Article

Clinical use of linguistic discourse analysis for the assessment of language in aphasia

Aphasiology

October 2016
31(10):1-22

DOI:10.1080/02687038.2016.1239013

Authors:

Lucy Bryant

University of Technology Sydney

Elizabeth L Spencer

University of Newcastle Australia

Alison Ferguson

Background: Linguistic discourse analysis is an assessment method widely applied within aphasia research literature to examine impairments as they affect the language of daily function—discourse. Although this literature suggests that clinical applications do occur, it also identifies barriers that may inhibit the translation of research to practice. Aims: This study aimed to identify the frequency of use and methods of linguistic discourse analysis application by speech pathologists when assessing their clients with aphasia. Methods & Procedures: A survey was distributed electronically to speech pathologists in five English-speaking countries using the online survey management tool Survey Monkey®. Clinical applications of linguistic discourse analysis were examined using descriptive statistics and cross-tabulation analyses. Outcomes & Results: Of 123 valid survey results, 106 clinicians reported use of linguistic discourse analysis to assess language in aphasia. Respondents collected language elicited in conversational contexts and expositional discourse samples most often, and subjected these samples to a range of linguistic measures. Most clinicians applied a judgement-based method of analysis based on clinical observation. Clinicians reported positive attitudes towards the use of linguistic discourse analysis, but were limited from widespread use by barriers such as a lack of available clinical time. Conclusions: Results revealed that speech pathologists defined and therefore implemented linguistic discourse analysis in a variety of ways. The methods used to elicit, prepare and analyse discourse varied among respondents. Further investigation is warranted to examine the effectiveness of clinical discourse analysis applications and to support the translation of evidence-based research methods to clinical practice.

Expanding the scope: multimodal dimensions in aphasia discourse analysis—preliminary findings

Article

Full-text available

Sep 2024
FRONT HUM NEUROSCI

Background Aphasia, resulting from acquired brain injury, disrupts language processing and usage, significantly impacting individuals’ social communication and life participation. Given the limitations of traditional assessments in capturing the nuanced challenges faced by individuals with aphasia, this study seeks to explore the potential benefits of integrating multimodal communication elements into discourse analysis to better capture narrative proficiency in this population. Objective This study examined how incorporating multimodal communication elements (e.g., physical gestures, writing, drawing) into discourse analysis may affect the narrative outcomes of persons with aphasia compared to those observed using methods that exclude multimodal considerations. Methods Participants included individuals with chronic aphasia and age-and education-matched healthy controls who completed a storytelling task—the Bear and the Fly story. Macrolinguistic scores were obtained using verbal-only and multimodal scoring approaches. Additionally, the frequency and type of multimodal communication use during storytelling were examined in relation to aphasia characteristics. Statistical analyses included both within-group and between-group comparisons as well as correlational analyses. Results Individuals with aphasia scored significantly higher in terms of their macrolinguistic abilities when multimodal scoring was considered compared to verbal-only scoring. Within the aphasia group, there were prominent differences noted in macrolinguistic scores for both fluent and nonfluent aphasia. Specifically, both groups scored higher on Main Concepts when multimodal scoring was considered, with the nonfluent group demonstrating significantly higher Main Concept and total macrolinguistic rubric scores in multimodal scoring compared to verbal scoring on the storytelling task. Additionally, aphasia severity showed moderate positive correlations with total macrolinguistic scores, indicating that individuals with less severe aphasia tended to produce higher quality narratives. Lastly, although persons with aphasia used different types of nonverbal modalities (i.e., drawing, writing), the use of meaning-laden gestures was most predominant during storytelling, emphasizing the importance of multimodal elements in communication for individuals with aphasia. Conclusion Our preliminary study findings underscore the importance of considering multimodal communication in assessing discourse performance among individuals with aphasia. Tailoring assessment approaches based on aphasia subtypes can provide valuable insights into linguistic abilities and inform targeted intervention strategies for improving communication outcomes.

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

Article

Apr 2024
CLIN NEUROPSYCHOL

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. Conclusions: 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.

Adaptation and Reliability of the Cinderella Story Retell Task in Canadian French Persons Without Brain Injury

Article

Full-text available

Sep 2023
AM J SPEECH-LANG PAT

Purpose Main concept (MC) analysis is a well-documented method of discourse analysis in adults with and without brain injury. This study aims to develop a MC checklist that is culturally and linguistically adapted for Canadian French speakers and examine its reliability. We also documented microstructural properties and provide a normative reference in persons not brain injured (PNBIs). Method Discourse samples from 43 PNBIs were collected. All participants completed the Cinderella story retell task twice. Manual transcription was performed for all samples. The 34 MCs for the Cinderella story retell task were adapted into Canadian French and used to score all transcripts. In addition, microstructural variables were extracted using Computerized Language Analysis (CLAN). Intraclass correlation coefficients were computed to assess interrater reliability for MC codes and microstructural variables. Test–retest reliability was assessed using intraclass correlations, Spearman's rho correlations, and the Wilcoxon signed-ranks test. Bland–Altman plots were used to examine the agreement of the discourse measures between the two sessions. Results The MC checklist for the Cinderella story retell task adapted for Canadian French speakers is provided. Good-to-excellent interrater reliability was obtained for most MC codes; however, reliability ranged from poor to excellent for the “inaccurate and incomplete” code. Microstructural variables demonstrated excellent interrater reliability. Test–retest reliability ranged from poor to excellent for all variables, with the majority falling between moderate and excellent. Bland–Altman plots illustrated the limits of agreement between test and retest. Conclusions This study provides the MC checklist for clinicians and researchers working with Canadian French speakers when assessing discourse with the Cinderella story retell task. It also addresses the gap in available psychometric data regarding test–retest reliability in PNBIs. Supplemental Material https://doi.org/10.23641/asha.24171087

Test–Retest Reliability of Microlinguistic Information Derived From Spoken Discourse in Persons With Chronic Aphasia

Article

Full-text available

Jun 2023
J SPEECH LANG HEAR R

Purpose The purpose of this study was to characterize test–retest reliability of discourse measures across a battery of common tasks in individuals with aphasia and prospectively matched adults without brain damage. Method We collected spoken discourse during five monologue tasks at two timepoints (test and retest; within 2 weeks apart) in an aphasia group (n = 23) and a peer group with no brain damage (n = 24). We evaluated test–retest reliability for percentage of correct information units, correct information units per minute, mean length of utterance, verbs per utterance, noun/verb ratio, open/closed class word ratio, tokens, sample duration (seconds), propositional idea density, type–token ratio, and words per minute. We explored reliability's relationship with sample length and aphasia severity. Results Rater reliability was excellent. Across tasks, both groups demonstrated discourse measures with poor, moderate, and good reliability, with the aphasia group having measures demonstrating excellent test–retest reliability. When evaluating measures within each task, test–retest reliability again ranged from poor to excellent for both groups. Across groups and task, measures that appeared most reliable appeared to reflect lexical, informativeness, or fluency information. Sample length and aphasia severity impacted reliability, and this differed across and by task. Conclusions We identified several discourse measures that were reliable across and within tasks. Test–retest statistics are intimately linked to the specific sample, emphasizing the importance of multiple baseline studies. Task itself should be considered an important variable, and it should not be assumed that discourse measures found to be reliable across several tasks (averaged) are likewise reliable for a single task. Supplemental Material https://doi.org/10.23641/asha.23298032

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

Article

Full-text available

May 2023
AM J SPEECH-LANG PAT

Purpose 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. Method 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. Results 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). Conclusions 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.

Choosing Discourse Types That Align With Person-Centered Goals in Aphasia Rehabilitation: A Clinical Tutorial

Article

Full-text available

Mar 2023

Purpose People with aphasia and their families want rehabilitation services that improve real-world communication. Thus, clinicians and researchers have increased focus on discourse-level interventions and outcome measures, most often using monologue tasks to assess discourse production and guide treatment planning. However, communication in everyday life usually involves participating in conversational discourse. This mismatch raises concern because the literature indicates that different types of discourse possess different linguistic and interactional characteristics and that the communication skills of people with aphasia vary across different types of discourse. In order to provide appropriate, client-centered services, speech-language pathologists (SLPs) need resources that outline the linguistic and interactional characteristics of each type of discourse. Few user-friendly materials of this sort exist. This tutorial aims to equip clinicians with essential foundational knowledge regarding features of narrative, procedural, and expository monologue, as well as conversation, to aid in the design of discourse-level interventions specific to each individual's discourse needs. Method This tutorial provides an overview of the research regarding the structure and function of commonly assessed and treated forms of discourse, along with findings regarding the varied and unpredictable communicative performance of people with aphasia across the different types of discourse. We then provide practical applied clinical examples to illustrate the literature findings. Conclusion Given the differences between types of discourse, when SLPs include discourse in a client's treatment program, the types of discourse activities the client wants to address should align very closely with the types of discourse assessed and treated in the clinic room.

Digital Assessment of Acquired Alexia and Agraphia: On the Relevance of Written Discourse

Article

Full-text available

May 2022

The digital revolution has created challenges as well as opportunities for people with acquired reading (= alexia) and writing (= agraphia) impairments. Although it is difficult to validly assess written discourse, it is imperative that people with alexia and agraphia (PwAA) receive reliable diagnostics for the following reasons: (1) discourse in written and oral forms is highly relevant to daily interaction and participation, but there are no established tests or diagnostic procedures to assess written discourse; (2) reliable diagnostic measures are a prerequisite for any language rehabilitation, especially for the complex skills needed for written discourse; and (3) the continuing trend in digitalization offers new opportunities for easily collecting and assessing written discourse via digital means. In our manuscript, we highlight the relevance of written discourse for social participation and in the digital world and argue that in order to improve social participation in general and digital participation in particular for PwAA, remote assessment of written discourse abilities can be the basis for speech and language therapy treatment focused on communicative abilities.

How Do Clinicians Judge Fluency in Aphasia?

Article

Full-text available

Mar 2022
J SPEECH LANG HEAR R

Purpose Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency. Method In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic. Results Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments. Conclusions This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets. Supplemental Material https://doi.org/10.23641/asha.19326419

Access to context-specific lexical-semantic information during discourse tasks differentiates speakers with latent aphasia, mild cognitive impairment, and cognitively healthy adults

Article

Full-text available

Jan 2025
FRONT HUM NEUROSCI

Purpose Mild language impairments experienced by adults with neurogenic communication disorders are often difficult to detect due to the lack of sensitive traditional performance-based measures. This is problematic since many adults who have mild language deficits experience daily activity and participation limitations that are undetected and not managed. This study evaluates the potential for variables derived through core lexicon analysis to differentiate two clinical groups (latent aphasia, MCI) from each other, and from a cognitively healthy adult group, across three different discourse tasks (Aim 1). Innovatively, it also contrasts the sensitivity with which each task differentiates the groups based on this metric (Aim 2). Methods Transcribed connected speech data from TalkBank were analyzed for three discourse tasks (i.e., Sandwich Procedure, Cat Rescue Picture Description, and Cinderella Story) from three participant groups [Mild Cognitive Impairment (MCI) n = 30, stroke-induced latent aphasia n = 29, and Cognitive Healthy Adults (CHA) n = 56]. Aim 1 used one-way ANOVAs (or non-parametric equivalents) to identify differences in lexical variables (total number of core lexical items; proportion of core lexical items out of all words produced; and rate of core lexical items produced per second) between participant groups. Aim 2 used linear discriminant analysis with cross validation to characterize the sensitivity of discourse task in identifying lexical variables differentiating the participant groups. Results Univariate analysis revealed significant differences among the three participant groups. During the Cinderella task, the latent aphasia and MCI groups produced significantly fewer core lexical items than CHAs, while their proportion of core lexical items to total tokens was higher than CHAs. The latent aphasia group produced core lexical items more slowly than the MCI group for all three discourse tasks. Finally, individuals with latent aphasia produced significantly fewer core lexical items during the Sandwich task than either the MCI or CHA groups. Aim 2’s sensitivity analysis revealed that number of core lexical items produced during the Cinderella task best differentiated the MCI group from CHAs, number of core lexical items produced during Sandwich best differentiated latent aphasia from CHAs, and core lexical items per second during Cinderella best differentiated latent aphasia from MCI. Conclusion Our study suggests that the Cinderella story is more sensitive than a picture description task for demonstrating the subtle lexical-semantic changes in MCI and latent aphasia compared to CHAs. Core lexicon appears to be a sensitive discourse metric to identify linguistic differences between CHAs and individuals with mild cognitive and/or language deficits. These findings further support calls to provide speech/language and cognitive therapy to individuals with MCI and/or latent aphasia.

A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study

Article

Full-text available

Jun 2024
PLOS ONE

Background Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. Objectives This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. Methods This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. Results The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. Conclusions Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. Trial registration Clinical trials registration: NCT05847023 (clinical trials.gov).

FOQUSAphasia: An Initiative to Facilitate Research of Spoken Discourse in Aphasia and Its Translation into Improved Evidence-based Practice for Discourse Treatment

Chapter

Feb 2024

A web-based application for eliciting narrative discourse from Greek-speaking people with and without language impairments

Article

Full-text available

Mar 2023

In this paper we present a web-based data collection method designed to elicit narrative discourse from adults with and without language impairments, both in an in-person set up and remotely. We describe the design, methodological considerations and technical requirements regarding the application development, the elicitation tasks, materials and guidelines, as well as the implementation of the assessment procedure. To investigate the efficacy of remote elicitation of narrative discourse with the use of the technology-enhanced method presented here, a pilot study was conducted, aiming to compare narratives elicited remotely to narratives collected in an in-person elicitation mode from ten unimpaired adults, using a within-participants research design. In the remote elicitation setting, each participant performed the tasks of a narrative elicitation protocol via the web application in their own environment, with the assistance of an investigator in the context of a virtual meeting (video conferencing). In the in-person elicitation setting, the participant was in the same environment with the investigator, who administered the tasks using the web application. Data were manually transcribed, and transcripts were processed with Natural Language Processing (NLP) tools. Linguistic features representing key measures of spoken narrative discourse were automatically calculated: linguistic productivity, content richness, fluency, syntactic complexity at clausal and inter-clausal level, lexical diversity, and verbal output. The results show that spoken narratives produced by the same individuals in the two different experimental settings do not present significant differences regarding the linguistic variables analyzed, in sixty six out of seventy statistical tests. These results indicate that the presented web-based application is a feasible method for the remote collection of spoken narrative discourse from adults without language impairments in the context of online assessment.

Validation of an Automated Procedure for Calculating Core Lexicon From Transcripts

Article

Full-text available

Aug 2022
J SPEECH LANG HEAR R

Purpose The aim of this study was to advance the use of structured, monologic discourse analysis by validating an automated scoring procedure for core lexicon (CoreLex) using transcripts. Method Forty-nine transcripts from persons with aphasia and 48 transcripts from persons with no brain injury were retrieved from the AphasiaBank database. Five structured monologic discourse tasks were scored manually by trained scorers and via automation using a newly developed CLAN command based upon previously published lists for CoreLex. Point-to-point (or word-by-word) accuracy and reliability of the two methods were calculated. Scoring discrepancies were examined to identify errors. Time estimates for each method were calculated to determine if automated scoring improved efficiency. Results Intraclass correlation coefficients for the tasks ranged from .998 to .978, indicating excellent intermethod reliability. Automated scoring using CLAN represented a significant time savings for an experienced CLAN user and for inexperienced CLAN users following step-by-step instructions. Conclusions Automated scoring of CoreLex is a valid and reliable alternative to the current gold standard of manually scoring CoreLex from transcribed monologic discourse samples. The downstream time saving of this automated analysis may allow for more efficient and broader utilization of this discourse measure in aphasia research. To further encourage the use of this method, go to https://aphasia.talkbank.org/discourse/CoreLexicon/ for materials and the step-by-step instructions utilized in this project. Supplemental Material https://doi.org/10.23641/asha.20399304

Méthode d’analyse des pauses pour l’évaluation de troubles cognitifs subtils appliquée au Cancer-Related Cognitive Impairment. Method for the analysis of pauses for assessing subtle cognitive impairment applied to Cancer-Related Cognitive Impairment.

Article

Full-text available

Dec 2024

Background. Speech analysis can detect subtle cognitive impairment, particularly because prosody contains fine elements, such as pauses, which might be behavioral markers of NeuroCognitive Disorders. However, the absence of simple, detailed methods compromises the feasibility of such an analysis in clinics. Mild Neurocognitive Disorders (mNCD) refer to a cognitive change reported by an individual whose autonomy is preserved. This terminology covers many underlying pathophysiologies, such as Cancer-Related Cognitive Impairment (CRCI). CRCI is an mNCD characterized by a memory complaint (e.g., "I forget what I’m told") and a language complaint (e.g., "I search for my words") for which the frequency and intensity exceed the scores of speech-language tests or neuropsychological tests. The lack of sensitive tools to detect this subtle impairment often leads to its underdiagnosis. New methods such as speech analysis are needed to assess CRCI. Objectives. The study aims are (i) to propose a method for analyzing pauses which is practical in clinical context, (ii) to identify participants with CRCI using this method. Methods. Thirteen participants post breast cancer and thirteen healthy controls were included in the study. The participants were instructed to tell a picture-based story. Their narratives were recorded, then automatically transcribed with Whisper and analyzed using SPPAS and Praat software. Silent pauses, filled pauses (e.g., "uh"), and sustained vowels (e.g., "a smaall boy") were annotated, then examined on JASP for a statistical analysis. Results. The duration of silent pauses in post-cancer participants was significantly longer than that of the controls. However, the duration of filled pauses and sustained vowels did not show a significant difference between the two groups. Similarly, the rate of pauses (i.e., number of occurrences/total speech duration) did not show a significant difference between the two groups. Conclusions. This study provides a well-described method for pause analysis designed for the purpose of clinical context. The results suggest that the duration of silent pauses is a good marker for differentiating post-cancer participants from controls.

Linguistic Markers of Subtle Cognitive Impairment in Connected Speech: A Systematic Review

Article

Full-text available

Nov 2024
J SPEECH LANG HEAR R

Purpose This systematic review covers the current stage of research on subtle cognitive impairment with connected speech. It aims at surveying the linguistic features in use to single out those that can best identify patients with mild neurocognitive disorders (mNCDs), whose cognitive changes remain underdiagnosed. Method We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and proposed a full definition of features for the analysis of speech features. Fifty-one studies met the inclusion criteria. Most of them focused on age-related progressive diseases and included fewer than 30 subjects. Results A total of 384 features labeled with 335 different names was retrieved, yielding various results in discriminating individuals with mNCDs from controls. Conclusions This finding highlights the need for harmonized labels to further investigate mNCDs with linguistic markers. We suggest two different ways of assessing a feature's reliability. We also point out potential methodological issues that remain to be resolved, along with recommendations for reproducible research in the field.

The Flu-ID: A New Evidence-Based Method of Assessing Fluency in Aphasia

Article

Full-text available

Oct 2024
AM J SPEECH-LANG PAT

Purpose Assessing fluency in aphasia is diagnostically important for determining aphasia type and severity and therapeutically important for determining appropriate treatment targets. However, wide variability in the measures and criteria used to assess fluency, as revealed by a recent survey of clinicians (Gordon & Clough, 2022), results in poor reliability. Furthermore, poor specificity in many fluency measures makes it difficult to identify the underlying impairments. Here, we introduce the Flu-ID Aphasia, an evidence-based tool that provides a more informative method of assessing fluency by capturing the range of behaviors that can affect the flow of speech in aphasia. Method The development of the Flu-ID was based on prior evidence about factors underlying fluency (Clough & Gordon, 2020; Gordon & Clough, 2020) and clinical perceptions about the measurement of fluency (Gordon & Clough, 2022). Clinical utility is maximized by automated counting of fluency behaviors in an Excel template. Reliability is maximized by outlining thorough guidelines for transcription and coding. Eighteen narrative samples representing a range of fluency were coded independently by the authors to examine the Flu-ID's utility, reliability, and validity. Results Overall reliability was very good, with point-to-point agreement of 86% between coders. Ten of the 12 dimensions showed good to excellent reliability. Validity analyses indicated that Flu-ID scores were similar to clinician ratings on some dimensions, but differed on others. Possible reasons and implications of the discrepancies are discussed, along with opportunities for improvement. Conclusions The Flu-ID assesses fluency in aphasia using a consistent and comprehensive set of measures and semi-automated procedures to generate individual fluency profiles. The profiles generated in the current study illustrate how similar ratings of fluency can arise from different underlying impairments. Supplemental materials include an analysis template, extensive guidelines for transcription and coding, a completed sample, and a quick reference guide. Supplemental Material https://doi.org/10.23641/asha.27078199

The Relationship Between Executive Functioning and Narrative Language Abilities in Aphasia

Article

Full-text available

Aug 2024
AM J SPEECH-LANG PAT

Purpose Although individuals with aphasia commonly exhibit challenges in executive functioning (EF) and spoken discourse, there is limited research exploring connections between these abilities within this specific population. Therefore, this study investigated the relationship between verbal and nonverbal EF and narrative productions in aphasia using a multilevel linguistic approach. Method Participants included 22 persons with aphasia (PWA) and 24 age- and education-matched, neurologically healthy controls (NHC). All participants completed assessments for EF and a story retelling task. Narrative samples were analyzed for microlinguistic (productivity, lexical and syntactic features, semantic content, word and sentence errors) and macrolinguistic (coherence, informational content, organization, and language use) characteristics. Correlational analyses were employed to explore the relationships among narrative variables. EF factors, extracted from principal component analysis, were used as predictive variables in hierarchical stepwise regression analyses to evaluate their role in predicting narrative performances of PWA and NHC. Results Relative to NHC, PWA exhibited impaired narrative performance affecting both microlinguistic and macrolinguistic levels. Breakdowns at the structural level (i.e., reduced productivity, syntax, lexical retrieval, and diversity) correlated with impaired story completeness, organization, and connectedness; this relationship was more prominent for PWA. Three EF factors representing (1) verbal EF, (2) verbal and nonverbal fluency, and (3) nonverbal EF were extracted. Factors 1 and 2 largely predicted narrative performance, whereas Factor 3 (i.e., nonverbal EF) contributed prominently to predicting macrolinguistic discourse performance in both groups although accounting for less variance in the data. Overall, lower EF scores, particularly verbal EF variables, predicted poor narrative performance in both groups. Conclusions Our results indicate that both linguistic and extralinguistic cognitive abilities play a role in story retelling performances among PWA. Notably, both verbal and nonverbal EF skills were found to be correlated with narrative abilities. However, the extent of their contributions varied depending on the discourse levels assessed. These findings provide a significant contribution to our understanding of the cognitive factors associated with breakdowns in discourse among PWA and highlight the importance of comprehensive assessment of EF and discourse within this population. Supplemental Material https://doi.org/10.23641/asha.26485627

The Case of the Cookie Jar: Differences in Typical Language Use in Dementia

Article

Full-text available

Aug 2024
J ALZHEIMERS DIS

Background Findings from language sample analyses can provide efficient and effective indicators of cognitive impairment in older adults. Objective This study used newly automated core lexicon analyses of Cookie Theft picture descriptions to assess differences in typical use across three groups. Methods Participants included adults without diagnosed cognitive impairments (Control), adults diagnosed with Alzheimer’s disease (ProbableAD), and adults diagnosed with mild cognitive impairment (MCI). Cookie Theft picture descriptions were transcribed and analyzed using CLAN. Results Results showed that the ProbableAD group used significantly fewer core lexicon words overall than the MCI and Control groups. For core lexicon content words (nouns, verbs), however, both the MCI and ProbableAD groups produced significantly fewer words than the Control group. The groups did not differ in their use of core lexicon function words. The ProbableAD group was also slower to produce most of the core lexicon words than the MCI and Control groups. The MCI group was slower than the Control group for only two of the core lexicon content words. All groups mentioned a core lexicon word in the top left quadrant of the picture early in the description. The ProbableAD group was then significantly slower than the other groups to mention a core lexicon word in the other quadrants. Conclusions This standard and simple-to-administer task reveals group differences in overall core lexicon scores and the amount of time until the speaker produces the key items. Clinicians and researchers can use these tools for both early assessment and measurement of change over time.

Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features

Article

Full-text available

Apr 2024
AM J SPEECH-LANG PAT

Purpose Speech fluency has important diagnostic implications for individuals with poststroke aphasia (PSA) as well as primary progressive aphasia (PPA), and quantitative assessment of connected speech has emerged as a widely used approach across both etiologies. The purpose of this review was to provide a clearer picture on the range, nature, and utility of individual quantitative speech/language measures and methods used to assess connected speech fluency in PSA and PPA, and to compare approaches across etiologies. Method We conducted a scoping review of literature published between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Forty-five studies were included in the review. Literature was charted and summarized by etiology and characteristics of included patient populations and method(s) used for derivation and analysis of speech/language features. For a subset of included articles, we also charted the individual quantitative speech/language features reported and the level of significance of reported results. Results Results showed that similar methodological approaches have been used to quantify connected speech fluency in both PSA and PPA. Two hundred nine individual speech-language features were analyzed in total, with low levels of convergence across etiology on specific features but greater agreement on the most salient features. The most useful features for differentiating fluent from nonfluent aphasia in both PSA and PPA were features related to overall speech quantity, speech rate, or grammatical competence. Conclusions Data from this review demonstrate the feasibility and utility of quantitative approaches to index connected speech fluency in PSA and PPA. We identified emergent trends toward automated analysis methods and data-driven approaches, which offer promising avenues for clinical translation of quantitative approaches. There is a further need for improved consensus on which subset of individual features might be most clinically useful for assessment and monitoring of fluency. Supplemental Material https://doi.org/10.23641/asha.25537237

Development of main concept and core lexicon checklists for the original and modern Cookie Theft stimuli

Article

Apr 2024

Correct Information Unit Analysis in Different Discourse Tasks Among Persons With Anomic Aphasia Based on Mandarin AphasiaBank

Article

Full-text available

Dec 2023
AM J SPEECH-LANG PAT

Purpose This study aimed to explore how well persons with anomic aphasia communicate information during discourse regarding quantity, quality, and efficiency compared to neurotypical controls, to investigate the influence of discourse tasks on informativeness and efficiency and to examine impact factors like aphasia severity and cognitive ability. Method Language samples of four discourse tasks from 31 persons with anomic aphasia and 31 neurotypical controls were collected from Mandarin AphasiaBank. Correct information unit (CIU) analysis measures including the total number of CIUs, percentage of CIUs, CIUs per minute, and words per minute were calculated. Group differences and the effects of discourse tasks on informativeness and efficiency were investigated. Correlations of CIU analysis measures with aphasia severity and cognitive ability were examined. Results Persons with anomic aphasia showed lower efficiency in conveying information than controls. They underperformed controls on all CIU analysis measures when executing story narrative tasks. Discourse tasks influenced the informativeness and efficiency of both groups. Neurotypical controls delivered the greatest quantity of information most efficiently when narrating stories. Persons with anomic aphasia exhibited reduced quantity of information during procedural discourse and displayed superior information quality in sequential-picture descriptions. Discourse information may be impacted by aphasia severity and cognitive ability, with varying effects depending on the task. Conclusions Persons with anomic aphasia are inefficient in communicating discourse messages and perform poorly on all measures in story narratives. When measuring discourse information, the effects of discourse tasks and factors like aphasia severity and cognitive ability should be considered.

Collaborative Commentary for Understanding Communication Disorders

Article

Full-text available

Jul 2023
AM J SPEECH-LANG PAT

Purpose The goal of the Collaborative Commentary (CC) system is to make the TalkBank adult clinical databases—including AphasiaBank, DementiaBank, RHDBank, and TBIBank—open to commentary and analysis from the full community of researchers, instructors, students, and clinicians. Method CC allows a group leader to establish a commentary group and invite colleagues or students to join as members of the group. Members can then browse through the transcript database using the TalkBank Browser. When they wish to insert a comment, they click on the utterance line number or drag the cursor across a range of utterances and a window opens to receive the comment. The comment can include open text along with codes selected from a predefined set of codes created by that commentary group. Results CC was released for public use in August 2022. It is being used currently in five research projects and eight classes. An important feature of CC is its ability to evaluate the reliability of coding systems and to sharpen analytic categories. By familiarizing instructors and researchers with the capabilities of CC, we expect to see an increasing usage of CC for a variety of clinical and research applications. Conclusions CC can contribute to a better understanding of connected speech features in aphasia, dementia, right hemisphere disorder, and traumatic brain injury. CC represents an extreme innovation not only for the study of adult neurogenic communication disorders but also for the study of spoken language generally.

Linguistic markers of subtle cognitive impairment in connected speech: A Systematic Review protocol

Preprint

Full-text available

Jun 2023

Introduction: Mild Neurocognitive Disorders (mNCD) are characterized by a subtle decline in cognitive performance. Discourse analysis is a research method that investigates the verbal production of patients and has been used to screen for subtle cognitive impairment. Studies using discourse analysis are, however, rarely replicated. One reason for this is likely to be the lack of consistency across studies regarding the selection and definition of relevant linguistic features. The goal of this review is to identify reliable linguistic markers for the detection of subtle cognitive impairment in connected speech, and generate hypotheses associating these markers with underlying cognitive functions in a given discourse context. Methods and analysis: Following the PRISMA guidelines, we will conduct a systematic review including five databases: PubMed, ScienceDirect, Embase, Web of Science, Google Scholar. We will include articles targeting a population of patients with subtle cognitive impairment, such as Mild Cognitive Impairment. Eligible articles will include at least one connected speech task and an analysis of linguistic features in this task. The data will be classified according to study population, connected speech task, analysed linguistic features, and methods used to compare cases and controls. PROSPERO registration number: CRD42023394729.

Curtin University Discourse Protocol—Adolescent Version (CUDP-A)

Article

Sep 2022

Reframing Aphasia Assessment: A principled and practical approach

Chapter

Full-text available

Mar 2022

Jennifer Thomson

Focus on the principles and practical guidance to semistructured interview / conversation based assessment methodology

Conversation as an Outcome of Aphasia Treatment: A Systematic Scoping Review

Article

Full-text available

Nov 2022
AM J SPEECH-LANG PAT

Purpose Conversation-focused speech-language pathology services are a top priority for people living with aphasia, but little is known about how researchers measure conversation as an outcome of treatment. This scoping review was undertaken to systematically review the evidence regarding the measurement of conversation in aphasia studies and to identify current practices and existing gaps. Method A systematic literature search was conducted for studies published between January 1995 and September 2019 in multiple electronic databases. Covidence software was used to manage search results, study selection, and data charting processes. Data were extracted from each study and then collated and organized to elucidate the breadth of approaches, tools, or procedures oriented to measuring conversation as an outcome and identify gaps in the existing literature. Results The systematic search of the literature resulted in 1,244 studies. A total of 64 studies met inclusion criteria and were included in the review. The review summarizes the various tools and procedures used to measure conversation as an outcome of aphasia intervention, including variations in data collection and analysis procedures. The review also evaluates the quality of conversation measures in terms of psychometric properties and informal measures of validity. There was a total of 211 measures used across the 64 studies. Conclusions While there was no clear measure that was objectively superior, several measures show promise and warrant future exploration. Some of the orientations, conceptualizations, and procedures we have presented can be seen as options that might be included in a future conversation-focused core outcome set. Supplemental Material https://doi.org/10.23641/asha.21514062

Two-Year Longitudinal Evaluation of Community Aphasia Center Participation on Linguistic, Functional Communication, and Quality of Life Measures Across People With a Range of Aphasia Presentations

Article

Full-text available

Oct 2022
AM J SPEECH-LANG PAT

Purpose The purpose of this study was to evaluate potential changes on a hierarchy of language tasks and measures of functional communication and quality of life in a group of people with aphasia (PWA) who attended a community aphasia center for 2 years. A secondary purpose was to determine whether there were any predictors of change. Method Twenty-seven PWA who attended Brooks Rehabilitation Aphasia Center (BRAC) were evaluated on an aphasia battery, confrontation naming, and structured discourse in addition to completing self-reported measures of functional communication and quality of life at three time points: before attending BRAC and after 1 (N = 27) and 2 (N = 20) years of BRAC participation. Twenty-six communication partners who communicated regularly with the PWA completed a questionnaire about their functional communication at the same time points. A mixed linear model was conducted for all dependent variables to determine change over time. Tau-b correlations were conducted between demographic and aphasia-related variables and difference scores for outcome measures that exhibited significant improvements. Results At 1-year testing, significant improvements were observed on the aphasia battery, object and action naming, and all self- and communication partner–reported measures. At 2-year testing, all improvements were maintained except for the self-reported measure of functional communication. Structured discourse showed increases in average number of words, percentage of meaningful words and utterances, and efficiency of meaningful word production after 2 years. No significant correlations were observed between predictor variables and difference scores. Conclusions Participation in aphasia centers can result in significant changes in language, functional communication, and quality of life in people with chronic aphasia. These findings support the importance of aphasia centers in the continuum of care for PWA. Supplemental Material https://doi.org/10.23641/asha.21313689

Building Trust between Speech Pathologists and Interpreters in the Assessment of Aphasia

Article

Oct 2022

Background Where a person with aphasia and the treating speech pathologist come from different linguistic backgrounds, an interpreter is often called upon to facilitate the clinical assessment. Previous research has documented the challenges that multilingual aphasia assessment can pose for both interpreter and speech pathologist. These challenges highlight the importance of interprofessional trust for an effective collaborative partnership. Aim Our aim is to understand how provider-interpreter trust – as an activity-specific practice – develops through interactions in aphasia assessment sessions. Methods & Procedures Extracts from two interpreter-mediated aphasia assessments involving speakers of two different languages (Tagalog and Greek) were selected from a larger corpus. Using interactional sociolinguistic discourse analysis, we identified particular interactional choices and patterns that contributed to the building of rapport and trust between the interpreter and speech pathologist. Outcomes Analysis revealed that participants invoked a range of interactive frames during the assessment sessions. Using the Framework of Provider-Interpreter Trust (Hsieh et al., 2010), we were able to demonstrate how socio-relationally oriented frames and clinically oriented frames can both serve the practice of trust building. Conclusions Interactional features that reflect shared goals between the interpreter and speech pathologist, as well as acknowledgement of professional boundaries, can foster trust. We argue that there is scope for trust to be further enhanced by providing space for the interpreter to offer cultural insights relevant to the speaker’s lifeworld that may be unfamiliar to the speech pathologist. We also argue that much of this work would be best achieved during dedicated pre-session briefings and post-session debriefings.

How do speech–language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice

Article

Full-text available

Sep 2022

Background: Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse-level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech-language pathologists (SLPs) assess and treat discourse after TBI. Aims: To investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations. Methods & procedures: This online survey consisted of 30 questions on SLPs' practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision-making. Participants were recruited through national and international SLP professional bodies, TBI-specific or SLP special-interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses. Outcomes & results: There were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self-monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings. Conclusions & implications: Overall, survey respondents' management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal-based approach. Factors affecting the use of discourse in practice included client-specific factors and needs, availability of time for transcription and analysis, and SLPs' knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision-making for SLPs working in TBI. What this paper adds: What is already known on this subject Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically. What this paper adds to existing knowledge This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents' practice was generally aligned with recommendations, featuring individualized, goal-based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors. What are the potential or actual clinical implications of this work? This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI-specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice.

An analysis of new English words created during COVID-19

Article

Full-text available

Nov 2021

The COVID-19 pandemic affects almost all aspects of life, including social and language aspects. One of the phenomena of language change is the emerging of new words during COVID-19. Taken from a linguistic perspective, this research aims to analyze the new words created during COVID-19, to analyze their meaning of the new words, and how they affect human social life. The method used in this research is discourse analysis using a descriptive qualitative research design. The researchers collected these new English words from social media, books, articles, and news. Findings reveal that there are nineteen new English words created during COVID-19. These new words are now very popular on social media and are used in general conversation. In addition, it suggests that these new words have profoundly affected our social life and also the teaching and learning process of English.

A multimodal approach to coordination in spontaneous conversation

Chapter

Jan 2025

Manon Lelandais

This chapter proposes a constructional framework that includes the verbal, vocal, and gestural modalities to describe coordination in conversation. I suggest a definition for coordination that is not modality-specific, and provide a detailed analysis of two coordinate structures from a corpus of spontaneous speech in British English that illustrates this definition. To assess its implications, a series of exploratory analyses investigating a relationship between discourse sequence type and coordination was carried out. This study is the first step into a new model for coordination that contributes to the development of a cognitive-linguistic approach to multimodal and interactional features of language use.

Heterogeneity of verbal and gestural functions in spoken discourse with MCI

Article

Jun 2024
J NEUROLINGUIST

Context: Previous research has identified a homogeneous language behavior among women speakers with a progressive mild cognitive impairment (MCI). These speakers primarily utilize verbal and non-verbal pragmatic markers with interactive functions to maintain communication with the interlocutor, and this function significantly increases in time. However, the speakers have observed variations, prompting the development of an individualized analysis of the participants’ discursive productions considering neurolinguistic models. Methods: A multimodal and individualized analysis was conducted on five women over 75, diagnosed with progressive MCI, using longitudinal and natural language corpora. The data were processed using transcription tools (i.e., verbal discourse) and annotation tools (i.e., gestures), then subjected to Principal Component Analyses due to the diverse data set and discursive modalities to analyze for each individual. Results & conclusion: The results reveal variations, even specialization, in verbal and gestural pragmatic markers based on cognitive and empathic profiles, as well as certain resilience factors among study participants. Three behavioral patterns emerge among the profiles of amnestic MCI with standard progression, multidomain MCI profiles, and MCI profiles occurring at a very advanced age in the context of good cognitive reserve. These findings encourage further research to characterize MCI as a dynamic and variable diagnostic entity from one individual to another. Additionally, corpus analysis could enable clinicians to assess the discourse of individuals with MCI for diagnostic purposes and evaluate treatments’ effectiveness, especially speech therapy.

Discourse compensation in pathological aging: a view from Alzheimer’s disease

Chapter

Jul 2024

Four dimensions of naturalistic language production in aphasia after stroke

Article

Jun 2024
BRAIN

There is a rich tradition of research on the neuroanatomical correlates of spoken language production in aphasia using constrained tasks (e.g., picture naming), which offer controlled insights into the distinct processes that govern speech and language (i.e., lexical-semantic access, morphosyntactic construction, phonological encoding, speech motor programming/execution). Yet these tasks do not necessarily reflect everyday language use. In contrast, naturalistic language production (also referred to as connected speech or discourse) more closely approximates typical processing demands, requiring the dynamic integration of all aspects of speech and language. The brain bases of naturalistic language production remain relatively unknown, however, in part because of the difficulty in deriving features that are salient, quantifiable, and interpretable relative to both speech-language processes and the extant literature. The present cross-sectional observational study seeks to address these challenges by leveraging a validated and comprehensive auditory-perceptual measurement system that yields four explanatory dimensions of performance—Paraphasia (misselection of words and sounds), Logopenia (paucity of words), Agrammatism (grammatical omissions), and Motor speech (impaired speech motor programming/execution). We used this system to characterize naturalistic language production in a large and representative sample of individuals with acute post-stroke aphasia (n = 118). Scores on each of the four dimensions were correlated with lesion metrics, and multivariate associations among the dimensions and brain regions were then explored. Our findings revealed distinct yet overlapping neuroanatomical correlates throughout the left-hemisphere language network. Paraphasia and Logopenia were associated primarily with posterior regions, spanning both dorsal and ventral streams, which are critical for lexical-semantic access and phonological encoding. In contrast, Agrammatism and Motor speech were associated primarily with anterior regions of the dorsal stream that are involved in morphosyntactic construction and speech motor planning/execution respectively. Collectively, we view these results as constituting a brain-behavior model of naturalistic language production in aphasia, aligning with both historical and contemporary accounts of the neurobiology of spoken language production.

The development of a novel, standardized, norm-referenced Arabic Discourse Assessment Tool (ADAT), including an examination of psychometric properties of discourse measures in aphasia

Article

Jun 2024
INT J LANG COMM DIS

Reem S.W. Alyahya

Background People with aphasia (PWA) typically exhibit deficits in spoken discourse. Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, the available discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use and limited evidence of the psychometric properties of published discourse measurements. Aims (1) To develop a standardized, norm‐referenced, culturally and linguistically appropriate Arabic Discourse Assessment Tool (ADAT); and (2) to examine the psychometric properties of content and construct validity and interrater reliability of different discourse measures elicited using three discourse genres (descriptive, narrative and procedural) in neurotypical control adults and matched PWA. Methods & Procedures Discourse samples were collected using three novel discourse stimuli that are sensitive to the Arabic language and culture from 70 neurotypical control adults and a matched group of 50 PWA. Transcription agreement was assessed. A standard approach was used to evaluate construct validity and interrater reliability for 16 discourse measures that assess fluency, language productivity, information content, lexical–semantics, lexical diversity, grammatical category, grammatical structure and syntactic complexity. Strong measures were identified based on their psychometric properties, and normative data were established on these measures. Discourse performance of PWA was then examined using the newly developed tool (ADAT). Outcomes & Results Transcription agreement was extremely high for all discourse stimuli in both groups. Eight discourse measures were proven to have consistently very high construct validity and consistently very good to excellent reliability across the three stimuli in both neurotypical control and aphasia groups: lexical information units, content information units, words per minute, discourse duration, number of different words, number of complete sentences and proportion of open and closed class words. Norms were established on these measures, and cut‐off scores of impairments were determined. Other measures showed low construct validity and variable or poor reliability across the two groups. Conclusions & Implications The newly developed, standardized, and norm‐referenced tool (ADAT) consist of three discourse stimuli and eight high‐quality discourse measures that assess multiple aspects of spoken discourse and were able to differentiate PWA from neurotypical adults consistently. ADAT also includes normative data and cut‐off impairment scores. The tool has great potential to enhance clinical practice and research with Arabic speakers. Evidence was provided that not all discourse measures are of high quality, as some are vulnerable to differences between raters, discourse stimuli and groups. Clinicians and researchers can use ADAT for accurate aphasia assessments, better management plans and to monitor therapy effectiveness. ADAT can be further validated in other clinical populations with language impairments. WHAT THIS PAPER ADDS What is already known on the subject Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, existing discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use in aphasia, and limited evidence of the psychometric properties of published discourse measurements. What this paper adds to existing knowledge A novel, standardized, norm‐referenced Arabic Discourse Assessment Tool (ADAT) was developed and validated in this study. ADAT was further validated among PWA. The study provides evidence that not all discourse measures are of high quality and thus should not be used with confidence. Specific measures are vulnerable to the type of stimuli, the rater and/or the tested group. On the other hand, eight discourse measures were identified to be reliable between different raters and across different stimuli for the two groups, and they were able to differentiate the discourse performance of PWA from neurotypical control adults. Normative data derived from neurotypical control adults were established on these strong measures, and the performance of PWA was classified as impaired based on these norms. What are the potential or actual clinical implications of this work? The present study provides a novel, standardized, norm‐referenced, validated discourse assessment tool that is culturally and linguistically appropriate for use by Arabic speakers (ADAT). ADAT holds immense potential to enhance clinical practice and research with Arabic speakers. The study also identified strong discourse measures that can be used to assess language productivity, information content, lexical–semantics, lexical diversity, grammatical category, and syntactic complexity for accurate and comprehensive assessments. This will lead to better rehabilitation management by guiding the development of tailored client‐centred interventions. ADAT can be utilized in clinical and research settings in PWA and has the potential to be further validated with other clinical populations.

Reliability of the Brief Assessment of Transactional Success in Communication in Aphasia

Article

May 2024

A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research

Article

Full-text available

Mar 2024
INT J LANG COMM DIS

Background It is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians’ and researchers’ desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation. Aims To use scoping review methodology to identify transcription‐less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: ‘What transcription‐less tools and analysis procedures are available to assess discourse in people with aphasia?’ and included several sub‐questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties. Methods The scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer‐reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. ‘Transcription‐less’ analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review. Main Contribution An overview of the state of transcription‐less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings. Conclusion Transcription‐less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings. What this paper adds What is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech‐language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription‐less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients’ desired outcomes. However, little is known about the current state of transcription‐less discourse analysis, blocking progress. What this paper adds to existing knowledge This study provides an overview of currently available transcription‐less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription‐less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro‐structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription‐less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription‐less procedures are lacking psychometric data including information about validity and reliability. What are the potential or actual clinical implications of this work? Transcription‐less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription‐less discourse analysis to better monitor clients’ desired treatment outcomes.

Clinically Feasible Analysis of Discourse: Current State and Looking Forward

Chapter

Feb 2024

Historical Review of Research in Discourse Deficits and Its Recent Advancement

Chapter

Feb 2024

Brielle C Stark

Discourse Task Type–Specific Linguistic Characteristics in Anomic Aphasia and Healthy Controls: Evidence From Mandarin–Chinese AphasiaBank

Article

Full-text available

Jan 2024
AM J SPEECH-LANG PAT

Purpose This study was designed to examine the hypothesis that discourse task types influence language performance in Mandarin Chinese–speaking people and to reveal the discourse task-specific linguistic properties of persons with anomic aphasia compared to neurotypical controls. Method Language samples from persons with aphasia (n = 31) and age- and education-matched controls (n = 31) across four discourse tasks (sequential-picture description, single-picture description, story narrative, and procedural discourse) were collected from Mandarin AphasiaBank. Task-specific distributions of parts of speech were analyzed using mosaic plots. The main effects of tasks in each group and the between-group differences within each task for several typical linguistic variables were evaluated, including the mean length of utterance, tokens, moving-average type-token ratio, words per minute, propositional density, noun–verb ratio, noun percentage, and verb percentage. Results The results revealed an impact of discourse tasks on most language variables in both groups. In the healthy controls, story narratives yielded the highest total words and lowest verb percentage. In the aphasia group, procedural discourse elicited the fewest total words and densest expressions, whereas their single-picture descriptions had the highest noun–verb ratio. For all tasks, the aphasia group performed worse than the control group in the mean length of utterance, tokens, moving-average type-token ratio, and words per minute. For noun–verb ratio, noun percentage, and verb percentage, only one task (i.e., single-picture description) showed significant between-group differences. Conclusion The selection of discourse tasks should be addressed in assessments and interventions for Mandarin Chinese–speaking individuals with aphasia to obtain more accurate and feasible outcomes.

To make a long story short: A descriptive study of formulaic language use in post-stroke fluent aphasia

Article

Oct 2023

Differences in Connected Speech Outcomes Across Elicitation Methods

Article

Aug 2023

The role of education, concept knowledge, work setting and clinical experience in communication partner training: A survey of Flemish speech and language therapists

Article

Jul 2023
INT J LANG COMM DIS

Background: Aphasia can affect the communication between the person with aphasia (PWA) and the communication partner (CP). It is therefore necessary to support both the PWA and their CPs. Communication partner training (CPT) focuses on training communication between dyads of whom one person has aphasia. Although there is increasing evidence supporting CPT as an effective intervention to improve communication and reduce the psychosocial consequences of stroke, implementation in clinical practice remains limited. Aim: To understand the mechanisms behind the practice-evidence gap currently hindering CPT implementation, this study investigated the role of (1) education, (2) concept knowledge, (3) work setting and (4) clinical experience in CPT. Methods & procedures: Flemish speech and language therapists (SLTs) clinically involved in aphasia rehabilitation were surveyed online regarding CPT. Statistical analyses include descriptive statistics to report survey results and non-parametric group comparisons to investigate the role of the four variables on CPT. Outcomes & results: In this study 72 SLTs were included, of whom 73.61% indicated they deliver CPT but of whom only 43.10% indicated CP presence during therapy. The most frequently identified barriers to CPT delivery were lack of time and CPT-specific knowledge. Other barriers were lack of resources, work setting dependent factors, PWA or CP dependent factors, individual therapy to the PWA being of higher priority, existing CPT methods and interventions being perceived as unclear and feeling uncertain about CPT delivery. Concerning the role of the four variables on CPT delivery, neither education nor concept knowledge had a significant effect on CPT delivery. Work setting and clinical experience did, however, influence CPT delivery. More specifically, CPT delivery and CP presence were higher in the private practice (chronic phase) compared to the other three settings and experienced SLTs deliver CPT more often compared with less experienced SLTs. Conclusions & implications: To reduce the practice-evidence gap, we suggest prioritising the two most frequently identified barriers, that is, lack of time and CPT-specific knowledge. To overcome the time barrier in CPT, we propose implementing automated natural speech analysis to reduce the workload. To enhance CPT-specific knowledge, speech and language therapy curricula should provide more in-depth theory and hands-on practice for CPT. In addition, increased awareness about CPT-specific methods is needed to further support clinical practice. What this paper adds: What is already known on the subject Communication partner training (CPT) is an effective intervention to improve communication and reduce the psychosocial consequences of stroke. Despite this evidence base, a current practice-evidence gap exists. What this study adds This is the first study to characterise CPT delivery in a Flemish cohort of speech and language therapists (SLTs). In addition, on a more international perspective, few studies have investigated the role of education, concept knowledge, work setting and clinical experience in CPT. We found that neither education nor concept knowledge has a significant effect on CPT delivery. CPT delivery and communication partner presence are significantly higher in the private practice compared to the hospital, rehabilitation centre or nursing home settings. Experienced SLTs deliver CPT more often compared with less-experienced SLTs. The two most prominent reported barriers include lack of time and CPT-specific knowledge. What are the clinical implications of this work? This study suggests reducing the practice-evidence gap by alleviating the main barriers identified, that is, lack of time and CPT-specific knowledge. Time-barriers can be addressed by implementing automated natural speech analyses. We additionally advocate for more in-depth theory and hands-on practice for CPT in speech and language therapy curricula.

Applying core lexicon analysis in patients with anomic aphasia: Based on Mandarin AphasiaBank

Article

Mar 2023
INT J LANG COMM DIS

Background: Patients with anomic aphasia experience difficulties in narrative processing. General discourse measures are time consuming and require necessary skills. Core lexicon analysis has been proposed as an effort-saving approach but has not been developed in Mandarin discourse. Aims: This exploratory study was aimed (1) to apply core lexicon analysis in Mandarin patients with anomic aphasia at the discourse level and (2) to verify the problems with core words among people with anomic aphasia. Methods & procedure: The core nouns and verbs were extracted from narrative language samples from 88 healthy participants. The production of core words for 12 anomic aphasia and 12 age- and education-matched controls were then calculated and compared. The correlation between the percentages and the Aphasia Quotients of the revised Western Aphasia Battery was analyzed as well. Outcomes & results: The core nouns and verbs were successfully extracted. Patients with anomic aphasia produced fewer core words than healthy people, and the percentages differed significantly in different tasks as well as word classes. There was no correlation between the core lexicon use and the severity of aphasia in patients with anomic aphasia. Conclusions & implications: Core lexicon analysis may potentially serve as a clinician-friendly manner of quantifying core words produced at the discourse level in Mandarin patients with anomic aphasia. What this paper adds: What is already known on the subject Discourse analyses in aphasia assessment and treatment have increasingly garnered attention. Core lexicon analysis based on English AphasiaBank has been reported in recent years. It is correlated with microlinguistic and macrolinguistic measures in aphasia narratives. Nevertheless, the application based on Mandarin AphasiaBank is still under development in healthy individuals and patients with anomic aphasia. What this paper adds to existing knowledge A Mandarin core lexicon set was developed for different tasks. The feasibility of core lexicon analysis to evaluate the corpus of patients with anomic aphasia was preliminarily discussed and the speech performance of patients and healthy people was then compared to provide a reference for the evaluation and treatment of clinical aphasia corpus. What are the potential or actual clinical implications of this work? The purpose of this exploratory study was to consider the potential use of core lexicon analysis to evaluate core word production in narrative discourse. Moreover, normative and aphasia data were provided for comparison to develop clinical use for Mandarin patients with anomic aphasia.

TBIBank: An International Shared Database to Enhance Research, Teaching and Automated Language Analysis for Traumatic Brain Injury Populations

Article

Jan 2023
ARCH PHYS MED REHAB

Traumatic Brain Injury has been established as a priority research area for public health, affecting an estimated 69 million individuals worldwide each year1. Large scale collaborative datasets may help to better understand this heterogenous and chronic health condition. In this paper we present TBIBank; an innovative digital health resource that aims to establish a shared database for the study of communication disorders after TBI. We provide an overview of the current database, the standard discourse protocol used for the main TBIBank corpus, and the automated language analyses that can enable diagnostic profiling, comparative evaluation of treatment effects and profiling of recovery patterns. We also highlight the e-learning component of the digital health resource as a research translation tool. We conclude with a discussion of the potential research, clinical, and educational applications of TBIBank and future directions for expanding this digital resource.

Voz y discurso en salud mental: esquemas diagnósticos en conflicto en un análisis de caso

Article

Full-text available

Dec 2022

Juan Eduardo Bonnin

En este trabajo presentamos un caso de error de diagnóstico en salud mental que, iniciado en la entrevista de admisión, se prolongó durante un año de tratamiento. Para interpretar las causas de dicho error, y basados en un proceso colaborativo con el equipo de salud mental, utilizamos dos categorías teóricas: “discurso” (entendido como el conjunto de regularidades semióticas y semánticas que se corresponden con un campo social, como en “discurso médico”, etc.) y “voz” (entendida como el producto singular de la articulación entre múltiples discursos a lo largo de la trayectoria biográfica de una persona). Metodológicamente, empleamos las herramientas descriptivas del análisis de la conversación en un corpus heterogéneo que atraviesa las diferentes etapas del diagnóstico y el tratamiento. El análisis muestra el efecto del discurso psicoanalítico, que selecciona algunos aspectos de la voz de la paciente ignorando otros, arribando a un diagnóstico de trastorno de conversión (“histeria”) e impidiendo otro, de afasia progresiva. En el final, se discute el potencial de los estudios de la interacción para el proceso diagnóstico y algunas implicancias del caso para el campo del análisis del discurso.

Validation of Videoconference Administration of Picture Description From the Western Aphasia Battery–Revised in Neurotypical Canadian French Speakers

Article

Full-text available

Nov 2022
AM J SPEECH-LANG PAT

Purpose During the COVID-19 pandemic, clinicians and researchers have increasingly used remote online assessments to pursue their activities, but mostly with tests not validated for videoconference administration. This study aims to validate the remote online administration of picture description in Canadian French neurotypical speakers and to explore the thematic unit (TU) checklist recently developed. Method Spoken discourse elicited through the picture description task of the Western Aphasia Battery–Revised (WAB-R) was collected from Canadian French neurotypical speakers from Québec aged between 50 and 79 years old. Forty-seven participants completed the task in person, and 49 participants completed the task by videoconference. Videos of each discourse sample were transcribed using CHAT conventions. Microstructural variables were extracted using the CLAN (Computerized Language ANalysis) program, whereas thematic informativeness was scored for each sample using TUs. Chi-square tests were conducted to compare both groups on each TU; t tests were also performed on the total score of TUs and microstructural variables. Results Groups were matched on sex, age, and education variables. The t tests revealed no intergroup difference for the total TU score and for the microstructural variables (e.g., mean length of utterances and number of words per minute). Chi-square tests showed no significant intergroup difference for all 16 TUs. Conclusions These findings support remote online assessment of the picnic scene of the WAB-R picture description in Canadian French neurotypical speakers. These results also validate the 16 TUs most consistently produced. The use of videoconference could promote and improve the recruitment of participants who are usually less accessible, such as people using assistive mobility technologies. Supplemental Material https://doi.org/10.23641/asha.21476961

Best practice guidelines for reporting spoken discourse in aphasia and neurogenic communication disorders

Article

Feb 2022

Background Spoken discourse is a fundamental form of communication, yet often disrupted in persons with aphasia and other neurogenic communication disorders. It follows that discourse analysis is important for understanding language, its impairments, and language recovery in these populations. Being a highly interdisciplinary field, discourse analysis would benefit from a set of guidelines (best practices) that help streamline reporting and discussion of discourse specific to populations with neurogenic communication disorders. This would enhance the overall quality of ongoing research by improving replicability, allowing meta-analysis, and supporting implementation in clinical practice. Aims To establish clear reporting guidelines for studies that use spoken discourse analysis in aphasia. Methods & Procedures An e-Delphi survey methodology was used. We identified aphasia and neurogenic communication disorder experts using Boolean search criteria and author consensus, then invited these individuals to participate in an online, three-round survey. The three rounds took place between November 2020 and June 2021. In each round, participants were asked to rank necessity of items on a scale of 1 (“not at all necessary”) to 5 (“extremely necessary”). Participants were instructed to rate based on whether the item was necessary to inform the creation of a minimum reporting guideline. Only participants who responded in the prior round were invited to participate in subsequent rounds. Items that met predetermined consensus criteria for ratings greater than “necessary” were brought forward to each subsequent round. New items were added to each round based on qualitative information collected from participants. Outcomes & Results Items that were rated by ≥ 70% of the participants as “highly necessary” or “extremely necessary” in Round 3 were those deemed as “necessary” to be reported in research, whereas items rated < 70% in Round 3 were deemed as “recommended” to be reported in research. Following Round 3, 16 items were deemed “necessary” to report in research. A further five items were “recommended”. Conclusions Consensus by leading researchers in the field established that 20 reporting items were “necessary” or “recommended” as the minimum information reported across all spoken discourse studies. These items included information about sampling, transcription, and analysis. Adherence to rigorously developed reporting guidelines is important for improving the overall quality and replicability of research in the field. We have archived the current recommendations on the Open Science Framework, which is where updates to the recommendations will also be located (https://osf.io/y48n9/).

Changes in discourse informativeness and efficiency following communication-based group treatment for chronic aphasia

Article

Feb 2022
APHASIOLOGY

Background: Evidence regarding the effect of conversationally based communication group treatment on discourse production in aphasia is limited. Given the rich, complex communication experiences provided in these groups, it seemed plausible that participation in them could result in improvement of simpler aspects of discourse production. Aims: To examine the effects of group communication treatment on the informativeness and efficiency of structured and conversational discourse tasks in adults with chronic aphasia. Methods & Procedures: The data for this study were discourses elicited prospectively from 23 adults with chronic aphasia by Elman & Bernstein-Ellis (1999a) as part of their randomised controlled trial, but never previously transcribed or analyzed. We evaluated changes in discourse informativeness and efficiency at treatment exit and followup with Bayesian generalised linear mixed-effects models. Individual effect sizes at exit and follow-up were estimated and a region-ofpractical- equivalence approach was used to evaluate whether the posterior distributions at each timepoint for each participant were clinically meaningful. Outcomes & Results: Results at the group level revealed that structured discourses became more informative and efficient after treatment, and that this improvement was at least maintained at follow-up. Informativeness of conversational discourse did not change from treatment entry to exit, but there was modest evidence of improvement at follow-up. There was no evidence of change to the efficiency of conversational discourse at either timepoint. There was wide variability in individual response to the treatment. Conclusions: Participation in conversation-based communication group treatment was associated with more informative and efficient structured discourse production and modestly improved informativeness in conversational discourse. Examining individual responses to treatment provided additional insight about the group-level outcomes and provided some clues about factors that might have influenced performance for some of the participants.

Phase I test development for a brief assessment of transactional success in aphasia: methods and preliminary findings of main concepts in non-aphasic participants

Article

Oct 2021

Background One obstacle for clinicians and third-party payers embracing a participation-based framework for assessing and treating aphasia is the dearth of clinically convenient instruments for measuring change in functional communication. Traditional assessments often do not capture subtle improvements in communicative success. However, analyzing conversation and other discourse is too labor intensive to be a useful, practical tool in clinical settings. Aims The purpose of this study was to acquire a set of story-retelling normative references from a sample of non-aphasic volunteers, and to develop checklists for the Brief Assessment of Transactional Success in conversation in aphasia (BATS). Methods & Procedures We examined 768 narratives from a sample of 96 healthy, non-aphasic volunteers from three age cohorts. We focus here on one macrolinguistic measure of discourse analysis, main concepts (MCs), that assesses a person’s ability to convey a story’s gist. Forty-eight narratives were elicited from each of 16 short video and/or audio stimuli from four categories that varied in the degree of reliance on auditory comprehension for story gist. Transcripts were analyzed for MCs using the methods of Richardson and Dalton (2016, 2020). Results Our analysis generated checklists, including essential elements of MCs that were produced by at least 33% of the normative sample, along with examples of alternative productions. Reference thresholds were established for “non-normal” scores falling below the 5% quantile in the ratio of an MC composite score to the number of MCs (MCComp/MCs). Similar to earlier studies, a younger third of participants produced narratives that were scored significantly higher in the ratio of MCComp/MCs. Whereas we have hypothesized that the non-verbal video stimuli would ultimately prompt the most accurate and complete narratives in aphasic narrative retells, in the current non-clinical sample, we expected and found that the narrated stimuli were more likely to elicit accurate and complete main concepts. Conclusions The next phase of development will involve testing the stimuli on a large clinical sample to acquire: 1) aphasic narratives; 2) topic-constrained conversations with non-aphasic conversation partners to establish intersubjectivity regarding story gist; and 3) conversation partner narratives. It is hoped that the BATS will become a popular, free, and accessible tool for clinicians and clinical researchers. Utilizing these short, engaging video/audio clips and checklists of MCs will help to narrow the chasm between standardized aphasia batteries and an elusive measure of communicative success.

The Internet Journal of Epidemiology How to identify information bias due to self-reporting in epidemiological research

Article

Full-text available

Jan 2009

Reality can be distorted in many ways when seen through a questionnaire or an interview. Such distortions may be systematic, introducing bias. Bias can spoil research by indicating false associations or failing to detect true relationships. It is practically impossible to eliminate measurement errors totally, but estimating the extent of disagreement and assessing whether the errors are systematic should be a priority in epidemiological research. The aim of this article is pedagogically oriented. Through Medline searches and cross-references, 1400 articles were identified, of which 53 were chosen. This review gives an overview of information bias, focusing on recall period, selective recall, social desirability, interview situation and interviewing tools, question phrasing, alternative answers and digit preference. We use a problem identification approach and also present some possible solutions, exemplifying the different topics by research conducted in the fields of HIV-AIDS, nutrition and alcohol abuse. Methods for measuring bias are presented.

Current practices regarding discourse analysis and treatment following non-aphasic brain injury: A qualitative study

Article

Full-text available

Jun 2015

Discourse production deficits are a common feature of non-aphasic brain injury (NABI). However, little is known about current practices of speech-language pathologists in the assessment and treatment of discourse production deficits following NABI. A phenomenological approach of inquiry was used to examine the experiences of speech-language pathologists in the assessment and treatment of individuals with NABI, with a particular focus on discourse production deficits. Nine speech-language pathologists participated in semi-structured individual interviews. Participants identified common discourse production deficits and hypothesized about the impact on a person's quality of life. However, external influences negatively impacted participants' practice regarding discourse assessment and treatment. External influences included time constraints, lack of standardized data, and the lack of formalized education regarding discourse assessment and treatment. These findings suggest that there is a discrepancy between speech-language pathologists' values and their actual clinical practice related to the analysis and implementation of treatment for discourse production deficits.

Beyond narrative: Is there an implicit structure to the way in which adults organise their discourse?

Article

Full-text available

Mar 2015
CLIN LINGUIST PHONET

Understanding the structure of discourse in healthy adults is fundamental to the assessment and diagnosis of discourse level impairments in clinical populations and the development of effective treatment regimes. Exploring discourse genre in healthy speakers that extend beyond the traditional narrative is equally paramount in facilitating maximum impact of clinical interventions in everyday speaking contexts. This study aimed to characterise the discourse of 30 healthy adult speakers across three age groups (20-39, 40-59 and 60+ years) and four discourse genres (recount, procedural, exposition and narrative), drawing on discourse frameworks used in classroom teaching. A clinically useful discourse protocol and analytic procedure using SALT was developed that profiled the macrostructure and key aspects of linguistic microstructure of the different genres, exploring coherence and cohesion within and across genre in a systematic manner. Analyses considered whether there were differences in coherence and cohesion among the different age groups, different genres and specific topics. Results showed that, while individual variability was present, healthy adults structured their discourse consistently, adhering to the frameworks described in the developmental literature, across all four genres. Significant age differences were only seen in the amount of information contained in the body of the discourse (i.e. events, steps or statements offered) with older participants offering less information. This dataset will enable comparisons to be drawn with clinical populations to determine the utility and the feasibility of the use of this framework for diagnosis and intervention.

Clinician survey of language sampling practices in Australia

Article

Full-text available

Jan 2014

A national online survey was used to investigate spontaneous language sampling and analysis practices by speech-language pathologists working with children and adolescents. A total of 257 responses were received from clinicians around Australia. Results indicated that spontaneous language samples are collected on a routine basis in elicitation contexts deemed appropriate to the clients' age or developmental stage. However, language samples were generally short, often not recorded, and analysed informally. Consistent with previous research into language sampling practices, the main barrier to more detailed language sample analysis appears to be the time needed for transcription. Despite rapid technological advances in the last two decades, only 12.5% of the respondents reported using computer-assisted transcription and analysis procedures. Suggestions are made on how to promote change in clinical practice to ensure spontaneous language samples are transcribed and analysed in more detail. By transcribing the samples, detailed analysis of children's language performance can be undertaken, allowing for effective goal-setting and assisting in objective progress measuring during and following intervention.

A simple system for the organization of turn-taking im conversation

Article

Full-text available

The CHILDES project: tools for analyzing talk

Article

Full-text available

Jan 2000

Brian Macwhinney

Language research thrives on data collected from spontaneous interactions in naturally occurring situations. However, the process of collecting, transcribing, and analyzing naturalistic data can be extremely time-consuming and often unreliable. This book describes three basic tools for language analysis of transcript data by computer that have been developed in the context of the "Child Language Data Exchange System (CHILDES)" project. These are: the "CHAT" transcription and coding format, the "CLAN" package of analysis programs, and the "CHILDES" database. These tools have brought about significant changes in the way research is conducted in the child language field. They are being used with great success by researchers working with second language learning, adult conversational interactions, sociological content analyses, and language recovery in aphasia, as well as by students of child language development. The tools are widely applicable, although this book concentrates on their use in the child language field, believing that researchers from other areas can make the necessary analogies to their own topics. This thoroughly revised 2nd edition includes documentation on a dozen new computer programs that have been added to the basic system for transcript analysis. The most important of these new programs is the "CHILDES" Text Editor (CED) which can be used for a wide variety of purposes, including editing non-Roman orthographies, systematically adding codes to transcripts, checking the files for correct use of "CHAT," and linking the files to digitized audio and videotape. In addition to information on the new computer programs, the manual documents changed the shape of the "CHILDES/BIB" system--given a major update in 1994--which now uses a new computer database system. The documentation for the "CHILDES" transcript database has been updated to include new information on old corpora and information on more than a dozen new corpora from many different languages. Finally, the system of "CHAT" notations for file transcript have been clarified to emphasize the ways in which the codes are used by particular "CLAN" programs. The new edition concludes with a discussion of new directions in transcript analysis and links between the "CHILDES" database and other developments in multimedia computing and global networking. It also includes complete references organized by research topic area for the more than 300 published articles that have made use of the "CHILDES" database and/or the "CLAN" programs. LEA also distributes the "CLAN" programs and the complete "CHILDES" Database--including corpora from several languages and discourse situations--described in "The CHILDES Project." Be sure to choose the correct platform (IBM or Macintosh) for the "CLAN" programs; the "CHILDES" Database CD-ROM runs on both platforms.

Transcription-less analysis of aphasic discourse: A clinician's dream or a possibility?

Article

Full-text available

Mar 2007

Background: Discourse analysis as a clinical tool in speech and language therapy remains underused, at least partly because of the time-consuming nature of the process of transcription that currently precedes it. If transcription-less discourse analysis were valid and reliable, then there would be the clinical opportunity to use this method in order to describe a person's communication impairment (for example aphasia), to help plan therapy and to measure outcomes. Aims: This study aimed to address the potential of transcription-less discourse analysis as a valid and reliable procedure for the measurement of gesture use, topic use, turn taking, repair, conversational initiation, topic initiation, and concept use. Methods & Procedures: Ten individuals with aphasia were audio- and video-recorded participating in a number of discourse tasks from three different discourse genres (conversation, procedural, and picture description). With the same analytical frameworks, the resulting data were compared using transcription-based discourse analysis and a transcription-less method in which the analysis was made directly from the recordings. Outcomes & Results: Validity was measured by comparing transcription-based and transcription-less analyses. Overall the results from that comparison demonstrated the potential of the latter method - none of the measures gave significant differences between scores from the two methods. The main (non-significant) disparities related to some aspects of gesture use and repair. The inter-rater reliability of the transcription-less method was also acceptable in general. Reliability was measured by the intraclass correlation coefficient (ICC) for the continuous measurements: it was strongest for the gesture totals and varied among the attributes of turn taking and repair. For the categorical measures (topic and conversation initiation and concept analysis) the percentage agreement was very good. Conclusions: These results indicate the potential availability of a valid and reliable transcription-less approach to analysis that speech and language therapists can apply to analyse their clients' discourse.

Presence, Completeness, and Accuracy of Main Concepts in the Connected Speech of Non-Brain-Damaged Adults and Adults With Aphasia

Article

Full-text available

Feb 1995
J SPEECH LANG HEAR R

A standard rule-based system was used to evaluate the presence, accuracy, and completeness of main concepts in the connected speech of 20 non-brain-damaged adults and 20 adults with aphasia. Main concepts form a skeletal outline of the most important information (or "gist") in a message. The interjudge and intrajudge reliability of the main concept scoring system and the test-retest stability of scores were acceptable. The non-brain-damaged group produced significantly more Accurate/complete main concepts, and significantly fewer Accurate/incomplete, Inaccurate, and Absent main concepts than the group with aphasia. However, when the performance of individual subjects was evaluated, what best discriminated the performance of subjects with aphasia from that of non-brain-damaged subjects was not the number of main concepts they failed to mention but the accuracy and completeness of the main concepts they did produce. Measures of main concept production may be a clinically useful complement to other measures of communicative informativeness and efficiency.

Speech Sample Size and Test-Retest Stability of Connected Speech Measures for Adults With Aphasia

Article

Full-text available

Apr 1994
J SPEECH LANG HEAR R

The effect of speech sample size on the test-retest stability of two measures of connected speech—words per minute (WPM) and percent of words that are correct information units (Percent CIUs)—was evaluated. A standard set of 10 stimuli was used to elicit connected speech from 20 non-brain-damaged adults and 20 adults with aphasia. Each subject’s responses to the 10 stimuli were transcribed and scored for WPM and Percent CIUs. Then each subject’s responses to the 10 stimuli were randomly divided to produce smaller speech samples representing his or her responses to 1, 2, 3, 4, 5, and 7 stimuli. The test-retest stability of the WPM and Percent ClUs measures was then evaluated for each of the smaller sample sizes and for the complete 10-stimulus sample. For both groups, the test-retest stability of the two measures increased as sample size increased, with the greatest increases occurring as samples increased in size from those representing 1 stimulus to those representing 4 or 5 stimuli, with smaller increases in stability thereafter. In general, these results suggest that the best balance between high test-retest stability and the time and effort required to transcribe and score speech samples can be achieved with samples representing 4 or 5 stimuli (an average of 300 to 400 words for aphasic subjects), although this will vary across individuals.

A System for Quantifying the Informativeness and Efficiency of the Connected Speech of Adults With Aphasia

Article

Full-text available

Apr 1993
J SPEECH LANG HEAR R

A standardized rule-based scoring system, the Correct Information Unit (CIU) analysis, was used to evaluate the informativeness and efficiency of the connected speech of 20 non-brain-damaged adults and 20 adults with aphasia in response to 10 elicitation stimuli. The interjudge reliability of the scoring system proved to be high, as did the session-to-session stability of performance on measures. There was a significant difference between the non-brain-damaged and aphasic speakers on each of the five measures derived from CIU and word counts. However, the three calculated measures (words per minute, percent CIUs, and CIUs per minute) more dependably separated aphasic from non-brain-damaged speakers on an individual basis than the two counts (number of words and number of CIUs).

Treatment and Generalization of Complex Sentence Production in Agrammatism

Article

Full-text available

Jun 1999
J SPEECH LANG HEAR R

The present study applies single-subject experimental design to examine (a) the acquisition and generalization of complex sentence production in agrammatism using Linguistic Specific Treatment (LST) and (b) the utility of syntactic theory in guiding hypotheses of treatment effects. LST trains construction and production of complex sentence structures. Four sentence types were selected for study: object clefts and object-extracted matrix and embedded questions (which are noncanonical with wh-movement), and embedded actives (which are canonical with no overt movement). All sentences contain overt material in the complementizer phrase (CP) of the syntactic tree. Three of five participants (1, 2, and 3) demonstrated generalization from object cleft treatment to production of matrix questions. Thus, LST was effective in improving their ability to generate less complex sentences with wh-movement. Once production of object clefts and matrix questions was acquired, all 5 participants demonstrated generalization from treatment to improved production of embedded questions and/or embedded actives. This generalization involved improved ability to generate embedded clausal structure to form complex sentences but continuing inability to express overt material in CP. Finally, direct treatment for embedded questions did not result in accurate production of embedded actives or vice versa. There were no trends across participants toward improved production of morphosyntactic behaviors in narrative. Persons 1, 2, and 3 showed generalization to increased informativeness and efficiency of expression and were judged by independent listeners to improve in content, coherence, and fluency of spontaneous production. The remaining two participants showed no change or a decline in performance in narrative language production (4 and 5, respectively). These participants demonstrated more severe Broca's aphasia at pretesting compared to Persons 1, 2, and 3, with greater impairments in auditory comprehension, naming, and reading. Etiology and size of lesion did not appear to account for the different behavioral patterns. This study supports the use of LST, which applies syntactic theory to predict patterns of generalization, as an effective treatment approach.

Discourse sampling in the 21st century

Article

Full-text available

Apr 2001
J COMMUN DISORD

Leanne Togher

This paper examines the importance of evaluating discourse in individuals with a neurogenic language disorder. Discourse analysis is acknowledged as an important tool for speech-language pathologists, although it is often not the assessment tool of choice due to its apparent time-consuming nature and the overwhelming number of options available. The wide range of analyses available to clinicians such as the number of T-units and total words produced or Pragmatic Protocol checklists make it difficult to choose assessment measures. Even more difficult is the decision of where to direct treatment efforts. This paper aims to show that there are a number of levels of discourse analysis available to clinicians and that it is possible to sample a number of different genres in a clinical setting. The significance of the communication partner's contribution is discussed, particularly with regard to the limitations of the therapeutic interaction and the need to assess clients with a range of communication partners. The discourse opportunities we make available to people with communication problems will influence what is possible for them. To achieve this, the benefits of a theory of linguistic analysis, namely, Systemic Functional Linguistics (SFL) [Halliday, M. A. K. (1994). An introduction to functional grammar (2nd ed.). London: Edward Amold.] will be explored.

Discourse Analysis

Book

Jul 1983

Discourse analysis is a term that has come to have different interpretations for scholars working in different disciplines. For a sociolinguist, it is concerned mainly with the structure of social interaction manifested in conversation; for a psycholinguist, it is primarily concerned with the nature of comprehension of short written texts; for the computational linguist, it is concerned with producing operational models of text-understanding within highly limited contexts. In this textbook, first published in 1983, the authors provide an extensive overview of the many and diverse approaches to the study of discourse, but base their own approach centrally on the discipline which, to varying degrees, is common to them all - linguistics. Using a methodology which has much in common with descriptive linguistics, they offer a lucid and wide-ranging account of how forms of language are used in communication. Their principal concern is to examine how any language produced by man, whether spoken or written, is used to communicate for a purpose in a context.

Designing and conducting mixed methods research

Book

Jan 2011

Language-oriented treatment: A psycholinguistic approach to aphasia

Chapter

Mar 2012

Linguistic analysis of discourse in aphasia: A review of the literature

Article

Mar 2016

This review examined previous research applications of linguistic discourse analysis to assess the language of adults with aphasia. A comprehensive literature search of seven databases identified 165 studies that applied linguistic measures to samples of discourse collected from people with aphasia. Analysis of methodological applications revealed an increase in published research using linguistic discourse analysis over the past 40 years, particularly to measure the generalisation of therapy outcomes to language in use. Narrative language samples were most frequently subject to analysis though all language genres were observed across included studies. A total of 536 different linguistic measures were applied to examine language behaviours. Growth in the research use of linguistic discourse analysis and suggestions that this growth may be reflected in clinical practice requires further investigation. Future research directions are discussed to investigate clinical use of discourse analysis and examine the differences that exist between research and clinical practice.

Data processing: Transcriptional and impressionistic methods

Chapter

Jan 2013

Assessment practices of speech-language pathologists for cognitive communication disorders following traumatic brain injury in adults: An international survey

Article

Aug 2014

Primary objective: This study's objective was to examine the current assessment practices of SLPs working with adults with acquired cognitive communication impairments following a TBI. Methods and procedures: Two hundred and sixty-five SLPs from the UK, the US, Canada, Australia and New Zealand responded to the online survey stating the areas of communication frequently assessed and the assessment tools they use. Main outcomes and results: SLPs reported that they routinely assessed functional communication (78.8%), whereas domains such as discourse were routinely assessed by less than half of the group (44.3%). Clinicians used aphasia and cognitive communication/high level language tools and tools assessing functional performance, discourse, pragmatic skills or informal assessments were used by less than 10% of the group. The country and setting of service delivery influenced choice of assessment tools used in clinical practice. Conclusions: These findings have implications for training of SLPs in a more diverse range of assessment tools for this clinical group. The findings raise questions regarding the statistical validity and reliability of assessments currently used in clinical practice. It highlights the need for further research into how SLPs can be supported in translating current evidence about the use of assessment tools into clinical practice.

The Recording of Audio and Video Data

Chapter

Jan 2012

Stuart Cunningham

The Western Aphasia Battery

Article

Jan 1982

Andrew Kertesz

Genre, verb, and coherence in picture‐elicited discourse of adults with aphasia

Article

Feb 2006

Gloria Streit Olness

Background: Discourse coherence is derived, in part, from the relationship between and among words and sentences. In studies of aphasia, the relationship between discourse‐level and sentence‐level phenomena may be examined through the verb. In clinical picture elicitations of discourse, the nature of the pictures or the accompanying elicitation instructions may influence the discourse genre of the response (descriptive vs narrative), which in turn may place different linguistic demands (e.g., verb production demands) on the speaker with aphasia. Aims: This study explores aphasic speakers' partial construction of discourse coherence through relationships between and among action, background, and setting information carried largely by the verb, in picture‐elicited discourse productions of two different genres: descriptive and narrative. Methods & Procedures: Twelve individuals with aphasia of mild to moderate severity were presented with five pictures: two composite and three complex. Verbal discourse responses were elicited with common clinical instructions. For the three complex pictures, discourse was also elicited with instructions that explicitly requested temporal sequencing. Discourse genre (descriptive vs narrative) of each response was determined. Verbs within each response were categorised on dimensions of form (tense) and function (degree of association with storyline). Outcomes & Results: For common clinical elicitations, discourse genre was descriptive, verb tense was present and/or non‐finite, and verbs filled background and setting functions, regardless of picture type. For elicitations that requested temporal sequencing, participants produced more narrative discourse genre, and more past tense and storyline function on verbs. Exceptions to the group patterns are discussed and exemplified. Conclusions: The patterns of group results and the exceptions to these patterns provide insights into the relationship between the discourse and sentence levels, and the ability of individuals with aphasia to negotiate this relationship in their discourse productions. Findings also hold methodological implications for sampling discourse production among individuals with aphasia. This study is part of a larger project supported by the National Institute on Deafness and Other Communication Disorders, grant number 1 R03 DC005151, and the Callier Center for Communication Disorders at the University of Texas at Dallas.My sincere thanks to the dedicated participant volunteers and to the organisations that have referred participants to date: Baylor Institute for Rehabilitation; Callier (Dallas) Aphasia Group; Community Partners Program (a collaborative programme of the University of Texas at Dallas and Baylor Institute for Rehabilitation); Department of Assistive and Rehabilitative Services – Division for Determination Services; Friendship West Baptist Church; HealthSouth Dallas Medical Center; HealthSouth Plano Medical Center; Methodist Dallas Medical Center; Mobility Foundation Stroke Center, UT Southwestern Medical School; North Texas Stroke Survivors (Patrick Boland); Parkland Hospital and Healthcare System; South Dallas Communication Groups Program (UTD Center for Brain Health) with St. John Missionary Baptist Church, Jubilee United Methodist Church, St. Paul AME, and St. Luke’s “Community” UMC; The Stroke Center – Dallas; the University of North Texas Speech and Hearing Center Adult Communication Therapy Program; and the University of Texas at Dallas, Communication and Learning Center. I acknowledge Beverly Richardson Moshay for her conscientious approach to interviews with participants; Alison Lee, Brooke Long, and Gretchen Melpolder for their careful attention to data transcription; and Jessica Donnaway for her contributions to the reliability analyses.

Aphasic discourse analysis: The story so far

Article

Sep 2000

Elizabeth Armstrong

This paper provides a critical review of the literature currently available relating to aphasic discourse. It outlines the major approaches which have been taken to analysis, differentiating the structuralist and functionalist frameworks in particular and discusses the resultant gap existing in aphasiology research between microstructural linguistic aspects of discourse and macrostructural/pragmatic aspects. Studies addressing lexical, syntactic, semantic, pragmatic and conversational aspects of discourse, as well as those focusing on specific aspects such as cohesion and text macrostructure are discussed and placed in a theoretical perspective. The different methodologies involved in the various studies are critically examined, with implications for using different elicitation techniques in particular discussed.

Aphasia rehabilitation in Australia: Current practices, challenges and future directions

Article

Jun 2013

This study reports on current aphasia rehabilitation practices of speech-language pathologists in Australia. A 30-item web-based survey targeted approaches to aphasia rehabilitation, education, discharge, follow-up practices, counselling, interventions to improve communication access, community aphasia support services, and challenges to practice. One hundred and eighty-eight surveys were completed representing ˜ 33% of the potential target population, with 58.5% urban and 41.5% rural participants across all states and territories. Respondents reported embracing a wide variety of approaches to aphasia rehabilitation; however, significant challenges in providing aphasia management in acute and residential care were identified. Low levels of knowledge and confidence were reported for both culturally and linguistically diverse clients and discourse approaches. Group and intensive services were under-utilized and clinicians reported inflexible funding models as major barriers to implementation. Few clinicians work directly in the community to improve communicative access for people with aphasia. Despite the chronic nature of aphasia, follow-up practices are limited and client re-entry to services is restricted. Counselling is a high frequency practice in aphasia rehabilitation, but clinicians report being under-prepared for the role. Respondents repeatedly cited lack of resources (time, space, materials) as a major challenge to effective service provision. Collective advocacy is required to achieve system level changes.

Multi-level discourse analysis: A feasible approach

Article

Mar 2007

Sue Sherratt

Background: The analysis of discourse has now become commonplace but the focus continues to be on discrete aspects or levels of discourse processing. Although this has provided the necessary groundwork, investigating the relationships and interconnections between these levels continues to be stressed. Recently, some studies have formulated multi-level discourse-processing theories and models that explain these inter-relationships and that identify the sub-processes involved in producing discourse. This study has used one such model to analyse different levels of discourse and investigate the interconnections between them. Aims: To assess the applicability and utility of using a multi-level discourse-processing model to examine the interaction between levels of discourse produced by individuals without brain damage. Methods & Procedures: A total of 14 narrative and procedural discourse samples were elicited from 32 non-brain-damaged males of different ages and socioeconomic status groups, yielding a total of 394 samples. These samples were analysed in terms of seven broad features (comprising 23 measures), relating to the levels of the multi-level discourse model. The correlations between these measures were determined using the Spearman's rho correlation test. Outcomes & Results: From the clustering of correlations, a number of fruitful relationships were revealed. Greater relevance was related to more appropriate discourse grammar as well as greater cohesion and syntactic complexity. Longer samples were correlated with an increased proportion of cohesive ties, cohesive errors, and syntactic complexity. An increase in non-specific elements was related to reduced syntactic complexity and cohesion. A higher occurrence of left-branching clauses was associated with increased dysfluency. These correlations are explained in terms of the multi-level discourse model. Conclusions: Three conclusions can be drawn. First, using a multi-level discourse-processing model can offer a more realistic perspective of discourse than the analysis of individual aspects. The differential diagnosis of relatively similar discourse impairments (e.g., following head injury, dementia, right brain damage) may ultimately rely on a comparison of the relative deficits at different levels. Second, certain discourse features that can be assessed more objectively (e.g., the number and type of conjunctions) can signal a breakdown at a more conceptual discourse level (e.g., the linking of propositions to each other at a semantic level). Third, these correlations can provide explanatory information regarding more subjective concepts that are difficult to define and measure (e.g., the perception of "relevance" relates to more structured discourse at the macro and micro level). Although this approach to discourse is challenging, it can provide a starting point for more productive investigations of discourse.

What people with aphasia want: Their goals according to the ICF

Article

Mar 2011
APHASIOLOGY

Background: The goals of people with aphasia should guide service delivery. Services are increasingly influenced by the International Classification of Functioning, Disability and Health (ICF) (WHO, 200145. World Health Organisation (WHO) . 2001. International classification of functioning, disability and health (ICF), Geneva, Switzerland: World Health Organisation. View all references), but little is yet known about whether the goals of people with aphasia span the full spectrum of the ICF. Aims: The purpose of this study was to describe the goals of people with aphasia and to code the goals according to the ICF. Methods & Procedures: A qualitative descriptive research approach was used involving semi-structured in-depth interviews with 50 participants with aphasia post-stroke. Interviews were videotaped and transcribed verbatim and then analysed using qualitative content analysis. The goals of a 30% consecutive subsample were then coded using the ICF. Outcomes & Results: Nine broad categories of goals were identified. Participants with aphasia wanted to return to their pre-stroke life and to communicate not only their basic needs but also their opinions. They also wanted information about aphasia, stroke, and available services; more speech therapy; greater autonomy; and dignity and respect. They identified the importance of engagement in social, leisure, and work activities as well as regaining their physical health. Interestingly, their goals included wanting to help others. Goals could be linked to all ICF components within the ICF, with the majority linked to Activities and Participation, followed by Environmental Factors, Body Functions and Structures, and Personal Factors. Conclusions: People with aphasia in this study were able to articulate a wide range of goals post-stroke that encompassed all of the ICF components but had a particular focus on the Activity and Participation components.

LARSPing by numbers

Article

Jul 2009
INT J LANG COMM DIS

The setting up of reference profiles of children's grammatical development, for clinical use, requires explicit attention to a number of factors which may affect reliability. This paper identifies and discusses three of these: segmentation, scoring and sampling. In addition the issue of the supplementation of LARSP by lexical information is addressed, with exemplification.

About time: A comparison of computerized and manual procedures for grammatical and phonological analysis

Article

Jul 2009

Steven H. Long

The time efficiency of procedures for phonological and grammatical analysis was studied, comparing manual and computerised methods. Participants were 256 students and practising clinicians who had received university-level instruction in the analysis procedures they performed. Phonological analyses included the evaluation of variability, homonymy, word shapes, phonetic inventory, accuracy of production and correspondence between target and production forms. Grammatical analyses included MLU and descriptive statistics, number of syntactic types, LARSP, DSS, and IPSyn. Three phonological samples and three grammatical samples, varying in size and complexity/severity, were analysed. Without exception, computerised analyses were completed faster and with equal or better accuracy than manual analyses. The time needed for both computerised and manual methods was affected by the type of analysis, the type of sample, and the efficiency of individual participants. Nevertheless, the overall findings support the view that non-standardized assessment is feasible even in a busy clinical timetable, if it is done by computer.

Quantitative Analysis of Aphasic Sentence Production: Further Development and New Data

Article

Jun 2000

The narrative production of patients with Broca's aphasia and age-and education-matched control subjects was analyzed using the Quantitative Production Analysis (Saffran et al., 1989), a procedure designed to provide measures of morphological and structural characteristics of aphasic production. In addition to providing data for a larger number of subjects than in the original study, we provide data on interrater and test-retest reliability. The data were also submitted to factor and cluster analyses. Two factors characterized the data and the cluster analysis yielded four sets of patients who performed differently on these factors. In particular, there is evidence that agrammatic patients can differ in their production of free and bound grammatical morphemes, substantiating earlier claims in the literature.

The quantitative analysis of agrammatic production: Procedure and data

Article

Nov 1989

Despite the long-standing interest in structural aspects of aphasic production, no method has emerged for the systematic analysis of aphasic speech. This paper attempts to address that need by outlining a procedure for the quantitative assessment of narrative speech which yields measures for both morphological and structural characteristics of aphasic production. In addition to complete instructions for carrying out this analysis, data for three groups of subjects are presented: agrammatic aphasics, aphasics who are similarly nonfluent but not clinically judged as agrammatic, and normal controls. While the agrammatics were distinguishable from the nonagrammatic patients on most measures, both nonfluent groups showed comparable reductions in the structural complexity of their propositional utterances. Other findings include indications from individual patient data that aspects of grammatical morphology may dissociate in agrammatism.

A multi-level approach to the analysis of narrative language in Aphasia

Article

Nov 2011

Background: Several studies have shown that traditional standardised aphasia tests may not be sensitive enough to adequately assess linguistic deficits and recovery patterns in persons with aphasia. As a result, both functional and structural methods for the analysis of connected language samples from people with aphasia have been devised (see Armstrong, 20001. Armstrong , E. 2000. Aphasic discourse analysis: The story so far. Aphasiology, 14(9): 875–892. [Taylor & Francis Online], [Web of Science ®], [CSA]View all references; Prins & Bastiaanse, 200449. Prins , R. and Bastiaanse , R. 2004. Analysing the spontaneous speech of aphasic patients. Aphasiology, 18(12): 1075–1091. [Taylor & Francis Online], [Web of Science ®]View all references). Aims: The present article focuses on our attempt to provide a comprehensive, multi-level procedure for both structural and functional analysis of narrative discourse produced by speakers with brain damage. Accordingly, we will describe a method for analysis of connected language samples elicited on single picture and cartoon story description tasks. This method has proven sensitive in the assessment of language deficits in many neurogenic populations. Methods & Procedures: A comprehensive description of the language production system, a thorough discussion of the different approaches to discourse analysis in persons with aphasia, and the procedure for the analysis of narrative discourse are detailed. The characteristics of the eliciting stimuli, the procedures for their administration and the transcription of the language samples are carefully explained. The analysis focuses on four main aspects of linguistic processing: productivity, lexical and grammatical processing, narrative organisation, and informativeness. To further illustrate the analytic procedure, two case reports and an appendix with the analysis of a narrative sample are provided. Outcomes & Results: We will provide direct evidence of the usefulness of the multi-level procedure for discourse analysis for assessing changes in discourse performance of two persons with fluent aphasia, with different aetiologies, that were not captured by traditional standardised aphasia tests. Conclusions: The method of analysis presented in this paper has strong grounds in linguistic and psychological theories of linguistic structure and functioning. It also has the advantage of being both quantitative and functional as it captures selective aspects of linguistic processing, and can provide relevant information about the person's communicative and informative skills.

Speech-language pathology services for people with aphasia: A survey of current practice in Australia

Article

Jun 2009

Currently, there is limited information on the nature and extent of speech-language pathology services in Australia for people with aphasia. This article reports on a survey to investigate speech-language pathology practice in Australia. An aim of the research was to identify and describe current practice in relation to the International Classification of Functioning, Disability and Health. Furthermore, the frequency, duration and types of services for people with aphasia, including the clinical approaches to intervention, are reported in the context of national clinical guidelines and evidence-based practice. Survey results from 70 respondents revealed that the provision of intensive speech-language pathology intervention for people with aphasia is most common in the inpatient rehabilitation setting. Individual therapy is provided more than any other type of intervention across the continuum of care. The majority of clinicians reported a functional approach to intervention for aphasia; however, the use of impairment-based assessments was predominantly recorded. The widespread use of the Australian Therapy Outcome Measures (AusTOMs), was an indication that the ICF framework informs outcome measurement in aphasia.

Developmental Sentence Types: A Method for Comparing Normal and Deviant Syntactic Development

Article

Dec 1966

Laura L. Lee

Conversational discourse analysis as a method for evaluating progress in aphasia: A case report

Article

May 1998
J COMMUN DISORD

Larry Boles

The gains made by a woman with Broca's aphasia as documented by traditional measures were paralleled by changes in conversation, including increased verbal output and efficiency, and changes in conversation repair patterns. Her conversational partner decreased her verbal output, as predicted. The progress documented with conversational discourse analysis was not observable from other test measures. Clinical and theoretical implications are discussed.

An investigation of sample size in conversational analysis. Paper presented at the ASHA Convention

D Elia
B Z Liles
R J Duffy
C A Coelho
S A Belanger

Web surveys in official statistics

J Bethlehem

Boston diagnostic aphasia examination

H Goodglass
E Kaplan
B Barresi

Systematic Analysis of Language Transcripts (SALT) (Version Research version

J Miller
A Iglesias

AphasiaBank protocol. TalkBank

Org Talkbank

Clinical use of linguistic discourse analysis for the assessment of language in aphasia

Abstract

No full-text available

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