The Relationship Between Confrontation Naming and Story Gist Production in Aphasia

Discourse Measures From the Modern Cookie Theft Picture Description Are Sensitive to Mild Communication Deficits Not Captured by the Western Aphasia Battery-Revised Aphasia Quotient

PURPOSE

The Western Aphasia Battery-Revised (WAB-R) is often used for diagnosis of aphasia. However, persons scoring above the WAB-R diagnostic cutoff may still present with language difficulties indicative of aphasia. Identification of residual language challenges is critical for treatment referral or inclusion in research. We examined differences in discourse following acute left-hemisphere stroke for those above/below the WAB-R diagnostic cutoff compared to healthy controls, as well as recovery during the first year.

METHOD

Sixty-eight participants with acute left-hemisphere stroke completed the WAB-R and were classified as aphasic by WAB-R (ABW; n = 42) or not aphasic by WAB-R (NABW; n = 26). They completed the Modern Cookie Theft (MCT) picture description task at two time points: acute and either 3, 6, or 12 months poststroke. Responses were analyzed for content units, total verbal output, efficiency, and lateralization of content (i.e., right vs. left side of stimulus) and compared to 49 healthy controls. Differences between groups were examined using Wilcoxon rank-sum tests. Change over time was examined using robust linear mixed-effects regression.

RESULTS

Wilcoxon tests showed differences between healthy controls and ABW or NABW on all MCT metrics except efficiency for those NABW. Regression models showed no main effects of group or interaction between group and time point.

CONCLUSIONS

The NABW group showed deficits in verbal output, content production, and laterality on the MCT picture description task, suggesting the presence of possible aphasia and hemispatial neglect. Measures derived from the MCT may be more sensitive to residual language/communication difficulties not captured by the WAB-R. The NABW group also showed similar patterns of recovery as the ABW group, highlighting the MCT task's ability to capture change for those with mild impairments. Results support use of the MCT task in clinical settings, particularly if/when mild deficits are probable/suspected.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28608116.

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

Purpose

Mild language impairments experienced by adults with neurogenic communication disorders are often difficult to detect due to the lack of sensitive traditional performance-based measures. This is problematic since many adults who have mild language deficits experience daily activity and participation limitations that are undetected and not managed. This study evaluates the potential for variables derived through core lexicon analysis to differentiate two clinical groups (latent aphasia, MCI) from each other, and from a cognitively healthy adult group, across three different discourse tasks (Aim 1). Innovatively, it also contrasts the sensitivity with which each task differentiates the groups based on this metric (Aim 2).

Methods

Transcribed connected speech data from TalkBank were analyzed for three discourse tasks (i.e., Sandwich Procedure, Cat Rescue Picture Description, and Cinderella Story) from three participant groups [Mild Cognitive Impairment (MCI) n = 30, stroke-induced latent aphasia n = 29, and Cognitive Healthy Adults (CHA) n = 56]. Aim 1 used one-way ANOVAs (or non-parametric equivalents) to identify differences in lexical variables (total number of core lexical items; proportion of core lexical items out of all words produced; and rate of core lexical items produced per second) between participant groups. Aim 2 used linear discriminant analysis with cross validation to characterize the sensitivity of discourse task in identifying lexical variables differentiating the participant groups.

Results

Univariate analysis revealed significant differences among the three participant groups. During the Cinderella task, the latent aphasia and MCI groups produced significantly fewer core lexical items than CHAs, while their proportion of core lexical items to total tokens was higher than CHAs. The latent aphasia group produced core lexical items more slowly than the MCI group for all three discourse tasks. Finally, individuals with latent aphasia produced significantly fewer core lexical items during the Sandwich task than either the MCI or CHA groups. Aim 2's sensitivity analysis revealed that number of core lexical items produced during the Cinderella task best differentiated the MCI group from CHAs, number of core lexical items produced during Sandwich best differentiated latent aphasia from CHAs, and core lexical items per second during Cinderella best differentiated latent aphasia from MCI.

Conclusion

Our study suggests that the Cinderella story is more sensitive than a picture description task for demonstrating the subtle lexical-semantic changes in MCI and latent aphasia compared to CHAs. Core lexicon appears to be a sensitive discourse metric to identify linguistic differences between CHAs and individuals with mild cognitive and/or language deficits. These findings further support calls to provide speech/language and cognitive therapy to individuals with MCI and/or latent aphasia.

Assessing Relative Linguistic Impairment With Model-Based Item Selection

PURPOSE

A picture naming test is presented that reveals impairment to specific mechanisms involved in the naming process, using accuracy scores on curated item sets. A series of psychometric validation experiments are reported.

METHOD

Using a computational model that enables estimation of item difficulty at the lexical and sublexical stages of word retrieval, two complimentary sets of items were constructed that challenge the respective psycholinguistic levels of representation. The difference in accuracy between these item sets yields the relative linguistic impairment (RLI) score. In a cohort of 91 people with chronic left-hemisphere stroke who enrolled in a clinical trial for anomia, we assessed psychometric properties of the RLI score and then used the new scale to make predictions about other language behaviors, lesion distributions, and functional activation during naming.

RESULTS

RLI scores had adequate psychometric properties for clinical significance. RLI scores contained predictive information about spontaneous speech fluency, over and above accuracy. A dissociation was observed between performance on the RLI item sets and performance on the subtests of an independent language battery. Sublexical RLI was significantly associated with apraxia of speech and with lesions encompassing perisylvian regions, while lexical RLI was associated with lesions to deep white matter. The RLI construct was reflected in functional brain activity during naming, independent of overall accuracy, with a respective shift of activation between dorsal and ventral networks responsible for different aspects of word retrieval.

CONCLUSION

The RLI assessment satisfies the psychometric requirements to serve as a useful clinical measure.

Picture naming test through the prism of cognitive neuroscience and linguistics: adapting the test for cerebellar tumor survivors-or pouring new wine in old sacks?

A picture naming test (PNT) has long been regarded as an integral part of neuropsychological assessment. In current research and clinical practice, it serves a variety of purposes. PNTs are used to assess the severity of speech impairment in aphasia, monitor possible cognitive decline in aging patients with or without age-related neurodegenerative disorders, track language development in children and map eloquent brain areas to be spared during surgery. In research settings, picture naming tests provide an insight into the process of lexical retrieval in monolingual and bilingual speakers. However, while numerous advances have occurred in linguistics and neuroscience since the classic, most widespread PNTs were developed, few of them have found their way into test design. Consequently, despite the popularity of PNTs in clinical and research practice, their relevance and objectivity remain questionable. The present study provides an overview of literature where relevant criticisms and concerns have been expressed over the recent decades. It aims to determine whether there is a significant gap between conventional test design and the current understanding of the mechanisms underlying lexical retrieval by focusing on the parameters that have been experimentally proven to influence picture naming. We discuss here the implications of these findings for improving and facilitating test design within the picture naming paradigm. Subsequently, we highlight the importance of designing specialized tests with a particular target group in mind, so that test variables could be selected for cerebellar tumor survivors.

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

PURPOSE

This study was designed to examine the hypothesis that discourse task types influence language performance in Mandarin Chinese-speaking people and to reveal the discourse task-specific linguistic properties of persons with anomic aphasia compared to neurotypical controls.

METHOD

Language samples from persons with aphasia (n = 31) and age- and education-matched controls (n = 31) across four discourse tasks (sequential-picture description, single-picture description, story narrative, and procedural discourse) were collected from Mandarin AphasiaBank. Task-specific distributions of parts of speech were analyzed using mosaic plots. The main effects of tasks in each group and the between-group differences within each task for several typical linguistic variables were evaluated, including the mean length of utterance, tokens, moving-average type-token ratio, words per minute, propositional density, noun-verb ratio, noun percentage, and verb percentage.

RESULTS

The results revealed an impact of discourse tasks on most language variables in both groups. In the healthy controls, story narratives yielded the highest total words and lowest verb percentage. In the aphasia group, procedural discourse elicited the fewest total words and densest expressions, whereas their single-picture descriptions had the highest noun-verb ratio. For all tasks, the aphasia group performed worse than the control group in the mean length of utterance, tokens, moving-average type-token ratio, and words per minute. For noun-verb ratio, noun percentage, and verb percentage, only one task (i.e., single-picture description) showed significant between-group differences.

CONCLUSION

The selection of discourse tasks should be addressed in assessments and interventions for Mandarin Chinese-speaking individuals with aphasia to obtain more accurate and feasible outcomes.

Combining executive function training and anomia therapy in chronic post-stroke aphasia: A preliminary study of multidimensional effects

PURPOSE

The influential relationship between executive functioning and aphasia rehabilitation outcomes has been addressed in a number of studies, but few have studied the effect of adding executive function training to linguistic therapies. The present study aimed to measure the effects of combining, within therapy sessions, executive function training and anomia therapy on naming and discourse abilities in people with chronic aphasia.

METHOD

A single-case experimental design with multiple baselines across participants was used. Four persons with chronic post-stroke aphasia received 12 sessions of a tailored treatment combining executive function training and semantic feature analysis (SFA) therapy. Naming accuracy of treated items was examined over the course of the treatment while control naming scores of untreated items and discourse measures were collected pre-treatment, immediately post-treatment, and 4 weeks post-treatment, in order to investigate the multidimensional effects of the treatment and their maintenance.

RESULT

Naming skills improved in all participants for treated and untreated items, were maintained over time, and were accompanied by improved discourse abilities. Visual and statistical analyses showed a significant treatment effect for naming skills in three out of the four participants.

CONCLUSION

A combination of executive function training and SFA treatment in people with chronic aphasia may improve both naming skills and discourse efficiency. Further studies are needed to substantiate these promising preliminary results.

Automating Intended Target Identification for Paraphasias in Discourse Using a Large Language Model

PURPOSE

To date, there are no automated tools for the identification and fine-grained classification of paraphasias within discourse, the production of which is the hallmark characteristic of most people with aphasia (PWA). In this work, we fine-tune a large language model (LLM) to automatically predict paraphasia targets in Cinderella story retellings.

METHOD

Data consisted of 332 Cinderella story retellings containing 2,489 paraphasias from PWA, for which research assistants identified their intended targets. We supplemented these training data with 256 sessions from control participants, to which we added 2,415 synthetic paraphasias. We conducted four experiments using different training data configurations to fine-tune the LLM to automatically "fill in the blank" of the paraphasia with a predicted target, given the context of the rest of the story retelling. We tested the experiments' predictions against our human-identified targets and stratified our results by ambiguity of the targets and clinical factors.

RESULTS

The model trained on controls and PWA achieved 50.7% accuracy at exactly matching the human-identified target. Fine-tuning on PWA data, with or without controls, led to comparable performance. The model performed better on targets with less human ambiguity and on paraphasias from participants with fluent or less severe aphasia.

CONCLUSIONS

We were able to automatically identify the intended target of paraphasias in discourse using just the surrounding language about half of the time. These findings take us a step closer to automatic aphasic discourse analysis. In future work, we will incorporate phonological information from the paraphasia to further improve predictive utility.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24463543.

Neuroanatomical correlates of macrostructural receptive abilities in narrative discourse in unilateral left hemisphere stroke: A behavioural and voxel-based morphometry study

BACKGROUND

Little is known about story retelling and comprehension abilities in groups with lower levels of education and socio-economic status (SES). A growing body of evidence suggests the role of an extended network supporting narrative comprehension, but few studies have been conducted in clinical populations, even less in developing countries.

AIMS

To extend our knowledge of the impact of a stroke on macrostructural aspects of discourse processes, namely main and complementary information, in individuals with middle-low to low SES and low levels of education. Relationships were tested between the performance in story retell and comprehension and reading and writing habits (RWH). Also, the associations between retelling and comprehension measures and their structural grey matter (GM) correlates were explored.

METHODS & PROCEDURES

A total of 17 adults with unilateral left hemisphere (LH) chronic ischaemic stroke without the presence of significant aphasia and 10 matched (age, education and SES) healthy controls (HC) participated in the study. Retell and comprehension tasks were performed after listening or reading narrative stories. Voxel-based morphometry (VBM) analysis was conducted on a subgroup of nine individuals with LH stroke and the 10 matched controls using structural magnetic resonance imaging (MRI).

OUTCOMES & RESULTS

Retelling and comprehension abilities were not significantly different between LH and HC, nonetheless quantitively lower in LH. Exploratory correlations showed that retelling and comprehension abilities in both written and auditory modalities were correlated with naming abilities. At the neural level, written comprehension positively correlated with GM density of the LH, including areas in the temporal pole, superior and middle temporal gyrus as well as the orbitofrontal cortex, precentral and postcentral gyri. Auditory narrative comprehension was associated with GM density of the lingual gyrus in the right hemisphere.

CONCLUSIONS & IMPLICATIONS

The present results suggest that retelling and comprehension of auditory and written narratives are relatively well-preserved in individuals with a LH stroke without significant aphasia, but poorer than in HC. The findings replicate previous studies conducted in groups with higher levels of education and SES both at the behavioural and neural levels. Considering that naming seems to be associated with narrative retell and comprehension in individuals with lower SES and education, this research provides evidence on the importance of pursuing further studies including larger samples with and without aphasia as well as with various SES and education levels.

WHAT THIS PAPER ADDS

What is already known on this subject Story retell and comprehension of auditory and written discourse have been shown to be affected after stroke, but most studies have been conducted on individuals with middle to high SES and high educational levels. What this paper adds to existing knowledge The study reports on narrative retell and comprehension in both auditory and written modalities in groups of HC and individuals with LH brain damage, with low-to-middle SES and lower levels of education. What are the potential or actual clinical implications of this work? This study highlights the importance of taking into consideration the sociodemographic and RWH of patients when assessing discourse retell and comprehension in both auditory and written modalities. It also underlines the importance of including patients without significant aphasia following LH stroke to look at the effect of both stroke and aphasia on narrative comprehension and story retelling.

Evaluating circumlocution in naming as a predictor of communicative informativeness and efficiency in discourse

Background

Discourse analyses yield quantitative measures of functional communication in aphasia. However, they are historically underutilized in clinical settings. Confrontation naming assessments are used widely clinically and have been used to estimate discourse-level production. Such work shows that naming accuracy explains moderately high proportions of variance in measures of discourse, but proportions of variance remain unexplained. We propose that the inclusion of circumlocution productions into predictive models will account for a significant amount more of the variance. Circumlocution productions at the naming-level, while they may not contain the target word, are similar to the content that contributes to discourse informativeness and efficiency. Thus, additionally measuring circumlocution may improve our ability to estimate discourse performance and functional communication.

Aim

This study aimed to test whether, after controlling for naming accuracy, the addition of a measure of circumlocution into predictive models of discourse-level informativeness and efficiency would account for a significant amount more of the variance in these discourse-level outcomes.

Methods & Procedures

Naming and discourse data from 43 people with poststroke aphasia were analyzed. Naming data were collected using 120 pictured items and discourse data were collected using two picture description prompts. Data scoring and coding yielded measures of naming accuracy, incorrect response type, communicative informativeness, and efficiency. We used robust hierarchical regression to evaluate study predictions.

Outcomes & Results

After controlling for naming accuracy, the inclusion of circumlocution into predictive models accounted for a significant amount more of the variance in both informativeness and efficiency. The subsequent inclusion of other response types, such as real word and nonword errors, did not account for a significant amount more of the variance in either outcome.

Conclusions

In addition to naming accuracy, the production of circumlocution during naming assessments may correspond with measures of informativeness and efficiency at the discourse-level. Reducing the burden of estimating patients' functional communication will increase our ability to estimate functional communication using tools that are easy to administer and interpret.

The Severity-Calibrated Aphasia Naming Test

PURPOSE

We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension.

METHOD

We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT.

RESULTS

The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead.

CONCLUSION

We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21476871.

Core lexicon in aphasia: A longitudinal study

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.

BNT-15: Revised Performance Validity Cutoffs and Proposed Clinical Classification Ranges

BACKGROUND

Abbreviated neurocognitive tests offer a practical alternative to full-length versions but often lack clear interpretive guidelines, thereby limiting their clinical utility.

OBJECTIVE

To replicate validity cutoffs for the Boston Naming Test-Short Form (BNT-15) and to introduce a clinical classification system for the BNT-15 as a measure of object-naming skills.

METHOD

We collected data from 43 university students and 46 clinical patients. Classification accuracy was computed against psychometrically defined criterion groups. Clinical classification ranges were developed using a z -score transformation.

RESULTS

Previously suggested validity cutoffs (≤11 and ≤12) produced comparable classification accuracy among the university students. However, a more conservative cutoff (≤10) was needed with the clinical patients to contain the false-positive rate (0.20-0.38 sensitivity at 0.92-0.96 specificity). As a measure of cognitive ability, a perfect BNT-15 score suggests above average performance; ≤11 suggests clinically significant deficits. Demographically adjusted prorated BNT-15 T-scores correlated strongly (0.86) with the newly developed z -scores.

CONCLUSION

Given its brevity (<5 minutes), ease of administration and scoring, the BNT-15 can function as a useful and cost-effective screening measure for both object-naming/English proficiency and performance validity. The proposed clinical classification ranges provide useful guidelines for practitioners.

Macrostructural Aspects in Oral Narratives in Brazilian Portuguese by Left and Right Hemisphere Stroke Patients With Low Education and Low Socioeconomic Status

OBJECTIVE

Individuals with a stroke in either the left hemisphere (LH) or the right hemisphere (RH) often present macrostructural impairments in narrative abilities. Understanding the potential influence of low education and low socioeconomic status (SES) is critical to a more effective assessment of poststroke language. The first aim was to investigate macrostructural processing in low-education and low-SES individuals with stroke in the LH or RH or without brain damage. The second aim was to verify the relationships between macrolinguistic, neuropsychological, and sociodemographic variables.

METHOD

Forty-seven adults with LH (n = 15) or RH (n = 16) chronic ischemic stroke and 16 matched (age, education, and SES) healthy controls produced three oral picture-sequence narratives. The macrostructural aspects analyzed were cohesion, coherence, narrativity, macropropositions, and index of lexical informativeness and were compared among the three groups. Then, exploratory correlations were performed to assess associations between sociodemographic (such as SES), neuropsychological, and macrostructural variables.

RESULTS

Both the LH and the RH presented impairments in the local macrostructural aspect (cohesion), whereas the RH also presented impairments in more global aspects (global coherence and macropropositions). All five macrostructural variables correlated with each other, with higher correlations with narrativity. Naming was correlated with all macrostructural variables, as well as prestroke reading and writing habits (RWH), showing that higher naming accuracy and higher RWH are associated with better macrostructural skills.

CONCLUSIONS

The present results corroborate the role of the LH in more local processing and that of the RH in more global aspects of discourse. Moreover, this study highlights the importance of investigating discourse processing in healthy and clinical populations of understudied languages such as Brazilian Portuguese, with various levels of education, SES, and RWH.

Are single-word picture naming assessments a valid measure of word retrieval in connected speech?

Purpose: Picture naming assessments are one of the most common methods of examining word retrieval in aphasia. However, currently, it is unclear whether these assessments are able to accurately predict word retrieval in "real-life" communication. This paper aims to explore the evidence in the current literature regarding the relationship between picture naming and word retrieval in connected speech in people with aphasia.Method: Literature was reviewed that examined the correlation between picture naming and word retrieval in connected speech. The literature search was limited to articles that were English language, participants with aphasia, and that were not therapy studies.Result: The existing studies showed mixed findings. However, comparison of study outcomes was complicated by inconsistency in the research methods used, including in word retrieval measures and connected speech elicitation.Conclusion: While there is some evidence of a relationship between picture naming and word retrieval in connected speech, correlation outcomes were mixed with possible influences from participant characteristics, assessment method and speech sample type. We therefore suggest that clinical decision-making would benefit from supplementing picture naming tests with an analysis of word retrieval in connected speech. Further research is required with a focus on natural conversation and the development of standard testing procedures for connected speech.

What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.

Assessment of language impairment and function

This chapter is written for the qualified neurologist or related professional working with persons who have had a stroke or other sudden brain injury. It is critical that the presence of aphasia is detected, no matter how mild the presentation, and to support that assertion, this chapter highlights the plight of persons with latent aphasia. At the individual level, the impact of aphasia is devastating, with overwhelming evidence that aphasia negatively impacts psychosocial outcomes. At the global level, sensitive detection and accurate diagnosis of aphasia are critical for accurate characterization and quantification of the global burden of aphasia. The word "LANGUAGE" is leveraged as an acronym to create a useful and memorable checklist to guide navigation of aphasia screening and assessment: it begins with the definition of language (L), followed by the definition and diagnostic criteria for aphasia (A). Then language abilities and characteristics to be considered in assessment are presented: naming (N); grammar and syntax (G); unintelligible words, jargon, and paraphasias (U); auditory comprehension and repetition (A); graphemic abilities-reading and writing (G); and everyday communication and discourse (E). Recommendations for improving procedural adherence are provided, and a list of potential brief assessment measures are introduced.

Spectral Resting-State EEG (rsEEG) in Chronic Aphasia Is Reliable, Sensitive, and Correlates With Functional Behavior

We investigated spectral resting-state EEG in persons with chronic stroke-induced aphasia to determine its reliability, sensitivity, and relationship to functional behaviors. Resting-state EEG has not yet been characterized in this population and was selected given the demonstrated potential of resting-state investigations using other neuroimaging techniques to guide clinical decision-making. Controls and persons with chronic stroke-induced aphasia completed two EEG recording sessions, separated by approximately 1 month, as well as behavioral assessments of language, sensorimotor, and cognitive domains. Power in the classic frequency bands (delta, theta, alpha, and beta) was examined via spectral analysis of resting-state EEG data. Results suggest that power in the theta, alpha, and beta bands is reliable for use as a repeated measure. Significantly greater theta and lower beta power was observed in persons with aphasia (PWAs) than controls. Finally, in PWAs theta power negatively correlated with performance on a discourse informativeness measure, while alpha and beta power positively correlated with performance on the same measure. This indicates that spectral rsEEG slowing observed in PWAs in the chronic stage is pathological and suggests a possible avenue for directly altering brain activation to improve behavioral function. Taken together, these results suggest that spectral resting-state EEG holds promise for sensitive measurement of functioning and change in persons with chronic aphasia. Future studies investigating the utility of these measures as biomarkers of frank or latent aphasic deficits and treatment response in chronic stroke-induced aphasia are warranted.

Main Concept, Sequencing, and Story Grammar Analyses of Cinderella Narratives in a Large Sample of Persons with Aphasia

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG’s six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs). We present descriptive statistical information for MSSG variables for a large sample of PWAs and compare their performance to a large sample of persons not brain injured (PNBIs). We observed significant differences between PWAs and PNBIs for all MSSG variables. These differences occurred at the omnibus group level and for each aphasia subtype, even for PWAs with very mild impairment that is not detected with standardized aphasia assessment. Differences between PWAs and PNBIs were also practically significant, with medium to large effect sizes observed for nearly all aphasia subtypes and MSSG variables. This work deepens our understanding of discourse informativeness and macrostructure in PWAs and further develops an efficient tool for research and clinical use. Future research should investigate ways to expand MSSG analyses and to improve sensitivity and specificity.

Word-finding in confrontation naming and picture descriptions produced by individuals with early post-stroke aphasia

OBJECTIVE

The present study aims to assess the relationship between quantitative measures of connected speech production and performance in confrontation naming in early post-stroke aphasia (8-14 days post-stroke). Method: We collected connected speech samples elicited by a picture description task and administered a confrontation naming task to 20 individuals with early post-stroke aphasia and 20 healthy controls. Transcriptions were made in compliance with the CHAT format guidelines. Several micro- (i.e. duration, total number of words, words per minute, mean length of utterances, ratio of open- to closed-class words and noun-to-verb ratio, VOC-D, repetitions, self-corrections, and phonological and semantic errors) and macrolinguistic (i.e. informativeness and efficiency) measures were extracted. Results: We provide evidence for the presence of impairments in an array of micro- and macrolinguistic measures of speech in individuals with early post-stroke aphasia. We show that in the patient group, confrontation naming abilities most strongly relate to informativeness in a picture description task. Conclusion: Our findings contribute to a better understanding of the relationship between performance in confrontation naming and in connected speech production in the first days after stroke onset and also suggest that discourse analysis may provide unique, possibly more complex information.

Evaluating Personal Stroke Narratives from Bilingual Greek-English Immigrants with Aphasia

OBJECTIVE

For people with aphasia (PWA) and their significant others, narratives are intricately intertwined with quality of life, culture, and social participation. This paper reports stories told by bilingual people with aphasia (bPWA), describing the events or consequences of a stroke on their lives.

PATIENTS AND METHODS

Six participants with chronic mild-moderate anomia (mean age 70 years) spontaneously produced a narrative recounting their personal experience of stroke in their native language (Greek) and in their second language (English). All bPWA had learned English in early adulthood upon migration from Greece to Australia, not through formal teaching but on the job (e.g., in the factory). The bPWA had lived in Australia for 46 years (average) and were less than 4 years post-stroke.

RESULTS

Narratives in the two languages underwent quantitative (number of propositions, noun/verb tokens) and qualitative analyses (ratings of coherence, ratings of clarity). Most bPWA produced coherent "tellable" stories despite disruptions in language because of aphasia. Overall, stories were better told (length, complexity of content, temporal-causal sequencing, reference) in Greek - their native language.

CONCLUSION

The results have implications for policy-makers providing health and welfare services to ageing immigrant populations. The findings are also relevant to other countries that have large immigrant populations of stroke survivors.

A Large-Scale Comparison of Main Concept Production Between Persons With Aphasia and Persons Without Brain Injury

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.

Main concepts for two picture description tasks: An addition to

BACKGROUND

Proposition analysis of the discourse of persons with aphasia has a long history, yielding important advancements in our understanding of communication impairments in this population. Recently, discourse measures have been considered primary outcome measures, and multiple calls have been made for improved psychometric properties of discourse measures.

AIMS

To advance the use of discourse analysis in persons with aphasia by providing Main Concept Analysis checklists and descriptive statistics for healthy control performance on the analysis for the Cat in the Tree and Refused Umbrella narrative tasks utilized in the AphasiaBank database protocol.

METHODS & PROCEDURES

Ninety-two control transcripts, stratified into four age groups (20-39 years; 40-59; 60-79; 80+), 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 a main concept. A multi-level coding system was used to determine the accuracy and completeness of the main concepts produced by control speakers.

OUTCOMES & RESULTS

Main concept checklists for two discourse tasks are provided. Descriptive statistics are reported and examined to assist readers with evaluation of the normative data.

CONCLUSIONS

These checklists provide clinicians and researchers with a tool to reliably assess the discourse of persons with aphasia. They also help address the gap in available psychometric data with which to compare persons with aphasia to healthy controls.