 men, 122 women). Baseline comparisons by gender groups were completed using independent samples t-tests and Pearson Chi square statistics. Univariate comparisons of the total Western Aphasia Battery-Revised (WAB-R) -AQ and -R subtests' scores were compared between the two groups using independent samples t-tests. Multivariate comparisons were completed by using multivariate analysis of variance (MANOVA). Gender differences were observed in the severity of aphasia with men exhibiting more severe aphasia than women. Analyses of WAB-R indicated greater impairment among men based on AQ and greater impairment was observed in individual subtest performance. Men exhibited statistically significantly lower WAB-R AQs than women (67.4 versus 75.6). Lower WAB-R AQs were derived from lower scores among men on individual subtests; information content, fluency, repetition, sentence completion, responsive speech and tests of comprehension (yes/no, auditory word recognition and sequential commands). This study offers evidence of gender differences in aphasia severity, global communication impairment and lower scores on individual subtests used to derive the WAB-R AQ. The limitations of the study with suggestions for future directions are presented.

The evidence for working memory training transfer effects on sentence comprehension and functional communication in persons with aphasia is inconclusive1

Q The primary aim of this study was to identify maintenance and generalization patterns in cognitive and language domains in persons with aphasia (PWA) following working memory (WM) training. The f...

Effects of executive attention on sentence processing in aphasia

ABSTRACT Background In the recent years there has been increasing interest in the effects of attentional control on syntactic comprehension, as measured in garden path sentence resolution. Persons with aphasia (PWA) experience greater penalties in garden path sentences compared to language-unimpaired adults but the origin of this deficit remains a controversial issue. One of the possible deficits has been claimed to be disambiguation of lexical cues in the sentence. However, in languages such as English with little morphological variation this connection is hard to establish. To test this hypothesis we used garden path sentences in a morphologically rich language, Greek, where morphological cues may resolve garden path at the lexical level. We further tested whether domain-general attentional control abilities and in particular shifts in attentional control predict garden path resolution in PWA and age- and education-matched controls. Aims This study aimed to determine whether PWA were able to integrate disambiguating morphological (Case) cues while processing garden path sentences. In addition, we tested whether domain-general attentional control and in particular attentional shift from global to local and local to global information (as defined by) correlates directly with garden path resolution in PWA and healthy controls. Methods & Procedures Fifteen participants with non-fluent/agrammatic aphasia along with fifteen age- and education-matched language-unimpaired adults performed an online self-paced reading and grammaticality judgment task that included object/subject ambiguous sentences. Syntactic ambiguity was created by the optional transitivity of verbs, while the garden path effect was resolved by morphological Case. The individuals’ executive attention skills were tested through an online non-verbal global-local attention shifting task that measured costs stemming from shifting attention from the global to the local level, and vice versa. Outcomes & Results PWA were slower and more erroneous than controls in integrating Case cues to disambiguate garden path sentences as manifested in the self-paced reading and grammaticality judgment task. In the global local task, PWA exhibited greater global-to-local (vs. local-to-global) attention shifting costs, while controls did not exhibit dissociation. In the regression analysis, garden path resolution in PWA was significantly predicted by global-to-local attention shifting costs, while controls’ garden path resolution was significantly predicted by local-to-global attention shift costs. Conclusions The present study showed for the first time that morphological cues can shed light in sentence comprehension deficits exhibited by PWA. Furthermore, domain-general attentional control abilities were significantly associated with sentence comprehension abilities in both healthy controls and PWA.

Effects of Verb Overlap on Structural Priming in Dialogue: Implications for Syntactic Learning in Aphasia.

Purpose Although there is increasing interest in using structural priming as a means to ameliorate grammatical encoding deficits in persons with aphasia (PWAs), little is known about the precise mechanisms of structural priming that are associated with robust and enduring effects in PWAs. Two dialogue-like comprehension-to-production priming experiments investigated whether lexically independent (abstract structural) priming and/or lexically (verb) specific priming yields immediate and longer, lasting facilitation of syntactic production in PWAs. Method Seventeen PWAs and 20 healthy older adults participated in a collaborative picture-matching task where participant and experimenter took turns describing picture cards using transitive and dative sentences. In Experiment 1, a target was elicited immediately following a prime. In Experiment 2, 2 unrelated utterances intervened between a prime and target, thereby allowing us to examine lasting priming effects. In both experiments, the verb was repeated for half of the prime-target pairs to examine the lexical (verb) boost on priming. Results Healthy older adults demonstrated abstract priming in both transitives and datives not only in the immediate (Experiment 1) but also in the lasting (Experiment 2) priming condition. They also showed significantly enhanced priming by verb overlap (lexical boost) in transitives during immediate priming. PWAs demonstrated abstract priming in transitives in both immediate and lasting priming conditions. However, the magnitude of priming was not enhanced by verb overlap. Conclusions Abstract structural priming, but not lexically specific priming, is associated with reliable and lasting facilitation of message-structure mapping in aphasia. The findings also suggest that implicit syntactic learning via a dialogue-like comprehension-to-production task remains preserved in aphasia.

Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia.

Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A’s husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.