Communication in children and adolescents after acquired brain injury: An exploratory study.

OBJECTIVE: The usability of the Communicative Effectiveness Index (CETI) in adolescents with acquired brain injury was investigated and compared with linguistic, cognitive and brain injury data. DESIGN: A prospective, longitudinal, between-group design. SUBJECTS: Thirty participants were divided into 2 subgroups: CETI+ and CETI- groups. METHODS: Parental CETI ratings of daily communication were compared with linguistic data and IQ test results. Lesion site and aetiology were also studied. RESULTS: The CETI+ group (n = 16) had a mean score greater than 75 out of 100, while the mean score of the CETI- group (n = 14) was below 75. Complex daily communication was impaired in both groups, but the CETI- group scored significantly lower on verbal IQ and grammar comprehension tests and had more naming difficulties. A majority of subjects in the CETI- group had a left hemisphere injury. Traumatic vs non-traumatic acquired brain injury did not differentiate the results.  Conclusion: Specific complex CETI items provided unique information that is not easily measured by linguistics and cognitive tests for use with the acquired brain injury group. Parental evaluations of communication skills were well reflected in language and verbal IQ test results. Left hemisphere injury was associated with poorer communication outcome.

Features of aphasic gesturing--an exploratory study of features in gestures produced by persons with and without aphasia.

The purpose of this study was to see how features of gestures produced by persons with aphasia (PWA) are affected and to relate the findings to possible underlying factors. Spontaneous gestures were studied in two contexts: (i) associated with the production of nouns and verbs and (ii) in relation to word finding or production difficulties. The method involved assembling two datasets of co-speech gestures, produced by PWA and by persons without aphasia and to code the gestures for a number of features of expression and content. Features that were affected in the Aphasia dataset were gaze, head movements, hand use and semantic features. The results point to possibly converging explanations, such as generally lower semantic complexity as a direct effect of the aphasia, more cognitive effort and/or a greater dependence on one-hand gestures leading more indirectly to increased gaze aversion, more head shakes and lower complexity in gestures in PWA.

Patterns of communicative interaction between a child with severe speech and physical impairments and her caregiver during a mealtime activity.

BACKGROUND: Interaction between caregivers and children with severe impairments is closely related to the demands of daily activities. This study examines the relationship between interaction and the routine mealtime activity at home. METHOD: Patterns of interaction between a child (aged 6 years and 6 months) with severe speech and physical impairments and her caregiver (focus dyad) and a child without impairments (aged 6 years and 6 months) and her caregiver (comparison dyad) were analysed using video recordings and activity-based communication analysis. RESULTS: The focus dyad's interaction was unaided. The dyad did not use the Blissymbol board but communicated using words, vocalisations, word approximations, and body communication. Interaction in the focus dyad included relatively few pauses and frequent interchanges of short and sometimes simultaneous communicative contributions. Strong relations between patterns of interaction and immediate activity management goals such as assisting with eating, eating and drinking were found and compared for the two dyads. Results were discussed with regard to child development and communication intervention. CONCLUSIONS: The focus dyad showed interactive efficiency and the fulfilment of goals relating to basic understanding and closeness, but mainly with regard to immediate mealtime issues. The comparison child and caregiver were more independent in the activity which made it possible for them to reach more extensive, and from a child perspective, age-adequate goals than the focus dyad.

Aphasia and text writing.

BACKGROUND: Good writing skills are needed in almost every aspect of life today, and there is a growing interest in research into acquired writing difficulties. Most of the findings reported so far, however, are based on words produced in isolation. The present study deals with the production of entire texts. AIMS: The aim was to characterize written narratives produced by a group of participants with aphasia. METHODS & PROCEDURES: Eight persons aged 28-63 years with aphasia took part in the study. They were compared with a reference group consisting of ten participants aged 21-30 years. All participants were asked to write a personal narrative titled 'I have never been so afraid' and to perform a picture-based story-generation task called the 'Frog Story'. The texts were written on a computer. OUTCOME & RESULTS: The group could be divided into participants with low, moderate, and high general performance, respectively. The texts written by the participants in the group with moderate and high writing performance had comparatively good narrative structure despite indications of difficulties on other linguistic levels. CONCLUSIONS & IMPLICATIONS: Aphasia appeared to influence text writing on different linguistic levels. The impact on overall structure and coherence was in line with earlier findings from the analysis of spoken and written discourse and the implication of this is that the written modality should also be included in language rehabilitation.

Embodiment in communication--aphasia, apraxia and the possible role of mirroring and imitation.

The role of embodiment in communication is attracting an increased interest. This interest is to some extent caused by hypotheses and findings concerning mirror neurons in macaques, that is, neurons that are activated by production as well as perception of, for example, a certain movement of action. Mirror neurons seem to provide a fairly simple mechanism for acting, perceiving, imitating and pantomime, which could be crucial to the development of human communication and language. A number of theories try to extend similar ideas in describing human embodied communication. Some of the consequences of these theories are: (1) the close relation between speech and gestures; (2) the close relation between speech/language and praxis; and (3) the reconsideration of the importance for communication of more automatized versus more controlled processing. The purpose here is to point to possible consequences for clinical research and therapy concerning language disorders.

Aphasia and the process of revision in writing a text.

Most of the previous research on aphasia and writing ability concentrates on the production of words in isolation. The purpose of the current study was to examine the process of producing written texts by clients with aphasia. By using keystroke logging, it was possible to analyse the participants' ongoing work during text writing. Results showed that the participants with aphasia composed their texts in what may be described as a linear way. Edits concerning syntax or text structure were almost absent in the subjects' data, but they spent much time and effort on revising smaller units of text, that is, letters and words, possibly as a result of changing their minds or not being able to realize their intentions. However, these changes did not always result in correctly written words in the final text. The findings are discussed in relation to current writing theories.

Inference in right hemisphere damaged individuals' comprehension: the role of sustained attention.

The ability to make inferences for the purposes of comprehension is considered an important factor in pragmatic ability. In this experimental group study with stroke patients, the ability to make inferences and its associations with sustained attention and verbal working memory were explored. A group of 14 left-hemisphere-damaged individuals had more difficulty with tasks requiring the ability to revise inferences than a matched control group. Their results on those tasks tended to be associated with verbal working memory capacity. A group of 14 right-hemisphere-damaged (RHD) individuals also had problems in revising inferences, but their results were associated with sustained attention. In addition, the RHD subjects had problems in making inferences about characters' attitudes or motives. A lack of significant differences in results on tasks between the groups of brain damaged individuals indicate that comprehension of complex information might be impaired post stroke, irrespectively of whether the damage is to the left or right hemisphere. The results suggest that sustained attention, whilst not being a solitary sufficient factor, might somehow be involved in comprehension problems related to RHD. Implications for further research and clinical management of these sometimes subtle problems are discussed.

Children with autistic spectrum disorders and speech-generating devices: communication in different activities at home.

The communication of four children with autistic spectrum disorder was investigated when they were supplied with a speech-generating device (SGD) in three different activities in their home environment: mealtime, story reading and "sharing experiences of the preschool day". An activity based communication analysis, in which collective and individual background factors for the activities were outlined, was used as a basis for the discussion of linguistic coding data derived from video-recordings made before and during SGD intervention. The coded communicative behaviours were engagement in activity, role in turn-taking, communicative form, function and effectiveness. An increase in communicative effectiveness was more noticeable when the SGDs could be used to fulfil goals and roles within the activity. The instruction to the parents to use the SGDs in their communication with the child had an important influence on the activities.

Argumentation with restricted linguistic ability: performing a role play with aphasia or in a second language.

The main objective of this study is to illustrate how adaptation to linguistic limitations takes place in a specific activity and is affected by factors pertaining to the social activity or the individuals. A man with aphasia is compared to an adult immigrant L2 learner. An argumentative role play was video-recorded, transcribed and analysed. Both subjects have a very limited vocabulary and produce short utterances. The L2 learner often uses words that are semantically related to the target word, while the subject with aphasia uses more general and vague words, like pronouns, in combination with adverbs and set phrases. Both subjects use gesturing as strategy, and it is suggested that the semantic specificity of words as well as gestures is important in determining the role of gesture. Apart from gesture, he L2 learner uses mainly simplification and appeal strategies, while the subject with aphasia uses mainly fluency and sociolinguistic strategies.