Training flexibility in fixed expressions in non-fluent aphasia: A case series report.

BACKGROUND: Many speakers with non-fluent aphasia (NFA) are able to produce some well-formed word combinations such as 'I like it' or 'I don't know', although they may not use variations such as 'He likes it' or 'I don't know that person'. This suggests that these utterances represent fixed forms. AIMS: This case series investigation explored the impact of a novel intervention aimed at enhancing the connected speech of individuals with NFA. The intervention, motivated by usage-based principles, involved filling open slots in semi-fixed sentence frames. METHODS & PROCEDURES: Five participants with NFA completed a 6-week intervention programme. The intervention trained participants to insert a range of different lexical items into the open slots of high-frequency phrases such as 'I like it' to enable more productive sentences (e.g., 'they like flowers'). The outcomes and acceptability were examined: The primary outcome measure focused on changes in connected narrative, and the availability of trained constructions (e.g., 'I like it') was explored through a story completion test. Two baseline measures of behaviour were taken prior to intervention, and outcomes assessed immediately after intervention and at a 6-week maintenance assessment. OUTCOME & RESULTS: A pre-/post-treatment comparison of connected speech measures showed evidence of enhanced connected speech for two of the five participants (P2 and P5). An analysis of story completion test scores revealed positive change for two participants (P1 and P2). Findings were mixed with regard to baseline stability of outcome measures and post-intervention stability of language changes. The intervention was acceptable to all participants. CONCLUSION & IMPLICATIONS: While this pilot study yielded promising findings with regard to the intervention's acceptability and increased connected speech for some participants, the findings were mixed across the sample of five participants. This research helps inform hypotheses and selection criteria for future studies. WHAT THIS PAPER ADDS: What is already known on the subject Despite difficulties producing grammatically correct sentences, many speakers with aphasia are able to produce well-formed utterances, often representing familiar expressions such as 'I don't know' and 'I like it'. In usage-based Construction Grammar (CxG) theories, familiar utterances are assumed to be processed as one unit and are therefore more resilient to brain damage. CxG assumes that residual utterances such as 'I like it' map onto more abstract sentence frames (e.g., '[REFERENT] like-TENSE [THING]'). What this paper adds to existing knowledge Sentence therapy, informed by CxG principles, is novel in aphasiology, and usage-based interventions need to be evaluated with regard to their impact on language processing at the connected speech level. This case series report explores the acceptability and outcomes of a usage-based sentence therapy. We also introduce and explore the value of an automated, frequency-based analysis tool for evaluating connected speech outcomes in aphasia therapy. What are the potential or actual clinical implications of this work? The findings inform further development of usage-based aphasia interventions targeting word combinations.

Automated profiling of spontaneous speech in primary progressive aphasia and behavioral-variant frontotemporal dementia: An approach based on usage-frequency.

Language production provides important markers of neurological health. One feature of impairments of language and cognition, such as those that occur in stroke aphasia or Alzheimer's disease, is an overuse of high frequency, "familiar" expressions. We used computerized analysis to profile narrative speech samples from speakers with variants of frontotemporal dementia (FTD), including subtypes of primary progressive aphasia (PPA). Analysis was performed on language samples from 29 speakers with semantic variant PPA (svPPA), 25 speakers with logopenic variant PPA (lvPPA), 34 speakers with non-fluent variant PPA (nfvPPA), 14 speakers with behavioral variant FTD (bvFTD) and 20 older normal controls (NCs). We used frequency and collocation strength measures to determine use of familiar words and word combinations. We also computed word counts, content word ratio and a combination ratio, a measure of the degree to which the individual produces connected language. All dementia subtypes differed significantly from NCs. The most discriminating variables were word count, combination ratio, and content word ratio, each of which distinguished at least one dementia group from NCs. All participants with PPA, but not participants with bvFTD, produced significantly more frequent forms at the level of content words, word combinations, or both. Each dementia group differed from the others on at least one variable, and language production variables correlated with established behavioral measures of disease progression. A machine learning classifier, using narrative speech variables, achieved 90% accuracy when classifying samples as NC or dementia, and 59.4% accuracy when matching samples to their diagnostic group. Automated quantification of spontaneous speech in both language-led and non-language led dementias, is feasible. It allows extraction of syndromic profiles that complement those derived from standardized tests, warranting further evaluation as candidate biomarkers. Inclusion of frequency-based language variables benefits profiling and classification.

Formulaic Language in People with Probable Alzheimer's Disease: A Frequency-Based Approach.

BACKGROUND: Language change can be a valuable biological marker of overall cognitive change in Alzheimer's disease (AD) and other forms of dementia. Previous reports have described increased use of language formulas in AD, i.e., combinations likely processed in a holistic manner. Words that commonly occur together are more likely to become a formula. OBJECTIVE: To determine if frequency of co-occurrence as one indicator for formulaic language can distinguish people with probable AD from controls and if variables are sensitive to time post-symptom onset. METHODS: We developed the Frequency in Language Analysis Tool (FLAT), which indicates degrees of formulaicity in an individual language sample. The FLAT accomplishes this by comparing individual language samples to co-occurrence data from the British National Corpus (BNC). Our analysis also contained more conventional language variables in order to assess novel contributions of the FLAT. We analyzed data from the Pitt Corpus, which is part of DementiaBank. RESULTS: Both conventional and co-occurrence variables were able to distinguish AD and control groups. According to co-occurrence data, people with probable AD produced more formulaic language than controls. Only co-occurrence variables correlated with disease progression. DISCUSSION: Frequency of word co-occurrences is one indicator for formulaicity and a valuable contribution to characterizing language change in AD.

The Language Profile of Behavioral Variant Frontotemporal Dementia.

BACKGROUND: The language profile of behavioral variant frontotemporal dementia (bvFTD) remains to be fully defined. OBJECTIVE: We aimed to quantify the extent of language deficits in this patient group. METHODS: We assessed a cohort of patients with bvFTD (n = 24) in relation to patients with semantic variant primary progressive aphasia (svPPA; n = 14), nonfluent variant primary progressive aphasia (nfvPPA; n = 18), and healthy age-matched individuals (n = 24) cross-sectionally and longitudinally using a comprehensive battery of language and general neuropsychological tests. Neuroanatomical associations of language performance were assessed using voxel-based morphometry of patients' brain magnetic resonance images. RESULTS: Relative to healthy controls, and after accounting for nonverbal executive performance, patients with bvFTD showed deficits of noun and verb naming and single word comprehension, diminished spontaneous propositional speech, and deterioration in naming performance over time. Within the bvFTD group, patients with MAPT mutations had more severe impairments of noun naming and single word comprehension than patients with C9orf72 mutations. Overall the bvFTD group had less severe language deficits than patients with PPA, but showed a language profile that was qualitatively similar to svPPA. Neuroanatomical correlates of naming and word comprehension performance in bvFTD were identified predominantly in inferior frontal and antero-inferior temporal cortices within the dominant hemispheric language network. CONCLUSIONS: bvFTD is associated with a language profile including verbal semantic impairment that warrants further evaluation as a novel biomarker.

The Relationship Between Apraxia of Speech and Oral Apraxia: Association or Dissociation?

Acquired apraxia of speech (AOS) is a motor speech disorder that affects the implementation of articulatory gestures and the fluency and intelligibility of speech. Oral apraxia (OA) is an impairment of nonspeech volitional movement. Although many speakers with AOS also display difficulties with volitional nonspeech oral movements, the relationship between the 2 conditions is unclear. This study explored the relationship between speech and volitional nonspeech oral movement impairment in a sample of 50 participants with AOS. We examined levels of association and dissociation between speech and OA using a battery of nonspeech oromotor, speech, and auditory/aphasia tasks. There was evidence of a moderate positive association between the 2 impairments across participants. However, individual profiles revealed patterns of dissociation between the 2 in a few cases, with evidence of double dissociation of speech and oral apraxic impairment. We discuss the implications of these relationships for models of oral motor and speech control.

A case of "order insensitivity"? Natural and artificial language processing in a man with primary progressive aphasia.

Processing of linear word order (linear configuration) is important for virtually all languages and essential to languages such as English which have little functional morphology. Damage to systems underpinning configurational processing may specifically affect word-order reliant sentence structures. We explore order processing in WR, a man with primary progressive aphasia (PPA). In a previous report, we showed how WR showed impaired processing of actives, which rely strongly on word order, but not passives where functional morphology signals thematic roles. Using the artificial grammar learning (AGL) paradigm, we examined WR's ability to process order in non-verbal, visual sequences and compared his profile to that of healthy controls, and aphasic participants with and without severe syntactic disorder. Results suggested that WR, like some other patients with severe syntactic impairment, was unable to detect linear configurational structure. The data are consistent with the notion that disruption of possibly domain-general linearization systems differentially affects processing of active and passive sentence structures. Further research is needed to test this account, and we suggest hypotheses for future studies.

Preservation of passive constructions in a patient with primary progressive aphasia.

Research into agrammatic comprehension in English has described a pattern of impaired understanding of passives and retained ability on active constructions. Some accounts of this dissociation predict that patients who are unable to comprehend actives will also be impaired in the comprehension of passives. We report the case of a man with primary progressive aphasia (PPA) (WR), whose comprehension was at chance on active sentences, but at ceiling on passives. In a series of reversible sentence comprehension tests WR displayed difficulties with active transitives and truncated actives with an auxiliary. In passive sentences, he displayed sensitivity to the agent marker by, as well as the passive morphology of the verb. This pattern of dissociation challenges current theories of agrammatic comprehension. We explore explanations based on the distinction between morphological and configurational cues, as well as on the semantic and discourse related differences between active and passive constructions.

Artificial grammar learning in individuals with severe aphasia.

One factor in syntactic impairment in aphasia might be damage to general structure processing systems. In such a case, deficits would be evident in the processing of syntactically structured non-linguistic information. To explore this hypothesis, we examined performances on artificial grammar learning (AGL) tasks in which the grammar was expressed in non-linguistic visual forms. In the first experiment, AGL behavior of four aphasic participants with severe syntactic impairment, five aphasic participants without syntactic impairment, and healthy controls was examined. Participants were trained on sequences of nonsense stimuli with the structure A(n)B(n). Data were analyzed at an individual level to identify different behavioral profiles and account for heterogeneity in aphasic as well as healthy groups. Healthy controls and patients without syntactic impairment were more likely to learn configurational (item order) than quantitative (counting) regularities. Quantitative regularities were only detected by individuals who also detected the configurational properties of the stimulus sequences. By contrast, two individuals with syntactic impairment learned quantitative regularities, but showed no sensitivity towards configurational structure. They also failed to detect configurational structure in a second experiment in which sequences were structured by the grammar A(+)B(+). We discuss the potential relationship between AGL and processing of word order as well as the potential of AGL in clinical practice.

Error reduction therapy in reducing struggle and grope behaviours in apraxia of speech.

We report an intervention study focused on the speech production difficulties present in acquired apraxia of speech (AOS). The intervention was a self-administered computer therapy that targeted whole word production and incorporated error reduction strategies. The effectiveness of the therapy was contrasted to that of a visuospatial sham computer program, and performance across treated words, and two sets of matched words, was assessed. Two groups of participants completed the study which employed a two-phase cross-over treatment design. Participants were randomly assigned to a speech first or sham first condition. Treatments were administered for six weeks, with a four week rest between interventions. Participants were assessed five times in total; twice at baseline, once following each of the intervention phases, and once following a lapse of eight weeks after the end of the second phase of intervention. The occurrence of accurate word production and speech characterised by struggle and groping behaviours was recorded on a repetition task. Participants showed significant gains in speech accuracy and fluency, and reductions in articulatory groping and struggle behaviours following the use of the speech program. These gains were largely maintained once the therapy was withdrawn.

Individual behavior in learning of an artificial grammar.

Artificial grammar learning (AGL) is a widely used experimental paradigm that investigates how syntactic structures are processed. After a familiarization phase, participants have to distinguish strings consistent with a set of grammatical rules from strings that violate these rules. Many experiments report performance solely at a group level and as the total number of correct judgments. This report describes a systematic approach for investigating individual performance and a range of different behaviors. Participants were exposed to strings of the nonfinite grammar A( n )B( n ). To distinguish grammatical from ungrammatical strings, participants had to pay attention to local dependencies while comparing the number of stimuli from each class. Individual participants showed substantially different behavioral patterns despite exposure to the same stimuli. The results were replicated across auditory and visual sensory modalities. It is suggested that an analysis that looks at individual differences grants new insights into the processes involved in AGL. It also provides a solid basis from which to investigate sequence-processing abilities in special populations, such as patients with neurological lesions.

Plasticity, permanence, and patient performance: study design and data analysis in the cognitive rehabilitation of acquired communication impairments.

Communication impairments such as aphasia and apraxia can follow brain injury and result in limitation of an individual's participation in social interactions, and capacity to convey needs and desires. Our research group developed a computerized treatment program which is based on neuroscientific principles of speech production (Whiteside and Varley, 1998; Varley and Whiteside, 2001; Varley, 2010) and has been shown to improve communication in people with apraxia and aphasia (Dyson et al., 2009; Varley et al., 2009). Investigations of treatment efficacy have presented challenges in study design, effect measurement, and statistical analysis which are likely to be shared by other researchers in the wider field of cognitive neurorehabilitation evaluation. Several key factors define neurocognitively based therapies, and differentiate them and their evaluation from other forms of medical intervention. These include: (1) inability to "blind" patients to the content of the treatment and control procedures; (2) neurocognitive changes that are more permanent than pharmacological treatments on which many medical study designs are based; and (3) the semi-permanence of therapeutic effects means that new baselines are set throughout the course of a given treatment study, against which comparative interventions or long term retention effects must be measured. This article examines key issues in study design, effect measurement, and data analysis in relation to the rehabilitation of patients undergoing treatment for apraxia of speech. Results from our research support a case for the use of multiperiod, multiphase cross-over design with specific computational adjustments and statistical considerations. The paper provides researchers in the field with a methodologically feasible and statistically viable alternative to other designs used in rehabilitation sciences.

A new set of 84 colored nonobjects.

In this article, we present 84 nonobjects we created by using the colored object pictures from Rossion and Pourtois (2004). These nonobjects were explored on a number of measures, including object resemblance, visual complexity, and an object decision task (ODT). Object resemblance for nonobjects is a construct comparable to the "word-likeness" of phonotactically legal pseudowords. The nonobjects were rated as possible objects, showing similarity to real objects. Visual complexity ratings for objects and nonobjects were comparable. In the ODT, response times (RTs) were significantly longer for nonobjects than for real-object pictures. This RT difference is analogous to the word advantage, or lexicality effect, found in lexical decision tasks, in which responses for words are generally faster than those for nonwords. This nonobject set is freely available and has the advantage of having a companion set of real-object pictures. The nonobjects are available in color and in grayscale from brm.psychonomic-journals.org/content/supplemental.

Agrammatic but numerate.

A central question in cognitive neuroscience concerns the extent to which language enables other higher cognitive functions. In the case of mathematics, the resources of the language faculty, both lexical and syntactic, have been claimed to be important for exact calculation, and some functional brain imaging studies have shown that calculation is associated with activation of a network of left-hemisphere language regions, such as the angular gyrus and the banks of the intraparietal sulcus. We investigate the integrity of mathematical calculations in three men with large left-hemisphere perisylvian lesions. Despite severe grammatical impairment and some difficulty in processing phonological and orthographic number words, all basic computational procedures were intact across patients. All three patients solved mathematical problems involving recursiveness and structure-dependent operations (for example, in generating solutions to bracket equations). To our knowledge, these results demonstrate for the first time the remarkable independence of mathematical calculations from language grammar in the mature cognitive system.