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Measuring Change at the Discourse-Level Following Conversation Treatment: Examples From Mild and Severe Aphasia
Abstract
This article reviews four discourse measures and examines whether they are sensitive to impairments in people with both mild and severe aphasia. We also ask whether these measures were sensitive to effects of conversation treatment in two case examples. Two people with aphasia, one mild and fluent and the other severe and nonfluent, served as case studies. Both case studies had participated in conversation treatment, in which individualized goals were targeted in the context of naturalistic conversation-based interactions. Picture descriptions were analyzed using three discourse measures: core lexicon, words per minute, and correct information units. In addition, words per minute and conversation turns were examined in personal narratives produced by the individual with severe nonfluent aphasia in a conversational context. For the individual with mild aphasia, both words per minute and core lexicon were sensitive to the presence of aphasia and treatment changes. For the individual with severe aphasia, all measures were sensitive to the presence of aphasia, but only words per minute and number/type of conversation turns were sensitive to effects of treatment. Discourse measures capture relevant aspects of communication that may not be seen on standardized measures of discrete language skills. Given different aphasia profiles and individual communication goals, clinicians need to choose the most relevant, reliable, and informative measures.
... Best treatment practice is usually presented as a certain type and specific amount of treatment provided, relative to the profile and severity of aphasia that the participant demonstrates (Simmons-Mackie et al., 2017). In the literature to date, amount of treatment provided is typically measured by the overall number of treatment hours together with the distribution of treatment hours over time (i.e., X number of treatment sessions over X number of weeks) (e.g., Baker, 2012bBaker, , 2012aBest & Nickels, 2000;Cherney, 2012;Cherney et al., 2011;DeDe & Hoover, 2021;Edmonds, 2016;Faroqi-Shah et al., 2010;Harvey et al., 2021;Pierce et al., 2021). This information may give a general indication as to how much treatment a person with aphasia is receiving and thus whether the treatment may potentially result in improvement to certain language skills, at least when the participant's aphasia profile and severity is reported. ...
... Overall treatment hours and distribution of those hours are important factors relating to the amount of treatment necessary to bring about robust improvements to language after a stroke. Indeed, it is common practice in the aphasia literature to refer to the number of treatment hours provided to participants (e.g., Best & Nickels, 2000;Cherney et al., 2011;DeDe & Hoover, 2021;Edmonds, 2016;Faroqi-Shah et al., 2010;Harvey et al., 2021). However, it is potentially misleading to only report on treatment hours without providing more specific reference to the active component(s) of treatment. ...
Background
Treatment dose in aphasia therapy is typically measured by the overall number of treatment hours together with the distribution of treatment sessions over time. However, in order to provide accurate information on treatment dose, it is also necessary to identify and report the active components of any given intervention (Baker, 2012b; Cherney, 2012).
Aims
In this study, the relationship between treatment hours (overall and average per week), post-stroke language abilities, and treatment dose was examined in multilingual people with aphasia. The effect of treatment dose of a targeted linguistic process (relevant SVO sentence production) on treatment outcomes related to that linguistic process was also analysed.
Methods and procedures
Four multilingual people with aphasia received Verb Network Strengthening Treatment in either their L1, or both their L1 and a later-acquired language. The number of times the VNeST protocol was completed (i.e., number of verb cycles) per treatment block was compared to (a) treatment hours and post-stroke language abilities, and (b) treatment outcomes of tasks related to relevant SVO sentence production.
Outcomes and results
With a relatively similar number of treatment hours, a measure of post-stroke language abilities was a good predictor of the number of verb cycles completed during treatment. Furthermore, a higher number of verb cycles completed during treatment indicated more potential for within-language generalisation of relevant SVO sentence production.
Conclusions
Identifying the active component(s) of a given treatment and reporting this information together with post-stroke language abilities and treatment hours will provide more accurate information regarding treatment dose than is currently standardly reported. This information is crucial to a better understanding of the mechanisms of aphasia recovery.
Background
General consensus exists between clinicians as to the incorporation of discourse outcome measures into language assessment for persons with aphasia (PWA). The development of core lexicon measures (CoreLex) has enabled clinicians to reduce time and labor intensive preparatory work for discourse analysis, which has been considered as an alternative measure to quantify word retrieval ability in discourse in a clinical context. Although previous studies have investigated the quality of the measure, CoreLex has rarely been longitudinally explored.
Aims
We aimed to investigate the adequacy of CoreLex to document linguistic changes in PWA over time. Specifically, we examined (1) whether natural language recovery from acute to chronic stages is manifested differentially by tasks and (2) the extent to which the ability to retrieve words in isolation predicts the ability to retrieve words in context.
Methods
A total of 19 PWA participated in the study. They completed a language assessment including confrontation naming tasks (Boston Naming Test [BNT] and Hopkins Action Naming Assessment [HANA]) and a picture description task using the Cookie Theft picture at acute and chronic stages. Discourse samples from the picture description task were quantified using CoreLex.
Results
We found significant differences across tasks and time-points by PWA. Moderate correlations between the confrontation naming tasks and CoreLex were found at the acute stage but not at the chronic stage. Additionally, McNemar’s tests demonstrated a significant difference in PWA’s performance in CoreLex from the acute to the chronic stages.
Conclusions
Our findings show that performance by PWA improves over time on all tasks, but language gains are manifested differentially by tasks. Performance in confrontation naming moderately predicts word retrieval in context acutely. However, lack of correlations between confrontation naming tasks and CoreLex later endorse inadequacy of using confrontation naming tasks as a proxy measure for discourse-level performance and improvement for PWA.
Purpose
The purpose of this study was to improve our understanding as to which factors determine online, spoken sentence production abilities of adults with latent aphasia in a discourse context.
Method
Discourse samples of the story of Cinderella elicited from AphasiaBank were analyzed with speech analysis software. Participants comprised people with latent and anomic aphasia as well as neurotypical controls (10 per group). Durations of pauses (silent and filled) were analyzed according to (a) the location they occurred (between or within sentences), (b) the syntactic complexity of sentences (simple, complex), and (c) sentence length (number of words). Statistical comparisons were conducted using mixed-effect models.
Results
The two clinical groups (latent and anomic) differed from controls in the duration of pauses, both between and within sentences. Syntactic complexity did not exert an effect on either of the two clinical groups as compared with controls. As compared with controls, both clinical groups paused more before long in comparison with short sentences.
Conclusion
Reduction in processing speed, which affects the ability to simultaneously maintain multiple linguistic and other cognitive demands associated with planning and monitoring of utterances, is a major factor that compromises sentence production in spoken discourse in latent aphasia.
Supplemental Material
https://doi.org/10.23641/asha.19448726
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.
Purpose:
This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia.
Method:
Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density.
Results:
Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia.
Conclusion:
Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.
Background: Discourse is fundamental to everyday communication, and is an increasing focus of clinical assessment, intervention, and research. Aphasia can affect the information a speaker communicates in discourse. Little is known about the psychometrics of the tools for measuring information in discourse, which means it is unclear whether these measures are of sufficient quality to be used as clinical outcome measures or diagnostic tools.
Aims: The current review aimed to profile the measures used to describe information in aphasic discourse, and assess the quality of these measures against standard psychometric criteria.
Methods: A scoping review method was employed. Studies were identified using a systematic search of Scopus, Medline, and Embase databases. Standard psychometric criteria were used to evaluate the measures’ psychometric properties.
Main contribution: The current review summarises and collates the information measures used to describe aphasic discourse, and evaluates their quality in terms of the psychometric properties of acceptability, reliability, and validity. Seventy-six studies described 58 discourse information measures, with a mean of 2.28 measures used per study (SD= 1.29, range 1-7). Measures were classified as functional measures (n= 33), which focused on discourse macrostructure, and functional and structural measures (n= 25), which focused on microlinguistic and macrostructural approaches to discourse as described by Armstrong (2000). There were no reports of the acceptability of data generated by the measures (distribution of scores, missing data). Test-retest reliability was reported for just 8/58 measures with 3/8 > 0.80. Intra-rater reliability was reported for 9/58 measures and in all cases % agreement was reported rather than reliability. Percent agreement was also frequently reported for inter-rater reliability, with only 4/76 studies reporting reliability statistics for 12/58 measures; this was generally high (> .80 for 11/12 measures). The majority of measures related clearly to the discourse production model described by Sherratt (2007), indicating content validity. 36/58 measures were used to make 41 comparisons between PWA and NHP, with 31/41 comparisons showing a difference between the groups. Four comparisons were made between genres, with two measures showing a difference between genres, and two measures showing no difference.
Conclusions: There is currently insufficient information available to justify the use of discourse information measures as sole diagnostic or outcome measurement tools. Yet the majority of measures are rooted in relevant theory, and there is emerging evidence regarding their psychometric properties. There is significant scope for further psychometric strengthening of discourse information measurement tools.
Measuring communicative informativeness under conversational discourse conditions is perhaps the most valid means of determining the interpersonal verbal communication abilities of adults with aphasia. Nevertheless, the data derived from such analyses are expensive to collect and subject to unknown sources of variability. In this study, samples of connected discourse were obtained from 20 subjects with aphasia under structured and conversational sampling conditions to determine the extent to which they were related on measures of communicative informativeness. Results revealed that subjects produced significantly greater percentages of informative words [i.e., correct information units (Nicholas & Brookshire, 1993)] under conversational discourse conditions, but that the percentage of correct information units produced during structured discourse tasks could be used to predict performance under conversational conditions with a high degree of accuracy.
Background: It is well documented in the literature that the ability to produce discourse is what matters most to people with aphasia (PWA) and their families. However, quantifying discourse in typical clinical settings is a challenging task due to its dynamic and multiply determined nature. As a result, professionals often depend on confrontation naming tests to identify and measure impaired underlying cognitive mechanisms that are also hypothesised to be important for discourse production. Aims: The main goals of the study were to investigate the extent to which confrontation naming test (CNT) scores are predictive of (i) the proportion of paraphasias in connect speech, and (ii) the amount of information PWA can effectively communicate. Methods & Procedures: Data from 98 monolingual PWA were retrieved from AphasiaBank and analysed using structural equation modelling. Performance in CNTs was modelled as a latent variable based on the Boston Naming Test, the Western Aphasia Battery–R Naming Subtest, and the Verb Naming Test. Performance at the discourse level was modelled based on the observed proportions of paraphasias in three discourse tasks (free speech, eventcasts, and story retell). Informativeness was quantified using the percentage of Correct Information Units based on story re-tell. Outcomes & Results: For the first question, the regression coefficient between the two latent factors was estimated to be –0.52. When the latent factor based on the CNTs was regressed on informativeness, the estimated regression coefficient was equal to 0.68. Conclusions: Performance on CNTs was not a strong predictor of the proportion of paraphasias produced in connected speech but was substantially higher for the amount of information communicated by PWA. Clinicians are cautioned not to predict a speaker’s performance at the discourse level after establishing CNT performance. Other anomic behaviours (e.g., pauses) during discourse production may be associated with CNT performance and should be considered in future investigations.
Background: Semi-spontaneous speech production tasks are commonly elicited to assess discourse ability. When knowledge of a topic, story, or event is shared, it is possible to gauge the informativeness of discourse by evaluating how accurately and completely an individual produces the concepts considered to be essential to the shared topic. This analysis, main concept analysis (MCA), quantifies the degree to which speakers are able to communicate the overall gist of an event. Though MCA is an easy-to-perform, informative, and reliable measure of discourse adequacy, its widespread adoption depends on the development of standardisation and normative reference. Given the large collection of control discourse transcripts available on the AphasiaBank database, it is possible to generate main concept lists based upon a large sample of control speakers and to characterise their performance to establish preliminary normative reference.
Aims: The first aim of this study was to develop main concept checklists drawn from a control population for three semi-spontaneous discourse tasks included in the AphasiaBank protocol—a picture sequence narrative (Broken Window), storytelling (Cinderella), and a procedure (Peanut Butter and Jelly). The second aim was to report MCA results for control speakers to provide a normative reference and to stratify the normative information by age.
Methods & Procedures: Ninety-two control transcripts, stratified into four age groups (20–39 years; 40–59 years; 60–79 years; 80+ years), were downloaded from the AphasiaBank database. Relevant concepts were identified, and those spoken by at least one-third of the control sample were considered to be main concepts. A multilevel coding system was used to determine the accuracy and completeness of the main concepts produced by control speakers.
Outcomes & Results: Main concept checklists for three discourse tasks are provided. Descriptive statistics are reported and examined to assist readers with evaluation of the normative data. No differences between age groups were observed for the Broken Window narrative. For the remaining discourse tasks, the younger half of the sample generally performed differently than the older half of the sample. Additionally, the two younger age groups did not differ significantly from each other, nor did the two older groups.
Conclusions: This study provides main concept checklists drawn from a large control sample. Normative information for main concept production is provided for three discourse tasks. The sample distribution is evaluated relative to the normal probability distribution and the sample composition is described, enabling readers to determine the adequacy of normative characteristics of the sample and also the fit between their patient or client and the normative sample. This study also provides information about main concept or event production for four age groups.
Despite agreement that dysnomia affects virtually every aphasic patient, there is no consensus about the purpose and effectiveness of techniques to treat it. Semantic feature analysis (SFA), a treatment technique designed to improve retrieval of conceptual information by accessing semantic networks, was used to treat aphasic dysnomia in a 57-year-old male who exhibited Broca's aphasia secondary to a left frontoparietal ischemic infarction. SFA was effective for improving confrontation naming and for generalized improvement to untreated pictures. However, no generalization to connected speech was seen on the measures of mean words per minute, mean correct information units per minute, or the percentage of all words that were correct information units.
Previous studies of therapy for acquired anomia have treated nouns in isolation. The effect on nouns in connected speech remains unclear. In a recent study in 2012, we used a novel noun syntax therapy and found an increase in the number of determiner plus noun constructions in narrative after therapy.
Two aims arose from the previous study: to identify the critical ingredient in the noun syntax therapy,specifically whether this is lexical production, or the syntactic context; and to extend the analysis of the effects beyond narrative into conversation.
We compared the effects of lexical therapy with those of noun syntax therapy in one individual with aphasia, in a sequential intervention design. We analysed the effects on conversation and on narrative.
There was improved picture naming of treated words after both therapies. Lexical therapy had no impact on narrative and conversation, whereas noun syntax therapy led to more noun production, primarily in the context of determiner plus noun combinations.
The results support the claim that greater impact on narrative and conversation can be achieved for some people with aphasia by treating nouns in syntactic contexts.
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: Verbs and sentences are often impaired in individuals with aphasia, and differential impairment patterns are associated with different types of aphasia. With currently available test batteries, however, it is challenging to provide a comprehensive profile of aphasic language impairments because they do not examine syntactically important properties of verbs and sentences. Aims: This study presents data derived from the Northwestern Assessment of Verbs and Sentences (NAVS; Thompson, 201159.
Thompson , C. K. 2011. Northwestern Assessment of Verbs and Sentences Evanston, IL View all references), a new test battery designed to examine syntactic deficits in aphasia. The NAVS includes tests for verb naming and comprehension, and production of verb argument structure in simple active sentences, with each examining the effects of the number and optionality of arguments. The NAVS also tests production and comprehension of canonical and non-canonical sentences. Methods & Procedures: A total of 59 aphasic participants (35 agrammatic and 24 anomic) were tested using a set of action pictures. Participants produced verbs or sentences for the production subtests and identified pictures corresponding to auditorily provided verbs or sentences for the comprehension subtests. Outcomes & Results: The agrammatic group, compared to the anomic group, performed significantly more poorly on all subtests except verb comprehension, and for both groups comprehension was less impaired than production. On verb naming and argument structure production tests both groups exhibited difficulty with three-argument verbs, affected by the number and optionality of arguments. However, production of sentences using three-argument verbs was more impaired in the agrammatic, compared to the anomic, group. On sentence production and comprehension tests, the agrammatic group showed impairments in all types of non-canonical sentences, whereas the anomic group exhibited difficulty primarily with the most difficult, object relative, structures. Conclusions: Results show that verb and sentence deficits seen in individuals with agrammatic aphasia are largely influenced by syntactic complexity; however, individuals with anomic aphasia appear to exhibit these impairments only for the most complex forms of verbs and sentences. The present data indicate that the NAVS is useful for characterising verb and sentence deficits in people with aphasia.
Background:
AphasiaBank is a collaborative project whose goal is to develop an archival database of the discourse of individuals with aphasia. Along with databases on first language acquisition, classroom discourse, second language acquisition, and other topics, it forms a component of the general TalkBank database. It uses tools from the wider system that are further adapted to the particular goal of studying language use in aphasia.
Aims:
The goal of this paper is to illustrate how TalkBank analytic tools can be applied to AphasiaBank data.
Methods & procedures:
Both aphasic (n = 24) and non-aphasic (n = 25) participants completed a 1-hour standardised videotaped data elicitation protocol. These sessions were transcribed and tagged automatically for part of speech. One component of the larger protocol was the telling of the Cinderella story. For these narratives we compared lexical diversity across the groups and computed the top 10 nouns and verbs across both groups. We then examined the profiles for two participants in greater detail.
Conclusions:
Using these tools we showed that, in a story-retelling task, aphasic speakers had a marked reduction in lexical diversity and a greater use of light verbs. For example, aphasic speakers often substituted "girl" for "stepsister" and "go" for "disappear". These findings illustrate how it is possible to use TalkBank tools to analyse AphasiaBank data.
A qualitative study of group therapy for aphasia was undertaken in order to discover interaction patterns and discourse management strategies that help define social or conversation group therapy for aphasia. Specifically, an analysis of the discourse of clients and therapists was conducted to identify patterns across therapists and settings. Six group communication therapy sessions involving individuals with aphasia were videotaped and analyzed. Within the well-managed social group therapy sessions studied, a variety of discourse management features were identified, including establishing the feel of discourse equality, focusing on everyday communicative events and genres, employing multiple communication modes, mediating communication, calibrating corrections, aiding turn allocation, and judiciously employing teachable moments. The discourse patterns identified in these social conversation groups differ from discourse patterns associated with traditional impairment-focused therapy described in the aphasia literature.
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.
To create two matched short forms of the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996) that yield similar results to the PNT for measuring anomia.
In Study 1, archived naming data from 94 individuals with aphasia were used to identify which PNT items should be included in the short forms. The 2 constructed sets of 30 items, PNT30-A and PNT30-B, were validated using archived data from a separate group of 56 individuals with aphasia. In Study 2, the reliability of the PNT, PNT30-A, and PNT30-B across independent test administrations was evaluated with a new group of 25 individuals with aphasia who were selected to represent the full range of naming impairment.
In Study 1, PNT30-A and PNT30-B were found to be internally consistent, and accuracy scores on these subsets of items were highly correlated with the full PNT. In Study 2, PNT accuracy was extremely reliable over the span of 1 week, and independent administrations of PNT30-A and PNT30-B produced similar results to the PNT and to each other.
The short forms of the PNT can be used to reliably estimate PNT performance, and the results can be compared to the provided norms. The 2 matched tests allow for the measurement of change in an individual's naming ability.
This paper investigates the relationship between change in picture naming with anomia therapy and changes in word retrieval in conversations between adults with aphasia and a regular conversational partner. We present data from two therapy projects (Hickin et al. [ 1 ] and Best et al. [ 2 ]). In each study, therapy involved cueing with the aim of improving retrieval of a set of nouns. Naming of the experimental items was assessed twice prior to therapy and again immediately afterwards. There was a significant change in word finding, as measured by picture naming, for the group and for 11 of the 13 participants. At the same time points, we collected conversations between the person with aphasia and a regular conversational partner. We analysed these using Profile of Word Errors and Retrieval in Speech (Herbert et al. [ 3 ]) and investigated a set of conversational variables predicted to change with therapy. Unsurprisingly, the conversation data is not straightforward. There is no significant change on the conversation measures for the group but some changes for individuals. We predicted change in word retrieval after therapy would relate to change in everyday conversations and tested this by correlating the change (post-therapy minus mean pre-therapy) in picture naming with the change in conversation variables. There was a significant positive relationship between the change in picture naming and change in some conversation measures including the number of nouns produced in 5 min of conversation (r = 0.50, p < 0.05, one-tailed) and the number of nouns produced per substantive turn (r = 0.55, p < 0.05, one-tailed). The findings suggest changes in word finding following therapy for aphasia can be reflected in changes in conversation. The clinical implications of the complex results are explored.
Fluency and hesitation in spontaneous speech have previously been shown to be symptomatic of variations in word transition probability. The purpose of the present experiment was to corroborate this conclusion by evidence demonstrating the influence of transition probability (amount of information) on selective behaviour stimulated in an experimental situation.
An experiment in sentence completion was designed in such a way as to recreate the conditions for word selection in sentences. As a result word transition probability was shown to be related not only to incidence but also to the length of hesitation pauses within sentences. The completion of gaps substituted for words that had originally been preceded by pauses required a significantly longer period of hesitation than the completion of gaps substituted for words which had been uttered fluently. A relation was thus shown to exist between periods of hesitation before verbalisation in different persons performing different operations within the same linguistic setting. The conditions under which this relation has been shown to hold have been found to be those of successful anticipation of the original speaker's intentions.
Purpose
Social approaches to intervention for aphasia are being increasingly employed to address the functional communication barriers experienced by persons with aphasia. One specific approach is the use of conversation-based treatment in both group and two-person dyads. Although there are several methods to measure improvement for stimulation and cognitive neurolinguistic approaches, researchers have consistently indicated a need for outcome measures that can objectively demonstrate improved communication following conversation treatment. This study aims to demonstrate the utility for examining the patterns of conversation trouble source and repair as indices for improved communication as a positive response to intervention.
Method
The conversations of 20 consecutive participants, before and after 3 months, or 40 hr, of group and individual conversation-based treatment, were transcribed using conventions of conversation analysis, and sociolinguistic discourse analysis was applied. Measures of trouble source and repair were aggregated and subjected to statistical analysis.
Results
Persons with aphasia demonstrated statistically significant improvement in patterns of conversation trouble source and repair posttreatment for the rate of conversation trouble source and the length of repair. However, measures of self-initiation and self-completion of repair did not reach significance.
Conclusion
The study indicates that, following conversation-based treatment, the conversations of persons with aphasias were more efficient, experiencing fewer trouble sources and shorter repair sequences. These findings suggest that measures of conversation for the rate of trouble source and length of the repair sequence are valid indices of improved conversation.
Background:
Discourse assessment and treatment in aphasia rehabilitation is a priority focus for a range of stakeholder groups. However, a significant majority of speech and language therapists (SLTs) infrequently conduct discourse analysis, and do not feel competent in doing so. Known barriers identified in other countries, specifically a lack of time, training, expertise and resources, affect use of discourse analysis in clinical practice.
Aims:
To investigate UK SLTs' reported practices and views of discourse analysis, barriers and facilitators, and clinical feasibility in aphasia rehabilitation.
Methods & procedures:
An online survey of 52 questions adapted from existing research and incorporating behaviour change literature was created for the study and piloted. UK SLTs working in aphasia rehabilitation for at least 6 months were invited to participate. Potential participants were contacted through national and local clinical excellence networks, a National Health Service (NHS) bespoke e-mail list, and national magazine advertisement, and the study was also advertised on social media (Twitter). Therapists read an online participant information sheet and submitted individual electronic consent online; then progressed to the Qualtrics survey. Descriptive, correlational and inferential statistical analyses were conducted, and content analysis was carried out on the questions requiring text.
Outcomes & results:
A total of 211 valid responses were received from primarily female SLTs, aged 20-40 years, working full-time in the NHS in England, in community, inpatient and acute/subacute multidisciplinary settings. A total of 30% SLTs collected discourse analysis often, were mostly very experienced, and working part-time in community settings. Years of experience was predictive of use. Discourse was most often collected using standardized picture descriptions and recounts during initial assessment. Samples were infrequently recorded, and typically transcribed in real-time. Most SLTs (53-95%) reported making clinical judgements or manually counted words, sentences, communication of ideas and errors, and were confident in doing so. Barriers included time constraints; lack of expertise, confidence, training, resources and equipment; and patient severity. Discourse 'super-users' were distinguished by significantly higher professional motivation for discourse and workplace opportunity than other SLTs, and 'non-users' were distinguished by significantly less knowledge and skills in discourse analysis than other SLTs. SLTs reported a desire and need for training, new/assistive tools and time to do more discourse analysis in practice.
Conclusions & implications:
Clinicians were highly engaged and relatively active in at least some aspects of discourse analysis practice. Interventions that target individual clinicians as well as organizations and systems are needed to improve the uptake of discourse analysis in practice. What this paper adds What is already known on the subject? Discourse in aphasia rehabilitation is a priority in clinical practice and research. However, the majority of clinicians infrequently collect and analyse discourse. Research in Australia and the United States indicated that lack of time, assessment resources and relevant knowledge and skills are the main barriers to use. What this paper adds to existing knowledge Compared with existing research, UK SLTs were more likely to see discourse analysis as part of their role and experienced fewer barriers, and more SLTs did it at least sometimes in clinic. However, practices were limited by lack of training, giving rise to challenges in selecting and interpreting findings for clients. More use was predicted by more experience and commitment to discourse analysis, particularly where workplaces supported this approach. Less use was associated with less knowledge and skills in discourse analysis. Practice and decision-making were influenced by client factors and constrained to a lesser degree by logistical challenges. What are the potential or actual clinical implications of this study? Education and training in discourse analyses and in specific procedures are needed to improve individual clinicians' knowledge, skills and confidence in using discourse analysis for clients' rehabilitation. Equally, organizational and systems changes are needed to promote, support and reinforce discourse analysis in the workplace.
Core Lexicon (CoreLex) is a relatively new approach assessing lexical use in discourse. CoreLex examines the specific lexical items used to tell a story, or how typical lexical items are compared with a normative sample. This method has great potential for clinical utilization because CoreLex measures are fast, easy to administer, and correlate with microlinguistic and macrolinguistic discourse measures. The purpose of this article is to provide clinicians with a centralized resource for currently available CoreLex checklists, including information regarding development, norms, and guidelines for use.
Surveys of speech-language pathologists who work with people with aphasia indicate that they view the large number of existing measures to be a barrier to using discourse analysis in their practice. This article provides a process that can help determine whether a particular discourse outcome measure might be useful with a particular client. The process involves answering questions about the client, the treatment, the work setting, and the psychometric properties of the discourse outcome measure in question. By following this systematic process, clinicians can eliminate outcome measures that are not likely to provide useful data and can focus on those that can help them demonstrate treatment-related change.
Purpose
General agreement exists in the literature that clinicians struggle with quantifying discourse-level performance in clinical settings. Core lexicon analysis has gained recent attention as an alternative tool that may address difficulties that clinicians face. Although previous studies have demonstrated that core lexicon measures are an efficient means of assessing discourse in persons with aphasia (PWAs), the psychometric properties of core lexicon measures have yet to be investigated. The purpose of this study was (a) to examine the concurrent validity by using microlinguistic and macrolinguistic measures and (b) to demonstrate interrater reliability without transcription by raters with minimal training.
Method
Eleven language samples collected from PWAs were used in this study. Concurrent validity was assessed by correlating performance on the core lexicon measure with microlinguistic and macrolinguistic measures. For interrater reliability, 4 raters used the core lexicon checklists to score audio-recorded discourse samples from 10 PWAs.
Results
The core lexicon measures significantly correlated with microlinguistic and macrolinguistic measures. Acceptable interrater reliability was obtained among the 4 raters.
Conclusions
Core lexicon analysis is potentially useful for measuring word retrieval impairments at the discourse level. It may also be a feasible solution because it reduces the amount of preparatory work for discourse assessment.
Purpose
The purpose of this study was to improve our understanding of the language characteristics of people with latent aphasia using measures that examined temporal (i.e., real-time) and episodic organization of discourse production.
Method
Thirty AphasiaBank participants were included (10 people with latent aphasia, 10 people with anomic aphasia, and 10 neurotypical control participants). Speech material of Cinderella narratives was analyzed with Praat software. We devised a protocol that coded the presence and duration of all speech segments, dysfluencies such as silent and filled pauses, and other speech behaviors. Using these durations, we generated a range of temporal measures such as speech, articulation, and pure word rates. Narratives were also coded into episodes, which provided information about the discourse macrostructure abilities of the participants.
Results
The latent aphasia group differed from controls in number of words produced, silent pause duration, and speech rate, but not articulation rate or pure word rate. Episodic organization of the narratives was similar in these 2 groups. The latent and anomic aphasia groups were similar in most measures, apart from articulation rate, which was lower in the anomic group. The anomic aphasia group also omitted more episodes than the latent aphasia group.
Conclusions
The differences between latent aphasia and neurotypical controls can be attributed to a processing speed deficit. We propose that this deficit results in an impaired ability to process information from multiple cognitive domains simultaneously.
Purpose: The purpose of this study was to determine
whether the correct information unit (CIU) can be reliably
applied to unstructured conversational discourse in people
with aphasia (PWA). The CIU was developed by Nicholas
and Brookshire (1993) to measure word-level informativeness
in structured monologue-level discourse and is widely used
by clinicians and researchers for this purpose. A case study
(Oelschlaeger & Thorne, 1999) investigating the use of the
CIU in conversation has suggested potential issues with
interrater reliability (IRR), which has discouraged
application of the CIU to this discourse context. However,
no further research has been conducted to replicate or
extend this finding. Given a clinical and research need for
reliable linguistic measures appropriate for use in unstructured
conversation, revisiting the reliability, stability, and suitability
of the CIU is indicated.
Method: The CIU protocol developed by Nicholas and
Brookshire (1993) was modified according to the needs
of conversational discourse, resulting in the CIU in conversation
(CIUconv) protocol. Two speech-language pathology graduate
student research assistants completed training on use of
the CIUconv with the 1st author. Sixteen conversations
held by 8 PWA (i.e., 2 conversations each) were used as
language samples to determine IRR of percent CIU (%CIU)
in conversation through use of the CIUconv. Test–retest
stability of %CIU as applied per this protocol was then
assessed across the 2 conversations collected for each
PWA.
Results: Use of the CIUconv resulted in excellent IRR of
%CIU for each research assistant and the 1st author.
Likewise, test–retest stability for the measure was excellent.
Results were evaluated at both the group and individual levels.
Conclusions: %CIU demonstrated excellent interrater
and test–retest reliability when applied to unstructured
conversation using the CIUconv procedure, which was
developed to account for expected linguistic characteristics
of conversation. These findings suggest that %CIU may
be a feasible, reliable measure of informativeness in
unstructured conversation in PWA when the CIUconv is
used by trained raters.
Purpose
Group conversation treatment has the potential to improve communication and reduce social isolation for people with aphasia. This project examined how 2 conflicting hypotheses—treatment dosage and group dynamics—affect treatment outcomes.
Method
Forty-eight participants with chronic aphasia were randomly assigned to either a dyad, a large group, or a delayed control group. Conversation group treatment was provided for an hour, twice per week, for 10 weeks. Individual goals were developed by each participant and addressed in the context of thematically oriented conversation treatment. Standardized testing across language domains was completed pretreatment (Time 1), posttreatment (Time 2), at a 6-week maintenance point (Time 3), and at 11-month follow-up for the experimental groups.
Results
Treatment groups showed greater changes on standardized measures than the control group posttreatment. Dyads showed the most changes on measures of language impairment, whereas changes on the self-reported functional communication measure (Aphasia Communication Outcome Measure) and connected speech task only showed significant changes in the large group.
Conclusions
This randomized controlled trial on conversation treatment indicated that both treatment groups—but not the delayed control group—showed significant changes on standardized tests. Hence, conversation treatment is associated with changes in measures of language impairment and quality of life. Dyads showed the most changes on measures of language impairment, whereas changes on the functional communication measure (Aphasia Communication Outcome Measure) and discourse production only showed significant changes in the large group. Thus, group size may be associated with effects on different types of outcome measures.
Purpose
The purposes of this study are to provide clinicians and researchers with introductory psychometric data for the main concept analysis (MCA), a measure of discourse informativeness, and specifically, to provide descriptive and comparative statistical information about the performance of a large sample of persons not brain injured (PNBIs) and persons with aphasia (PWAs) on AphasiaBank discourse tasks.
Method
Transcripts of 5 semi-spontaneous discourse tasks were retrieved from the AphasiaBank database and scored according to detailed checklists and scoring procedures. Transcripts from 145 PNBIs and 238 PWAs were scored; descriptive statistics, median tests, and effect sizes are reported.
Results
PWAs demonstrated overall lower informativeness scores and more frequent production of statements that were inaccurate and/or incomplete. Differences between PNBIs and PWAs were observed for all main concept measures and stories. Comparisons of PNBIs and aphasia subtypes revealed significant differences for all groups, although the pattern of differences and strength of effect sizes varied by group and discourse task.
Conclusions
These results may improve the investigative and clinical utility of the MCA by providing descriptive and comparative information for PNBIs and PWAs for standardized discourse tasks that can be reliably scored. The results indicate that the MCA is sensitive to differences in discourse as a result of aphasia.
Supplemental Material
https://doi.org/10.23641/asha.7485647
Background
Discourse analysis procedures are time consuming and impractical in a clinical setting. Critical to clinicians are simple and informative discourse measures that require minimal time and labour to complete. Many studies, however, have overlooked difficulties that clinicians face. We recently developed core lexicon lists for nouns, verbs, adjectives and adverbs for two narrative discourse tasks with healthy control groups. Core lexicon lists consist of important lexical items required to produce coherently meaningful discourse in response to discourse tasks. Measuring core lexicon is useful for quantifying word retrieval impairments at the discourse level in clinical populations.
Aims
To apply an age‐based core lexicon list for nouns, verbs, adjectives and adverbs for the wordless picture books Good Dog Carl (1985) and Picnic (1984) and to determine how well the lists measured linguistic impairments in persons with aphasia (PWA).
Materials & Methods
Lemma forms were extracted from 470 control participants who were divided into seven age groups. Twenty‐five core lexicons were identified for four word classes (nouns, verbs, adjectives and adverbs) among the seven age groups. The nouns, verbs, adjectives and adverbs for each PWA (N = 11) were then compared with the core lexicon for their respective age group. Per cent agreement was computed by comparing the number of total items within each list to the number of items that PWA produced. A Spearman's correlation coefficient was computed between the WAB‐R AQ and the per cent agreement for each word type for PWA.
Outcomes & Results
The percentage of agreement for each word type among the age cohorts ranged between 56% and 96%. Of the four word types, core verbs significantly correlated with the WAB AQs for both discourse tasks. A post‐hoc analysis found significant differences between fluent and non‐fluent aphasia for core verbs.
Conclusions & Implications
Core lexicon analysis appears to be a practical way to capture impairments in word retrieval at the discourse level. Core verbs may be a better indicator to understand holistic language performances for PWA. Use of the core lexicon checklist can serve as an option to reconcile ecological validity with clinical usability.
Conceptualisation is the first step of speech production and describes the process by which we map our thoughts onto spoken language. Recent studies suggest that some people with language impairments have conceptualisation deficits manifested by information selection and sequencing difficulties. In this study, we examined conceptualisation in the complex picture descriptions of individuals with and without aphasia. We analysed the number and the order of main concepts (ideas produced by ≥60% of unimpaired speakers) and non-main concepts (e.g. irrelevant details). Half of the individuals with aphasia showed a reduced number of main concepts that could not be fully accounted for by their language production deficits. Moreover, individuals with aphasia produced both a larger amount of marginally relevant information, as well as having greater variability in the order of main concepts. Both findings provide support for the idea that conceptualisation deficits are a relatively common impairment in people with aphasia.
Background: People with aphasia (PWA) and their families identify as their priority the ability to use language at the discourse level in order to meet their daily communicative needs. However, measuring connected speech can be a challenging task due to the complex and multidimensional nature of discourse. As a result, professionals often depend on confrontation naming tests to identify and measure impaired underlying cognitive mechanisms that are also hypothesized to be important for discourse production.
Aims: In the current study, we investigated the validity of making inferences about discourse performance based on scores from confrontation naming tests. Specifically, we investigated the strength of the relationship between word retrieval abilities, and the ability to convey information during discourse production.
Method & Procedures: Data from 118 monolingual PWA were retrieved from AphasiaBank and analyzed using structural equation modeling. Performance in confrontation naming tests was modeled as a latent variable based on the Boston Naming Test, the Western Aphasia Battery – R Naming Subtest, and the Verb Naming Test. Performance at the discourse level was modeled based on indices of informativeness in three discourse tasks (free speech, eventcasts, and story re-tell). Informativeness was quantified using the percentage of Correct Information Units.
Outcomes and Results: Based on the fit statistics, the model exhibited adequate fit, indicating that the relationship between confrontation picture naming and informativeness was adequately reflected in the model. We found a strong relationship between confrontation naming test performance and discourse informativeness (standardized regression coefficient between the two latent factors = .79).
Conclusions: Performance on confrontation naming tests was a strong predictor of the amount of information PWA communicated during discourse production. However, our results also highlight that performance on the latter cannot be predicted solely from the former, as evidenced by the large proportion of unexplained variance in the informativeness latent variable.
Background: Over the past few decades, clinical aphasiologists have increasingly included various measures of discourse, across a variety of genres, to assess treatment effects and to understand spoken language in people with aphasia. The paradigm shift from assessing language at the word and sentence level to assessing at the discourse level shows an increased awareness of capturing meaningful outcomes; however, this has led to a proliferation of new discourse metrics. These new metrics often lack reliability, validity, and stability data to support their use. In fact, we propose that a tipping point has been reached.
Aims: To review the recent move toward establishing a basic core outcome set (COS) for aphasia. In support of this effort, we make a strong argument for the need to dovetail these efforts with the development of a core outcome set for discourse (D-COS).
Main contribution: We make a case that the current state of the art in aphasia-related discourse research leaves researchers unsure of the most representative outcomes to include in future investigations and clinicians with little guidance on best practice. We applaud and support the recent efforts toward the development of a general COS for aphasia; however, we propose that the need for a D-COS is urgent because the increasing numbers of discourse measures make it difficult to replicate and compare outcomes across studies. Moreover, these issues likely interfere with adaptation of the use of discourse measurement in clinical practice.
Conclusions: Many health-related fields have adopted a COS to guide their research and ensure that the field’s data can be compiled, compared, and contrasted for a better overall understanding of how treatments address targeted illnesses. We argue that, in addition to the recent progress toward a COS for aphasia, a D-COS is also required to improve our understanding of how our treatments improve the discourse of people with aphasia, which in turn will aid in evoking a paradigm shift in clinical practice. To be successful, it is essential that the development of a D-COS includes a process by which all stakeholders are included: people with aphasia, caregivers, clinicians, and clinical researchers.
Background: When it comes to aphasia assessments, many speech and language pathologists (SLPs) rely heavily on norm-referenced language tests, even though they are aware that certain important language skills can only be evaluated by analysis of conversational discourse. The formalized aphasia test situation is a typical example of institutional interaction, which differs in systematic ways from everyday conversations. This article examines conversations between persons with aphasia (PWAs) and SLPs in the two different contexts, a topic where previous research is limited.
Aims: The aim is to compare the interactions between PWAs and SLPs in test conversations and in more everyday-like conversations and to relate the interactional data to the participants’ performance on the aphasia test battery.
Methods & Procedures: Ten PWAs and three SLPs participated in the study. Each PWA participated in two conversations with an SLP, a test conversation, while performing tasks targeting the ability to produce sentences and narratives from an aphasia test battery, and a more everyday-like conversation. The conversations were audio and video recorded and thereafter transcribed. Three main observations considered to be important mechanisms for interaction organization were identified and calculated in the transcriptions. The test results were summarized and analyzed.
Outcomes & results: The results demonstrated that there were a larger number of turns produced by the PWAs in the everyday conversations compared to the test conversations. Furthermore, there were more communicative initiatives and nonverbal contributions in the everyday conversations. The number of repairs initiated by the PWAs were equivalent, but looking at repair characteristics, it was found that repairs resolved within the same turn were found in the test conversations while repairs stretching over several turns were more frequent in the everyday conversations.
Conclusions: The results of the present study demonstrated differences of the interaction between PWAs and SLPs in test conversations and in more everyday-like conversations. Furthermore, there seemed to be no obvious relationship between the participant’s actual test scores on the aphasia test battery and aspects of conversation that can be related to being a competent speaker.
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.
Purpose: Two philosophies of intervention exist in aphasia rehabilitation: impairment-based approaches and socially oriented approaches. Both approaches have been shown to improve communication in persons with aphasia, but no studies have directly compared the effects of each approach or a combined approach on a targeted linguistic skill. This article explores the effects of individual and group therapies used both in isolation and in combination on verb production in aphasia.Methods: Twelve individuals with chronic aphasia were trained on transitive verbs under three conditions—individual, group and combined—over a 6-week interval. Treatment was counterbalanced across subject and training groups. A delayed-treatment, within-participant design was used. Verb probe data were collected at 10 points throughout the study. Language measures were taken at two intervals pre- and two intervals post-treatment. Functional, narrative and quality-of-life measures were taken once pre- and once post-treatment.Results: Significant change was observed on linguistic, functional communication and quality-of-life measures. There was no significant effect of treatment condition.Conclusions: The results provide evidence of linguistic and psychosocial change in individuals with chronic aphasia following this treatment. Results failed to find that one treatment condition was superior to others.
To investigate the structure and measurement properties of the Aphasia Communication Outcome Measure (ACOM), a patient-reported outcome measure of communicative functioning for persons with aphasia.
Three hundred twenty-nine participants with aphasia responded to 177 items asking about communicative functioning. The data were analyzed using a categorical item factor analysis approach. Validity of ACOM scores based on their convergence with performance-based, clinician-reported, and surrogate-reported assessments of communication was also assessed.
Fifty-nine items that obtained adequate fit to a modified bifactor measurement model and functioned similarly across several demographic and clinical subgroupings were identified. The factor model estimates were transformed to item response theory graded response model parameters, and the resulting score estimates showed good precision and moderately strong convergence with other measures of communicative ability and functioning. A free software application for administration and scoring of the ACOM item bank is available from the first author.
The ACOM provides reliable measurement of patient-reported communicative functioning in aphasia. The results supported the validity of ACOM scores insofar as (1) factor analyses provided support for a coherent measurement model, (2) items functioned similarly across demographic and clinical subgroups, and (3) scores showed good convergence with measures of related constructs.
Purpose:
This study examined the test-retest stability of select word-retrieval measures in the discourses of people with aphasia who completed a 5-stimulus discourse task.
Method:
Discourse samples across 3 sessions from 12 individuals with aphasia were analyzed for the stability of measures of informativeness, efficiency, main concepts, noun and verb retrieval, word-finding difficulty, and lexical diversity. Values for correlation coefficients and the minimal detectable change score were used to assess stability for research and clinical decision making.
Results:
Measures stable enough to use in group research studies included the number of words; the number of correct information units (CIUs); the number of accurate-complete, accurate-incomplete, and absent main concepts; the percentage of T-units that had word-finding behaviors of any kind; the percentage of T-units that contained empty words; and a lexical diversity measure. Words per minute, CIUs per minute, and the percentage of T-units that contained time fillers or delays were sufficiently stable to use when making clinical decisions about an individual.
Conclusion:
Although several of the measures demonstrated acceptable stability for group research studies, relatively few were sufficiently stable for making clinical decisions about individuals on the basis of a single administration.
Background: Conversation is one of the most important forms of human communication. The way in which one participates in conversation is necessarily impacted by aphasia. Recent changes in delivery of rehabilitation services place greater emphasis on functional outcome and this, in turn, has been a catalyst for the development of rehabilitation approaches that focus on conversation. However, an important missing element in studies of the efficacy of such approaches is a method for evaluating success in conversation. Aims: The object of this study was to develop an ecologically valid and reliable measure of transactional success in conversation. Methods & Procedures: The procedures for measuring transactional success in conversation described in this study utilizes standardized procedures while simulating natural conversations as much as possible. It provides a method for measuring what has been understood/exchanged when the conversation concludes, and affords an external reference against which the accuracy of this information can be judged. Data for this study were gathered from 14 people with aphasia of moderate severity each of whom engaged in 4 semi-structured conversations with unfamiliar partners. Outcomes & Results: The method of measuring transactional success in conversation described in this study was shown to have good validity and reliability. Conclusions: Transactional success in conversation is clearly a unique construct that is not predicted by traditional aphasia assessment. The method for measuring transactional success in conversation developed in this investigation provides a much-needed means for clinicians to evaluate the efficacy of conversation therapy. Furthermore, combining this new measure with Conversation Analysis (CA) offers a potentially powerful tool to identify those conversational behaviors that contribute to successful transfer of ideas. Such information could then be used to inform the design of treatment programs that seek to improve conversational success for people with aphasia.
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.
This study recorded and analysed conversation samples from a group of six people with chronic aphasia during three different sampling conditions. The authors examined each group member's verbal output using components of SALT for Windows ® (Miller & Chapman, 1999) and a preliminary conversational-turn rating system. Results showed high variability in the SALT data (i.e., quantitative performance) and slight variability in the preliminary conversational-turn ratings (i.e., qualitative performance) for participants in each conversational topic. Possible key features of aphasia group communication were identified. New directions for aphasia group study are discussed.
Recent interest in aphasia group treatment has been motivated by the potential benefits of working in a group environment. This article provides research evidence for the speech-language and psychosocial benefits of conversationally based aphasia groups. The history of aphasia groups and independent aphasia centers consistent with a social model of healthcare and the Life Participation Approach to Aphasia is traced. Research evidence is reviewed that demonstrates positive health benefits of building interpersonal relationships and community. It is argued that an important role for the speech-language pathologist is to help reconnect persons with aphasia to their family members, their friends, and their community.
This article discusses identity as it relates to aphasia and the resulting impact on life participation. The relationships among social identity, language, and social interaction are considered from the sociocultural perspective. Core social identity concepts are identified and used to examine the broad classifications of aphasia intervention. Examples are provided to illustrate how one long-standing stroke support group has promoted renegotiation of identity. A rationale is provided for speech-language pathologist's involvement in stroke support groups that promote healthy renegotiation of identity. Additional clinical recommendations for facilitating identity are offered.
This article explores the relationship and integration of a narrative and the life participation approach to aphasia (LPAA). Literature from the social sciences situates narrative as a fundamental life concern of humans. Health, illness, and particularly stroke narratives are explored as processes that are inextricably intertwined with the life participation of persons with aphasia and their significant others. The role of self-narratives (storying of self) in recovery and in regaining a sense of coherence in the life story is discussed as part of assessment and treatment that can further the life participation of those affected by aphasia, a guiding principle of LPAA. A brief case study is interwoven with the text to explore the theoretical linkages between narrative and the LPAA, and to demonstrate the role of social others for the storying of self during group therapy.
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.
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.
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.
This article gives an overview of the application to aphasia of conversation analysis (CA), a qualitative methodology for the analysis of recorded, naturally occurring talk produced in everyday human interaction. CA, like pragmatics, considers language use in context, but it differs from other analytical frameworks because the clinician is not making interpretations about how an aspect of language should be coded or judging whether an utterance is successful or adequate in terms of communication. We first outline the CA methodology before discussing its application to the assessment of aphasia, principally through the use of two published assessment tools. We then move on to illustrate applications of CA in the field of aphasia therapy by discussing two single case study interventions. Key conversation behaviors are illustrated with transcripts from interactions recorded by the person with aphasia and the person's habitual conversation partner in the home environment. Finally, we explore the implications of using CA as a tool for assessment and treatment in aphasia.