Porch Index Of Communicative Ability Research Articles

Looking at gesture: The reciprocal influence between gesture and conversation

IntroductionThere is limited research in group communication treatment for people with aphasia but existing studies report benefits of gesture to support conversation. Gesture supports conversation through recipient design features and reducing linguistic demands of lexical retrieval and formulation. Additionally, gesture serves an affiliative function. However, the relationship between gesture use and gestural capacity has not been widely examined. As part of a larger study on group cohesiveness and conversation, this investigation examined the patterns of co-speech gesture within authentic conversations among persons with aphasia to discern the functions of gesture use for the participants, changes in the use of gesture over time, and the relationship between gesture use and gesture ability. MethodsConversation Analysis (CA) was applied in an embedded case-study design. Three participants received an academic semester of group and individual conversation-based treatment according to Facilitating Authentic Conversation (Damico et al., 2015). Four conversations from the treatment were selected and transcribed for multi-modality communication with CA conventions applied, and then cyclically analysed for patterns of gesture. ResultsParticipants demonstrated gesture that served social and linguistic functions: ratifying clinicians’ proxy turns, turn-allocation, turn repair, relaying novel visual information, emphasizing content, demonstrating affiliation with the prior speaker, demonstrating their assessment others’ talk, and demonstrating humor. All three participants showed an increased rate of gesture per turn and increasingly used gesture to repair conversation breakdown. Increased gesture use over the course of the semester coincided with increased scores for pantomime on the Porch Index of Communicative Ability (Porch, 1981, PICA). ConclusionIndividuals with aphasia demonstrated increased use of gesture for varied purposes and improved gestural processing following a semester of conversation-based treatment. This is significant because gesture is an effective support for the repair of conversation breakdown typical of persons with aphasia.

Defining aphasia: Content analysis of six aphasia diagnostic batteries

Clear operational definitions of constructs are necessary to ensure that research findings are meaningful and interpretable. In the field of aphasiology, aphasia is often defined to the effect of “aphasia is an acquired language disorder often due to brain injury that affects expressive and receptive language.” To contribute to our understanding of the construct of aphasia, we conducted a content analysis of six diagnostic aphasia tests: the Minnesota Test for the Differential Diagnosis of Aphasia, the Porch Index of Communicative Ability, the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, the Comprehensive Aphasia Test, and the Quick Aphasia Battery. These chosen tests have historical prominence, with several in regular clinical and research use today. We hypothesized that the content of the aphasia tests should be very similar since they all purport to identify and characterize (if present) aphasia, with recognition that there may be some subtle differences in test content stemming in large part to epistemological differences in the test makers’ views of aphasia. Instead, we found predominantly weak Jaccard indices, a similarity correlation coefficient, between test targets. Only five test targets were found in all six aphasia tests: auditory comprehension of words and sentences, repetition of words, confrontation naming of nouns, and reading comprehension of words. The qualitative and quantitative results suggest that the content across aphasia tests may be more disparate than expected. We conclude by discussing the implication of our results for the field, including the importance of updating, if necessary, the operational definition of aphasia through conversation with a broad audience of interested and affected people.

Efficacy of cognitive behavior language therapy for aphasia following stroke: Implications for language education research

Background/Objective:Evidence from previous research has shown that the incidence of aphasia following a stroke is high in Nigeria and other countries, and there is a call for intervention programs. The objective of the current study was to investigate the efficacy of cognitive behavior language therapy (CBLT) on aphasia following a stroke.Methods:The study was designed as a group randomized trial, which involved treatment and no-treatment control procedures. The participants of the study were 86 patients who had experienced aphasia following a stroke. The Porch Index of Communicative Ability (PICA) and Speech-Language Unhelpful Thoughts and Beliefs Scale (SLUTBS) were the measures used in the study. The repeated measures analysis of variance procedure, with Partial eta squared , adjusted R2, mean, standard deviation, and upper/lower limit was followed in analyzing the data collected in the study.Results:The CBLT intervention significantly reduced aphasia following a stroke and significantly reduced speech-language and unhelpful thought and beliefs among aphasic stroke patients exposed to the treatment intervention when compared with the no-treatment control group.Conclusion:Based on the findings of the study, language educators, speech and language pathologists and therapists in education institutions, hospitals, and rehabilitation centers should adopt the principles of CBLT used in the current study to help them improve communication ability among aphasia stroke patients.

Language Remediation in a Case of Wernicke’s Aphasia Post Herpes Simplex Virus Type 1 Viral Encephalitis

Objective: This report aims to disseminate a successful language remediation in a case of Wernicke’s aphasia following encephalitis caused by herpes simplex virus type 1. Methods: A female patient was referred two months post onset of Herpes Simplex Encephalitis (HSE) with severe Wernicke’s aphasia, confusion, environmental disorientation, and dependence in activities of daily living. Non-standardized portions of the Porch Index of Communicative Ability (PICA) was administered in speech-language assessment. A treatment program following the Context-Based Therapy was applied on an intensive schedule, with emphasis on the auditory system. PICA’s multidimensional scoring system was used to monitor patient’s progress. Results: Sixteen months post onset of Wernicke’s aphasia, patient was able to perform auditory comprehension/ memory tasks with gestural/ visual augmentation and demonstrate no deficits on a non-standardized PICA, other than occasional delays and self-corrections. Patient became independent and functional in activities of daily living. Conclusion: There is no proven method for rehabilitation of the Wernicke’s aphasia. The successful rehabilitation including language remediation in this case suggests that a treatment program following the Context-Based Therapy may be helpful in rehabilitation of Wernicke’s aphasia caused by HSE when administered on an intensive schedule.

Comments on “Comparison of Alternatives to Multidimensional Scoring in the Assessment of Language Comprehension in Aphasia” by Odekar and Hallowell (2005)

These comments are written in response to an article by A. Odekar and B. Hallowell (2005) which argues that the use of plus-minus scoring may be faster and more efficient than "traditional multidimensional scoring" in current clinical contexts. As a long-time clinician and as the developer of binary choice multidimensional scoring as used in the Porch Index of Communicative Ability (PICA), I felt it necessary to correct some inaccuracies, to provide some clarifications and cautions, and to give the readers an alternative point of view regarding scoring issues. Four major issues are addressed. First, there is a growing trend to develop more, not fewer, multidimensional scoring systems because the older plus-minus method loses too much information about the patient. Second, although the Odekar and Hallowell article has an extensive discussion on the PICA, implying that this test battery is to be the focus of the study, the actual experiment employed the Revised Token Test and had little to do with the PICA. Third, the stated aim of the study, to demonstrate that plus-minus scoring is faster and less time consuming than multidimensional scoring, was not included in the experimental design. Finally, changes that replace established and effective clinical methods must not affect patient care negatively.

Assessment of school discourse: Is the PICAC an option?

This study examines the feasibility of using the Porch Index of Communicative Ability in Children (PICAC), a standardized test of general communication, as an out-of-setting school discourse evaluation tool. The rationale for considering the PICAC was based on the expectation that the test creates a teaching–learning context where materials, tasks, instructional talk and assistance reflect the practices that occur in traditional classrooms. The comparison of the PICAC test to full day school transcripts provided support for using the PICAC as a criterion reference measure that could facilitate sharing of information and results among professionals and could promote use of classroom learning processes more individualized to a particular student. Learning outcomes: The reader will be able to: (1) describe school discourses and (2) describe similarities between PICAC administration and classroom instruction.

Prognosis for aphasia: Relationship between selected biographical and behavioural variables and outcome and improvement

Background: Numerous biographical and behavioural variables have been investigated for their prognostic value in aphasia. Tompkins, Jackson, and Schulz (1990) recommended ways to reconceptualise some of these variables and suggested exploration of additional variables that have been neglected.Aims: The purpose of this investigation was to examine the relationship between selected biographical and behavioural variables and initial performance, outcome, and amount of change in aphasia.Methods & Procedures: A total of 34 participants, from the first Veterans Administration Cooperative Study on Aphasia, composed the study sample. Each was evaluated with the Porch Index of Communicative Ability (PICA) and the Rating of Functional Performance (RFP) (a modification of the Functional Communication Profile) at 4 and 48 weeks post‐onset (WPO), before and after a 44‐week treatment trial. Information for 10 biographical and behavioural variables was available for each participant at 4 WPO. Spearman's correlations were employed to determine the relationship between each biographical and behavioural variable and initial performance, outcome, and amount of change on the PICA and RFP.Outcomes & Results: Performance at 4 WPO, pre‐treatment, on the PICA and RFP was significantly correlated. Similarly, performance on the PICA and RFP at 4 WPO was significantly correlated with conversational, Token Test, and word fluency performance at 4 WPO. Outcome on the PICA and the RFP at 48 WPO, post‐treatment, was significantly correlated with PICA, RFP, and word fluency performance at 4 WPO. Moreover, outcome on the PICA at 48 WPO was significantly correlated with conversational and Token Test performance at 4 WPO. Amount of change on the PICA between 4 WPO and 48 WPO was significantly negatively correlated with PICA, word fluency, Token Test, and conversational performance at 4 WPO. Amount of change on the RFP between 4 WPO and 48 WPO was significantly negatively correlated with RFP performance at 4 WPO.Conclusions: The results indicate that there are significant relationships between specific behavioural variables and initial performance, outcome, and amount of change on measures of language impairment and functional communication. Moreover, there is a difference between formulating a prognosis for outcome and amount of change in aphasia–‐individuals who attain higher outcomes do not necessarily make more improvement. However, the influence of a ceiling effect must be considered in this relationship. Finally, to determine the predictive precision of these relationships, future investigations will require a larger sample size and application of multiple regression analysis.

Accuracy of formal tests for diagnosing mild aphasia: An application of evidence‐based medicine

Background: Normal elderly and mildly aphasic individuals may exhibit similar impairments in language comprehension and expression. Accurate differential diagnosis is essential for providing a prognosis, focusing treatment, and justifying reimbursement for services.Aims: We employed the principles of evidence‐based medicine to examine the accuracy of two general language tests (Porch Index of Communicative Ability; Western Aphasia Battery) and two functional communication tests (Communication Activities of Daily Living; American Speech‐Language‐Hearing Association's Functional Assessment of Communication Skills for Adults) for diagnosing mild aphasia, beyond individual clinical expertise.Methods & Procedures: The test performance of 10 mildly aphasic patients was compared with that of 10 non‐brain‐injured (NBI) adults. An operational definition of aphasia was applied as a reference standard for correct diagnosis. Pre‐test and post‐test diagnostic probabilities were compared, using the likelihood ratio as an index of accuracy.Outcomes & Results: In our sample, obtained positive likelihood ratios ranged from 3.00 to 6000.60, and the post‐test probability of a correct positive diagnosis ranged from 91% to 100%. However, the pre‐test probability of a correct positive diagnosis was already high (70–100%), because information necessary to diagnose correctly was available to the clinician prior to formal test administration. Thus, an overall score derived from subsequent administration of a formal test added, at best, moderate improvement over individual clinical expertise. The tests may prove more important for clinicians uncertain of a patient's diagnosis or for diagnosing “borderline” patients whose symptoms are unclear. For pre‐test probabilities between 40% and 60%, administration of one of the formal tests we examined may increase or decrease diagnostic probability by as many as 60 percentage points.Conclusion: Results indicate that overall scores derived from these tests are accurate but may or may not be important in confirming the presence or absence of mild aphasia, depending on the pre‐test probability of a positive diagnosis. Suggestions for testing the validity of our results within a wider spectrum of patients are provided.

Clinical significance of change in language performance: social validation of writing response improvement in aphasia

Evaluation of change in performance based on feedback from people other than the experimenters has become known as 'social validation' and assumes an increasingly important role in models of treatment efficacy. This study selected a sample of 141 community members diverse in age, education and occupation to judge the accuracy of changes in writing samples from individuals with aphasia. Counterbalanced pairs of writing samples derived from sentences on the Porch Index of Communicative Ability (PICA) were judged. Subjects were able to discern and judge changes in writing samples when compared to actual measured changes at levels far above chance. These findings lend social validation support to measured improvement in writing performance of individuals with aphasia.

A comparison of the mismatch negativity (MMN) event-related potential to tone and speech stimuli in normal and aphasic adults

We evaluated the mismatch negativity (MMN) event-related potential (ERP) in normal and aphasic adults to tone and speech stimuli to determine aphasic patients' auditory discrimination and the relationship between MMN measures and severity of aphasia. MMNs were present in 89% of normal subjects and 79% of aphasic subjects to tone stimuli. MMNs were present in 100% of normal subjects and 54% of aphasic subjects to speech stimuli. The duration of the MMN ERP to speech stimuli was significantly related to severity of aphasia on the Western Aphasia Battery, Porch Index of Communicative Ability, and the Token Test. Thus, not all aphasic people show an early, preconscious orientation response to tone and speech stimuli. However, the duration of this response, when present, to speech stimuli appears to be related to the severity of aphasia.

Relationship between language impairment and pragmatic behavior in aphasic adults

We explored the relationship between language impairment and pragmatic performance in aphasic adults during the first 48 weeks postonset. Twenty patients, ten fluent and ten nonfluent, who had suffered a single left hemisphere stroke participated in the study. Half of the patients received 44 weeks of individual treatment and half received 44 weeks of group treatment. Language impairment—auditory comprehension, reading, oral-expressive language, and writing—was determined with the Porch Index of Communicative Ability at four weeks postonset, pretreatment, and at 15, 26, 37, and 48 weeks postonset. Pragmatic performance—verbal aspects, paralinguistic aspects, and nonverbal aspects—was assessed during conversation with a pragmatic protocol at the same points in time. The patients made significant improvement in both language impairment and pragmatic performance between 4 and 48 weeks postonset, and there were no significant differences in improvement between the fluent and nonfluent groups or between patients receiving individual or group treatment. In our fluent aphasic patients, language impairment and pragmatic performance were significantly related at four weeks postonset but not thereafter. Conversely, in our nonfluent aphasic patients, language impairment and pragmatic performance were not significantly related at four weeks postonset, but they were significantly related at 15, 26, 37, and 48 weeks postonset. The significance of the relationship between language impairment and pragmatic performance was sporadic over time in the individual and group treatment groups.

Promoting recovery in chronic aphasia with an interactive technology

Objective: To assess chronic aphasic patients' responses to resumption of therapy using an innovative, computer-based treatment system. Design: Patients were assessed pretreatment and posttreatment using standardized assessment tools. Pretreatment and posttreatment performance score means were computed and compared, with statistical significance of the differences established using a one-tailed, matched t test. Setting: The work was conducted at (1) a Veterans Affairs medical center participating in treatment research and (2) a regional aphasia center delivering therapy services for reimbursement. Patients: Chronic aphasic patients ( n = 23) from 6 months to more than 15 years postonset were enrolled in the study. They included a wide range of types and seventies of aphasia, and all had received traditional speech-language therapy services earlier. Interventions: All patients were treated in 1-hour clinical sessions by speech-language pathologists using the designated computer-based treatment system. All but one of the patients had access to the computer-based treatment system at home for practice between clinical therapy sessions. Main Outcome Measures: The outcome measures used were (1) the Porch Index of Communicative Ability (PICA), (2) the Boston Naming Test (BNT), (3) the Western Aphasia Battery (WAB), and (4) the Boston Diagnostic Aphasia Examination (BDAE). Results: The majority of patients improved significantly in multiple modalities as assessed by these instruments. Conclusions: Specific measures of language function can be broadly, positively, and significantly influenced by computer-based language therapy in chronic aphasia.

Aphasia in African-Americans and Caucasians: Severity, improvement, and rate of improvement

We compared initial severity, amount of improvement, and rate of improvement of aphasia in African-Americans and Caucasians. Study patients were aphasic subsequent to a first, left hemisphere, thromboembolic infarct, and all were entered in a 44-week treatment trial designed to provide 6–8 h of treatment each week between 4 and 48 weeks post-onset. There was no significant difference between African-Americans and Caucasians in severity of aphasia on the Porch Index of Communicative Ability, a word fluency measure, or the Token Test prior to the initiation of treatment at 4 weeks post-onset. At 48 weeks post-onset, African-Americans performed significantly lower on the Porch Index of Communicative Ability Gestural and Graphic modality scores. Both African-American and Caucasian aphasic patients displayed significant improvement in aphasia during the 44-week treatment trial, and there were no significant differences between groups in the amount or rate of improvement. Thus, our samples of African-American and Caucasian aphasic patients displayed essentially the same initial severity, amount of improvement, and rate of improvement of aphasia during the first year post-onset.

Formal thought disorder in schizophrenia. Linguistic, attentional, and intellectual correlates.

Formal thought disorder (i.e., abnormal utterances and communication problems) is a prominent feature of schizophrenia. To investigate the hypothesis that formal thought disorder in schizophrenics represents a disturbance of language functioning, we compared 21 thought-disordered and 16 non-thought-disordered schizophrenics on the Porch Index of Communicative Ability. The thought-disordered schizophrenics were significantly more impaired. We also examined nonlinguistic factors potentially impacting language performance in schizophrenics (e.g., disturbed attention, intellect, and/or thought content). Reduced attention was the best predictor of language performance in the thought-disordered group, whereas low intellect and reduced attention were predictive of language dysfunction in the non-thought-disordered group. Disturbed thought content was not predictive of language impairment in either group. These findings provide partial support for the idea that formal thought disorder in schizophrenics represents defective language functioning.

Expressive language characteristics of schizophrenic subjects with different medication histories

In this descriptive study the verbal performance of four previously unmedicated schizophrenic subjects was evaluated prior to and two weeks following the effects of antipsychotic treatment … and compared to the performance of five continuously medicated schizophrenic subjects. Results obtained using two subtests of the Porch Index of Communicative Ability (PICA) and on the “Cookie Theft” picture description task from the Boston Aphasia Diagnostic Examination, revealed a variety of language disturbances that appeared to be related to medication status and classification of schizophrenia. Previously unmedicated subjects performed worse than medicated subjects on all tasks, however, disordered verbal performance was observed for all patients. Results are discussed in reference to a theory of hyperactivity of the cortical areas, and the influence of medication on performance.

Use of amphetamine in the treatment of aphasia

The effects of d-amphetamine on the recovery of aphasia following stroke was examined in 6 patients. Patients entered the study between 10 and 30 days post onset and were followed for 3 months. The Porch Index of Communicative Ability was used to project a 6 month recovery score. By 3 months post onset, 5 of the 6 patients obtained scores in excess of 100% of the 6 month projections.

The use of novel and real-word stimuli in the assessment of english morphology in adults with aphasia

Abstract Fifteen aphasic subjects were administered two 10-item production tasks of English morphology based on the novel words like those from the Berko Test and equivalent real words selected from the Grammatic Closure subtest of the Illinois Test of Psycholinguistic Abilities (ITPA). Aphasia severity was estimated with the Porch Index of Communicative Ability (PICA). Analysis of the results revealed that significantly more correct responses were obtained from meaningful words than novel words, and there was a positive and significant correlation between severity of aphasia and an aphasic subject's production of certain bound English morphemes. There was a similar hierarchy of morphological forms produced by aphasic subjects on both test forms. Further, the hierarchy of forms assessed through these novel-word stimuli did not parallel closely the order of acquisition of these same morphological structures found previously in children.

Nonlinguistic auditory capabilities in aphasia

Nonlinguistic auditory capabilities were assessed through psychophysical tests in 11 left-CVA aphasic, four right-CVA nonaphasic, and eight normal male subjects selected from the same age group. The tests included frequency discrimination, gap detection, gap discrimination, frequency sweep discrimination, assessment of the magnitude of the frequency uncertainty effect in the detectability of tones in noise, and assessment of frequency selectivity through simultaneous masked thresholds. Results of these tests were compared to measures of auditory comprehension obtained from the Boston Diagnostic Aphasia Examination, the Porch Index of Communicative Ability, and the Token Test. Nonlinguistic auditory performance of the three subject groups differed significantly from each other. For the left-CVA subjects, frequency sweep discrimination, frequency discrimination, and the frequency uncertainty effect in tone-in-noise detection were the best predictors of verbal auditory comprehension. The right-CVA subjects displayed marked deficits with regard to all pitch-related tests. The findings stress the importance of considering the presence of nonlinguistic auditory dysfunctions when evaluating linguistic auditory capabilities in aphasia.

The course of chronic aphasia

Abstract Little is known about the long term recovery or stability of aphasia following brain injury. Thirty-five male stroke patients were studied repeatedly from 3 to 55 months post-onset with the Porch Index of Communicative Ability (PICA) in order to follow improvement in each of five previously extracted factors (speaking, writing, comprehension, gesturing, and copying) across the five-year span. Patients were grouped into one of four categories based on a previous analysis of 118 patients. PICA overall score increased over the first year, became asymptotic in the second year, and either remained level or declined in the third and fourth years post-onset. Language factors showed differential changes with the greatest improvement in speaking. Different categories of patients showed different patterns of change over time. Ten patients had greater than an 11% PICA overall decline beyond the second year. They were among those with the mildest aphasias. Reasons for decline included: change in health statu...

A measure of revised token test ordinality and intervality

Abstract Multidimensional scoring of behaviours associated with aphasia came to the fore initially with the publication of the Porch Index ofcommunicative Ability (PICA) (Porch 1967, 1971). Before this test was standardized and proposed for clinical use, it was designed to determine the effectiveness of a 16-point multidimensional scoring system for the assessment of aphasia. Multidimensional scoring was developed in order to minimize the weaknesses of plus-minus scoring, descriptive notes, rating scales and simple category scales. While multidimensional scoring does appear to be a successful method for attenuating the weakness present in other scoring systems, the data derived from this method must meet certain statistical requirements. When mean Scores are used to evaluate patient performance, the scoring system must be at least ordinal. If parametric statistics are used to evaluate the data, intervality of the scoring system is required (Labowitz 1970). Studies by McNcil, Prescott and Chang (1975) and Duffy and Dale (1977) have provided methods and data which suggest that while the PICA scoring system may not be exactly ordinal nor interval, ifused in the context of the PICA, it is robust enough to function as an ordinal and interval scale.