Western Aphasia Battery-Revised Research Articles

Reliability of the picture description task of the Western Aphasia Battery – revised in Laurentian French persons without brain injury

Objective: Limited normative data (including psychometric properties) are currently available on discourse tasks in non-dominant languages such as Laurentian (Quebec) French. The lack of linguistic and cultural adaptation has been identified as a barrier to discourse assessment. The main aim of this study is to document inter-rater and test-retest reliability properties of the picnic scene of the Western Aphasia Battery – Revised (WAB-R), including the cultural adaptation of an information content unit (ICU) list, and provide a normative reference for persons without brain injury (PWBI). Method: To do so, we also aimed to adapt an ICU checklist culturally and linguistically for Laurentian French speakers. Discourse samples were collected from 66 PWBI using the picture description task of the WAB-R. The ICU list was first adapted into Laurentian French. Then, ICUs and thematic units (TUs) were extracted manually, and microstructural variables were extracted using CLAN. Inter-rater reliability and test-retest reliability were determined. Results: Excellent inter-rater reliability was obtained for ICUs and TUs, as well as for all microstructural variables, except for mean length of utterance, which was found to be good. Conversely, test-retest reliability ranged from poor to moderate for all variables. Conclusion: The present study provides a validated ICU checklist for clinicians and researchers working with Laurentian French speakers when assessing discourse with the picnic scene of the WAB-R. It also addresses the gap in available psychometric data regarding inter-rater and test-retest reliability in PWBI.

Defining Trajectories of Linguistic, Cognitive-Communicative and Quality of Life Outcomes in Aphasia: Longitudinal Observational Study Protocol

ObjectiveTo describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (HRQOL) outcomes following stroke in persons with aphasia DesignLongitudinal observational study from inpatient rehabilitation to 18 months following stroke. SettingFour U.S. mid-west inpatient rehabilitation facilities (IRFs). ParticipantsWe plan to recruit 400 adult (older than 21 years) English speakers who meet the following inclusion criteria: (1) Diagnosis of aphasia after a left-hemisphere infarct confirmed by CT scan or magnetic resonance imaging (MRI); (2) first admission for inpatient rehabilitation due to a neurological event; and (3) sufficient cognitive capacity to provide informed consent and participate in testing. Exclusion criteria include any neurological condition other than stroke that could affect language, cognition or speech, such as Parkinson ’s disease, Alzheimer's disease, traumatic brain injury, or the presence of right-hemisphere lesions. InterventionsNot applicable Main Outcome MeasuresSubjects are administered a test battery of linguistic, cognitive-communicative, and HRQOL measures. Linguistic measures include the Western Aphasia Battery-Revised and the Apraxia of Speech Rating Scale. Cognitive-communicative measures include the Communication Participation Item Bank, Connor's Continuous Performance Test-3, the Communication Confidence Rating Scale for Aphasia, the Communication Effectiveness Index, the Neurological Quality of Life measurement system (Neuro-QoL) Communication short form, and the Neuro-QoL Cognitive Function short form. HRQOL measures include the 39-item Stroke & Aphasia Quality of Life Scale, Neuro-QoL Fatigue, Sleep Disturbance, Depression, Ability to Participate in Social Roles & Activities, and Satisfaction with Social Roles & Activities tests, and the Patient-Reported Outcome Measurement and Information System (PROMIS) 10-item Global Health short form. The test battery is administered initially during inpatient rehabilitation, and at 3-, 6-, 12-, and 18-months post-IRF discharge. Biomarker samples are collected via saliva samples at admission and a subgroup of participants also undergo resting state fMRI scans. ResultsNot applicable ConclusionsThis longitudinal observational study will develop trajectory models for recovery of clinically relevant linguistic, cognitive-communicative, and quality of life outcomes over 18 months following inpatient rehabilitation. Models will identify individual differences in the patterns of recovery based on variations in personal, genetic, imaging, and therapy characteristics. The resulting models will provide an unparalleled representation of recovery from aphasia resulting from stroke. This improved understanding of recovery will enable clinicians to better tailor and plan rehabilitation therapies to individual patient's needs.

Exploring the association between social determinants and aphasia impairment: A retrospective data integration approach.

Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA). PWA indexed within AphasiaBank-a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information-were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results. PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression. These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.

Initial evaluation of the TALES (technology and literacy engagement after stroke) programme targeting functional literacy and social engagement in people with aphasia after stroke

ABSTRACT Background and aims Literacy skills are typically affected in people with stroke aphasia, leading to reduced engagement in functional everyday reading/writing tasks, such as email/messaging via social media. The aim of this study was to investigate the outcomes of the TALES (Technology And Literacy Engagement after Stroke) programme, a group-based online literacy-focused programme for people with aphasia after stroke. This first evaluation of this programme aimed to examine outcomes related to feasibility, changes in language, literacy and self-ratings of communication skills. Methods Five participants with aphasia were assessed on a range of outcome measures relating to language and self-perception of communication skills. These were: the Western Aphasia Battery-Revised (WAB-R; (Kertesz, 2007)), literacy subtests from the Psycholinguistic Assessment of Language Processing in Aphasia (PALPA; (Kay et al., 1996)) and the Communication Outcomes after Stroke (COAST; (Long et al., 2008)). TALES consisted of a weekly group online session, 1:1 supported telehealth reading/writing practice and regular messaging via email. Results and main contribution From a descriptive statistics perspective, the mean gains across the cohort were 7.94 (from 84.24 to 92.18) on the WAB AQ (aphasia quotient), 8.92 (from 81.18 to 90.10) on the WAB LQ (language quotient). Additionally, there was a change in the mean scores for PALPA subtests (31, 37 and 40) observed between the pre-treatment assessment and post-treatment assessment. Finally, the mean score increased by 8.8 (from 49.40 to 58.20) on the COAST (max score = 80). Results indicated gains in literacy and communication measures as well as changes to self-rating of communication reflecting changes in communication confidence. Conclusions Mindful of the threats to the internal validity inherent in the study design, the reported online therapy can overcome barriers such as distance and mobility limitations and may provide greater accessibility to therapy for individuals with aphasia. TALES was a low-therapist-input yet reasonably intensive treatment approach which embedded language practice immediately in functional use through the social group format and personally-relevant written communication. Implications The TALES programme meets many neuroscience principles of neurorehabilitation including “use it or lose it”, salience and transference. Future research may usefully investigate the contribution of the group format versus the functional literacy components towards these potentially promising early data.

Dissociating reading and auditory comprehension in persons with aphasia.

Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia Battery-Revised from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Repeated-measures and univariate ANOVA were used to assess the relationship between auditory comprehension and aphasia types and correlations were employed to test the relationship between reading and auditory comprehension deficits. Lesion-symptom mapping was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice versa. Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus and posterior thalamic radiation. Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioural and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.

Abstract WP103: The Role of Social Determinants in Aphasia Outcomes

Introduction: Aphasia is a post-stroke communication disorder that negatively impacts quality of life and life satisfaction even in its mildest form. Traditionally predictors of aphasia outcomes have emphasized neurological factors and little is known about the role that the social, cultural, environmental, and economic determinants of aphasia outcomes. Hypothesis: We hypothesize that non-neurological social factors (social determinants) are linked to post-stroke aphasia outcomes in a large, diverse population of individuals with aphasia. Methods: Merged data from the AphasiaBank—a large database designed to explore aphasia outcomes using data collected from aphasia studies based on standardized protocols were matched with data from the National Health Interview Survey (NHIS) based on range of sociodemographic and clinical outcomes to create an integrated dataset to examine the association between social determinants and aphasia outcomes. Generalized log-linear regression models were utilized to examine the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and sociodemographic, economic, and environmental characteristics. Regression models accounted for geographic clustering of respondents and the stratification of data collection to ensure the robustness of estimates. Results: Blacks had 6.1% (SE=0.009) lower WAB-AQ scores compared to Whites as did those who were married (β-0.030, SE=0.004) and living in the Southern US (β=-0.013, SE=0.003) even after controlling forage, environment, and aphasia type. Individuals with aphasia and living in larger families (β=0.031,SE=0.004) and those who visited their medical provider regularly (β=0.051, SE=0.002) had higher scores compared to the reference group. Income-to-poverty ratio and home ownership were significantly correlated with impairment level. The analysis indicated that having available transportation did not influence observed outcomes. Finally racial disparities did not persist at the highest income levels. Conclusion: The findings of this study suggest researcher should look beyond neurologic correlates when exploring aphasia outcomes..

Discourse- and lesion-based aphasia quotient estimation using machine learning

Discourse is a fundamentally important aspect of communication, and discourse production provides a wealth of information about linguistic ability. Aphasia commonly affects, in multiple ways, the ability to produce discourse. Comprehensive aphasia assessments such as the Western Aphasia Battery-Revised (WAB-R) are time- and resource-intensive. We examined whether discourse measures can be used to estimate WAB-R Aphasia Quotient (AQ), and whether this can serve as an ecologically valid, less resource-intensive measure. We used features extracted from discourse tasks using three AphasiaBank prompts involving expositional (picture description), story narrative, and procedural discourse. These features were used to train a machine learning model to predict the WAB-R AQ. We also compared and supplemented the model with lesion location information from structural neuroimaging. We found that discourse-based models could estimate AQ well, and that they outperformed models based on lesion features. Addition of lesion features to the discourse features did not improve the performance of the discourse model substantially. Inspection of the most informative discourse features revealed that different prompt types taxed different aspects of language. These findings suggest that discourse can be used to estimate aphasia severity, and provide insight into the linguistic content elicited by different types of discourse prompts.

Cerebellar Atrophy and Language Processing in Chronic Left-Hemisphere Stroke

Abstract Chronic stroke results in significant downstream changes at connected cortical sites. However, less is known about the impact of cortical stroke on cerebellar structure. Here, we examined the relationship between chronic stroke, cerebellar volume, cerebellar symmetry, language impairment, and treatment trajectories in a large cohort (N = 249) of chronic left hemisphere (LH) stroke patients with aphasia, using a healthy aging cohort (N = 244) as control data. Cerebellar gray matter volume was significantly reduced in chronic LH stroke relative to healthy control brains. Within the chronic LH stroke group, we observed a robust relationship between cerebellar volume, lesion size, and days post-stroke. Notably, the extent of cerebellar atrophy in chronic LH patients, particularly in the contralesional (right) cerebellar gray matter, explained significant variability in post-stroke aphasia severity, as measured by the Western Aphasia Battery—Revised, above and beyond traditional considerations such as cortical lesion size, days post-stroke, and demographic measures (age, race, sex). In a subset of participants that took part in language treatment studies, greater cerebellar gray matter volume was associated with greater treatment gains. These data support the importance of considering both cerebellar volume and symmetry in models of post-stroke aphasia severity and recovery.

Pilot Results for ECoLoGiC-Tx: A New Conversation-Level Intervention Improving Language in People With Moderate to Severe Aphasia.

This study reports pilot data for a novel intervention, ECoLoGiC-Tx, delivered to four people with moderate to severe aphasia. ECoLoGiC-Tx addresses language and communication in unstructured, participant-led conversation. The speech-language pathologist (SLP) uses a framework to choose turns that facilitate a social interaction. When communication breakdown occurs, the SLP implements a least-to-most hierarchy to maximize the people with aphasia's (PWA's) independence in self-repair. ECoLoGiC-Tx draws its theoretical underpinnings from conversation analysis and theories of rehabilitation, including principles of complexity, neuroplasticity, and learning. Four PWA attended 60-min sessions twice weekly for 10 weeks. Assessment occurred at pretreatment, posttreatment, and 6-week maintenance. Outcomes included established discourse measures for conversation and monologue, tests of language and functional communication, and patient-/family-reported outcome measures (P/FROMs). Discourse samples were collected three times per assessment. Interrater reliability and fidelity for assessment and treatment procedures are reported. Participants presented with Broca's aphasia (one moderate, one severe) or conduction aphasia (one moderate, one severe). Each demonstrated improvements in discourse, test batteries, and P/FROMs. They all demonstrated reduced aphasia severity measured by the Western Aphasia Battery-Revised at posttreatment or maintenance. Change in conversation and monologue was robust for three participants, but was mixed for one person (P1: moderate Broca's aphasia). P/FROMs indicated improvement at posttreatment and maintenance for all participants. Most treatment gains were maintained at 6-week follow-up. This study provides promising results for ECoLoGiC-Tx to improve language function of people with chronic moderate to severe aphasia. Generalization occurred to tests, functional communication, spontaneous conversation, and structured monologue tasks.

43 Application of the Moroccan Arabic Bedside Western Aphasia battery-Revised in Acute Stroke Care

Objective:Despite the prevalence of aphasia in Morocco, standardized quick assessment tools are not available for use with patients in acute stroke care. The present study set out to (1) describe the processes of linguistic adaptation of a Moroccan Arabic (MA) version of the Bedside Western Aphasia Battery-Revised (WAB-R), (2) examine the test’s sensitivity to the detection of aphasia in an acute clinical setting, and (3) measure the instrument’s ability to detect improvement in language ability in the acute period.Participants and Methods:To achieve the first objective, the English Bedside WAB-R was adapted to Moroccan Arabic by a group of linguists. The instrument’s psychometric properties were established by (1) ascertaining the test’s sensitivity to the presence of aphasia, and (2) verifying the tool’s validity and reliability. Participants included a group of age- and education-matched non-brain-damaged individuals (N = 106), a group of right hemisphere brain-lesioned patients (N = 20), and a group of left hemisphere aphasic patients (N = 52). To accomplish the second and third objectives, the Bedside MA-WAB-R was administered to a group of aphasic participants in the acute period (less than three months post-stroke), and a group of age- and education-matched participants (N = 20). Aphasic patients in the acute stage were tested twice on a seven-day interval (3 days and 10 days post-onset). All data were collected from the Neurology department at the University Medical Hospital Hassan II, and the study received approval from the ethics committee of the Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah.Results:Regarding the first objective, the results indicated that the MA-WAB-R is sensitive to the presence of aphasia, as revealed by the significantly worse performance of the aphasic group on all subtests relative to matched normal and right-hemisphere participants (p = .000). Analyses revealed excellent content and construct validity (correlations between subtests and AQ ranging from .5 to .8) as well as high inter-rater reliability, intra-rater reliability and test-retest reliability (ICC (2,1) > .9). For the second and third objectives, the results supported the test’s sensitivity to the detection of aphasia in the acute phase, as confirmed by the significantly worse performance of aphasic patients relative to matched normal controls (p = .000). The instrument also proved as a reliable measure of language improvement in the acute period, as supported by better scores on the second testing point relative to the first across all subtests.Conclusions:The MA-WAB-R is the first standardized assessment tool that can be used for a quick but reliable screening of aphasia in both chronic and acute clinical settings. The test can inform the initial diagnosis of aphasia, and guide a more comprehensive assessment of patients’ spared and impaired linguistic abilities within a context receiving little attention in the aphasia literature.

Longitudinal Progression of White Matter Hyperintensity Severity in Chronic Stroke Aphasia

ObjectiveTo determine whether longitudinal progression of small vessel disease in chronic stroke survivors is associated with longitudinal worsening of chronic aphasia severity. DesignA longitudinal retrospective study. Severity of white matter hyperintensities (WMHs) as a marker for small vessel disease was assessed on fluid-attenuated inversion recovery (FLAIR) scans using the Fazekas scale, with ratings for deep WMHs (DWMHs) and periventricular WMHs (PVHs). SettingUniversity research laboratories. ParticipantsThis study includes data from 49 chronic stroke survivors with aphasia (N=49; 15 women, 34 men, age range=32-81 years, >6 months post-stroke, stroke type: [46 ischemic, 3 hemorrhagic], community dwelling). All participants completed the Western Aphasia Battery-Revised (WAB) and had FLAIR scans at 2 timepoints (average years between timepoints: 1.87 years, SD=3.21 years). InterventionsNot applicable. Main Outcome MeasuresChange in white matter hyperintensity severity (calculated using the Fazekas scale) and change in aphasia severity (difference in Western Aphasia Battery scores) were calculated between timepoints. Separate stepwise regression models were used to identify predictors of WMH severity change, with lesion volume, age, time between timepoints, body mass index (BMI), and presence of diabetes as independent variables. Additional stepwise regression models investigated predictors of change in aphasia severity, with PVH change, DWMH change, lesion volume, time between timepoints, and age as independent predictors. Results22.5% of participants (11/49) had increased WMH severity. Increased BMI was associated with increases in PVH severity (P=.007), whereas the presence of diabetes was associated with increased DWMH severity (P=.002). Twenty-five percent of participants had increased aphasia severity which was significantly associated with increased severity of PVH (P<.001, 16.8% variance explained). ConclusionIncreased small vessel disease burden is associated with contributing to chronic changes in aphasia severity. These findings support the idea that good cardiovascular risk factor control may play an important role in the prevention of long-term worsening of aphasic symptoms.

Word Repetition Paired With Startling Stimuli Decreases Aphasia and Apraxia Severity in Severe-to-Moderate Stroke: A Stratified, Single-Blind, Randomized, Phase 1 Clinical Trial.

This prospective, single-blinded, parallel, stratified, randomized clinical trial via telehealth aimed to investigate the impact of Startle Adjuvant Rehabilitation Therapy (START) on aphasia, apraxia of speech (AOS), and quality of life in individuals with chronic stroke. The study hypothesized that START would have a greater effect on AOS-related measures and more severe individuals. Forty-two participants with poststroke aphasia, AOS, or both were randomly assigned to the START or control group. Both groups received 77-dB GET READY and GO cues during a word repetition task for three 1-hr sessions on consecutive days. The START group additionally received 105-dB white noise GO cues during one third of trials. The Western Aphasia Battery-Revised, Apraxia Battery for Adults, Stroke Impact Scale, and Communication Outcomes After Stroke scale were administered at Day 1, Day 5, and 1-month follow-up. START improved performance on some subtests of the Western Aphasia Battery (Comprehension, Repetition, Reading) and measures of AOS (Diadochokinetic Rate, Increasing Word Length) in individuals with moderate/severe aphasia, whereas moderate/severe controls saw no changes. Individuals with mild aphasia receiving START had improved Reading, whereas mild controls saw improved Comprehension. The START group had increased mood and perceived communication recovery by Day 5, whereas controls saw no changes in quality of life. This study is the first to evaluate the impact of training with startling acoustic stimuli on clinical measures of aphasia and AOS. Our findings suggest START can enhance both nontrained speech production and receptive speech tasks in moderate/severe aphasia, possibly by reducing poststroke cortical inhibition. Our findings should be considered carefully, as our limitations include small effect sizes, within-group variability, and low completion rates for quality-of-life assessments and follow-up visits. Future studies should explore a mechanism of action, conduct larger and longer Phase 2 clinical trials, and evaluate long-term retention. https://doi.org/10.23641/asha.24093519.

Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: A randomized sham-controlled trial

BackgroundAphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery. ObjectiveWe aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery. MethodsThis randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment. ResultsNinety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group. ConclusionThe stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.

Feasibility of remote assessment of language and cognition in healthy subjects with heterogeneous educational levels

AbstractBackgroundThe COVID‐19 pandemic is accelerating the use of telemedicine in the management of chronic neurological diseases. However, studies on the feasibility of assessing language and cognition are still scarce, especially in developing countries in which education is very heterogeneous. This pilot study evaluated the feasibility of using telemedicine for linguistic‐cognitive assessment, by comparing the performance of healthy adults in face‐to‐face and online assessments in a Brazilian sample. We also verified the influence of age and education on the two assessment forms.MethodThe sample consisted of 15 cognitively healthy subjects, aged between 57‐70 years (M = 63.2; SD = 4.6) and between 8‐22 years of education (M = 14.7; SD = 4.3). The Western Aphasia Battery‐Revised (WAB‐R) (Kertesz, 2007; Neves et al., 2014) was used for language assessment, with subtests for spontaneous speech, auditory verbal comprehension, repetition, naming, reading, and writing. The Addenbrooke’s Cognitive Examination‐revised version (ACE‐R) (Mioshi et al., 2006; Carvalho e Caramelli, 2007) was used for a brief cognitive screening and is composed of five subscales assessing attention and orientation, memory, fluency, language, and visuospatial skills. Subjects were randomly evaluated both face‐to face and online, with an interval of 1‐6 months.ResultNo differences were found in both WAB‐R and ACE‐R scores obtained in a face‐to‐face versus online environment. However, performance was associated with different sociodemographic variables in the two different evaluation contexts. In face‐to‐face assessment, there was a positive correlation between education and writing subtests (Spearman r = 0.878; p = 0.004). In the remote form of evaluation, there was a negative correlation between age and auditory verbal comprehension (Spearman r = ‐0.722; p = 0.043), and a positive correlation between education and spontaneous speech (Spearman r = 0.871; p = 0.004), auditory verbal comprehension (Spearman r = 0,768; p = 0,025), writing (Spearman r = 0.727; p = 0.040) and Aphasia Coefficient score (Spearman r = 0.736; p = 0.037).ConclusionThe absence of statistical difference between the two forms of evaluation demonstrated the viability of remote assessment of language and cognition in healthy subjects, despite the more significant influence of education in this evaluation form. Further studies will be conduct to verify the feasibility of remote assessment in individuals with mild cognitive impairment and dementia.

Analyzing Language in the Picnic Scene Picture and in Conversation: The Type of Discourse Sample We Choose Influences Findings in People With Aphasia.

People with aphasia express that improved conversational discourse is a primary rehabilitation goal. Discourse is usually assessed using monologue, such as a picture description task, but research shows that language in monologue varies from language in everyday conversation. Consequently, we investigated the relationship of language in unstructured conversation and in the picnic scene picture because it is a part of the most often used aphasia battery (Western Aphasia Battery-Revised) and thus is frequently used to inform therapy. Second, because previous research suggests people with severe aphasia may not demonstrate language production variability between types of monologue-level discourse, we evaluated the relationship of severity and the difference in scores between conversation and the picnic scene task. Thirty-four people with mild-to-severe aphasia described the picnic scene and provided a conversation sample. We measured language production and communicative success using seven measures with established psychometrics in conversation/monologue. We conducted correlations to answer the research questions. Correlations were moderate and weaker for the measures in the two conditions. A strong negative relationship was demonstrated between aphasia severity and global coherence. All other relationships were moderate and weaker for the remaining measures when correlated with aphasia severity (also negative). Results are consistent with other studies indicating that language varies in different types of discourse. We conclude that for accurate, meaningful assessment, discourse sampling needs to include the specific type of discourse the individual wishes to address in therapy, because discourse samples and their findings are not interchangeable.

The Moroccan Arabic Bedside Western Aphasia Battery-Revised: Linguistic and Psychometric Properties.

The objectives of this study were (a) to linguistically and culturally adapt the English bedside version of the Western Aphasia Battery-Revised (Bedside WAB-R) into Moroccan Arabic (MA) and (b) to assess its psychometric properties. The Bedside MA-WAB-R was piloted on a population of 20 participants after a process of linguistic adaptation from English to MA. To verify the psychometric properties of the test, a group of healthy controls (n = 106) and a group of persons with chronic aphasia (n = 52) completed the Bedside MA-WAB-R. The test's content validity, construct validity, and the concurrent validity of the aphasia classification system were examined. In addition, the interrater reliability, intrarater reliability, test-retest reliability, and internal consistency of the instrument were evaluated. The results indicated that the Bedside MA-WAB-R overall met standard criteria for excellent psychometric properties, as evinced by high content and construct validity and concurrent validity with independent measures of aphasia diagnosis (speech-language pathologists' impression and lesion location) as well as high internal consistency, inter- and intrarater reliability, and test-retest reliability. The test was also found to have very high sensitivity and specificity for the detection of aphasia, as revealed by the performance of controls. By controlling for age and educational level effects, specific cutoff values were determined to optimize the aphasia diagnosis. The Bedside MA-WAB-R is the first standardized quick aphasia assessment tool with associated psychometric properties for clinical use with an MA-speaking population, particularly within the 26- to 58-year age range. It meets standard criteria for a valid and reliable measure than can have a variety of clinical and research applications.

Acceptability, feasibility and preliminary efficacy of low-moderate intensity Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy in chronic aphasia after stroke

ABSTRACT Background High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. Methods A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. Results Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. Conclusions Low–moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low–moderate intensity. These results support a powered trial investigating these interventions at a low–moderate intensity.

Fatigue Influences Social Participation in Aphasia: A Cross-sectional and Retrospective Study Using Patient-Reported Measures

ObjectiveTo examine associations between social participation, fatigue, and aphasia severity using patient-reported outcome measures and to examine associations between demographic/diagnostic variables and fatigue in people with aphasia. DesignRetrospective analysis of patient-reported outcome measures using a Bayesian framework. SettingUrban rehabilitation research hospital. Participants67 participants (N=67) with chronic aphasia (mean age=54.1 years) as a consequence of stroke. InterventionsNot applicable. Main Outcome MeasuresAbility to Participate in Social Roles and Activities, Fatigue, and Global Health Questionnaire scales from the Patient-Reported Outcomes Measurement Information System initiative and the Western Aphasia Battery–Revised. We hypothesized an association between social participation and fatigue in people with aphasia. ResultsPeople with aphasia with higher fatigue levels tended to report less social participation. Also, people with aphasia who were a longer time post-stroke tended to report higher social participation. People with aphasia who reported better physical health were more likely to report higher social participation. ConclusionsThere is an association between fatigue and social participation in people with aphasia. Fatigue should be considered in clinical assessments and treatments for this population.

Evaluating Fluency in Aphasia: Fluency Scales, Trichotomous Judgements, or Machine Learning

ABSTRACT Background Speech-language pathologists (SLPs) and other clinicians often use aphasia batteries, such as the Western Aphasia Battery-Revised (WAB-R), to evaluate both severity and classification of aphasia. However, the fluency scale on the WAB-R is not entirely objective and has been found to have less than ideal inter-rater reliability, due to variability in weighing the importance of one dimension (e.g. articulatory effort or grammaticality) over another. This limitation has implications for aphasia classification. The subjectivity might be mitigated through the implementation of machine learning to identify fluent and non-fluent speech. Aims We hypothesized that two models consisting of convolutional and recurrent neural networks can be used to identify fluent and non-fluent aphasia as judged by SLPs, with greater reliability than use of the WAB-R fluency scale. Methods & Procedures The training and testing dataset for the networks was collected from the public domain, and the validation dataset was collected from participants in post-stroke aphasia studies. We used Kappa scores to evaluate inter-rater reliability among SLPs, and between the networks and SLPs. Outcome and Results Using public domain samples, the model for detecting non-fluent aphasia achieved high accuracy on the training dataset after 10 epochs (i.e., when algorithm scans the entire dataset) and 81% testing accuracy using public domain samples. The model for detecting fluent speech had high training accuracy and 83% testing. Across samples, using the WAB-R fluency scale, there was poor to perfect agreement among SLPs on the precise WAB-R fluency score, but substantial agreement on non-fluent (score 0-4) versus fluent (score of 5-9). The agreement between the model and the SLPs was moderate for identifying non-fluent speech and substantial fpr identifying fluent speech. When SLPs were asked to identify each sample as fluent, non-fluent, or mixed (without using the fluency scale), the agreement between SLPs was almost perfect (Kappa 0.94). The agreement between the SLPs’ trichotomous judgement and the models was fair for detecting non-fluent speech and substantial for detecting fluent speech. Conclusions Results indicate that neither the WAB-R fluency scale nor the machine learning algorithms were as useful (reliable and valid) as a simple trichotomous judgement of fluent, non-fluent, or mixed by SLPs. These results, together with data from the literature, indicate that it is time to re-consider use of the WAB-R fluency scale for classification of aphasia. It is also premature, at present, to rely on machine learning to rate spoken language fluency.

Neuromyelitis Optica Spectrum Disorder: Case Description and Information for Speech-Language Pathologists

Neuromyelitis optica spectrum disorder (NMOSD) is an acquired neurological disorder primarily affecting physical and visual functioning. There is a lack of empirical evidence in the existing literature about the nature of speech, language, and cognitive deficits associated with NMOSD. Hence, this case study provides assessment information about a 32-year-old female diagnosed with NMOSD who was administered the following formalized tests via teleconference: the Apraxia Battery for Adults–2nd edition, Cognitive Linguistic Quick Test, and Western Aphasia Battery-Revised. The participant, classified as having anomic aphasia, demonstrated good auditory and reading comprehension, writing difficulties, apraxia of speech, and mild difficulties with cognitive tasks requiring writing.