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A Linguistic Analysis of Three People with No Prior AAC Experience Using an AAC Device
Full text linkSince approximately 50% of people with aphasia experience incomplete restoration of language, augmentative and alternative communication (AAC) for people with aphasia has been used primarily as a compensatory therapeutic intervention. AAC is less frequently considered to restore linguistic functions (Weissling & Prentice 2010). Recently, researchers described the communication patterns used by people with aphasia when they retold personal narratives using four different AAC screen layouts (Dietz, Griffith, & Macke, 2014; Dietz, Weissling, Griffith, & McKelvey, 2014; Griffith, Dietz, & Weissling, 2014). Across these reports, the people with aphasia employed a variety of expressive modality units (i.e., spoken, written, drawn, picture, text box, and speak button) to retell their stories; however, they predominately used the spoken modality to retell each story. Despite the presence of an AAC device, they spoke, on average 70% of the time across all retells, (Dietz et al, 2014a; 2014b; Griffith et al., 2014). The question remains, though, whether these high levels of spoken output translates in to more effective and efficient verbal expression. Therefore, as such, the purpose of this retrospective case series study was to describe and analyze the spoken linguistic output of the people with aphasia and no prior AAC experience from the Dietz et al., (2014a; 2014b) studies
Story Grammar Analysis in Persons with Mild Aphasia
No full textNarratives are often the basis of daily conversational interactions. When narrative skills are compromised, functional conversation is negatively impacted. Narrative coherence can be impacted even in clinical populations with mild word-finding deficits, such as anomic aphasia (Andreetta, Cantagallo, & Marini, 2012). The narrative abilities of those individuals who have had a stroke (and perhaps a previous aphasia diagnosis) but who perform within the normal range on standardized aphasia assessment measures have not been characterized. As every clinician/clinical researcher knows, this subgroup still includes individuals who have difficulty in conversation, who cannot return to work, and whose life participation is negatively impacted. Using AphasiaBank categorization (as this study relies on AphasiaBank transcripts), we refer to this subgroup as “not aphasic by WAB” (NABW). In both persons with anomic aphasia (PWaAs) and NABWs, deficits may be so minor that they are not apparent on traditional standardized assessment measures, but it should not be assumed that they do not exist and do not affect functional communication abilities. Unfortunately, there is often very little help to be offered for this population. In order to continue progressive development of interventions for PWaAs and NABWs, more information regarding narrative strengths and weaknesses in this population is needed.
Story grammar analysis is a well-known method of analyzing narrative discourse in several clinical populations and is likely to be sensitive to differences between closely matched groups. The specific aims of this study are to 1) determine if there are differences between PWaAs, NABW, and non-brain injured controls (NBIs) on production of story grammar components during retelling of the Cinderella story, and 2) to examine the relationship between story grammar measures and an easily and quickly derived discourse measure called CoreLex to further characterize the relationship between micro- and macro-level processes in persons with mild aphasia
Korean Passive Sentence Comprehension Deficits and its Relation to Working Memory Capacity in Persons with Aphasia
No full textThe current study investigated Korean passive sentence comprehension deficits in aphasia and its underlying processing mechanisms using three types of syntactic structures: 1) active sentences with a 2-argument structure, 2) active sentences with a 3-argument structure, and 3) passive counterparts of active sentences with a 2-argument structure. Persons with aphasia showed differentially greater difficulties in passive than 2-place active sentences compared to the normal elderly adults, but the group differences were not significant between the passive and 3-place active sentences. Working memory, not the short-term memory, was significantly correlated with overall aphasia severity and performance on sentence comprehension tasks
Effects of Individual and Group Therapies on Verb Production in Aphasia
No full textLanguage interventions are frequently classified along a continuum (Paul & Cascella, 2007). At one end of the continuum are impairment-based approaches that aim to remediate a particular language skill. Successful treatments often utilize models of cognitive-linguistic processing and have been shown to improve language performance in individuals with aphasia (Thompson & Shapiro, 2005; Whitworth, Webster, & Howard, 2005, Wertz et al 1981). At the other end of the continuum is the participant-centered approach. These types of interventions place the client at the center of the intervention. Group treatment is a socially oriented intervention and an example of a participant-centered approach. Studies support the use of conversation group treatments to improve language performance in individuals with aphasia (Wertz et al., 1981, Elman & Bernstein-Ellis, 1999b). Considerable evidence exists in the literature to support both these types of interventions and both interventions seek to improve communication in the individual with aphasia (Martin, Thompson & Worrall, 2008). However, there have been no studies that compare the effects of these two approaches.
This study compared the effect of these two approaches on remediation of verb production in aphasia. The goals were 1) to determine if performance on verbs trained in an impairment-based approach, a participant-centered approach, or an integrated context that used both approaches improved to a greater extent, and 2) to determine whether combining these training approaches led to improvements in related language functions and in verbal communication
EVAL: A computerized language analysis program for clinicians
Full text linkClinicians generally have limited time to evaluate their aphasic clients, and thus are often unable to include discourse-level language in their assessments. Sampling and analyzing language at the discourse level by hand can be very time-consuming, but since it is the level at which day-to-day communication occurs, it provides important information about language use and competence in context. It can also point the way to functional goals for therapy.
In this presentation we will illustrate the use of EVAL, a recent addition to the wide array of CLAN computerized language analysis programs freely available from TalkBank (MacWhinney, 2000). EVAL is designed for quick and simple use by clinicians. It measures 25 language characteristics in a transcription of discourse and displays them in an Excel spreadsheet. It can then compare the results with those of a comparison group selected from the AphasiaBank database, or it can compare the results with those of the same participant at earlier or later measurement times (e.g., pre- and post-therapy). It is based on a simplified system of transcription and error coding, designed with the time constraints of busy clinicians in mind. While transcription is done in the CHAT format required for CLAN programs, it can be less detailed
Feedback and feedforward control in apraxia of speech: Noise masking effects on fricative production
No full textThe present study tested two hypotheses about apraxia of speech (AOS), framed in the DIVA model (Guenther, Ghosh, & Tourville, 2006). The DIVA model assumes that speech targets are regions in auditory space, and combines two mechanisms to reach those targets: feedback control and feedforward control. The Feedforward System Deficit (FF) hypothesis states that feedforward control is impaired in AOS, with consequently a greater reliance on feedback control (Jacks, 2008; Maas, Mailend, & Guenther, 2013). The Feedback System Deficit (FB) hypothesis states that feedback control is impaired in AOS; for example, self-generated auditory feedback may be disruptive (cf. Ballard & Robin, 2007).
We tested these hypotheses by measuring acoustic fricative contrast in normal listening and noise masking conditions. The rationale is that noise masking effectively eliminates the self-generated auditory feedback signal, thus forcing a greater reliance on feedforward control. For unimpaired speakers, we predict a reduction in acoustic contrast, given evidence that speakers monitor and use auditory feedback on-line (e.g., Tourville, Reilly, & Guenther, 2008), though this reduction is expected to be small given the robust feedforward commands presumably available to unimpaired speakers (e.g., Perkell, 2012).
For speakers with AOS, the FF hypothesis predicts greater reduction of contrast with masking in AOS patients than in controls, because removal of auditory feedback will reveal the impaired feedforward commands. The FB hypothesis predicts increased contrast with feedback masking, because removal of interfering auditory feedback enables intact feedforward commands to produce adequate contrasts
Measuring Outcomes in Aphasia and Apraxia of Speech in the Context of a Learning Health Care System
No full textNone
Main Concept Production in Persons with Aphasia: A Comparison of Subtypes
No full textNarrative abilities are negatively impacted in persons with aphasia (PWAs), with even the mildest PWAs producing narratives that, though well-structured, are characterized by reduced lexical diversity, complexity, content, length, coherence, and more (e.g., Andreetta, Cantagallo, & Marini, 2012; Capilouto, Wright, and Wagovich, 2006; Fergadiotis & Wright, 2011; Nicholas & Brookshire, 1995; Ulatowska, North, & Macaluso-Haynes, 1981). Even those categorized as “not aphasic by WAB” (NABW) produce significantly different story retell narratives compared to typical and aphasic peers (Author2, Dillow, & Author1, 2013). Diminished narrative abilities, and associated reduced functional communication, have a marked negative impact on quality of life (QoL) in PWAs, more so than physical limitations that accompany stroke (Hilari, 2011; Northcott & Hilari, 2011). Indeed, narrative ability may be a better predictor of life participation and QoL than traditionally administered outcome measures (Ross & Wertz, 1999), making imperative the advancement of narrative assessment and treatment.
Three primary barriers to narrative assessment impede widespread use - standardization, norm-reference, and time constraints. AphasiaBank developers (http://talkbank.org/AphasiaBank/) addressed the first barrier by making available a standard discourse protocol. Regarding the second barrier, norm-referenced Main Concept (MC) lists based on 150+ control transcripts for three different types of discourse were recently developed using AphasiaBank (Author2, Campbell, Williams, Dillow, & Author1, 2013). The MC lists included concepts spoken by 50% of the control population. The authors elected to develop MC lists primarily because 1) MC analysis is a reliable and valid method of assessing narrative adequacy in PWAs (Nicholas & Brookshire, 1995), and 2) generation of standardized, norm-referenced, non-transcription-based MC lists would reduce the amount of time required for narrative assessment (third barrier).
Previous MC research has revealed differences between controls and PWAs, and between fluent and non-fluent PWAs (Kong, 2009, 2011; Nicholas & Brookshire, 1995). Previous MC studies have also combined certain codes (see Discussion), which may lead to inaccurate representation of communicative abilities and/or masking of differences between subtypes. We extracted lengthy narrative samples of a large group of PWAs and analyzed the samples with a multi-level MC coding system using norm-referenced MCs in order to determine 1) if there were significant differences in MC production between different aphasia subtypes, and 2) if so, which subtypes were significantly different from each othe
Investigating the role of intensity in a comprehensive, aphasia therapy program: A non-intensive trial of Aphasia LIFT
No full textIntensive, comprehensive aphasia programs (ICAPs) are an emerging service delivery in aphasia rehabilitation (Rose, Cherney, & Worrall, 2013). Positive therapeutic outcomes for the ICAP Aphasia LIFT (Language Impairment and Functioning Therapy) have been demonstrated across World Health Organisation International Classification of Functioning and Disability (ICF) domains (Rodriguez et al., 2013). Within aphasia rehabilitation, there is evidence favouring intensive treatment models (Cherney, Patterson, & Raymer, 2011; Robey, 1998); however, the optimal treatment intensity for even one type of aphasia therapy is yet to be established (Cherney, 2012). Evidence from the neurosciences literature, based predominantly on animal studies of stroke rehabilitation, suggests that optimal learning outcomes are achieved when training is provided intensively (i.e., many hours per day) (Kleim & Jones, 2008). In contrast, studies of learning in healthy humans suggest that optimal long-term learning is achieved when training is distributed over time (Cepeda, Pashler, Vul, Wixted, & Rohrer, 2006). This study evaluated the therapeutic effect of non-intensive Aphasia LIFT (NiLIFT) on impairment and functional communication outcomes in adults with chronic aphasia
