GriffinShare @ Fontbonne University

A member of the Class of 2023  smiles with Dr. Nancy Blattner, President of Fontbonne University, outside Ryan Hall on May 6, 2023.https://griffinshare.fontbonne.edu/uasc-photos/8220/thumbnail.jp

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A member of the Class of 2023  smiles with Dr. Nancy Blattner, President of Fontbonne University, outside Ryan Hall on May 6, 2023.https://griffinshare.fontbonne.edu/uasc-photos/8215/thumbnail.jp

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Fellows, Jeremy

Jeremy Fellows

Turner, Rebecca

Rebecca Turner

Challenges in auditory comprehension ability are some of the most crippling aspects of aphasia. The degree to which auditory comprehension is impacted by aphasia is variable, can be inconsistent, and may depend on the severity of the neural damage. ‘High-level’ aphasic patients can be dismissed or go unnoticed due to ignorance of symptoms, passing scores on standardized assessments, and the frequent, inconspicuous nature of a mild-moderate diagnosis. Understanding deficits in mild-moderate aphasia related to auditory comprehension could aid in choosing beneficial communication modalities for conversation partners to use during intervention, interactions, and daily activities.https://griffinshare.fontbonne.edu/slp-posters-2023/1025/thumbnail.jp

Johnson, Kirsten

Aphasia is	an	acquired	neurogenic	disorder	resulting	from	brain	injury	and	
resulting	in	impairments	in	spoken	language	expression/comprehension,	reading	
comprehension,	and	written	expression	(4).
Studies	suggest	that	around	2.5	million	Americans	are	currently	living	with	
aphasia	(9).
Auditory	comprehension (AC)	is	the	ability	to	understand	and	
accurately	process	language.	
Communication	and	comprehension	breakdowns	occur	as	a	result	of	
deficits	in	auditory	comprehension	due	to:
ü Challenges	in	the	use	of	phonological	and	semantic	processes	for	
discriminating	sounds/words	and	deciphering	word	meanings	
ü Retention	and	processing	deficits	
Assessing Auditory Comprehension in Persons with Mild-
Moderate Aphasia
Kirsten Johnson, B.S.
Faculty Sponsor: Carmen Russell, Ph.D., CCC-SLP
Fontbonne University, Department of Communication Disorders and Deaf Education
Challenges	in	auditory	comprehension	ability	are	some	of	the	
most	crippling	aspects	of	aphasia.	The	degree	to	which	auditory	
comprehension	is	impacted	by	aphasia	is	variable,	can	be	
inconsistent,	and	may	depend	on	the	severity	of	the	neural	
damage.	‘High-level’	aphasic	patients	can	be	dismissed	or	go	
unnoticed	due	to	ignorance	of	symptoms,	passing	scores	on	
standardized	assessments,	and	the	frequent,	inconspicuous	
nature	of	a	mild-moderate	diagnosis.	Understanding	deficits	in	
mild-moderate	aphasia	related	to	auditory	comprehension	could	
aid	in	choosing	beneficial	communication	modalities	for	
conversation	partners	to	use	during	intervention,	interactions,	and	
daily	activities.
Learner	Outcomes
• Viewers	will	be	able	to	summarize	the	etiology	and	
symptomatology	of	mild-moderate	aphasia.
• Viewers	will	be	able	to	identify	the	prevalence	of	auditory	
comprehension	for	communication	and	the	effects	of	deficits	
related	to	lifestyles	of	mild-moderate	aphasics.
• Viewers	will	be	able	to	apply	recommendations	for	successful	
interactions	with/for	mild-moderate	aphasics.
AC	impairments for	people	with	mild-moderate	aphasia	include,	but	are	not	
limited	to:	
• Slow	rise	times	(reduced	understanding	of	the	final	components	of	spoken	
messages)
• Accumulation	of	noise	(the	auditory	system	becomes	overwhelmed	with	
the	length	and	complexity	of	spoken	messages)
• Information	capacity	(difficulty	receiving	and	processing	information	
simultaneously	as	well	as	retaining	that	input)	
• Challenges	in	word-finding/understanding	word	meaning
• Trouble	following	multi-step	directions
o Attention	deficits	present	might	restrict	the	ability	to	orient	to,	sustain	
focus	of,	or	selectively	attend	to	one	or	more	tasks	(Marshall	&	English,	
2004)
• Decreased	processing	speed/delayed	processing
o Auditory	processing	encompasses	both	the	comprehension	of	a	spoken	
message	and	it’s	retention	in	memory	(Marshall	&	English,	2004)
• Poor	engagement	in	complex	conversations	where	high	levels	of	
language	are	required	(I.e	arguments	or	negotiations)
Difficulty understanding language can be a barrier to full societal 
participation, inducing anger, frustration, social isolation, and 
depression.
Restrictions on daily participation can influence relationships and  
social networks, thereby reducing quality of life and overall 
communication satisfaction.
Many with mild-moderate aphasia report improved confidence with 
familiar conversation partners, but reduced communication 
effectiveness with those who ‘lack an understanding of aphasia’ or 
provide feedback that is misaligned from an aphasic individual’s 
own view of their capacity (Cavanaugh &	Haley,	2020).
Recovery from mild-moderate aphasia varies widely and factors 
predicting recovery are not generally understood.
ü Recent findings suggest chronicity was predictive of auditory 
comprehension recovery, indicating mild-moderate aphasic 
patients can continue to show spontaneous improvement beyond 
one-year post stroke (Lwi et at., 2021).
During intervention, the SLP should: 
• Acknowledge the desires of PWA to define therapeutic goals, 
collaborate with clients to resume relevant activities, and close the 
gap between what they want, need, and can currently do 
(Knollman-Porter et al., 2019)
• Motivate active participation in more complex psychosocial 
settings
• Increase demands on attention, linguistic precision, clarity, and 
efficiency during conversations 
When interacting with a PWA and AC deficits:
• Reduce verbal demands, limiting the overuse of neural 
resources 
• Face-to-face communication, allowing for auditory/visual 
information integration from articulation cues 
• Increase message saliency by increasing volume of stressed 
words or modifying pitch to emphasize portions of messages 
• Reduce speaking rate and utilize within-sentence pauses to 
compensate for decreased processing time and facilitate better 
comprehension 
• Provide added response time before allowing PWA to respond 
and/or ask PWA to verify what was said 
• Use supplementary cues, both visual and manual, to enhance 
auditory comprehension.
While	often	difficult	to	differentiate	between,	mild	and	moderate	aphasia	
are	considered	‘high-level’	aphasia	types,	most	commonly	characterized	by	
word-finding	deficits	and	decreased	processing	speed.
The	outward	symptoms	of	mild-moderate	aphasia	vary.	Many	living	with	
this	condition	report	deficits	feeling	more	severe	than	they	appear.	
• Mild	aphasics	experience	communication	difficulties	25%	of	the	time	
(Sutton,	2022).
Recent	studies	suggest	these	individuals	demonstrate	abnormal	
performance	on	discourse	measures,	including	communication	speed,	
vocabulary	access,	utterance	productivity,	information	content,	and	word	
error	frequency	(Cavanaugh &	Haley,	2020).
Cognitive	deficits	are	likely	at	play	for	those	with	mild-moderate	aphasia;	
limited	research	suggests	that	mild-moderate	aphasias	may	demonstrate	
difficulties	with	shifting	attention,	verbal/nonverbal	working	memory,	and	
generation	and	concept	formation	– all	of	which	contribute	to	deficits	in	
repair.	
Individuals with mild-moderate aphasia may pass aphasia 
batteries, but continue to exhibit language deficits in 
communication. SLPs should remain aware of the impact of 
subtle language impairments and consider how those 
deficits influence personal identity and environmental 
factors related to life participation and communication 
confidence.  
• Abstract How Mild-Moderate Aphasia Affects 
Auditory Comprehension
How AC Deficits Influence Quality of Life/ 
Effective Communication 
The SLPs Role In Encouraging Successful 
Communication for/with Mild-Moderate 
Aphasia  
How Does Mild-Moderate Aphasia Present 
Itself?
• Acknowledgements
Critical	Cerebral	Areas	Involved
Single-word/sentence	comprehension	is	
associated	with	the	left	mid-posterior	
temporal	cortex,	with	a	common	overlap	
in	the	left	posterior	middle	temporal	
gyrus	
Tasks	involving	picture/object	stimuli	are	
associated	with	more	inferior	temporal	
cortical	regions,	while	sentence	level	tasks	
(which	likely	engage	verbal	working	
memory)	tap	into	more	superior	temporal	
and	inferior	parietal	cortices	(7)	
• Conclusion
Neurosurgery	Wiki,	2019


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Jeremy Fellows

Rebecca Turner

Assessing Auditory Comprehension in Persons with Mild-Moderate Aphasia

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DEI Lesson 15: Native Voices

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