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

Background: Discourse analyses yield quantitative measures of functional communication in aphasia. However, they are historically underutilized in clinical settings. Confrontation naming assessments are used widely clinically and have been used to estimate discourse-level production. Such work shows that naming accuracy explains moderately high proportions of variance in measures of discourse, but proportions of variance remain unexplained. We propose that the inclusion of circumlocution productions into predictive models will account for a significant amount more of the variance. Circumlocution productions at the naming-level, while they may not contain the target word, are similar to the content that contributes to discourse informativeness and efficiency. Thus, additionally measuring circumlocution may improve our ability to estimate discourse performance and functional communication. Aim: This study aimed to test whether, after controlling for naming accuracy, the addition of a measure of circumlocution into predictive models of discourse-level informativeness and efficiency would account for a significant amount more of the variance in these discourse-level outcomes. Methods & Procedures: Naming and discourse data from 43 people with poststroke aphasia were analyzed. Naming data were collected using 120 pictured items and discourse data were collected using two picture description prompts. Data scoring and coding yielded measures of naming accuracy, incorrect response type, communicative informativeness, and efficiency. We used robust hierarchical regression to evaluate study predictions. Outcomes & Results: After controlling for naming accuracy, the inclusion of circumlocution into predictive models accounted for a significant amount more of the variance in both informativeness and efficiency. The subsequent inclusion of other response types, such as real word and nonword errors, did not account for a significant amount more of the variance in either outcome. Conclusions: In addition to naming accuracy, the production of circumlocution during naming assessments may correspond with measures of informativeness and efficiency at the discourse-level. Reducing the burden of estimating patients' functional communication will increase our ability to estimate functional communication using tools that are easy to administer and interpret.

A Review of Poststroke Aphasia Recovery and Treatment Options.

Poststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language therapy with a speech-language pathologist is the most common form of aphasia therapy. In this review, the authors also discuss augmentative treatment methodologies, collaborative goal setting frameworks, and recommendations for future research.

The Communication Success Screener: A Preliminary Investigation of Perceived Communicative Success Across Modalities, Environments, and Demands.

PURPOSE: Behavioral intervention targeting speech, language, and communication concerns is an established therapeutic approach for patients with communication concerns across a range of acquired neurogenic disorders. The multidimensional factors that contribute to a person's self-identified communication challenges and strengths in their daily communication needs must be considered to provide functional and person-centered care. While assessments grounded in clinician observation or client self-report exist, there is a direct need for a screening tool that comprehensively evaluates the roles of modality (verbal, text, gesture) and environment (in-person, virtual) on self-reported success across communicative demands. In this study, we describe a preliminary approach to monitoring the progression of receptive and expressive communication skills in people with chronic poststroke aphasia in the context of communication practices of the 21st century, culminating in the development and exploratory implementation of a novel clinical instrument: the Communication Success Screener (COMSS). METHOD: Thirty-three participants with aphasia due to stroke were recruited to complete and evaluate the COMSS via an online survey. Quantitative responses and open-ended participant feedback were collected to validate and propose adaptations to the COMSS. Group-level analyses and case presentations were used to highlight COMSS features and outcomes. RESULTS: Participant responses to the COMSS questionnaire suggest that this screening tool creates differentiated communicative success profiles based on self-report. Participant feedback also indicated that the COMSS appropriately evaluates self-reported success across modalities of verbal, text, and gesture in the context of in-person and virtual environments. CONCLUSIONS: The communication concerns experienced by people with aphasia are often heterogeneous and vary as a function of their daily activities of living, preferred language modalities, and environmental supports. We present preliminary feasibility analyses of the COMSS as a potential tool to support the monitoring of functional change by evaluating self-reported communicative success across form, modality, environment, and task demand. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24521044.

Incorporating Metacognitive Strategy Training Into Semantic Treatment Promotes Restitutive and Substitutive Gains in Naming: A Single-Subject Investigation.

PURPOSE: This study tested the effectiveness of a modified semantic feature analysis (SFA) treatment protocol that incorporated metacognitive strategy training (MST). Regarding its restitutive component, SFA most reliably results in improved word retrieval for treated items and untreated, semantically related items, but evidence of response generalization is often small/inconsistent. Regarding its substitutive component, SFA is thought to facilitate successful communication via habituation of the SFA circumlocution strategy. However, repeated practice with SFA's strategy in the absence of direct MST may not result in independent strategy use and/or generalization. Furthermore, people with aphasia's independent use of the SFA strategy in moments of anomia is presently underreported. To address these limitations, we incorporated MST into SFA and directly measured substitutive outcomes. METHOD: Four people with aphasia participated in 24 treatment sessions of SFA + MST in a single-subject, A-B experimental design with repeated measurements. We measured word retrieval accuracy, strategy use, and explicit strategy knowledge. We calculated effect sizes to measure changes in word retrieval accuracy and strategy use and used visual inspection to assess gains in explicit strategy knowledge from pre- to posttreatment and retention. RESULTS: Participants achieved marginally small to medium effects in word retrieval accuracy for treated; untreated, semantically related; and untreated, semantically unrelated items and marginally small to large effects in independent strategy use. Explicit strategy knowledge was variable. CONCLUSIONS: Across participants, SFA + MST yielded positive changes in word retrieval accuracy or strategy use, or both. Positive changes in word retrieval accuracy were comparable to other SFA studies. Positive changes in strategy use demonstrate preliminary evidence of this treatment's ability to yield restitutive and substitutive gains. Overall, this study offers preliminary evidence of SFA + MST's effectiveness and highlights the importance of directly measuring SFA's substitutive outcomes, which showed that people with aphasia can respond to this treatment in multiple successful ways-not just improved target word production.

Speaking with a KN95 face mask: a within-subjects study on speaker adaptation and strategies to improve intelligibility.

Mask-wearing during the COVID-19 pandemic has prompted a growing interest in the functional impact of masks on speech and communication. Prior work has shown that masks dampen sound, impede visual communication cues, and reduce intelligibility. However, more work is needed to understand how speakers change their speech while wearing a mask and to identify strategies to overcome the impact of wearing a mask. Data were collected from 19 healthy adults during a single in-person session. We investigated the effects of wearing a KN95 mask on speech intelligibility, as judged by two speech-language pathologists, examined speech kinematics and acoustics associated with mask-wearing, and explored KN95 acoustic filtering. We then considered the efficacy of three speaking strategies to improve speech intelligibility: Loud, Clear, and Slow speech. To inform speaker strategy recommendations, we related findings to self-reported speaker effort. Results indicated that healthy speakers could compensate for the presence of a mask and achieve normal speech intelligibility. Additionally, we showed that speaking loudly or clearly-and, to a lesser extent, slowly-improved speech intelligibility. However, using these strategies may require increased physical and cognitive effort and should be used only when necessary. These results can inform recommendations for speakers wearing masks, particularly those with communication disorders (e.g., dysarthria) who may struggle to adapt to a mask but can respond to explicit instructions. Such recommendations may further help non-native speakers and those communicating in a noisy environment or with listeners with hearing loss.