Perspectives of U.S. speech-language pathologists on supporting the psychosocial health of individuals with aphasia.

INTRODUCTION: Individuals living with aphasia (IWA) are more likely than stroke survivors without aphasia to experience depression, anxiety, stress, and social isolation due to communication difficulties, social and life barriers, and neurobiological changes (Hilari, 2011). Researchers in the U.K., Australia, and elsewhere have surveyed speech-language pathologists (SLPs) to ascertain their training and confidence in addressing the psychosocial well-being of IWA (Northcott et al., 2017; Sekhon et al., 2015). To date, no similar survey has been performed in the U.S. The aim of this study was to survey the perspectives of U.S. SLPs on addressing the psychosocial well-being of IWA. METHODS: The survey questions were drawn from Northcott et al. (2017), with adjustments for a U.S. audience and additional questions. We conducted a Qualtrics survey which remained open from November 2021 through May 2022 and collected 101 responses. Responses to the closed questions were analyzed using descriptive statistics and open-ended responses were analyzed with qualitative content analysis. RESULTS: Some of the most significant findings of this survey include the low levels of confidence in addressing psychological health, lack of training among SLPs, and rarity of successful collaboration with mental health professionals. In comparison to surveys conducted in other countries, many overarching themes were similar, but there was some variation in specific responses and patterns. Categories emerging from the open-ended responses included the need for more trained mental health professionals, improved collaboration, and emphasis on the importance of the topic. CONCLUSIONS: This research highlights the necessity of increased training, as well as improved interprofessional collaboration between SLPs and mental health professionals. Limitations of the study include the potential bias of respondents, as well as the number and scope of the questions and responses. Future studies can employ interviews, trial models for collaboration, and partner with IWA to explore their experiences with psychosocial health support and services.

Effect of Lexical-Semantic Cues during Real-Time Sentence Processing in Aphasia.

Using a visual world eye-tracking paradigm, we investigated the real-time auditory sentence processing of neurologically unimpaired listeners and individuals with aphasia. We examined whether lexical-semantic cues provided as adjectives of a target noun modulate the encoding and retrieval dynamics of a noun phrase during the processing of complex, non-canonical sentences. We hypothesized that the real-time processing pattern of sentences containing a semantically biased lexical cue (e.g., the venomous snake) would be different than sentences containing unbiased adjectives (e.g., the voracious snake). More specifically, we predicted that the presence of a biased lexical cue would facilitate (1) lexical encoding (i.e., boosted lexical access) of the target noun, snake, and (2) on-time syntactic retrieval or dependency linking (i.e., increasing the probability of on-time lexical retrieval at post-verb gap site) for both groups. For unimpaired listeners, results revealed a difference in the time course of gaze trajectories to the target noun (snake) during lexical encoding and syntactic retrieval in the biased compared to the unbiased condition. In contrast, for the aphasia group, the presence of biased adjectives did not affect the time course of processing the target noun. Yet, at the post-verb gap site, the presence of a semantically biased adjective influenced syntactic re-activation. Our results extend the cue-based parsing model by offering new and valuable insights into the processes underlying sentence comprehension of individuals with aphasia.

Effects of Semantic Feature Type, Diversity, and Quantity on Semantic Feature Analysis Treatment Outcomes in Aphasia.

Purpose Semantic feature analysis (SFA) is a naming treatment found to improve naming performance for both treated and semantically related untreated words in aphasia. A crucial treatment component is the requirement that patients generate semantic features of treated items. This article examined the role feature generation plays in treatment response to SFA in several ways: It attempted to replicate preliminary findings from Gravier et al. (2018), which found feature generation predicted treatment-related gains for both trained and untrained words. It examined whether feature diversity or the number of features generated in specific categories differentially affected SFA treatment outcomes. Method SFA was administered to 44 participants with chronic aphasia daily for 4 weeks. Treatment was administered to multiple lists sequentially in a multiple-baseline design. Participant-generated features were captured during treatment and coded in terms of feature category, total average number of features generated per trial, and total number of unique features generated per item. Item-level naming accuracy was analyzed using logistic mixed-effects regression models. Results Producing more participant-generated features was found to improve treatment response for trained but not untrained items in SFA, in contrast to Gravier et al. (2018). There was no effect of participant-generated feature diversity or any differential effect of feature category on SFA treatment outcomes. Conclusions Patient-generated features remain a key predictor of direct training effects and overall treatment response in SFA. Aphasia severity was also a significant predictor of treatment outcomes. Future work should focus on identifying potential nonresponders to therapy and explore treatment modifications to improve treatment outcomes for these individuals. Supplemental Material https://doi.org/10.23641/asha.12462596.

Structural white matter connectometry of word production in aphasia: an observational study.

While current dual-steam neurocognitive models of language function have coalesced around the view that distinct neuroanatomical networks subserve semantic and phonological processing, respectively, the specific white matter components of these networks remain a matter of debate. To inform this debate, we investigated relationships between structural white matter connectivity and word production in a cross-sectional study of 42 participants with aphasia due to unilateral left hemisphere stroke. Specifically, we reconstructed a local connectome matrix for each participant from diffusion spectrum imaging data and regressed these matrices on indices of semantic and phonological ability derived from their responses to a picture-naming test and a computational model of word production. These connectometry analyses indicated that both dorsally located (arcuate fasciculus) and ventrally located (inferior frontal-occipital, uncinate, and middle longitudinal fasciculi) tracts were associated with semantic ability, while associations with phonological ability were more dorsally situated, including the arcuate and middle longitudinal fasciculi. Associations with limbic pathways including the posterior cingulum bundle and the fornix were also found. All analyses controlled for total lesion volume and all results showing positive associations obtained false discovery rates < 0.05. These results challenge dual-stream accounts that deny a role for the arcuate fasciculus in semantic processing, and for ventral-stream pathways in language production. They also illuminate limbic contributions to both semantic and phonological processing for word production.

What Matters in Semantic Feature Analysis: Practice-Related Predictors of Treatment Response in Aphasia.

Purpose: This study investigated the predictive value of practice-related variables-number of treatment trials delivered, total treatment time, average number of trials per hour, and average number of participant-generated features per trial-in response to semantic feature analysis (SFA) treatment. Method: SFA was administered to 17 participants with chronic aphasia daily for 4 weeks. Individualized treatment and semantically related probe lists were generated from items that participants were unable to name consistently during baseline testing. Treatment was administered to each list sequentially in a multiple-baseline design. Naming accuracy for treated and untreated items was obtained at study entry, exit, and 1-month follow-up. Results: Item-level naming accuracy was analyzed using logistic mixed-effect regression models. The average number of features generated per trial positively predicted naming accuracy for both treated and untreated items, at exit and follow-up. In contrast, total treatment time and average trials per hour did not significantly predict treatment response. The predictive effect of number of treatment trials on naming accuracy trended toward significance at exit, although this relationship held for treated items only. Conclusions: These results suggest that the number of patient-generated features may be more strongly associated with SFA-related naming outcomes, particularly generalization and maintenance, than other practice-related variables. Supplemental Materials: https://doi.org/10.23641/asha.5734113.

Processing distinct linguistic information types in working memory in aphasia.

BACKGROUND: Recent investigations have suggested that adults with aphasia present with a working memory deficit that may contribute to their language-processing difficulties. Working memory capacity has been conceptualised as a single "resource" pool for attentional, linguistic, and other executive processing-alternatively, it has been suggested that there may be separate working memory abilities for different types of linguistic information. A challenge in this line of research is developing an appropriate measure of working memory ability in adults with aphasia. One candidate measure of working memory ability that may be appropriate for this population is the n-back task. By manipulating stimulus type, the n-back task may be appropriate for tapping linguistic-specific working memory abilities. AIMS: The purposes of this study were (a) to measure working memory ability in adults with aphasia for processing specific types of linguistic information, and (b) to examine whether a relationship exists between participants' performance on working memory and auditory comprehension measures. METHOD #ENTITYSTARTX00026; PROCEDURES: Nine adults with aphasia participated in the study. Participants completed three n-back tasks, each tapping different types of linguistic information. They included the PhonoBack (phonological level), SemBack (semantic level), and SynBack (syntactic level). For all tasks, two n-back levels were administered: a 1-back and 2-back. Each level contained 20 target items; accuracy was recorded by stimulus presentation software. The Subject-relative, Object-relative, Active, Passive Test of Syntactic Complexity (SOAP) was the syntactic sentence comprehension task administered to all participants. OUTCOMES #ENTITYSTARTX00026; RESULTS: Participants' performance declined as n-back task difficulty increased. Overall, participants performed better on the SemBack than PhonoBack and SynBack tasks, but the differences were not statistically significant. Finally, participants who performed poorly on the SynBack also had more difficulty comprehending syntactically complex sentence structures (i.e., passive & object-relative sentences). CONCLUSIONS: Results indicate that working memory ability for different types of linguistic information can be measured in adults with aphasia. Further, our results add to the growing literature that favours separate working memory abilities for different types of linguistic information view.