Oral and written picture description in individuals with aphasia

Written discourse in diagnosis for acquired neurogenic communication disorders: current evidence and future directions

Purpose

We aimed to perform the first review of research focusing on written discourse performance in people with acquired neurogenic communication disorders. In studies from 2000 onward, we specifically sought to determine: (1) the differences between patient populations and control groups, (2) the differences between different patient populations, (3) longitudinal differences between patient populations, and (4) modality differences between spoken and written discourse performance.

Methods

We completed a thorough search on MEDLINE, Embase, Cochrane, APAPsycinfo, Web of Science, and Scopus databases. We identified studies that focus on written discourse performance in people with aphasia, primary progressive aphasia, mild cognitive impairment, and Alzheimer's disease.

Results

Nineteen studies were identified from the review of literature, some of which addressed more than one of our review questions. Fifteen studies included a comparison between clinical populations and controls. Six studies compared different characteristics of patient populations. Three studies reported changes over time in progressive disorders. Six studies targeted different modalities of discourse.

Conclusion

Differences in linguistic features by patient populations are not yet clear due to the limited number of studies and different measures and tasks used across the studies. Nevertheless, there is substantial evidence of numerous linguistic features in acquired neurogenic communication disorders that depart from those of healthy controls. Compared to the controls, people with aphasia tend to produce fewer words, and syntactically simpler utterances compared to the controls. People with Alzheimer's disease produce less information content, and this feature increases over time, as reported in longitudinal studies. Our review imparts additional information that written and spoken discourse provide unique insights into the cognitive and linguistic deficits experienced by people with aphasia, Alzheimer's disease, mild cognitive impairment and primary progressive aphasia and provide targets for treatment to improve written communication in these groups.

Handwritten and Typed Discourse in People With Aphasia: Reference Data for Sequential Picture Description and Comparison of Performance Across Modality

PURPOSE

Writing can be completed by hand or by typing. Increasingly, functional and social activities are completed in the virtual domain, which often requires discourse level writing. Yet, there is a shortage of research on discourse writing in aphasia. The purpose of this study was to provide preliminary reference data for a sequential picture description task in writing by hand and typing for people with aphasia. Additionally, we examined individual modality differences when comparing handwritten and typed discourse.

METHOD

Fifteen people with mild-moderate aphasia participated in this study. They completed a sequential picture description task in handwriting and in typing. Discourse samples were coded for Correct Information Units (CIUs) and Complete Utterances. Measures of productivity were also evaluated (e.g., Total Words, Total Utterances). Participants completed a computer use questionnaire regarding their current and premorbid typing and computer use.

RESULTS

Preliminary reference data are reported. No significant differences were found at the group level for the measures evaluated. At the individual level, there was evidence of a modality effect for seven participants who demonstrated differences in the proportion of CIUs.

CONCLUSIONS

Although preliminary, these findings suggest that, at the group level, the handwritten and typed discourse produced by people with mild-moderate aphasia is similar. However, at the individual level, there is potential for modality differences. Consistent patterns of premorbid computer use, difficulty ratings, and individual differences in writing modes were not identified for the participants who demonstrated a modality effect. However, there was preliminary evidence that poststroke handedness may contribute to modality differences exhibited by some participants, which should be explored in future research. Additionally, these reference data are preliminary and further research is required from a more heterogeneous group of people with aphasia and to better establish assessment practices for discourse writing.

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.

Picnic, Accident or Cookies? A Systematic Approach to Guide the Selection of the Picture Definition Tasks in Linguistic Assessment

OBJECTIVE

Picture description tasks are used to elicit language samples in individuals with aphasia and other cognitive disorders. However, task selection may affect the type of language variables elicited. In this study, our goal is to compare the strengths and the weaknesses of the two internationally used picture description tasks with a novel picture description task developed specifically for Turkish-speaking individuals.

MATERIALS AND METHODS

In sum, 20 cognitively healthy individuals with a mean age of 52 ± 14/3 were included. Three different picture description tasks composed of single pictures were used: The Picnic Scene from the Western Aphasia Battery-Revised, the Cookie Theft picture from the Boston Diagnostic Aphasia Examination and the Accident Scene from the Turkish Language Assessment Test for Aphasia. All language samples were recorded using a digital voice recorder. Automated and semi-automated approaches were used for the systematic analysis of the language features that were classified into four levels: general language measures, the morphosyntactic level, the lexicosemantic level and the sentence level.

RESULTS

Participants showed greater efficiency and produced the greatest number of subordinate clauses, derivational suffixes, passive voice suffixes and relative past tense construction during the Accident Scene description. On the lexicosemantic level, the Picnic Scene was particularly superior to the Cookie Theft Picture in eliciting nouns. Imperfective aspect use was less frequent in the Accident Scene description.

CONCLUSION

All three tasks had limitations and advantages compared with each other. We recommend the development of novel picture description tasks that would be more effective in eliciting specific language features in Turkish-speaking individuals.

Picture description in the assessment of connected speech intelligibility in Parkinson's disease: A pilot study

Introduction

Assessment of intelligibility in dysarthria tends to rely on oral reading of sentences or words. However, self-generated utterances are closer to a client's natural speech. This study investigated how transcription of utterances elicited by picture description can be used in the assessment of intelligibility in speakers with Parkinson's disease.

Methods

Speech samples from eleven speakers with Parkinson's disease and six neurologically healthy persons were audio-recorded. Forty-two naive listeners completed transcriptions of self-generated sentences from a picture description task and orally read sentences from the Swedish Test of Intelligibility, as well as scaled ratings of narrative speech samples.

Results

Intelligibility was higher in orally read than self-generated sentences and higher for content words than for the whole sentence in self-generated sentences for most of the speakers, although these within-group differences were not statistically significant at the group level. Adding contextual leads for the listeners increased intelligibility in self-generated utterances significantly but with individual variation. Although correlations between the intelligibility measures were at least moderate or strong, there was a considerable inter- and intra-speaker variability in intelligibility scores between tasks for the speakers with Parkinson's disease, indicating individual variation of factors that impact intelligibility. Intelligibility scores from neurologically healthy speakers were generally high across tasks with no significant differences between the conditions.

Conclusion

Within-speaker variability supports literature recommendations to use multiple methods and tasks when assessing intelligibility. The inclusion of transcription of self-generated utterances elicited by picture description to the intelligibility assessment has the potential to provide additional information to assessment methods based on oral reading of pre-scripted sentences and to inform the planning of interventions.

The PROGRAM study: awake mapping versus asleep mapping versus no mapping for high-grade glioma resections: study protocol for an international multicenter prospective three-arm cohort study

INTRODUCTION

The main surgical dilemma during glioma resections is the surgeon's inability to accurately identify eloquent areas when the patient is under general anaesthesia without mapping techniques. Intraoperative stimulation mapping (ISM) techniques can be used to maximise extent of resection in eloquent areas yet simultaneously minimise the risk of postoperative neurological deficits. ISM has been widely implemented for low-grade glioma resections backed with ample scientific evidence, but this is not yet the case for high-grade glioma (HGG) resections. Therefore, ISM could thus be of important value in HGG surgery to improve both surgical and clinical outcomes.

METHODS AND ANALYSIS

This study is an international, multicenter, prospective three-arm cohort study of observational nature. Consecutive HGG patients will be operated with awake mapping, asleep mapping or no mapping with a 1:1:1 ratio. Primary endpoints are: (1) proportion of patients with National Institute of Health Stroke Scale deterioration at 6 weeks, 3 months and 6 months after surgery and (2) residual tumour volume of the contrast-enhancing and non-contrast-enhancing part as assessed by a neuroradiologist on postoperative contrast MRI scans. Secondary endpoints are: (1) overall survival and (2) progression-free survival at 12 months after surgery; (3) oncofunctional outcome and (4) frequency and severity of serious adverse events in each arm. Total duration of the study is 5 years. Patient inclusion is 4 years, follow-up is 1 year.

ETHICS AND DISSEMINATION

The study has been approved by the Medical Ethics Committee (METC Zuid-West Holland/Erasmus Medical Center; MEC-2020-0812). The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID number NCT04708171 (PROGRAM-study), NCT03861299 (SAFE-trial).

Aphasia and spelling to dictation: Analysis of spelling errors and editing

INTRODUCTION

Spelling difficulty is a common symptom of aphasia and can entail editing difficulties. Previous research has shown that extensive editing is related to a lower production rate in text writing for persons with aphasia, yet editing difficulty is not commonly examined. It is not known if editing difficulty is related to reading and writing skills or to aspects of the word.

AIMS

To analyse spelling and editing processes as well as errors in a dictation task performed by Swedish-speaking adults with post-stroke aphasia. Furthermore, the study aimed to identify any relationships between spelling and editing difficulties and characteristics of individual words. Finally, relationships between successful edits and reading and phonological ability were investigated and specific editing strategies or behaviours identified. Correlation analyses were performed between measures of spelling and editing and word frequency and length as well as participants' scores on tests of reading, phonological spelling and phonological decoding.

METHODS & PROCEDURES

A total of 16 Swedish speaking participants with post-stroke aphasia wrote a word-dictation task in a keystroke logging program and were tested for phonological spelling, phonological decoding and reading ability. Spelling errors were categorized and analysed.

OUTCOMES & RESULTS

The most common error type was omission of letter(s) and there was evidence of aphasia-specific writing errors. Both spelling and editing difficulty were related to word frequency and word length. Successful editing was related to participants' scores on the phonological spelling task, but not to phonological decoding or reading ability. Specific editing strategies could be identified, and some strategies were individual, while others were more commonly used.

CONCLUSIONS & IMPLICATIONS

Word length and word frequency should be taken into consideration in spelling tests for persons with aphasia, and the presence of editing difficulty should be taken into account when assessing spelling difficulties. Treatment for writing difficulties in aphasia should include training in successful editing strategies and individual fitting of digital writing aids. What this paper adds What is already known on the subject Post-stroke aphasia often causes writing and spelling difficulties. Spelling difficulties may entail editing difficulties, in turn causing extensive and/or unsuccessful editing. Extensive editing is known to impede productivity in text writing. Still, editing behaviour, abilities relating to editing or what features of a word that causes editing difficulty has not been investigated for persons with aphasia. What this paper adds to existing knowledge This study adds an in-depth analysis of spelling ability, spelling errors and editing behaviour for persons with aphasia, using keystroke logging and a single-word dictation task. Results showed that both features of the target word (frequency and word length) and the individual abilities of the person with aphasia (score on a phonological spelling task) related to spelling and editing difficulty, editing behaviour and successful editing. Specific editing strategies were analysed and described. What are the potential or actual clinical implications of this work? Word length and word frequency should be taken into consideration when testing single-word spelling for persons with aphasia. When assessing spelling difficulties, both correctness of spelling as well as the presence and nature of any editing difficulties should be taken into account and treatment for writing difficulties in should include training in successful editing strategies. The fitting of digital writing aids for persons with aphasia should be individual, since many of the editing strategies used were individual.

Comparing language samples of Bangla speakers using a colour photograph and a black-and-white line drawing

BACKGROUND

A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black-and-white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP).

AIMS

To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black-and-white LD from neurologically healthy native Bangla speakers.

METHODS & PROCEDURES

A total of 30 participants (mean age = 36.03 years) were recruited based on self-reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black-and-white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM).

OUTCOMES & RESULTS

Of the four measures, only MLU showed a statistically significant difference between the CP and the black-and-white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM.

CONCLUSIONS & IMPLICATIONS

This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples. What this paper adds What is already known on the subject There are studies on neurologically healthy individuals as well as on PWA that identified the impact of using different visuographic variables (colour and photograph) separately, which enhanced the picture comprehension and improved performances on associated language production tasks. To our knowledge, no studies have identified the combined impact of these two visuographic variables on spontaneous language production. Therefore, this initial study on neurologically healthy Bangla adults reports the impact of using a CP as a stimulus item for a PDT task to elicit spontaneous language samples. What this paper adds to existing knowledge This study reports that using a culturally appropriate CP for a PDT enhances the grammatical complexity of spontaneous language production of neurologically healthy adults. To our knowledge, this is the first study in Bangla that used the MLU as a measurement variable to analyse adults' spontaneous language production. What are the potential or actual clinical implications of this work? The development of future aphasia assessments should consider incorporating CPs as stimuli for PDTs, which may guide speech-language pathologists to provide accurate diagnoses for aphasia and related language disorders.