Standardizing Assessment of Spoken Discourse in Aphasia: A Working Group With Deliverables

A targeted review of prosodic production in agrammatic aphasia

It is unclear whether individuals with agrammatic aphasia have particularly disrupted prosody, or in fact have relatively preserved prosody they can use in a compensatory way. A targeted literature review was undertaken to examine the evidence regarding the capacity of speakers with agrammatic aphasia to produce prosody. The aim was to answer the question, how much prosody can a speaker "do" with limited syntax? The literature was systematically searched for articles examining the production of grammatical prosody in people with agrammatism, and yielded 16 studies that were ultimately included in this review. Participant inclusion criteria, spoken language tasks, and analysis procedures vary widely across studies. The evidence indicates that timing aspects of prosody are disrupted in people with agrammatic aphasia, while the use of pitch and amplitude cues is more likely to be preserved in this population. Some, but not all, of these timing differences may be attributable to motor speech programming deficits (AOS) rather than aphasia, as these conditions frequently co-occur. Many of the included studies do not address AOS and its possible role in any observed effects. Finally, the available evidence indicates that even speakers with severe aphasia show a degree of preserved prosody in functional communication.

Data-driven classification of narrative speech characteristics in stroke aphasia distinguishes neurological and strategic contributions

Narrative speech deficits are common in post-stroke aphasia, resulting in negative influences on social participation and quality of life. Speech rate, complexity, and informativeness deficits all contribute to narrative speech. Research studies typically (implicitly) assume that these aspects of narrative speech production are a result of cognitive/neurological impairment, but they may also result from strategic choices made as individuals with aphasia attempt to produce narrative speech. Here, we used data-driven methods to classify aphasic narrative speech patterns and evaluated their predictability from lesion patterns. 76 stroke aphasia patients completed 11 narrative speech production tasks. Quantitative Production Analysis (QPA) and Correct Information Unit (CIU) analysis were used to measure their structural and functional properties. Based on prior work, we selected QPA measures of speech rate (words per minute) and complexity (mean sentence length, inflection index, and auxiliary index) and four CIU measures of informativeness (#CIU, CIU/min, %CIU, #nonCIU). These measures produced two orthogonal dimensions with four orthogonal participant clusters. Comprehensive comparison between clusters revealed that speech rate and complexity were strongly associated with general aphasia severity and total lesion volume, and were predicted by frontoparietal grey matter and dorsal pathway white matter damage. In contrast, informativeness was independent of other behavioral and neurological deficits, and was not predictable from lesion patterns, suggesting that it reflects communication strategy rather than specific neurological impairment. These results provide an important step toward distinguishing neurological and strategic aspects of narrative speech deficits in post-stroke aphasia, with potential implications for treatment approaches that target communication strategies.

Four dimensions of naturalistic language production in aphasia after stroke

There is a rich tradition of research on the neuroanatomical correlates of spoken language production in aphasia using constrained tasks (e.g. picture naming), which offer controlled insights into the distinct processes that govern speech and language (i.e. lexical-semantic access, morphosyntactic construction, phonological encoding, speech motor programming/execution). Yet these tasks do not necessarily reflect everyday language use. In contrast, naturalistic language production (also referred to as 'connected speech' or 'discourse') more closely approximates typical processing demands, requiring the dynamic integration of all aspects of speech and language. The brain bases of naturalistic language production remain relatively unknown, however, in part because of the difficulty in deriving features that are salient, quantifiable and interpretable relative to both speech-language processes and the extant literature. The present cross-sectional observational study seeks to address these challenges by leveraging a validated and comprehensive auditory-perceptual measurement system that yields four explanatory dimensions of performance-Paraphasia (misselection of words and sounds), Logopenia (paucity of words), Agrammatism (grammatical omissions) and Motor speech (impaired speech motor programming/execution). We used this system to characterize naturalistic language production in a large and representative sample of individuals with acute post-stroke aphasia (n = 118). Scores on each of the four dimensions were correlated with lesion metrics, and multivariate associations among the dimensions and brain regions were then explored. Our findings revealed distinct yet overlapping neuroanatomical correlates throughout the left-hemisphere language network. Paraphasia and logopenia were associated primarily with posterior regions, spanning both dorsal and ventral streams, which are critical for lexical-semantic access and phonological encoding. In contrast, agrammatism and motor speech were associated primarily with anterior regions of the dorsal stream that are involved in morphosyntactic construction and speech motor planning/execution, respectively. Collectively, we view these results as constituting a brain-behaviour model of naturalistic language production in aphasia, aligning with both historical and contemporary accounts of the neurobiology of spoken language production.

Reliability of the picture description task of the Western Aphasia Battery - revised in Laurentian French persons without brain injury

Objective: Limited normative data (including psychometric properties) are currently available on discourse tasks in non-dominant languages such as Laurentian (Quebec) French. The lack of linguistic and cultural adaptation has been identified as a barrier to discourse assessment. The main aim of this study is to document inter-rater and test-retest reliability properties of the picnic scene of the Western Aphasia Battery - Revised (WAB-R), including the cultural adaptation of an information content unit (ICU) list, and provide a normative reference for persons without brain injury (PWBI). Method: To do so, we also aimed to adapt an ICU checklist culturally and linguistically for Laurentian French speakers. Discourse samples were collected from 66 PWBI using the picture description task of the WAB-R. The ICU list was first adapted into Laurentian French. Then, ICUs and thematic units (TUs) were extracted manually, and microstructural variables were extracted using CLAN. Inter-rater reliability and test-retest reliability were determined. Results: Excellent inter-rater reliability was obtained for ICUs and TUs, as well as for all microstructural variables, except for mean length of utterance, which was found to be good. Conversely, test-retest reliability ranged from poor to moderate for all variables. Conclusion: The present study provides a validated ICU checklist for clinicians and researchers working with Laurentian French speakers when assessing discourse with the picnic scene of the WAB-R. It also addresses the gap in available psychometric data regarding inter-rater and test-retest reliability in PWBI.

Expanding the scope: multimodal dimensions in aphasia discourse analysis-preliminary findings

Background

Aphasia, resulting from acquired brain injury, disrupts language processing and usage, significantly impacting individuals' social communication and life participation. Given the limitations of traditional assessments in capturing the nuanced challenges faced by individuals with aphasia, this study seeks to explore the potential benefits of integrating multimodal communication elements into discourse analysis to better capture narrative proficiency in this population.

Objective

This study examined how incorporating multimodal communication elements (e.g., physical gestures, writing, drawing) into discourse analysis may affect the narrative outcomes of persons with aphasia compared to those observed using methods that exclude multimodal considerations.

Methods

Participants included individuals with chronic aphasia and age-and education-matched healthy controls who completed a storytelling task-the Bear and the Fly story. Macrolinguistic scores were obtained using verbal-only and multimodal scoring approaches. Additionally, the frequency and type of multimodal communication use during storytelling were examined in relation to aphasia characteristics. Statistical analyses included both within-group and between-group comparisons as well as correlational analyses.

Results

Individuals with aphasia scored significantly higher in terms of their macrolinguistic abilities when multimodal scoring was considered compared to verbal-only scoring. Within the aphasia group, there were prominent differences noted in macrolinguistic scores for both fluent and nonfluent aphasia. Specifically, both groups scored higher on Main Concepts when multimodal scoring was considered, with the nonfluent group demonstrating significantly higher Main Concept and total macrolinguistic rubric scores in multimodal scoring compared to verbal scoring on the storytelling task. Additionally, aphasia severity showed moderate positive correlations with total macrolinguistic scores, indicating that individuals with less severe aphasia tended to produce higher quality narratives. Lastly, although persons with aphasia used different types of nonverbal modalities (i.e., drawing, writing), the use of meaning-laden gestures was most predominant during storytelling, emphasizing the importance of multimodal elements in communication for individuals with aphasia.

Conclusion

Our preliminary study findings underscore the importance of considering multimodal communication in assessing discourse performance among individuals with aphasia. Tailoring assessment approaches based on aphasia subtypes can provide valuable insights into linguistic abilities and inform targeted intervention strategies for improving communication outcomes.

Determinants of Multilevel Discourse Outcomes in Anomia Treatment for Aphasia

PURPOSE

Individuals with aphasia identify discourse-level communication (i.e., language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, are poorly understood, and vary greatly among individuals with aphasia. In response, this study consisted of a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis (SFA) clinical trials. Aim 1 evaluated changes in theoretically motivated discourse outcomes representing lexical-semantic processing, lexical diversity, grammatical complexity, and discourse informativeness. Aim 2 explored the potential moderating role of nonlanguage cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes.

METHOD

This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for n = 60 (Aim 1) and a subset n = 44 (Aim 2). Outcome measures included lexical-semantic processing (% semantic errors), lexical diversity (moving average type-token ratio), grammatical complexity (mean utterance length), and discourse informativeness (% correct information units). Bayesian generalized mixed-effects models were used to examine changes across four study time points: enrollment, entry, exit, and 1-month follow-up.

RESULTS

The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after SFA when measured using standard, general-topic discourse stimuli. There was weak and inconsistent evidence that nonlanguage cognitive factors may play a role in moderating treatment response.

CONCLUSIONS

These findings indicate a clear need to pair theoretically informed treatments designed to facilitate generalization to discourse with intentional measurement paradigms designed to capture it. Furthermore, there is a clear need to examine how established treatments, restorative or compensatory, can better facilitate generalization to discourse-level communication. These priorities are critical for meaningfully improving everyday communication and reducing the profound communication and psychosocial consequences of aphasia.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26524081.

The development of a novel, standardized, norm-referenced Arabic Discourse Assessment Tool (ADAT), including an examination of psychometric properties of discourse measures in aphasia

BACKGROUND

People with aphasia (PWA) typically exhibit deficits in spoken discourse. Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, the available discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use and limited evidence of the psychometric properties of published discourse measurements.

AIMS

(1) To develop a standardized, norm-referenced, culturally and linguistically appropriate Arabic Discourse Assessment Tool (ADAT); and (2) to examine the psychometric properties of content and construct validity and interrater reliability of different discourse measures elicited using three discourse genres (descriptive, narrative and procedural) in neurotypical control adults and matched PWA.

METHODS & PROCEDURES

Discourse samples were collected using three novel discourse stimuli that are sensitive to the Arabic language and culture from 70 neurotypical control adults and a matched group of 50 PWA. Transcription agreement was assessed. A standard approach was used to evaluate construct validity and interrater reliability for 16 discourse measures that assess fluency, language productivity, information content, lexical-semantics, lexical diversity, grammatical category, grammatical structure and syntactic complexity. Strong measures were identified based on their psychometric properties, and normative data were established on these measures. Discourse performance of PWA was then examined using the newly developed tool (ADAT).

OUTCOMES & RESULTS

Transcription agreement was extremely high for all discourse stimuli in both groups. Eight discourse measures were proven to have consistently very high construct validity and consistently very good to excellent reliability across the three stimuli in both neurotypical control and aphasia groups: lexical information units, content information units, words per minute, discourse duration, number of different words, number of complete sentences and proportion of open and closed class words. Norms were established on these measures, and cut-off scores of impairments were determined. Other measures showed low construct validity and variable or poor reliability across the two groups.

CONCLUSIONS & IMPLICATIONS

The newly developed, standardized, and norm-referenced tool (ADAT) consist of three discourse stimuli and eight high-quality discourse measures that assess multiple aspects of spoken discourse and were able to differentiate PWA from neurotypical adults consistently. ADAT also includes normative data and cut-off impairment scores. The tool has great potential to enhance clinical practice and research with Arabic speakers. Evidence was provided that not all discourse measures are of high quality, as some are vulnerable to differences between raters, discourse stimuli and groups. Clinicians and researchers can use ADAT for accurate aphasia assessments, better management plans and to monitor therapy effectiveness. ADAT can be further validated in other clinical populations with language impairments.

WHAT THIS PAPER ADDS

What is already known on the subject Discourse analysis is the gold standard approach to assess language deficits beyond sentence level. However, existing discourse assessment tools are biased towards English and European languages and Western culture. Additionally, there is a lack of consensus on which discourse measures to use in aphasia, and limited evidence of the psychometric properties of published discourse measurements. What this paper adds to existing knowledge A novel, standardized, norm-referenced Arabic Discourse Assessment Tool (ADAT) was developed and validated in this study. ADAT was further validated among PWA. The study provides evidence that not all discourse measures are of high quality and thus should not be used with confidence. Specific measures are vulnerable to the type of stimuli, the rater and/or the tested group. On the other hand, eight discourse measures were identified to be reliable between different raters and across different stimuli for the two groups, and they were able to differentiate the discourse performance of PWA from neurotypical control adults. Normative data derived from neurotypical control adults were established on these strong measures, and the performance of PWA was classified as impaired based on these norms. What are the potential or actual clinical implications of this work? The present study provides a novel, standardized, norm-referenced, validated discourse assessment tool that is culturally and linguistically appropriate for use by Arabic speakers (ADAT). ADAT holds immense potential to enhance clinical practice and research with Arabic speakers. The study also identified strong discourse measures that can be used to assess language productivity, information content, lexical-semantics, lexical diversity, grammatical category, and syntactic complexity for accurate and comprehensive assessments. This will lead to better rehabilitation management by guiding the development of tailored client-centred interventions. ADAT can be utilized in clinical and research settings in PWA and has the potential to be further validated with other clinical populations.

Open Brain AI and language assessment

Neurolinguistic assessments play a vital role in neurological examinations, revealing a wide range of language and communication impairments associated with developmental disorders and acquired neurological conditions. Yet, a thorough neurolinguistic assessment is time-consuming and laborious and takes valuable resources from other tasks. To empower clinicians, healthcare providers, and researchers, we have developed Open Brain AI (OBAI). The aim of this computational platform is twofold. First, it aims to provide advanced AI tools to facilitate spoken and written language analysis, automate the analysis process, and reduce the workload associated with time-consuming tasks. The platform currently incorporates multilingual tools for English, Danish, Dutch, Finnish, French, German, Greek, Italian, Norwegian, Polish, Portuguese, Romanian, Russian, Spanish, and Swedish. The tools involve models for (i) audio transcription, (ii) automatic translation, (iii) grammar error correction, (iv) transcription to the International Phonetic Alphabet, (v) readability scoring, (vi) phonology, morphology, syntax, semantic measures (e.g., counts and proportions), and lexical measures. Second, it aims to support clinicians in conducting their research and automating everyday tasks with "OBAI Companion," an AI language assistant that facilitates language processing, such as structuring, summarizing, and editing texts. OBAI also provides tools for automating spelling and phonology scoring. This paper reviews OBAI's underlying architectures and applications and shows how OBAI can help professionals focus on higher-value activities, such as therapeutic interventions.

Reliability of the Brief Assessment of Transactional Success in Communication in Aphasia

Background

While many measures exist for assessing discourse in aphasia, manual transcription, editing, and scoring are prohibitively labor intensive, a major obstacle to their widespread use by clinicians (Bryant et al., 2017; Cruice et al., 2020). Many tools also lack rigorous psychometric evidence of reliability and validity (Azios et al., 2022; Carragher et al., 2023). Establishing test reliability is the first step in our long-term goal of automating the Brief Assessment of Transactional Success in aphasia (BATS; Kurland et al., 2021) and making it accessible to clinicians and clinical researchers.

Aims

We evaluated multiple aspects of test reliability of the BATS by examining correlations between human/machine and human/human interrater edited transcripts, raw vs. edited transcripts, interrater scoring of main concepts, and test-retest performance. We hypothesized that automated methods of transcription and discourse analysis would demonstrate sufficient reliability to move forward with test development.

Methods & Procedures

We examined 576 story retelling narratives from a sample of 24 persons with aphasia and familiar and unfamiliar conversation partners (CP). Participants with aphasia (PWA) retold stories immediately after watching/listening to short video/audio clips. CP retold stories after six-minute topic-constrained conversations with a PWA in which the dyad co-constructed the stories. We utilized two macrostructural measures to analyze the automated speech-to-text transcripts of story retells: 1) a modified version of a semi-automated tool for measuring main concepts (mainConcept: Cavanaugh et al., 2021); and 2) an automated natural language processing 'pipeline' to assess topic similarity.

Outcomes & Results

Correlations between raw and edited scores were excellent, interrater reliability on transcripts and main concept scoring were acceptable. Test-retest on repeated stimuli was acceptable. This was especially true of aphasic story retellings where there were actual within subject repeated stimuli.

Conclusions

Results suggest that automated speech-to-text was generally sufficient in most cases to avoid the time-consuming, labor intensive step of transcribing and editing discourse. Overall, our study results suggest that natural language processing automated methods such as text vectorization and cosine similarity are a fast, efficient way to obtain a measure of topic similarity between two discourse samples. Although test-retest reliability for the semi-automated mainConcept method was generally higher than for automated methods of measuring topic similarity, we found no evidence of a difference between machine automated and human-reliant scoring.

Verb Tense Production in People With Nonfluent Aphasia Across Different Discourse Elicitation Tasks

PURPOSE

Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are inconsistent and lacking at the discourse level. In addition, language production can be affected by discourse elicitation tasks depending on the cognitive linguistic demands and instructions unique to each task. There is limited evidence regarding whether verb tense production in people with nonfluent aphasia is impacted by discourse task demands. Understanding this potential impact is important for clinicians and researchers who are interested in assessing and then identifying effective clinical goals for this population. Therefore, this study aimed to investigate the trends of verb tense production across various discourse elicitation tasks in people with nonfluent aphasia compared to people without aphasia.

METHOD

Language samples for 23 people with nonfluent aphasia and 27 people without aphasia were obtained for six discourse tasks from the AphasiaBank database. We calculated ratios of past tense, present tense, future tense, imperative, and unknown verb types to compare which tense was used most frequently within and across the tasks and groups.

RESULTS AND CONCLUSIONS

Our findings revealed evidence of verb tense production deficits and a selective past tense impairment in people with nonfluent aphasia. Discourse task effects were shown for people without aphasia but were scarce in people with nonfluent aphasia. This finding could be explained by an overall reduction of verb production and overreliance on present tense production in nonfluent aphasia. These results suggest the potential methodological implications of using different discourse tasks to evaluate verb tense production in people with nonfluent aphasia. Future studies need to evaluate discourse task effects on other aspects of verb production (e.g., moods) and specific task factors (e.g., presence or absence of visual stimulus).

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25146242.

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.

Correct Information Unit Analysis in Different Discourse Tasks Among Persons With Anomic Aphasia Based on Mandarin AphasiaBank

PURPOSE

This study aimed to explore how well persons with anomic aphasia communicate information during discourse regarding quantity, quality, and efficiency compared to neurotypical controls, to investigate the influence of discourse tasks on informativeness and efficiency and to examine impact factors like aphasia severity and cognitive ability.

METHOD

Language samples of four discourse tasks from 31 persons with anomic aphasia and 31 neurotypical controls were collected from Mandarin AphasiaBank. Correct information unit (CIU) analysis measures including the total number of CIUs, percentage of CIUs, CIUs per minute, and words per minute were calculated. Group differences and the effects of discourse tasks on informativeness and efficiency were investigated. Correlations of CIU analysis measures with aphasia severity and cognitive ability were examined.

RESULTS

Persons with anomic aphasia showed lower efficiency in conveying information than controls. They underperformed controls on all CIU analysis measures when executing story narrative tasks. Discourse tasks influenced the informativeness and efficiency of both groups. Neurotypical controls delivered the greatest quantity of information most efficiently when narrating stories. Persons with anomic aphasia exhibited reduced quantity of information during procedural discourse and displayed superior information quality in sequential-picture descriptions. Discourse information may be impacted by aphasia severity and cognitive ability, with varying effects depending on the task.

CONCLUSIONS

Persons with anomic aphasia are inefficient in communicating discourse messages and perform poorly on all measures in story narratives. When measuring discourse information, the effects of discourse tasks and factors like aphasia severity and cognitive ability should be considered.

Exploring Spoken Discourse and Its Neural Correlates in Women With Alzheimer's Disease With Low Levels of Education and Socioeconomic Status

PURPOSE

Early impairments in spoken discourse abilities have been identified in Alzheimer's disease (AD). However, the impact of AD on spoken discourse and the associated neuroanatomical correlates have mainly been studied in populations with higher levels of education, although preliminary evidence seems to indicate that socioeconomic status (SES) and level of education have an impact on spoken discourse. The purpose of this study was to analyze microstructural variables in spoken discourse in people with AD with low-to-middle SES and low level of education and to study their association with gray matter (GM) density.

METHOD

Nine women with AD and 10 matched (age, SES, and education) women without brain injury (WWBI) underwent a neuropsychological assessment, which included two spoken discourse tasks, and structural magnetic resonance imaging. Microstructural variables were extracted from the discourse samples using NILC-Metrix software. Brain density, measured by voxel-based morphometry, was compared between groups and then correlated with the differentiating microstructural variables.

RESULTS

The AD group produced a lower diversity of verbal time moods and fewer words and sentences than WWBI but a greater diversity of pronouns, prepositions, and lexical richness. At the neural level, the AD group presented a lower GM density bilaterally in the hippocampus, the inferior temporal gyrus, and the anterior cingulate gyrus. Number of words and sentences produced were associated with GM density in the left parahippocampal gyrus, whereas the diversity of verbal moods was associated with the basal ganglia and the anterior cingulate gyrus bilaterally.

CONCLUSIONS

The present findings are mainly consistent with previous studies conducted in groups with higher levels of SES and education, but they suggest that atrophy in the left inferior temporal gyrus could be critical in AD in populations with lower levels of SES and education. This research provides evidence on the importance of pursuing further studies including people with various SES and education levels.

WHAT IS ALREADY KNOWN ON THIS SUBJECT

Spoken discourse has been shown to be affected in Alzheimer disease, but most studies have been conducted on individuals with middle-to-high SES and high educational levels.

WHAT THIS STUDY ADDS

The study reports on microstructural measures of spoken discourse in groups of women in the early stage of AD and healthy women, with low-to-middle SES and lower levels of education.

CLINICAL IMPLICATIONS OF THIS STUDY

This study highlights the importance of taking into consideration the SES and education level in spoken discourse analysis and in investigating the neural correlates of AD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24905046.

Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke

Introduction

Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown.

Methods

In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task.

Results

Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions.

Discussion

These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.

Telling Stories in Noise: The Impact of Background Noises on Spoken Language for People With Aphasia

PURPOSE

The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task.

METHOD

Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions.

RESULTS

Background noise resulted in higher fundamental frequency (fo) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise.

CONCLUSIONS

Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23681703.

Test-Retest Reliability of Microlinguistic Information Derived From Spoken Discourse in Persons With Chronic Aphasia

PURPOSE

The purpose of this study was to characterize test-retest reliability of discourse measures across a battery of common tasks in individuals with aphasia and prospectively matched adults without brain damage.

METHOD

We collected spoken discourse during five monologue tasks at two timepoints (test and retest; within 2 weeks apart) in an aphasia group (n = 23) and a peer group with no brain damage (n = 24). We evaluated test-retest reliability for percentage of correct information units, correct information units per minute, mean length of utterance, verbs per utterance, noun/verb ratio, open/closed class word ratio, tokens, sample duration (seconds), propositional idea density, type-token ratio, and words per minute. We explored reliability's relationship with sample length and aphasia severity.

RESULTS

Rater reliability was excellent. Across tasks, both groups demonstrated discourse measures with poor, moderate, and good reliability, with the aphasia group having measures demonstrating excellent test-retest reliability. When evaluating measures within each task, test-retest reliability again ranged from poor to excellent for both groups. Across groups and task, measures that appeared most reliable appeared to reflect lexical, informativeness, or fluency information. Sample length and aphasia severity impacted reliability, and this differed across and by task.

CONCLUSIONS

We identified several discourse measures that were reliable across and within tasks. Test-retest statistics are intimately linked to the specific sample, emphasizing the importance of multiple baseline studies. Task itself should be considered an important variable, and it should not be assumed that discourse measures found to be reliable across several tasks (averaged) are likewise reliable for a single task.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23298032.

Descriptive discourse in fluent aphasia: The predictive role of attention, phonology, lexical retrieval and semantics

AIMS

To study the relationship between cognitive and linguistic skills (as measured through standardized tasks) over spontaneous speech elicited during a picture description task.

METHODS & PROCEDURES

21 controls and 19 people with fluent aphasia matched by age and sex were evaluated using transcripts made from a picture description task coded using the CHAT format and analyzed using Computerized Language Analysis (CLAN). Indices obtained from the speech samples contained measures of lexical quantity and diversity, morphosyntactic complexity, informativeness, and speech fluency, along with different kinds of speech errors. We studied their correlations with attentional measures from Conners' Continuous Performance Test and with standardized measures of naming, pseudoword repetition and semantic non-verbal association. We further used stepwise linear regression to analyze the predictive value of standardized linguistic and cognitive skills over discursive indices.

OUTCOMES & RESULTS

Contrary to our initial hypothesis, there were no significant correlations between attentional scores and discourse variables in aphasic participants. Moreover, semantic association, along with naming, was the measure more related with discourse performance in people with fluent aphasia, but cognitive and linguistic standardized measures had overall little predictive power on most discourse indices. In the control group, there was a certain association of naming skills and attentional reaction time with discourse variables, but their predictive power was also low.

CONCLUSIONS & IMPLICATIONS

The current results do not support a strong relationship between basic attentional skills and performance in descriptive discourse in fluent aphasia. Although some of the standardized tasks seem to bear some relationship with spontaneous speech, there is a high amount of interindividual variability in discourse that is not captured by classical cognitive tasks routinely used in assessment. Further work on the determinants of discourse performance in aphasia and on the clinical application of discourse analysis is warranted.

Pausing before verb production is associated with mild cognitive impairment in Parkinson's disease

Background

Cognitive dysfunction and communication impairment are common and disabling symptoms in Parkinson's Disease (PD). Action verb deficits occur in PD, but it remains unclear if these impairments are related to motor system dysfunction and/or cognitive decline. The objective of our study was to evaluate relative contributions of cognitive and motor dysfunction to action verb production in naturalistic speech of patients with PD. We proposed that pausing before action-related language is associated with cognitive dysfunction and may serve as a marker of mild cognitive impairment in PD.

Method

Participants with PD (n = 92) were asked to describe the Cookie Theft picture. Speech files were transcribed, segmented into utterances, and verbs classified as action or non-action (auxiliary). We measured silent pauses before verbs and before utterances containing verbs of different classes. Cognitive assessment included Montreal Cognitive Assessment (MoCA) and neuropsychological tests to categorize PD participants as normal cognition (PD-NC) or mild cognitive impairment (PD-MCI) based on Movement Disorders Society (MDS) Task Force Tier II criteria. Motor symptoms were assessed using MDS-UPDRS. We performed Wilcoxon rank sum tests to identify differences in pausing between PD-NC and PD-MCI. Logistic regression models using PD-MCI as dependent variables were used to evaluate the association between pause variables and cognitive status.

Results

Participants with PD-MCI demonstrated more pausing before and within utterances compared to PD-NC, and the duration of these pauses were correlated with MoCA but not motor severity (MDS-UPDRS). Logistic regression models demonstrated that pauses before action utterances were associated with PD-MCI status, whereas pauses before non-action utterances were not significantly associated with cognitive diagnosis.

Conclusion

We characterized pausing patterns in spontaneous speech in PD-MCI, including analysis of pause location with respect to verb class. We identified associations between cognitive status and pausing before utterances containing action verbs. Evaluation of verb-related pauses may be developed into a potentially powerful speech marker tool to detect early cognitive decline in PD and better understand linguistic dysfunction in PD.

Toward harmonization of strategies for investigating lucidity in AD/ADRD: A preliminary research framework

Episodes of lucidity (ELs) in Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD), have garnered increasing attention as an important area of research. Efforts to study lucidity suffer from a lack of clear definitional criteria, inconsistent conceptualization, and diverse approaches to operationalizing features of these events. To advance systematic investigation of ELs in AD/ADRD, there is a need for clarity and precision in labeling event attributes, markers, and specific measurement strategies that enable operational harmonization across distinct approaches to investigating the relatively broad and nascent phenomenon. To that end, we propose a preliminary research framework to guide harmonization of approaches to investigating ELs in AD/ADRD. Our goal is to provide an initial schematic that encourages uniform labeling of operational decisions about ELs.

The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach

The aim of this study was to characterize the oral discourse of CBS patients and to verify whether measures obtained during a semi-spontaneous speech production could differentiate CBS patients from controls. A second goal was to compare the performance of patients with CBS probably due to Alzheimer's disease (CBS-AD) pathology and CBS not related to AD (CBS-non-AD) in the same measures, based on the brain metabolic status (FDG-PET) and in the presence of amyloid deposition (amyloid-PET). Results showed that CBS patients were significantly different from controls in speech rate, lexical level, informativeness, and syntactic complexity. Discursive measures did not differentiate CBS-AD from CBS-non-AD. However, CBS-AD displayed more lexical-semantic impairments than controls, a profile that is frequently reported in patients with clinical AD and the logopenic variant of primary progressive aphasia (lvPPA). CBS-non-AD presented mainly with impairments related to motor speech disorders and syntactic complexity, as seen in the non-fluent variant of PPA.

A Telemedicine Platform for Aphasia: Protocol for a Development and Usability Study

BACKGROUND

Aphasia is a central disorder of comprehension and expression of language that cannot be attributed to a peripheral sensory deficit or a peripheral motor disorder. The diagnosis and treatment of aphasia are complex. Interventions that facilitate this process can lead to an increase in the number of assisted patients and greater precision in the therapeutic choice by the health professional.

OBJECTIVE

This paper describes a protocol for a study that aims to implement a computer-based solution (ie, a telemedicine platform) that uses deep learning to classify vocal data from participants with aphasia and to develop serious games to treat aphasia. Additionally, this study aims to evaluate the usability and user experience of the proposed solution.

METHODS

Our interactive and smart platform will be developed to provide an alternative option for professionals and their patients with aphasia. We will design 2 serious games for aphasia rehabilitation and a deep learning-driven computational solution to aid diagnosis. A pilot evaluation of usability and user experience will reveal user satisfaction with platform features.

RESULTS

Data collection began in June 2022 and is currently ongoing. Results of system development as well as usability should be published by mid-2023.

CONCLUSIONS

This research will contribute to the treatment and diagnosis of aphasia by developing a telemedicine platform based on a co-design process. Therefore, this research will provide an alternative method for health care to patients with aphasia. Additionally, it will guide further studies with the same purpose.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40603.

Validation of Videoconference Administration of Picture Description From the Western Aphasia Battery-Revised in Neurotypical Canadian French Speakers

PURPOSE

During the COVID-19 pandemic, clinicians and researchers have increasingly used remote online assessments to pursue their activities, but mostly with tests not validated for videoconference administration. This study aims to validate the remote online administration of picture description in Canadian French neurotypical speakers and to explore the thematic unit (TU) checklist recently developed.

METHOD

Spoken discourse elicited through the picture description task of the Western Aphasia Battery-Revised (WAB-R) was collected from Canadian French neurotypical speakers from Québec aged between 50 and 79 years old. Forty-seven participants completed the task in person, and 49 participants completed the task by videoconference. Videos of each discourse sample were transcribed using CHAT conventions. Microstructural variables were extracted using the CLAN (Computerized Language ANalysis) program, whereas thematic informativeness was scored for each sample using TUs. Chi-square tests were conducted to compare both groups on each TU; t tests were also performed on the total score of TUs and microstructural variables.

RESULTS

Groups were matched on sex, age, and education variables. The t tests revealed no intergroup difference for the total TU score and for the microstructural variables (e.g., mean length of utterances and number of words per minute). Chi-square tests showed no significant intergroup difference for all 16 TUs.

CONCLUSIONS

These findings support remote online assessment of the picnic scene of the WAB-R picture description in Canadian French neurotypical speakers. These results also validate the 16 TUs most consistently produced. The use of videoconference could promote and improve the recruitment of participants who are usually less accessible, such as people using assistive mobility technologies.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21476961.

An open dataset of connected speech in aphasia with consensus ratings of auditory-perceptual features

Purpose

Auditory-perceptual rating of connected speech in aphasia (APROCSA) involves trained listeners rating a large number of perceptual features of speech samples, and has shown promise as an approach for quantifying expressive speech and language function in individuals with aphasia. The aim of this study was to obtain consensus ratings for a diverse set of speech samples, which can then be used as training materials for learning the APROCSA system.

Method

Connected speech samples were recorded from six individuals with chronic post-stroke aphasia. A segment containing the first five minutes of participant speech was excerpted from each sample, and 27 features were rated on a five-point scale by five researchers. The researchers then discussed each feature in turn to obtain consensus ratings.

Results

Six connected speech samples are made freely available for research, education, and clinical uses. Consensus ratings are reported for each of the 27 features, for each speech sample. Discrepancies between raters were resolved through discussion, yielding consensus ratings that can be expected to be more accurate than mean ratings.

Conclusions

The dataset will provide a useful resource for scientists, students, and clinicians to learn how to evaluate aphasic speech samples with an auditory-perceptual approach.

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.

Finding "Zen" in Aphasia: The Benefits of Yoga as Described by Key Stakeholders

PURPOSE

Recently, the literature has witnessed a surging interest regarding the use of mind-body approaches with people who have aphasia, generating a plethora of possible outcome measures. During this same time, a core outcome set for aphasia has been recommended. The purpose of this clinical focus article is to give our survivor, co-survivor, and clinician stakeholder coauthors a platform to share their personal narrative regarding their yoga journey, with the goal of identifying primary outcome domains central to capturing the impact of yoga on the recovery process for people with poststroke aphasia. Ultimately, we hope this clinical focus article helps clinicians understand how yoga might benefit their patients and draws attention to potential outcome measures, while also highlighting the important fact that traditional aphasia assessments do not capture the improvements stakeholders pinpoint as crucial to the essence of mind-body interventions.

METHOD

This clinical focus article summarizes the case reports of Terri's and Chase's poststroke yoga journeys using the power of personal narrative and an adapted photovoice method. Additional stakeholders share in this storytelling process, using a variety of narrative tools. As this story is unveiled, several patient-identified outcome domains are highlighted as essential to document the impact of yoga on survivors.

RESULTS

Terri's and Chase's yoga journeys revealed the multifaceted impact of yoga on five domains: (a) feelings of wholeness and "zen," (b) increased attentional capacity for language tasks, (c) increased verbal fluency, (d) decreased pain, and (e) relationship mutuality.

CONCLUSION

Team Yoga realized that the practice of yoga-whether as a stand-alone practice or integrated into therapy sessions-fosters feelings of wholeness or "zen," which likely correlates with decreased pain with a simultaneous increase in resilience and flexibility of coping strategies to manage the host of chronic poststroke challenges. Supplemental Material https://doi.org/10.23641/asha.17003464.

Spoken Discourse Assessment and Analysis in Aphasia: An International Survey of Current Practices

Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail. Conclusions The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database. Supplemental Material https://doi.org/10.23641/asha.166395100.

Applying the Rehabilitation Treatment Specification System (RTSS) to Functional Communication Treatment Approaches for Aphasia

There are many different approaches to the rehabilitation of aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called "functional communication interventions" aims to enhance communication success as opposed to solely improve linguistic abilities. This approach encompasses many skills (e.g., gesturing) and factors (e.g., access to communication supports) that support sending and receiving messages in "real world" daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes three connected elements - a single target, one or more ingredients, and a mechanism of action - that, taken together, attempt to explain how and why a treatment works. While the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics' Communicative Effectiveness (PACE), Modified Response Elaboration Training (M-RET), Script Training, Conversation Treatment, and Communication Partner Training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.

Enhancing the Classification of Aphasia: A Statistical Analysis Using Connected Speech

BACKGROUND

Large shared databases and automated language analyses allow for the application of new data analysis techniques that can shed new light on the connected speech of people with aphasia (PWA).

AIMS

To identify coherent clusters of PWA based on language output using unsupervised statistical algorithms and to identify features that are most strongly associated with those clusters.

METHODS & PROCEDURES

Clustering and classification methods were applied to language production data from 168 PWA. Language samples were from a standard discourse protocol tapping four genres: free speech personal narratives, picture descriptions, Cinderella storytelling, procedural discourse.

OUTCOMES & RESULTS

Seven distinct clusters of PWA were identified by the K-means algorithm. Using the random forests algorithm, a classification tree was proposed and validated, showing 91% agreement with the cluster assignments. This representative tree used only two variables to divide the data into distinct groups: total words from free speech tasks and total closed class words from the Cinderella storytelling task.

CONCLUSION

Connected speech data can be used to distinguish PWA into coherent groups, providing insight into traditional aphasia classifications, factors that may guide discourse research and clinical work.

A Comparison of Manual Versus Automated Quantitative Production Analysis of Connected Speech

Purpose Analysis of connected speech in the field of adult neurogenic communication disorders is essential for research and clinical purposes, yet time and expertise are often cited as limiting factors. The purpose of this project was to create and evaluate an automated program to score and compute the measures from the Quantitative Production Analysis (QPA), an objective and systematic approach for measuring morphological and structural features of connected speech. Method The QPA was used to analyze transcripts of Cinderella stories from 109 individuals with acute-subacute left hemisphere stroke. Regression slopes and residuals were used to compare the results of manual scoring and automated scoring using the newly developed C-QPA command in CLAN, a set of programs for automatic analysis of language samples. Results The C-QPA command produced two spreadsheet outputs: an analysis spreadsheet with scores for each utterance in the language sample, and a summary spreadsheet with 18 score totals from the analysis spreadsheet and an additional 15 measures derived from those totals. Linear regression analysis revealed that 32 of the 33 measures had good agreement; auxiliary complexity index was the one score that did not have good agreement. Conclusions The C-QPA command can be used to perform automated analyses of language transcripts, saving time and training and providing reliable and valid quantification of connected speech. Transcribing in CHAT, the CLAN editor, also streamlined the process of transcript preparation for QPA and allowed for precise linking of media files to language transcripts for temporal analyses.

Dialectally-sensitive norms of the Spanish version of Main Concept Analysis (Span-MCA) for quantifying neurogenically impaired spoken discourse

Aphasia is an acquired language impairment caused by damage in the regions of the brain that support language. The Main Concept Analysis (MCA; Kong, 2016b) is a published formal assessment battery that allows the quantification of the presence, accuracy, completeness, and efficiency of content in spoken discourse produced by persons with aphasia (PWA). It utilizes a sequential picture description task (with four sets of pictures) for language sample elicitation. The MCA results can also be used clinically for targeting appropriate interventions of aphasic output. The purpose of this research is to develop a Spanish adaptation of the MCA (i.e., Span-MCA) by establishing normative data based on native unimpaired speakers of Spanish from four different dialect origins (Central American Caribbean, Andean-Pacific, Mexican, and Central-Southern Peninsular regions). A total of 91 unimpaired participants that consisted of different age groups, education levels, and dialect origins were recruited to establish four sets of dialect-specific norms and scoring criteria of Span-MCA, including target main concepts and corresponding lexical items related to the picture sets. The Span-MCA was also applied to one pilot native Spanish PWA. The normative data suggested that speakers who were younger or with a higher level of education levels produced significantly more accurate and complete main concepts in their spoken discourse. The application of Span-MCA to the pilot native Spanish PWA successfully identified impaired performance, as compared to the dialectally-sensitive norms established in this study. This study highlighted the clinical value of Span-MCA as a supplement to evaluate spoken discourse and target intervention by speech-language pathologists and related healthcare practitioners.