Verb Tense Production in People With Nonfluent Aphasia Across Different Discourse Elicitation Tasks.

PURPOSE: Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are inconsistent and lacking at the discourse level. In addition, language production can be affected by discourse elicitation tasks depending on the cognitive linguistic demands and instructions unique to each task. There is limited evidence regarding whether verb tense production in people with nonfluent aphasia is impacted by discourse task demands. Understanding this potential impact is important for clinicians and researchers who are interested in assessing and then identifying effective clinical goals for this population. Therefore, this study aimed to investigate the trends of verb tense production across various discourse elicitation tasks in people with nonfluent aphasia compared to people without aphasia. METHOD: Language samples for 23 people with nonfluent aphasia and 27 people without aphasia were obtained for six discourse tasks from the AphasiaBank database. We calculated ratios of past tense, present tense, future tense, imperative, and unknown verb types to compare which tense was used most frequently within and across the tasks and groups. RESULTS AND CONCLUSIONS: Our findings revealed evidence of verb tense production deficits and a selective past tense impairment in people with nonfluent aphasia. Discourse task effects were shown for people without aphasia but were scarce in people with nonfluent aphasia. This finding could be explained by an overall reduction of verb production and overreliance on present tense production in nonfluent aphasia. These results suggest the potential methodological implications of using different discourse tasks to evaluate verb tense production in people with nonfluent aphasia. Future studies need to evaluate discourse task effects on other aspects of verb production (e.g., moods) and specific task factors (e.g., presence or absence of visual stimulus). SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25146242.

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.

Semantic Aspects of Verb Production in Various Discourse Tasks in People With Nonfluent Aphasia.

PURPOSE: The purpose of this study was to investigate how people with nonfluent aphasia produce semantically weighted verbs compared to people without aphasia, as well as how a discourse elicitation task affects verb production in people with nonfluent aphasia and people without aphasia. METHOD: This study included 30 people with nonfluent aphasia and 32 age-matched people without aphasia from AphasiaBank. Language samples of five different discourse tasks were obtained and coded for heavy, light, and be-copular verbs. The number of verbs per utterance and the proportion of heavy, light, and be-copular verbs were compared between groups and between tasks. RESULTS: People with nonfluent aphasia showed a similar proportion of heavy verbs but reduced verbs per utterance and proportion of light verbs compared to people without aphasia. With regard to discourse task effects, we found a trend for a higher proportion of heavy verbs in sequential picture descriptions, and a higher proportion of be-copular verbs and lower proportion of heavy verbs for a recount compared to other tasks in people without aphasia. The discourse task effects were minimally found in people with nonfluent aphasia. CONCLUSIONS: Our results suggest that people with nonfluent aphasia present with relatively preserved heavy verb production but with impaired production of light verbs in discourse. In addition, it appears that discourse tasks do not significantly influence the type of verbs produced by people with nonfluent aphasia possibly due to the floor effects and wide range of individual variability. This study is a preliminary effort to evaluate methodological factors that impact verb production; future studies are needed to develop a framework for clinical decision making when selecting a discourse elicitation task for people 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.

Treatment of the Linguistic and Temporal Components of Lexical Activation to Improve Word Retrieval in Aphasia.

Current approaches to treatments for word processing impairments in aphasia emphasize two components to target, the linguistic content, semantic or phonological representations of words, and the processing component, access to and retrieval of those representations. In this study, we explore these two components of a treatment to improve lexical activation that supports access and retrieval of word representations. Five people with aphasia participated. The treatment task was repetition of concrete word pairs after a 5-s response delay which was intended to provide practice in maintaining activation of the words for that 5-s period before reproducing them. Two of the five participants demonstrated a difficulty in maintaining activation of single words in repetition, with accuracy decreasing significantly after the 5-s interval. The treatment was applied to all participants, however, to determine if its benefit was specific to those with the activation maintenance impairment. Results confirmed that the activation maintenance treatment in the context of this repetition task led to more treatment gains for the two participants who demonstrated this specific impairment. They made gains on four of the nine measures compared to improvements on one to two measures for the other participants. A second question addressed in this study was the relative importance of the item component (linguistic content) of the treatment and the processing component, maintenance of activation. To that end, there were two conditions of treatment probes, (1) repeated content for all treatment, immediate post-treatment and 3-month maintenance probes and (2) novel content for probes in these three phases of treatment. Only one participant showed significant improvement in treatment when items were novel for all probes. We discuss the possibility that this outcome reflects a more specific deficit in the temporal processing component of lexical activation compared to the two other participants who showed better performance on probes with repeated items in treatment and post-treatment phases. Clinical implications of this study and directions of future research are discussed.

Effect of Working Memory Load and Typicality on Semantic Processing in Aphasia.

PURPOSE: This study evaluated the effects of a linguistic characteristic, typicality, and a processing variable, working memory on the abilities of people with aphasia (PWA) and neurologically intact adults to process semantic representations. This was accomplished using a newly developed assessment task, the Category Typicality Test, which was created for the Temple Assessment of Language and Short-Term Memory in Aphasia. METHOD: A post hoc quasi-experimental design was used. Participants included 27 PWA and 14 neurologically intact adults who completed the picture and word versions of the Category Typicality Test, which required them to determine if two items are in the same category. Memory load was altered by increasing the number of items to be compared, and the typicality of items was altered to increase linguistic complexity. RESULTS: A four-way mixed analysis of covariance was conducted. There was a significant interaction between working memory load and category typicality with performance accuracy decreasing as working memory load increased and category typicality decreased. There was also a significant interaction for typicality and stimuli with better performance in the picture condition and a significant interaction for working memory and group with lower performance accuracy for PWA. Post hoc pairwise comparisons revealed differences between memory load, typicality, stimuli conditions, and group. PWA also showed greater magnitude of change than neurologically intact adults when comparing high and low working memory load conditions, but not typicality conditions. DISCUSSION: Increasing working memory load had the most substantial impact on the accuracy of category judgments in PWA, but the interaction between increased working memory load and decreased category typicality of items to be compared resulted in reduced accuracy in both groups. These findings suggest that manipulation of processing and linguistic variables in assessment will provide insight into the nature of linguistic breakdown in aphasia. Supplemental Material https://doi.org/10.23641/asha.14781996.

Demystifying the Complexity of Aphasia Treatment: Application of the Rehabilitation Treatment Specification Systemx.

A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate articles in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.

Applying the Rehabilitation Treatment Specification System to Functional Communication Treatment Approaches for Aphasia.

There are many different approaches to the rehabilitation of patients with aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called "functional communication interventions" aims to enhance communication success as opposed to solely improving linguistic abilities. This approach encompasses many skills (eg, gesturing) and factors (eg, access to communication supports) that support sending and receiving messages in "real-world" daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes 3 connected elements-a single target, 1 or more ingredients, and a mechanism of action-that, taken together, attempt to explain how and why a treatment works. Although the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics' Communicative Effectiveness (PACE), modified Response Elaboration Training (M-RET), script training, conversation treatment, and communication partner training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.

Clinician Perspectives on the Assessment of Short-Term Memory in Aphasia.

BACKGROUND: Verbal short-term memory (STM) and the related ability, working memory (WM), are widely understood to be integral components of language production and comprehension. However, assessment of these abilities in people with aphasia is hampered by a lack of valid, standardized measures that are clinically appropriate. Focusing primarily on verbal STM, we held a series of five focus groups with speech-language pathologists (SLPs) to understand better their current clinical practices and their beliefs and attitudes regarding assessment of verbal STM in aphasia. AIMS: The purpose of this study was to explore the attitudes, beliefs and preferences of clinical SLPs to determine: (1) current practices related to verbal STM assessment; (2) the extent to which practices reflect current theories of aphasia and the role of verbal STM in language processing; and (3) practical considerations regarding aphasia assessment in clinical practice. METHODS & PROCEDURES: Five focus groups were conducted using a semi-structured interview protocol with a total of 44 SLPs. Grounded theory methodology was used to collect, code and analyse the data. Codes were reviewed to identify emerging themes. Themes were compared to explore meta-themes, connections and potential theoretical frameworks. OUTCOMES & RESULTS: Five main themes were identified: (1) The theoretical understanding that clinical SLPs have regarding the role of verbal STM in aphasia is not always consistent with clinical practice; (2) Clinical SLPs highly value functionally relevant assessments; (3) The intense time constraints in clinical practice affect all aspects of assessment; (4) Clinical SLPs feel that there is a lack of appropriate tests for assessment of STM in aphasia; and (5) Clinical SLPs prefer tests that are comprehensive, easy to administer and psychometrically sound. CONCLUSIONS: Clinical SLPs report a lack of standardized measures to assess STM in individuals with aphasia. Researchers are met with several challenges in the development of these tests including effective communication with clinicians regarding the benefit of verbal STM assessments, especially as it relates to functional skills, and the creation of a test that is comprehensive yet simple, quick and easy to administer.

Treatment of verbal short-term memory abilities to improve language function in aphasia: A case series treatment study.

Recent approaches to interventions for aphasia have incorporated verbal short-term memory (STM) and working memory (WM) components. We investigated whether a treatment involving repetition of word sequences after a response delay would improve tolerance of increased verbal STM load in repetition and, consequently, improve performance on repetition and other language tasks. Eight individuals with aphasia participated. We used a single subject design with outcome measures on near-transfer tasks closely related to the treatment task and far-transfer tasks more distantly related to the treatment task. We minimized repeated presentation of stimuli in all phases of treatment to control for confounding effects of repeated exposure of treated items. Four participants demonstrated modest acquisition effects. On outcome measures, we observed improvements by some participants on near-transfer tasks, (repetition of concrete and abstract word strings and verbal spans) and far-transfer tasks (naming and discourse). Some participants demonstrated a significant decline in word repetition accuracy after a response delay before treatment, indicating difficulty in maintaining activation of linguistic representations. It was these participants who showed the most improvement on outcome measures. More studies are needed to determine who will respond to this treatment and what factors might influence the effectiveness of this treatment approach.

Evaluating Change in the Conversation of a Person With Mild Aphasia After Attentive Reading With Constrained Summarization-Written Treatment.

Purpose The purpose of this project was to evaluate the effect of a discourse-level treatment, Attentive Reading with Constrained Summarization-Written (ARCS-W), on conversational discourse. ARCS-W aims to improve spoken and written output by addressing the cognitive-linguistic requirements of discourse production through constrained summarization of novel material. Method This is an experimentally controlled case study with a single participant, Bill. Three conversation samples were collected at pretreatment, and a single conversation was collected 1 month after treatment. The participant completed 24 ARCS-W treatment sessions, and each session included reading and then summarizing a novel current event article following specific constraints (use lexically precise words, stay on topic, use complete sentences) in speaking and writing. Conversation outcomes evaluated the success of each utterance (1-4 scale), grammaticality, and the proportion of utterances with relevant content (relevant utterances). Additionally, behavioral manifestations of word-finding difficulty were evaluated in conversation. Results Bill improved communicative success at the utterance level based on the minimal detectable change. He also demonstrated reductions in behavioral manifestations of lexical retrieval difficulty based on decreases in the percentage of false starts (e.g., t*, t*), mazes (e.g., uh, s*, um), and abandoned utterances. Bill did not increase the proportion of relevant utterances or grammatical utterances in conversation. Conclusions This case study provides preliminary evidence of the potential impact of ARCS-W treatment in conversation. Additionally, the measures implemented to evaluate conversation represent a promising adaptation of a novel methodology to capture change in conversation. Supplemental Material https://doi.org/10.23641/asha.12375053.

Evaluating the Contribution of Executive Functions to Language Tasks in Cognitively Demanding Contexts.

Purpose The purpose of this study was to determine the degree to which the executive functions of attention switching and inhibition predicted performance on language subtests from the Temple Assessment of Language and (Verbal) Short-Term Memory in Aphasia (TALSA; N. Martin, Minkina, Kohen, &Kalinyak-Fliszar, 2018) across 3 interval conditions (no delay, 5-s delay, and 5-s filled delay), which was designed to add a memory and executive load to language tasks. Method This study was a post hoc experimental design. Participants included 27 people with aphasia who were administered 5 subtests from the TALSA (Naming, Word Repetition, Nonword Repetition, Category Judgment, and Rhyming Judgment), which were selected to evaluate input and output levels of processing in the 3 interval conditions listed above. Three executive tasks were administered to evaluate inhibition (Simon and Flanker tasks) and attention switching (number-letter shifting). Results Independent variables were proportion correct on each TALSA task in 3 separate time conditions, and predictor variables were efficiency on the Simon task and number-letter shifting task. Linear regression modeling was completed, which revealed that inhibition was a significant predictor of proportion correct for Word Repetition and Category Judgment in the 5-s filled interval condition. Conclusions Our findings indicate that inhibition plays a role in completing tasks that require lexical and/or semantic processing in cognitively demanding conditions. Attention switching was not a significant predictor for any task. These results are an important step toward creating methods to evaluate executive skills in the context of language production. Supplemental Material https://doi.org/10.23641/asha.9765107.

Evaluating informative content and global coherence in fluent and non-fluent aphasia.

BACKGROUND: Discourse analysis is an important component of aphasia assessment because it can provide an insight into functional communication abilities. However, there are many unknowns regarding the levels of discourse breakdowns that occur across aphasia types. The purpose of the current study is to explore the possible differences in discourse-level communication in persons with fluent and non-fluent aphasia during picture description. AIMS: To examine if persons with fluent and non-fluent aphasia differ on utterance-level discourse measures when evaluating informative content and global coherence. Additionally, to evaluate and compare the types of global coherence violations made by each group. METHODS & PROCEDURES: Data from 31 people with aphasia was collected from AphasiaBank, which included 13 people with fluent aphasia and 18 people with non-fluent aphasia. Discourse samples from three picture descriptions were analysed. Discourse outcomes included utterances with new information (UNIs-relevant utterances containing new information) and global coherence (the extent to which each utterance maintained the overall discourse theme). Additionally, seven types of errors were identified to explore the nature of breakdowns in global coherence. OUTCOMES & RESULTS: People with fluent aphasia produced significantly higher proportions of UNIs and had significantly higher average global coherence ratings than those with non-fluent aphasia. Differences in global coherence violations were identified with people with fluent aphasia producing more non-specific, incorrect and off-topic utterances and people with non-fluent aphasia producing more incomplete utterances. One of the most common global coherence error types in both groups was commentary. CONCLUSIONS & IMPLICATIONS: Although people with fluent aphasia produced more types of global coherence errors, including incorrect, non-specific and off-topic utterances, the group was still rated significantly higher on utterance relevance and topic maintenance, indicating that the ability to produce a complete utterance plays an important role in some aspects of discourse production. Additionally, these findings provide an insight into potential targets for intervention.

Attentive Reading With Constrained Summarization Adapted to Address Written Discourse in People With Mild Aphasia.

Purpose: The purpose of this study was to examine the preliminary efficacy of Attentive Reading and Constrained Summarization-Written (ARCS-W) in people with mild aphasia. ARCS-W adapts an existing treatment, ARCS (Rogalski & Edmonds, 2008), to address discourse level writing in mild aphasia. ARCS-W focuses on the cognitive and linguistic skills required for discourse production. Method: This study was a within-subject pre-postdesign. Three people with mild aphasia participated. ARCS-W integrates attentive reading or listening with constrained summarization of discourse level material in spoken and written modalities. Outcomes included macro- (main concepts) and microlinguistic (correct information units, complete utterances) discourse measures, confrontation naming, aphasia severity, and functional communication. Results: All 3 participants demonstrated some generalization to untrained spoken and written discourse at the word, sentence, and text levels. Reduced aphasia severity and/or increased functional communication and confrontation naming were also observed in some participants. Conclusions: The findings of this study provide preliminary evidence of the efficacy of ARCS-W to improve spoken and written discourse in mild aphasia. Different generalization patterns suggest different mechanisms of improvement. Further research and replication are required to better understand how ARCS-W can impact discourse abilities.