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Cohesion in the discourse of people with post-stroke aphasia
Abstract
Aphasic discourse has been investigated through two major approaches: a micro-linguistic approach and a macro one, but the separate analysis of the micro and macro aspects of aphasic discourse has led to a noticeable gap between them. Cohesion analysis is one of the possible ways that can directly connect these two aspects. However, few studies have investigated cohesion in aphasic discourse in an integrated manner. The present study employs a mixed-methods approach to examine whether and how patients with fluent and non-fluent stroke-induced aphasia differ from normal individuals in the cohesion of their discourse, aiming to provide a more comprehensive understanding of this issue. We compared the use of cohesive devices in the discourse of 7 non-fluent aphasics (4 males, mean age = 70.9) and 9 fluent aphasics (4 males, mean age = 70.7) against 16 non-aphasic controls (NACs) (8 males, mean age = 71.0). Transcripts were analysed and conclusions were drawn based on the combination of quantitative and qualitative observations. As predicted, discourse by aphasic participants is less cohesive than that by non-aphasic participants and the three groups’ discourse differs from each other in the distribution of cohesion categories, with non-fluent aphasics having more trouble in using grammatical cohesive devices while fluent aphasics more severely affected in constructing lexical cohesion. Results suggest that cohesion in post-stroke aphasic discourse may vary between different aphasia types and thus can be rather complicated. Additional work involving more aphasia types and more dimensions of discourse cohesion is needed to provide further insight into this question.
... In addition, combining multiple discourse tasks and samples has been recommended to improve testretest stability in word-retrieval measures (Boyle, 2014). Various combinations of discourse tasks and samples have been reported to date (e.g., Edmonds & Babb, 2011;Whitworth et al., 2015;Zhang et al., 2020), but no precise combination of discourse tasks has been recommended in post-stroke discourse research to date. ...
... In contrast, Ellis et al. (2005) studied personal retell, and our study included a combination of three discourse samples (i.e., single picture description, personal narrative, and story retell). A recent study (Zhang et al., 2020) reported on the multidimensional aspect of cohesion in post-stroke aphasia discourse performance using a combination of multiple discourse tasks (i.e., nine tasks from AphasiaBank). Results highlighted the complexity of cohesive use in people with chronic aphasia. ...
... Indeed, different profiles of lexical cohesion in non-fluent and fluent aphasia speakers compared to controls have been observed. More precisely, non-fluent speakers have demonstrated less diversity of lexical ties but were not significantly different from controls, whereas fluent aphasia speakers produced significantly fewer lexical ties than controls (Zhang et al., 2020). In our study, when examining the raw data, lexical ties were less frequently used than reference and conjunction ties for all participants, which is consistent with Stockbridge et al.'s (2019) report. ...
Background:
Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery.
Aims:
To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs.
Methods & procedures:
Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24 h; acute: 24-72 h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame.
Outcomes & results:
Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase.
Conclusions & implications:
This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia.
What this paper adds:
What is already known on the subject Multi-level discourse analysis allows for in-depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi-level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post-stroke aphasia recovery. What this paper adds to existing knowledge The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work? This study suggests that multilevel discourse analysis will allow a better understanding of post-stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities.
... Aphasia is a grave symptom of stroke, presenting with language malfunctions including spontaneous speech, repetition, naming, auditory comprehension, reading, and writing [4]. According to epidemiology research, the incidence of aphasia after the first stroke onset ranges from 23% to 38% [5][6][7]. Compared with the nonaphasia poststroke patients, the patient's mortality rate in the hospital is nearly 2 times higher and the hospital stay is 1.6 times longer [8,9]. Chronic aphasia devastates patients' social participation and life quality. ...
Background:
Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study.
Methods:
Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics.
Result:
After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales.
Conclusion:
In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.
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.
In patients with aphasia, there are various language deficits, which are also manifested at the level of discourse. The aim of the research was to describe the discourse of patients with Broca's aphasia and anomic aphasia and to compare their discourses with the discourses of the control groups of the same age, education and gender. The research sample consisted of 34 respondents: 7 patients with Broca's aphasia, 10 patients with anomic aphasia and 17 intact people in the control groups. Discourse samples were elicited, using the narration of the Cinderella story. Discourse analysis focused on three basic areas: productivity and fluency, errors and corrections, cohesion and informativeness. The performances of patients with Broca's and anomic aphasia were significantly weaker in all three analysed areas than the performances of the control groups.
The language of adults with non-Alzheimer’s dementias is still relatively unexplored. This is problematic given that, in the absence of definitive biomarkers, linguistic features have an important role to play in the diagnosis of these dementias. In this article, the performance of adults with primary progressive aphasia during narration of the Cinderella story is examined. The adults were all participants in an investigation of primary progressive aphasia conducted by researchers in the School of Medicine at Johns Hopkins University. Narration of the Cinderella story is a high-level language task which permits a detailed examination of cognitive-linguistic skills to be undertaken. This examination reveals that the narrative impairments of adults with primary progressive aphasia cannot be entirely explained by the structural language deficits of these adults. The sensitivity of the Cinderella story to cognitive-linguistic impairments in primary progressive aphasia warrants the use of this narrative task in the diagnostic evaluation of adults with this form of dementia.
The lexical-grammatical divide has been a widely addressed topic in aphasia. Speech parts are generally classified as either belonging to a lexical or a grammatical category based on the frequency of acquisition of new members in their paradigms (open vs. closed classes), thus neglecting heterogeneity within categories. Such an approach has led to contradictory findings. First, prepositions form closed classes, but are classically taken as lexical items. Pronouns, also belonging to a closed class, are analyzed as grammatical elements. Second, both within the group of prepositions and pronouns, forms with different syntactic and semantic properties co-exist.
Following the theoretical notions granted by a usage-based theory of grammar, the ProGram theory, and taking focalizability as the classification criteria, we hypothesize that individuals with non-fluent aphasias will experience more severe problems with grammatical prepositions and pronouns, given that these elements are secondary and dependent, whereas informants in the fluent group will experience more severe trouble with lexical forms, potentially primary and independent. We focused on the performance of nine Spanish-speaking individuals with aphasia from the Rosell (2005) corpus. Samples of 300 words were transcribed and analyzed. As predicted, grammatical prepositions were found to be more severely compromised in the speech output of individuals with deficits of motor predominance, whereas lexical prepositions are more severely affected in individuals with deficits of sensory predominance. Although less conclusively, the same tendency holds in the case of pronouns. Our results, consistent with previous findings, confirm the heterogeneity of prepositions and pronouns, which should no longer be analyzed en bloc.
The distinction between grammatical and lexical words is standardly dealt with in terms of a semantic distinction between function and content words or in terms of distributional distinctions between closed and open classes. This paper argues that such distinctions fall short in several respects, and that the grammar-lexicon distinction applies even within the same word class. The argument is based on a recent functional and usage-based theory of the grammar-lexicon distinction (Boye & Harder 2012) and on the assumption that aphasic speech data represent the ideal testing ground for theories and claims about this contrast. A theoretically-based distinction between grammatical and lexical instances of Dutch modal verb forms and the verb form 'hebben 'was confronted with agrammatic and fluent aphasic speech. A dissociation between the two aphasia types was predicted and confirmed.
The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.
Background: It has been suggested that individuals with fluent aphasia demonstrate microlinguistic impairments and relatively preserved macrolinguistic abilities (Glosser & Deser, 1990). However, results of a previous study in which measures of sentence production, intersentential cohesion, and story grammar were assessed longitudinally over a period of 12 months did not support this contention (Coelho, Liles, Duffy, Clarkson, & Elia, 1994). In that investigation, as the individual with fluent aphasia recovered severity of aphasia decreased and microlinguistic abilities improved, but macrolinguistic skills remained quite limited.Aims: The present study sought to clarify the discrepancy between these two studies by re-analysing the narrative samples collected by Coelho et al. for adequacy of coherence in order for similar macrolinguistic measures to be compared across studies.Methods & Procedures: Two types of story narratives were elicited from a 55-year-old male with mild-moderate anomic aphasia on a monthly basis over a 12-month period. Story narratives were analysed for local and global coherence, and coherence ratings were compared to the mean performance of three matched non-brain-injured participants.Outcomes & Results: Neither local or global coherence improved appreciably over the 12-month period and both remained moderately impaired, inspite of gains noted in microlinguistic abilities. The individual with fluent aphasia also consistently demonstrated greater difficulties with global than local coherence.Conclusions: This pattern of impaired macrolinguistic abilities, is consistent with that of individuals with Alzheimer's disease and closed head injuries, and suggests that difficulty with discourse organisation may result from focal as well as diffuse brain pathology. These findings suggest the importance of expanding assessment procedures for individuals with aphasia, particularly mild aphasia, to include macrolinguistic dimensions of discourse organisation such as the analysis of coherence and story grammar-and further, that such macrolinguistic abilities need to addressed specifically in language therapy.
Background: Gesture frequently accompanies speech in healthy speakers. For many individuals with aphasia, gestures are a target of speech-language pathology intervention, either as an alternative form of communication or as a facilitative device for language restoration. The patterns of gesture production for people with aphasia and the partici- pant variables that predict these patterns remain unclear.
Aims: We aimed to examine gesture production during conversational discourse in a large sample of individuals with aphasia. We used a detailed gesture coding system to deter- mine patterns of gesture production associated with specific aphasia types and severities. Methods & Procedures: We analysed conversation samples from AphasiaBank, gathered from 46 people with post-stroke aphasia and 10 healthy matched controls all of whom had gestured at least once during a story re-tell task. Twelve gesture types were coded. Descriptive statistics were used to describe the patterns of gesture production. Possible significant differences in production patterns according to aphasia type and severity were examined with a series of analyses of variance (ANOVA) statistics, and multiple regression analysis was used to examine these potential predictors of gesture production patterns.
Outcomes & Results: Individuals with aphasia gestured significantly more frequently than healthy controls. Aphasia type and severity impacted significantly on gesture type in specific identified patterns detailed here, especially on the production of meaning-laden gestures.
Conclusions: These patterns suggest the opportunity for gestures as targets of aphasia therapy. Aphasia fluency accounted for a greater degree of data variability than aphasia severity or naming skills. More work is required to delineate predictive factors.
A number of recent studies have indicated that conversational discourse abdities are preserved in aphasia, at least at the global level. For example, Holland (1982) found that aphasic subjects exhibited communicative success much more frequently than they did communicative Cilure. Schienberg and Holland (1980). in a study of two Wemicke's aphasic subjccts, found that conversational turn-taking behaviour remained intact. Prim (1980) found that aphasic subjects were capable of formulating requests utihzing both verbal and non-verbal strategies.
Background: Important to the assessment of aphasia are analyses of discourse production and, in particular, lexical diversity analyses of verbal production of adults with aphasia. Previous researchers have used type-token ratio (TTR) to measure conversational vocabulary in adults with aphasia; however, this measure is known to be sensitive to sample size, requiring that only samples of equivalent length be compared. The number of different words (NDW) is another measure of lexical diversity, but it also requires input samples of equivalent length. An alternative to these measures, D, has been developed (Malvern & Richards, 1997) to address this problem. D allows for comparisons across samples of varying lengths. Aims: The first objective of the current study was to examine the relationships among three measures of productive vocabulary in discourse for adults with aphasia: TTR, NDW, and D. The second objective was to use these measures to determine in what ways, and to what degree, they each can differentiate fluent and nonfluent aphasia. Methods & Procedures: Eighteen adults with aphasia participated in this study (nine with nonfluent aphasia; nine with fluent aphasia). Participants completed the Western Aphasia Battery (WAB) and produced language samples consisting of conversation and picture description. Samples were then subjected to the three lexical diversity analyses. Outcomes & Results: Results indicated that, although the measures generally correlated with each other, adults with fluent aphasia evidenced significantly higher D and NDW values than those with nonfluent aphasia when whole samples were subjected to analyses. Once samples were truncated to 100- and 200-word samples, groups differed significantly for all three measures. Conclusions: These findings add further support to the notion that because TTR and, although to a lesser extent, NDW are sensitive to sample size, length differences across samples tend to confound results. As an alternative to these measures, the use of D for the measurement of conversational vocabulary of adults with aphasia enables the analysis of entire language samples, so that discarding language sample data is not necessary. In the present study, D values differed for fluent and nonfluent aphasia samples.
Where does grammar come from? How does it develop in children? Developmental psycholinguists who set out to answer these questions quickly find themselves impaled upon the horns of a dilemma, caught up in a modern variant of the ancient war between empiricists and nativists. Indeed, some of the fiercest battles in this war have been waged in the field of child language. Many reasonable individuals in this field have argued for a middle ground, but such a compromise has proven elusive thus far, in part because the middle ground is difficult to define. So let us begin with some definitions. The core of this debate is about epistemology, a branch of philosophy that we can define as “The study of knowledge, its form and source, and the process by which it comes to be. ” Within this framework, empiricism can be defined as “The belief that knowledge originates in the environment and comes into the mind/brain through the
From May to June 2011, during a survey of the wheat-growing areas in Meknes in the Saïs Region of Morocco, several cyst nematode populations were detected. Sampling was performed 1 month before wheat (Triticum durum) harvest, in fields showing patches of stunted plants. Plants were growing poorly, had chlorotic lower leaves, and a reduced numbers of ears. Root systems were short and had a bushy appearance because of increased secondary root production. No cysts were visible on the roots, but were found in the soil. Cysts were collected from soil on 200-µm sieves by the modified Cobb decanting and sieving method (1) and identified by morphology and internal transcribed spacer (ITS)-rDNA sequencing. All isolates were identified as Heterodera avenae except the isolate from Aïn Jemâa. From the latter, key morphological features from cysts and second-stage juveniles (J2) were determined. The cysts (n = 10) had the following characteristics: bifenestrate vulval cone, body length without neck 590 µm (551 to 632 µm), body width 393 µm (310 to 490 µm), neck length 75 µm (65 to 90 µm), fenestra length 64 µm (60 to 72 µm) and width 21 µm (18 to 25 µm), underbridge length 96 µm (85 to 115 µm), vulval slit length 8 µm (7 to 9 µm), vulva bridge width 27 µm (24 to 33 µm), and bullae absent. The J2s (n = 10) had the following characteristics: body length 445 µm (412 to 472 µm), body width 19 µm (19 to 21 µm), stylet length 24 µm (23 to 25 µm), four lateral lines, tail length 50 µm (46 to 54 µm), and hyaline terminal tail 28 µm (24 to 31 µm). Values of the morphological characters were within the range of H. latipons reported by Handoo (3). The bifenestrate cysts with a strong underbridge and no bullae and J2 with a tail length greater than 40 µm, a stylet longer than 15 µm, and four incisures in the lateral field were typical for H. latipons. To confirm the identification, molecular observations were made. DNA was extracted from three juveniles from three different cysts separately (4). The ITS-rDNA region was amplified using the primers 5′-CGT AAC AAG GTA GCT GTA G-3′ and 5′-TCC TCC GCT AAA TGA TAT G-3′ as described by Ferris et al. (2). This resulted in a 1,040-bp DNA fragment. The PCR-products were purified and sequenced (Macrogen, Inc., Seoul, Korea). All sequences obtained (GenBank Accession Nos. per cyst: JQ319035, JQ319036, and JQ319037) were compared with sequences available from the GenBank database (www.ncbi.nlm.nih.gov), including several species of Heterodera. This comparison revealed a sequence similarity of 97 to 99% with H. latipons and 89% or lower with any other species of Heterodera. Morphological and molecular identification demonstrated that the population of cyst nematodes from a wheat field in Aïn Jemâa, Morocco was H. latipons. In the patches with poor growing plants, 65 cysts per 100 cm 3 soil were found. To our knowledge, this detection represents a new record of H. latipons. Since the nematode can cause considerable damage to wheat, one of the main cereals produced in Morocco, care should be taken to prevent the spread to other regions.
Background: Qualitative research methods are still largely untapped, but research has shown that they are appropriate for capturing the complexity of the psychosocial consequences of aphasia. While “single case” research in various guises has been widely utilised, the qualitative case study research design has had quite limited application to the study of aphasia. Aims: The aim of this paper is to outline the characteristics of the qualitative case study research design and to discuss potential applications of this methodology to research of the psychosocial consequences of aphasia. Main Contribution: An overview of the qualitative case study design is presented. The aspects described include case selection, data collection, data analysis, and methods to enhance trustworthiness. Conclusions: It is concluded that qualitative case study research allows the study of complex communication behaviours in context. Its end product is a holistic and intensive description and interpretation of communication. It can answer questions related to how and why communication changes after intervention programmes that address the psychosocial consequences of aphasia. This methodology appears to offer great promise in making significant contributions to the knowledge base and practice of speech‐language pathology with adults and families with aphasia.
BACKGROUND: AphasiaBank is a computerized database of interviews between persons with aphasia (PWAs) and clinicians. By February 2011, the database had grown to include 145 PWAs and 126 controls from 12 sites across the United States. The data and related analysis programs are available free over the web. AIMS: The overall goal of AphasiaBank is the construction of a system for accumulating and sharing data on language usage by PWAs. To achieve this goal, we have developed a standard elicitation protocol and systematic automatic and manual methods for transcription, coding, and analysis. METHODS #ENTITYSTARTX00026; PROCEDURES: We present sample analyses of transcripts from the retelling of the Cinderella story. These analyses illustrate the application of our methods for the study of phonological, lexical, semantic, morphological, syntactic, temporal, prosodic, gestural, and discourse features. MAIN CONTRIBUTION: AphasiaBank will allow researchers access to a large, shared database that can facilitate hypothesis testing and increase methodological replicability, precision, and transparency. CONCLUSIONS: AphasiaBank will provide researchers with an important new tool in the study of aphasia.
Typically, young children diagnosed with specific language impairment (SLI; also called Developmental language disorder, DLD) have been found to show weakness in narrative development, and such weakness has been judged to be unlikely to resolve over time. However, developmental outcomes for adolescents with a prior SLI diagnosis have not been thoroughly studied. In particular, studies on the evaluative aspects of narratives of such persons are almost non-existent. Here we examine the question whether narrative evaluation of adolescents formerly diagnosed with SLI remains problematic into adolescence or comes to resemble more typical narrative performance. We compare the use of evaluative expressions in the narratives of 19 adolescents diagnosed with SLI against 19 typically language developing (TLD) peers. Spoken narratives by the SLI group (Mean age = 14.3; SD = 0.64) and TLD group (Mean age = 14.5; SD = 0.84) using the wordless picture storybook “Frog, where are you?” (https://childes.talkbank.org/access/Clinical-MOR/Conti/Conti4.html) were analysed. Each narrative was coded for evaluative clauses, types of evaluative devices (frames of mind, character speech, hedges, negatives, and causal connectives), as well as evaluative perspectives (global vs. local). Although the quantitative analysis did not reveal any significant differences between the two groups, the qualitative analysis showed certain notable strengths in the narrative skills of the focal group of SLI adolescents. Results suggest that adolescents with a history of SLI may approximate TLD narrative skill in evaluating their own narratives, but additional work with more sensitive measures applied at intervals are needed to illuminate developmental pathways of narrative production and of evaluative capacities in adolescents formerly diagnosed with SLI.
Discourse production is crucial for communicative success and is in the core of aphasia assessment and treatment. Coherence differentiates discourse from a series of utterances/sentences; it is internal unity and connectedness, and, as such, perhaps the most inherent property of discourse. It is unclear whether people with aphasia, who experience various language production difficulties, preserve the ability to produce coherent discourse. A more general question of how coherence is established and represented linguistically has been addressed in the literature, yet remains unanswered. This dissertation presents an investigation of discourse production in aphasia and the linguistic mechanisms of establishing coherence.
The language of adults with non-Alzheimer’s dementias is still relatively unexplored. This is problematic given that, in the absence of definitive biomarkers, linguistic features have an important role to play in the diagnosis of these dementias. In this article, the performance of adults with primary progressive aphasia during narration of the Cinderella story is examined. The adults were all participants in an investigation of primary progressive aphasia conducted by researchers in the School of Medicine at Johns Hopkins University. Narration of the Cinderella story is a high-level language task which permits a detailed examination of cognitive-linguistic skills to be undertaken. This examination reveals that the narrative impairments of adults with primary progressive aphasia cannot be entirely explained by the structural language deficits of these adults. The sensitivity of the Cinderella story to cognitive-linguistic impairments in primary progressive aphasia warrants the use of this narrative task in the diagnostic evaluation of adults with this form of dementia.
This study explored the relationship between Working Memory (WM) and discourse production in people with aphasia, based on data from the AphasiaBank. The dataset comprised the children's story “Cinderella” and basic WM measures of span, collected from 45 participants (15 people with nonfluent Broca's aphasia, 15 people with anomic aphasia, 15 people with fluent Wernicke's aphasia). Discourse samples were coded for and analyzed in terms of content, micro- (words and sentences) and macro- (groups of sentences) linguistic components, known to demonstrate multi-level discourse ability. Comparisons were made among the different participant groups to identify differences and/or commonalities in performance. Results showed that WM, as measured by reduced word and sentential span, influences macrolinguistic narrative components and may be sensitive to aphasia type. Findings were interpreted in terms of a potential deficit to Baddeley's episodic buffer, affecting sequential and hierarchical narrative information processing.
Linguistic Analyses of Aphasic Language represents results from linguistic and neurolinguistic research on aphasic language performance. The contributions encompass all linguistic levels, ranging from phonetics to discourse, and present results on languages other than English. The findings and applied methods are both relevant to the study of aphasia in general and to cross-linguistic analyses. Furthermore, they have clear implications for language and speech therapy and thus show the importance of linguistic concepts for language testing and therapeutic intervention.
A previous study of 10 patients with BrocaÕs aphasia demonstrated that the advantage for producing the past tense of irregular over regular verbs exhibited by these patients was eliminated when the two sets of past-tense forms were matched for phonological complexity (Bird, Lambon Ralph, Seidenberg, McClelland, & Patterson, 2003). The interpretation given was that a generalised pho-nological impairment was central to the patientsÕ language deficits, including their poor performance on regular past tense verbs. The current paper provides further evidence in favour of this hypothesis, on the basis of a detailed analysis of the errors produced by these same 10 patients in reading, repetition, and sentence completion for a large number of regular, irregular, and nonce verbs. The patientsÕ predominant error types in all tasks and for all verb types were close and distant phonologically related responses. The balance between close and distant errors varied along three continua: the severity of the patient (more distant errors produced by the more severely impaired patients); the difficulty of the task (more distant errors in sentence completion > reading > repetition); the difficulty of the item (more distant errors for novel word forms than real verbs). A position analysis for these phonologically related errors revealed that vowels were most likely to be preserved and that consonant onsets and offsets were equally likely to be incorrect. Critically, the patientsÕ errors exhibited a strong tendency to simplify the phonological form of the target. These results are consistent with the notion that the patientsÕ relatively greater difficulty with regular past tenses reflects a phonological impairment that is sensitive to the complexity of spoken forms.
This revised book provides a thorough explanation of the foundation of robust methods, incorporating the latest updates on R and S-Plus, robust ANOVA (Analysis of Variance) and regression. It guides advanced students and other professionals through the basic strategies used for developing practical solutions to problems, and provides a brief background on the foundations of modern methods, placing the new methods in historical context. Author Rand Wilcox includes chapter exercises and many real-world examples that illustrate how various methods perform in different situations. Introduction to Robust Estimation and Hypothesis Testing, Second Edition, focuses on the practical applications of modern, robust methods which can greatly enhance our chances of detecting true differences among groups and true associations among variables. * Covers latest developments in robust regression * Covers latest improvements in ANOVA * Includes newest rank-based methods * Describes and illustrated easy to use software.
Current interest in discourse performance has been motivated by the explanatory power provided by recent developments in discourse grammar. Discourse, unlike sentences, does not have a strict set of rules that specify grammaticality. Nor does discourse have a specified length. Although discourse is often described as a series of connected sentences, it may be a single word, a phrase, a sentence, or an infinite combination of all these forms. The length is specified in terms of communicative function (i.e., discourse is a unit of language that conveys a message). Discourse grammar provides a linguistic description of the properties that contribute to acceptability or well-formedness of discourse. There are several discourse types (e.g., narrative, procedural, expository, and conversational) that differ in structure and information content.
During the last two decades, most psycholinguistic research on aphasia started from the assumption that only elementary linguistic units and regularities are worth studying. According to this view, only these units and regularities are expected to have a specific impact on language production and comprehension of aphasic patients. Furthermore, the study of text and discourse processing can be disregarded for both methodological and theoretical reasons. On one hand, in text there is always complex interaction between numerous elementary linguistic parameters, which prevents a precise specification of the underlying linguistic deficit. On the other hand, those parameters that are unique to text, such as stylistic cohesion, semantic coherence, and narrative form as represented in a story grammar, appear to be irrelevant for understanding aphasia.
Contributions characterizing specific disturbances of discourse or text organization have been rather late and few (for the 1970s see Dressler & Stark, 1976; Engel, 1977; Stachomiak, Huber. Poeck & Kerschensteiner. 1977; for the 1980s see below). Our use of the term “discourse” refers to the American tradition of discourse analysis, and of the term (written or oral) “text” to the German tradition of text linguistics (see Beaugrande & Dressler, 1981; Dijk, 1977a, b; Halliday & Hasan. 1974; for narratives, the main text type studied here, see Reinhart, 1984). The word “specific” relates to the issue of whether there are disturbances of discourse at a higher level than, and beyond, the organization of individual sentences. Particularly we mean by “specific textual disturbances” the:
1.
Written or oral disturbances
a.
Disturbances of various linguistic levels (with possible consequences for the textual level) or
b.
General cognitive disturbances
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Specific aphasic disturbances in general or specific aphasia types in particular
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.
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Background: The label “fluent aphasia” applies to different aphasic syndromes characterised by fluent speech with difficulties in lexical retrieval and/or grammatical processing.
Aims: This study aims at investigating microlinguistic and macrolinguistic skills in persons with fluent aphasia. We hypothesised that their lexical and syntactic (i.e., microlinguistic) difficulties would affect also their narrative (i.e., macrolinguistic) skills.
Methods & Procedures: Growing evidence shows that traditional tests may not be sensitive enough to capture the patterns of the linguistic impairments observed in these persons. Therefore, we used a narrative task to elicit linguistic samples. Spontaneous speech was elicited through a picture description task. The narrative samples were analysed with a multilevel approach that allows clinicians to quantify their productivity levels as well as their lexical, grammatical, and narrative skills. The spontaneous speech produced by a group of 20 persons with fluent aphasia was compared to that of a group of 20 healthy participants. All participants with aphasia were in the phase of neurological stability. The two groups were matched for age and level of formal education.
Outcomes & Results: Results showed that the lexical impairment observed in the group of participants with fluent aphasia hampered the ability to produce well-formed sentences that, in turn, lowered the levels of cohesion of their narrative samples. Furthermore, the reduced levels of lexical informativeness were found correlated also to the production of errors of global coherence.
Conclusions: These findings support the hypothesis that in these patients, microlinguistic difficulties might affect macrolinguistic processing. Furthermore, these results stress the importance of a multilevel approach to assess linguistic skills in patients with fluent aphasia, as it assesses both microlinguistic and macrolinguistic dimensions in parallel. Therefore, it allows linguists, psychologists, and clinicians to observe how the linguistic levels interact during natural language processing.
Much of the recent literature in the field of stuttering has a primary reliance on experimental designs and quantitative analysis. Since human communication is complex and multidimensional, it is difficult to study in an unnatural experimental setting. This paper proposes an alternative methodology for queries into the complex behaviors that are associated with stuttering. Qualitative methodologies have already been used as effective research tools in anthropology, sociology, and several other social sciences. Their emergence in the field of speech-language pathology is recent. The purpose of these paper is to justify the use of qualitative methodologies as an adjunct and/or alternative to more traditional experimental methodologies. Educational Objectives: The reader will learn and be able to (1) describe the objectives of qualitative research, (2) contrast quantitative and qualitative research goals and methods, and (3) list the major strengths and weaknesses of qualitative research.
This study examined the effects of right brain-damage (RBD) on oral discourse production using a multi-layered discourse processing model. Narrative and procedural discourse samples from participants with RBD and no brain damage were analysed in terms of seven broad areas corresponding to the processing levels of the model. Participants also completed attention, cognitive, general communication and RBD assessments. Despite their normal performance on all assessments (except those on attention), the participants with RBD demonstrated statistically significant differences in syntactic complexity, clarity disruptors and dysfluencies, as well as in discourse grammar and clausal structure in the narratives and in cohesion in the procedures. A model-based theoretical explanation accounting for the deficits noted in participants with RBD, together with clinical guidelines, is provided.
Background: It is well known that about 20% of patients with anomic aphasia still show residual aphasic symptoms 1 year post onset. As we do not have any tests to reliably diagnose residual aphasia it is difficult to decide whether these persisting problems are signs of residual aphasia that have to be treated, or are indications of a normal variability in language use, which also may occur in elderly people.Aims: The main aim of this research is to find out whether there are variables in spontaneous communication of persons with residual aphasia (P-RA) that enable us to distinguish them from persons without aphasia (P-NA).Methods & Procedures: Following a detailed linguistic analysis of spontaneous speech we employed binary logistic regression analysis to find the most relevant variables for differentiation between P-RA (N = 41) and P-NA (N = 25).Outcomes & Results: Significant group differences at different processing levels could be observed. Lexically varied, informative, and cohesively tied phrases in particular pose the main problem for P-RA. Regression analysis including variables of spontaneous communication explains 82.5% (R2) of the variation and correctly identifies 39 of 41 (95.1%) cases of P-RA and 21 of 25 (84.0%) cases of P-NA.Conclusions: Analysing spontaneous communication seems to be a promising possibility for diagnosing residual aphasia. The importance of spontaneous communication in everyday interaction, and its sensitivity to even slight deficits in language processing, promote the described analysis as a very useful screening instrument to distinguish P-RA from P-NA.
The quantitative and qualitative use of cohesive ties in the expository discourse of groups of normal young adults, normal older adults, older people with anomic aphasia and older people with probable Alzheimer's Disease (AD) was investigated. Lack of a published suitable diagnostic tool which can differentiate the language disorder of fluent aphasia and the language disorder associated with AD, plus a dearth of normative data concerning the use of cohesion in the above groups, were the main foci of the investigation. It aimed to describe patterns of cohesion for each group, to compare group patterns and to focus specifically on whether any variations in use could significantly differentiate the discourse of people with AD from that of people with anomic aphasia. Discourse samples were subjected to analysis for appropriate and disrupted cohesive ties. Results revealed both quantitative and qualitative differences in the discourse cohesion of the groups, indicating how language use changes through senescence and pathology. Significant differences in the quantity and patterns of use of cohesive ties in the discourse of people with anomic aphasia and people with AD revealed that cohesion analysis can differentiate the language disorders found in these two groups.
Two studies are reported in which the following theory is tested: The agrammatic sentence form which is observed in the spontaneous speech of Broca's aphasics is due to the selection of elliptical syntactic structures in which the slots for many of the closed-class words that occur in complete sentences are lacking. The selection is strategic: Its purpose is to prevent the computational overload that would result if a complete sentence form were attempted. Paragrammatic output, as observed in the spontaneous speech of Wernicke's aphasics, results from a lack of such strategic adaptation - the computational overload now causes morphological errors to occur. For eight properties of normal ellipsis in German, it was predicted that they would be more characteristic of agrammatic than of paragrammatic spontaneous speech. These properties were frequent omission of function words; infrequent omission of inflections; infrequent substitution of function words or inflections; frequent use of the infinitive; frequent omission of the main verb; frequent omission of the grammatical subject; frequent sentence-final position of the verb; frequent use of the strong adjective inflection. A second prediction was that in a sentence elicitation task, where the freedom to avoid the production of grammatical morphemes was limited, the output of the Broca's aphasics would become less agrammatic, i.e. less elliptical in the sense of the features given above. Three groups of aphasics were studied: a group of German-speaking Broca's aphasics, a group of German-speaking Wernicke's aphasics and, for comparison, a group of Dutch-speaking Broca's aphasics. In support of the theory, it was found that except for the omission of bound morphology, the spontaneous speech of the Broca's aphasics was more “elliptical” than that of the Wernicke's aphasics. Furthermore, on these same features, their output became less elliptical in the sentence elicitation task and more similar to the output of the Wernicke's aphasics.
Background: Deficits of executive function (EF) have been proposed as all or part of the underlying mechanisms of language impairment in at least some types of aphasia. Executive functions also play a role in the recovery process. There is evidence that bilingual persons have some executive functioning advantages compared to monolingual persons. In this paper we combine two lines of recent investigation in order to explore the relationship between executive function and conversational strategies in bilingual aphasia.Aims: The aim of this preliminary research was to compare the executive functioning profiles of bilingual individuals to those of monolingual participants with aphasia. A further aim was to examine evidence in the conversational samples of the participants in relation to the application of a range of executive skills and to link cognitive and conversational profiles using Barkley's (1997) model of executive functions.Methods & Procedures: The performance of two bilingual individuals with aphasia on a test battery of executive function tests was compared with that of eight monolingual persons (seven with aphasia and one with right hemisphere damage). The test battery included measures of behavioural inhibition, working memory, problem solving, and reconstitution. The presence or absence of executive features in the conversational samples of the participants was judged by four raters using conversational analysis methods.Outcomes & Results: Significant differences were found between the scores of the bilingual participants and those of the monolingual participants on measures of behavioural inhibition, working memory, planning and problem solving, and reconstitution. The bilingual participants' scores were mostly within normal limits and suggested well‐retained executive functions. Conversation analysis showed evidence of differential application of these executive functions to conversational management. Regardless of severity or type of aphasia, the bilingual participants showed evidence of good topic management, repair, and flexibility compared to the monolingual participants.Conclusions: The results are interpreted in relation to current issues in bilingualism. Our preliminary findings shed light on differential approaches to assessment, therapy, and choice of language for bilingual aphasia.
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.
This study examines the lexical self- and other-repetition and the strategic use of repetition by two aphasic speakers (J and M) with agrammatic and severe word-finding difficulties in group discussions. Whereas the speakers aphasia profiles were rather similar, as defined by clinical testing (Western Aphasia Battery), their use of lexical repetition as a communicative strategy was significantly different. One speaker (speaker M) had more contextually supported words, especially other-repetitions. M sometimes repeated her own lexical elements and elaborated the repetitions morphologically and prosodically and expanded them syntactically. These elaborated and expanded repetitions were attempts at communicative clarity and grammatical acceptability. After encountering problems in production, speaker M used selfand other-repetition both in affective confirmations and in meaning negotiations. Speaker J, on the other hand, did not attempt to produce grammatical well-formed utterances, but relied on his interlocutors interpretations of his turns. Speaker J did not elaborate or expand his one or two word utterances, but frequently repeated fillers and polite idiomatic phrases. He used more self-repetition, typically in confirmations, to express emotion and in turn keeping, and less other-repetition, which only occurred in negotiations to reach mutual understanding. The methods and results are discussed in the framework of the adaptation theory of agrammatism. We suggest that pathological and communicative repetitions form a continuum and that the study of strategic choices can contribute to the development of communicative speech therapy.
This paper describes an investigation of the temporal reliability of analyses of collaborative repair in aphasic conversation. Whilst it has been proposed that conversation analysis has a useful contribution to make to the assessment of aphasia, assessment methods which use natural interaction as a basis for analysis have been assumed to lack reliability because of variability in conversation in contrast to the standardization across assessments possible with formal assessments. This issue was addressed through comparison of quantitative and qualitative analyses of collaborative repair in dyadic conversations recorded on four different occasions between eight people with aphasia and their relatives. Quantitative results revealed significant within-participant variation in the quantity of collaborative repair occurring in the conversations but between-participant variation was of much greater magnitude. The findings of the qualitative analysis indicated reliability in the interactional challenges experienced as a consequence of aphasia, with consistency in the nature of trouble sources giving rise to collaborative repair work across the participants four conversations. The findings also indicated reliability in the interactional mechanisms employed to deal with trouble sources, with consistency across the participants four conversations in the resolution of collaborative repair. The implications of the findingsfor the use of conversation analysis as an assessment tool to motivate intervention and to measure change over time are discussed.
This study investigated the influence of aphasia, familiarity and activity on conversational repair in interactions between nine aphasic individuals and 18 normal subjects (nine of whom lived with the aphasic subjects, and nine of whom were visiting the aphasic subjects). Data were collected in the homes of the aphasic subjects, and comprised unstructured conversation, semi-structured interaction involving retelling the events witnessed in a mock car accident, and structured testing. Conversation Analysis investigated the frequency of interactive trouble-indicating behaviour (metalinguistic comment and hypothesis forming per minute), and the nature of repair pattern (proportional pattern of repair trajectories used). Normal subjects increased their frequency of interactive trouble-indicating behaviour, and used more interactive repair patterns when conversing with aphasic partners as compared with when conversing with normal partners. The difference in familiarity between subjects did not appear to affect the frequency of interactive trouble-indicating behaviour, but it was noted that ‘visiting’ subjects tended to make more use of ‘other repair’ patterns than did subjects living with aphasic individuals. Conversational repair was found to differ across activities. The theoretical and clinical implications are discussed.
Two chronic fluent aphasic patients were assessed on a range of standard, functional and linguistic measures at a testing interval of five years. Though no change was noted in the performance of either patient on the standard test, a shift was seen in both patients in functional communication and on certain syntactic and pragmatic dimensions. These shifts were interpreted within a framework of compensatory strategies. Certain processes common to both patients and related to increased communicative effectiveness are described and discussed. The chronic patient is viewed as an individual with potential for dynamic functional language change in certain aspects of communication not directly linked to the structural components of the message. Implications for therapy are discussed.
This study examined the changes in the discourse produced by recent and chronic aphasic speakers while describing the bank robbery picture from the Montréal-Toulouse protocol (Nespoulous et al. 1986) at two different assessments, on average 6 weeks apart. The manifestations of word-finding difficulties, content unit production and several efficacy of communication indices were analysed. No statistical improvement of word-finding difficulties or of content unit production was found in the discourse in the recent aphasic group. Overall, both groups were more efficient on the second assessment on the index of number of open-class words per unit of time. Significant correlations were observed between aphasia severity and content unit production, as well as with the efficacy of communication indices.
Background: Aphasia has very serious consequences for speech production and, hence, for communication in daily life. Nevertheless, in the standard diagnostic procedures and in clinical practice, analysis of speech production in daily life is usually ignored or is restricted to the scoring of one or more variables on rating scales. Many methods for describing and analysing discourse production have been developed during the last few decades, with different aims and focusing on different linguistic levels. Aims: The aim of this paper is to present a critical review of the various methods that are currently used for the analysis of spontaneous speech ("discourse") of aphasic patients. A distinction is made between semi-spontaneous speech (description of situational pictures or story telling) and "real" spontaneous speech (conversations or interviews based on standardised questions). Both types of connected speech can be analysed with two types of measuring instruments: rating scales and quantified linguistic variables. The advantages and disadvantages of the measuring instruments most frequently used for pragmatic, conversational, and linguistic analyses are discussed. Special attention is paid to the (ecological) validity and reliability of the methods. Main Contribution: The general outcome of the evaluation of procedures for analysing speech production and communicative abilities is that several methods do not fulfil the requirements for reliability and validity. Other methods are extremely time-consuming or give little information on the consequences of the outcomes for clinical practice. Conclusions: None of the discussed procedures is perfect, although some are better than others. Most methods do not give indications for treatment of speech production and communicative disorders in daily life and are not suitable for determining changes in the spontaneous speech of individual patients.
The grammatical abilities of fluent aphasics have received scant attention to date. There is some debate as to the nature of paragrammatism and whether this phenomenon results from an underlying lexical or grammatical deficit. In this paper we define grammatical domains in three different languages (Dutch, English and Hungarian), which enables comparisons to be made between aphasic speakers and normal controls both within and between languages. We describe the methodology and examine some of the results focusing on the possible relation between lexical and syntactic aspects. Specifically we define and discuss the frequency and diversity of lexical verbs and their arguments, the deployment of subordinate clauses and the distribution of two types of adjuncts in the three different languages.
Presents 2 studies that seek to extend the parallels between disordered speech production in aphasia and in normals. Study 1 examined the key findings of D. E. Bloch's (1986, unpublished manuscript) study that compared a corpus of errors generated by a jargon aphasic male patient with a published corpus of normal speech errors. Study 2 investigated how the error pattern of 20 normal speakers evolved as utterances became more practiced. Based on these studies, a hypothesis about the nature of the variation between more and less disordered systems is offered. This claim, which is developed in the context of spreading activation models of production, is that such variation is tied to the ability of the system to deliver activation to intended units, relative to that of unintended units, within the time required by the task at hand. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter summarizes 16 empirical studies that employ quantitative and/or qualitative discourse analytic techniques published in applied linguistics journals over the last five years. These studies tend to analyze spoken discourse in formal contexts, produced by both adults and children who are native and nonnative speakers of English. Unfortunately, all studies focus only on English discourse, which suggests that analyses of discourse in other languages are clearly needed; moreover, it was extremely difficult to find published discourse analytic studies which employ only quantitative research methods. Although each of these discourse analytic studies presents segments of transcribed discourse, researchers collect data of the type and in the amount prescribed by the analytical tradition employed—those working within the conversation analytic tradition collect, transcribe, analyze, and present only recorded social interaction, while researchers who situate themselves in the ethnography of communication framework collect and present various forms of “triangulated” data to support their conclusions. The chapter concludes by mentioning the problem of evaluative criteria for qualitative research, and by suggesting that applied linguists need to address this issue and articulate some reasonable solutions, so that all published research is, in fact, quality research.