Morphological decomposition in Broca’s aphasia

Background: Few studies have investigated how individuals diagnosed with post-stroke Broca’s aphasia decompose words into their constituent morphemes in real-time processing. Previous research has focused on morphologically complex words in non-time-constrained settings or in syntactic frames, but not in the lexicon.

Aims: We examined real-time processing of morphologically complex words in a group of five Greek-speaking individuals with Broca’s aphasia to determine: (1) whether their morphological decomposition mechanisms are sensitive to lexical (orthography and frequency) vs. morphological (stem-suffix combinatory features) factors during visual word recognition, (2) whether these mechanisms are different in inflected vs. derived forms during lexical access, and (3) whether there is a preferred unit of lexical access (syllables vs. morphemes) for inflected vs. derived forms.

Methods & Procedures: The study included two real-time experiments. The first was a semantic judgment task necessitating participants’ categorical judgments for high- and low-frequency inflected real words and pseudohomophones of the real words created by either an orthographic error at the stem or a homophonous (but incorrect) inflectional suffix. The second experiment was a letter-priming task at the syllabic or morphemic boundary of morphologically transparent inflected and derived words whose stems and suffixes were matched for length, lemma and surface frequency.

Outcomes & Results: The majority of the individuals with Broca’s aphasia were sensitive to lexical frequency and stem orthography, while ignoring the morphological combinatory information encoded in the inflectional suffix that control participants were sensitive to. The letter-priming task, on the other hand, showed that individuals with aphasia—in contrast to controls—showed preferences with regard to the unit of lexical access, i.e., they were overall faster on syllabically than morphemically parsed words and their morphological decomposition mechanisms for inflected and derived forms were modulated by the unit of lexical access.

Conclusions: Our results show that in morphological processing, Greek-speaking persons with aphasia rely mainly on stem access and thus are only sensitive to orthographic violations of the stem morphemes, but not to illegal morphological combinations of stems and suffixes. This possibly indicates an intact orthographic lexicon but deficient morphological decomposition mechanisms, possibly stemming from an underspecification of inflectional suffixes in the participants’ grammar. Syllabic information, however, appears to facilitate lexical access and elicits repair mechanisms that compensate for deviant morphological parsing procedures.     

The role of prosody in a case of foreign accent syndrome (FAS)

Foreign accent syndrome (FAS) is a rare disorder characterized by the emergence of a perceived foreign accent following brain damage. The symptomotology, functional bases, and neural substrates of this disorder are still being elucidated. In this case study, acoustic analyses were performed on the speech of a 46‐year old monolingual female who presented with FAS of unknown aetiology. The patient had a pseudo‐accent frequently described as ‘Swedish’ or ‘Eastern European’. Stop consonant VOT, consonant burst spectra and duration, vowel durations, formant frequencies, and trajectories were analysed, along with prosodic cues for lexical stress assignment and sentence‐level intonation. Results indicated VOT values were generally preserved, while there was a strong tendency to realize the English alveolar flap as a full stop, and to produce flaps that had greater‐than‐normal closure durations. The spectral properties of the patient's vowels resembled those of normal talkers (with the possible exceptions of decreased F1 values for /i/ and slight differences in formant dynamics for /u/, /o/, /i/, and /?/). However, vowel durations were relatively long, contributing to exaggerated tense/lax contrasts. Token‐to‐token variability in vowel production was slightly higher than normal for duration, but not for formant frequency values. Lexical stress assignment was inaccurate and highly variable (with similar problems noted for non‐speech materials), and sentence level intonation showed occasional deviations from typical American English patterns. For this patient, an underlying timing/rhythm difficulty appeared responsible for the range of segmental and suprasegmental changes leading to the impression of a foreign accent.     

Alignment following left and right hemisphere damage

Background: Patients with fluent aphasia have been reported to exhibit abnormal timing of some linguistic units, but the basis of this deficit is unclear. It has been hypothesised that these patients have impaired ability to control temporal information stored in lexical items, but timing at the level of intonation phrase (IP) is intact for them. One aspect of temporal control at the level of IP is alignment, the relative timing of events in fundamental frequency (F0) contours associated with intonation and events in the segmental string.

Aim: The present study sought to determine whether patients with fluent aphasia have intact ability for alignment.

Methods & Procedures: Absolute and relative measures of intervals between F0 peaks and valleys, as well as syllable duration were evaluated in sentences produced by patients with fluent aphasia, nonfluent aphasia, right hemisphere damage (RHD), and a group of neurologically normal individuals. The productions were evaluated perceptually by five neurologically normal native speakers.

Outcomes & Results: The patients with fluent aphasia performed poorly on absolute and relative measures of alignment. Their nonfluent counterparts exhibited abnormally long absolute durations on all measures including final syllable length, and the RHD performed comparably with the control participants on both absolute and relative measures of alignment and syllable duration. All groups were perceptually indistinguishable.

Conclusion: The data for all three groups of patients are consistent with previous reports on speech timing following brain damage. The performance of the patients with fluent aphasia on alignment does not support the view that these patients have intact ability for speech timing at the level of IP.     

The vowel lengthening exaggeration effect in speakers with apraxia of speech: Compensation,artifact, or primary deficit?

Abstract

Vowel duration functions contrastively in English to signal the voicing feature of syllable-final stop consonants. This study examines three hypotheses posited to explain why speakers with apraxia of speech and a concomitant aphasia exhibit an exaggerated vowel lengthening effect relative to speakers with dysarthria, aphasia without apraxia and controls. The investigation addresses the hypotheses that the vowel lengthening exaggeration effect is attributable to: (1) a compensatory strategy, (2) an artifact of slow speaking rate, (3) the concomitant language impairment, or (4) a primary deficit reflecting the underlying nature of the apraxia disorder. The results do not support the first three of these hypotheses. It is hypothesized that the temporal measures most likely to reveal abnormalities which are uniquely characteristic of speakers with apraxia of speech are those which are relational in nature, either with respect to inter-articulator timing or contrastive durations.     

Vowel duration as a cue to postvocalic stop voicing in aphasia and apraxia of speech

Background: In American English, vowel duration is, on average, longer preceding postvocalic voiced stops than preceding postvocalic voiceless stops. Preliminary investigations have reported a preservation of this acoustic contrast for speakers with aphasia and apraxia of speech (AOS) on the basis of mean data. However, clinical interpretation of the available research is difficult due to lack of attention to the range of performance among and within speakers from both normal and disordered populations. Concurrent perceptual analysis is warranted to evaluate functional implications of acoustic variations, but standard approaches using a single listener and presentation may not be sufficiently sensitive to reveal subtle variations. Aims: (1) To determine whether aphasic and apraxic speakers produce a normal vowel duration differentiation between voiced and voiceless postvocalic stops. (2) To explore whether the produced vowel duration variations are associated with predicted perceptual effects. Methods & Procedures: Eight speakers with coexisting aphasia and AOS, eight with aphasia and no AOS, and eight normal control speakers produced 24 repetitions of the words “had” and “hat” in a short carrier phrase. For each utterance, the duration of the vowel was measured. Perceptual testing was conducted using three normal listeners and a forced‐choice perceptual identification paradigm. Outcomes & Results: As expected, all normal speakers, and most aphasic and apraxic speakers, displayed a mean vowel duration distinction between the voicing cognates. The magnitude of the distinction did not differ across groups. Instead, there was substantial inter‐speaker variability in the magnitude of duration contrast in all three groups. Some aphasic speakers with and without AOS did not distinguish in vowel duration between voicing cognates, and others displayed bimodal, but overlapping, distributions for /d/ and /t/. Results of the perceptual identification experiment indicated that there was good, but not perfect, agreement between variations in vowel duration and voicing perception and that several utterances produced by aphasic and apraxic speakers were perceptually ambiguous. Conclusions: (1) Although the mean duration for vowels preceding voiced and voiceless stops may be indistinguishable from normal, several abnormal acoustic patterns are found among individual aphasic speakers both with and without AOS. (2) The magnitude of acoustic distinction can vary considerably across normal speakers and this variation must be considered when evaluating disordered speech. (3) Perceptual identification testing facilitates the interpretation of acoustic data, particularly when the two levels of analysis are matched on an utterance‐by‐utterance basis. (4) Perceptual ambiguity can be demonstrated in disordered speech through perceptual identification testing.     

Stimulus duration and diversity do not reverse the advantage for superordinate‐level representations: the animal is seen before the bird

Basic‐level categorization has long been thought to be the entry level for object representations. However, this view is now challenged. In particular, Macé et al. [M.J.‐M. Macé et al. (2009) PLoS One, 4 , e5927] showed that basic‐level categorization (such as ‘bird’) requires a longer processing time than superordinate‐level categorization (such as ‘animal’). It has been argued that this result depends on the brief stimulus presentation times used in their study, which would degrade the visual information available. Here, we used a go/no‐go paradigm to test whether the superordinate‐level advantage could be observed with longer stimulus durations, and also investigated the impact of manipulating the target and distractor set heterogeneity. Our results clearly show that presentation time had no effect on categorization performance. Both target and distractor diversity influenced performance, but basic‐level categories were never accessed faster or with higher accuracy than superordinate‐level categories. These results argue in favor of coarse to fine visual processing to access perceptual representations.     

Prosodic disturbance in aphasia: speech timing versus intonation production

Temporal control has often been suspected to be a critical factor in intonation production. In particular, disturbance in the production of fundamental frequency (F0) associated with intonation in patients with aphasia has been attributed to a primary underlying deficit in speech timing. The present study examined the speech timing abilities of two groups of patients with fluent and nonfluent aphasia who were found in a companion study to have relatively normal intonation production ability. Results indicated severe temporal control abnormalities for the patients with nonfluent aphasia. The fluent aphasic patients performed at comparable levels with the normal subjects, although in absolute terms their durations were also generally longer than normal. These findings do not support the view that intonation production depends critically on speech timing, and that its disturbance in aphasia is due to underlying temporal control deficit.     

Prosodic disturbance in aphasia: speech timing versus intonation production

Temporal control has often been suspected to be a critical factor in intonation production. In particular, disturbance in the production of fundamental frequency (F0) associated with intonation in patients with aphasia has been attributed to a primary underlying deficit in speech timing. The present study examined the speech timing abilities of two groups of patients with fluent and nonfluent aphasia who were found in a companion study to have relatively normal intonation production ability. Results indicated severe temporal control abnormalities for the patients with nonfluent aphasia. The fluent aphasic patients performed at comparable levels with the normal subjects, although in absolute terms their durations were also generally longer than normal. These findings do not support the view that intonation production depends critically on speech timing, and that its disturbance in aphasia is due to underlying temporal control deficit.     

Phonological encoding in apraxia of speech and aphasia

Background: Apraxia of speech (AOS) is considered a speech motor planning/programming disorder. While it is possible that co-occurring phonological impairments exist, the speech motor planning/programming deficit often makes it difficult to assess the phonological encoding stage directly. Studies using online methods have suggested that activation of phonological information may be protracted in AOS.

Aims: The present study was designed to investigate the integrity of the phonological encoding stage in AOS and aphasia. We tested two specific hypotheses, the Frame Hypothesis and the Segment Hypothesis. According to the Frame Hypothesis, speakers with AOS have an impairment in retrieving metrical frames (e.g., number of syllables); according to the Segment Hypothesis, speakers with AOS have an impairment in retrieving segments (e.g., consonants).

Methods & Procedures: Four individuals with AOS and varying degrees of aphasia, two speakers with aphasia, and 13 age-matched control speakers completed an online priming task in which participants name pictures in sets that do or do not share number of syllables (e.g., balcony-coconut-signature vs. balcony-carrot-sock), the initial consonant (e.g., carpenter-castle-cage vs. carpenter-beaver-sun), or both (e.g., boomerang-butterfly-bicycle vs. boomerang-sausage-cat). Error rates and reaction times were measured.

Outcomes & Results: Data for controls replicated previous literature. Reaction time data supported the Segment Hypothesis for speakers with AOS and for one speaker with aphasia without AOS, with no differences in pattern from controls for the other speaker with aphasia without AOS.

Conclusions: These results suggest that speakers with AOS may also have difficulties at the phonological encoding stage. Theoretical and clinical implications of these findings are discussed.     

Information,support and training needs of relatives of people with aphasia: Evidence from the literature

Background: Aphasia has an impact beyond the person with aphasia; relatives of people with aphasia are affected by communication difficulties and are service users in their own right, requiring information, support, and training. Research studies have consulted relatives of people with aphasia, but the evidence is complex and widely dispersed in the literature; this makes it difficult to determine what the needs of relatives of people with aphasia are, and how best to meet them. There is also evidence of a gap between perceived needs and current service provision.

Aims: The aim of this review is to provide a synthesis, from the literature, of relatives’ views about their own intervention needs in relation to acquired aphasia, in terms of both content and timing.

Main Contribution: A literature search identified articles which contained relatives’ views about their own need for information, support, or training. Recommendations emerging within individual studies were clustered, focusing on the type and timing of intervention. The synthesis of studies provides a framework in which service users’ recommendations for interventions for relatives of people with aphasia can be readily accessed, making an evidence-based resource for research and clinical applications. The outcome of the review also supports service delivery to relatives, by enhancing awareness and anticipation of their needs, and by validating best use of resources. In addition, the framework of data has clinical and research applications as the basis for dynamic and flexible tools to audit service provision and consider quality of care in this field.

Conclusions: The review acknowledges the value of seeking service user opinion on their needs and service provision. It highlights the specific needs of relatives of people with aphasia. The need for factual information provided proactively in a flexible and supportive manner predominated, particularly in the initial period following the stroke. The need for ongoing psychosocial support over the long term was apparent. The perceived benefits of training in supported conversation skills were more varied. It is challenging to synthesise such a diverse literature, but the synthesis could support service delivery to families of people with aphasia, by allowing services to consider how they are meeting the needs that relatives have identified.     

Addressing the long-term impacts of aphasia: how far does the Conversation Partner Programme go?

Background: Approximately 176,000 new individuals in the United Kingdom and Ireland are diagnosed with stroke annually with up to one third experiencing aphasia. Qualitative research methods are increasingly used to capture the complexity of service users’ experiences of health and illness; however, the voice of service users with aphasia continues to be limited in published healthcare literature. This participatory research study included people with aphasia as co-researchers in the exploration of aphasia and a Conversation Partner Programme (CPP).

Aims: To describe participants’ insider (emic) experiences of (1) aphasia and (2) a CPP.

Methods & Procedures: Following a pilot study, the generation and analysis of qualitative data involved a Participatory Learning and Action (PLA) approach based on the interpretive paradigm. Using purposeful sampling, participants included people with aphasia (n = 5) who had experience of the CPP. Through (n = 5) 3-hr data generation sessions across 12 months using PLA techniques—Flexible Brainstorming and Card Sort—participants’ unique perspectives of aphasia and the CPP were recorded. The principles of thematic analysis guided the co-analysis of data with participants. To explore transferability of findings, data generated in Ireland were presented to an international interstakeholder group in Connect UK.

Outcomes & Results: Participants identified eight themes describing the lived experience of aphasia including (1) Back to Pre-School, (2) Tiredness, (3) It’s Like in Prison, (4) Emotions, (5) Not Able to Talk the Words, (6) Escape, (7) Changing and Adapting, and (8) Family. Five additional themes were co-generated capturing the value of the CPP. It appeared that because the CPP training and programme acknowledged the expertise of individuals with aphasia and provided opportunities for conversations with unfamiliar people, the negative feelings of communicative incompetence described in “Back to Pre-School” and “Not Able to Talk the Words” were minimised. Feelings of marginalisation captured in “Escape,” “It’s Like in Prison,” and “Emotions” were reported to be reduced through the social aspects of the programme.

Conclusions: Aphasia changes communication situations and interpersonal relationships often resulting in psychosocial impacts and disempowerment. The CPP contributed to promoting successful communication and reducing social exclusion. Participants reported transformative experiences related to identity, independence, and confidence. These outcomes are encouraging as marginalisation and vulnerability to “secondary handicap” are recognised long-term risks of aphasia. Findings will be of interest to those living and working with people with aphasia and to those designing, delivering, and participating in CPPs.     

Brief report: Attention patterns to non-social stimuli and associations with sensory features in autistic children

BackgroundAberrant attention patterns have been commonly reported in autistic children. However, few studies have examined attention to non-social stimuli varying in salience and complexity using eye-tracking technology, as well as their links to clinical sensory features.MethodForty-one children [16 with autism spectrum disorder (ASD), 10 with developmental delay (DD), and 15 neurotypical (NT)] ages 4 to 13 years were included in this cross-sectional study. Children completed a passive-viewing eye-tracking task designed to measure visual attention (e.g., fixation duration and count) to non-social stimuli with sensory qualities involving motion (spinning or non-spinning) and sound. Parents completed a clinical questionnaire about their child’s sensory behaviors. Eye-tracking metrics were compared across stimulus conditions and diagnostic groups, and their associations with parent-report sensory features were examined.ResultsOverall children showed longer fixation durations and fewer fixation counts to more complex stimuli (e.g., moving or spinning objects), but such facilitatory effects of stimulus properties tended to be less evident in DD versus ASD or NT groups. More clinical sensory features, especially hyperresponsiveness, were moderately to highly associated with quicker initial fixations and longer fixation durations across stimulus conditions in ASD, but not in DD and NT groups.ConclusionThe overall attention and initial orientation to non-social stimuli were comparable across autistic children and their non-autistic peers, with some sensory properties such as dynamic motion producing a facilitatory effect (i.e., fewer fixations of longer durations) on attention. However, sensory differences, particularly hyperresponsiveness, might underlie attention patterns as impacted by stimulus properties specifically in autism.     

Phonetic and phonological aspects of speech in Alzheimer’s disease

ABSTRACT

Background: Alzheimer’s disease (AD) can involve changes in communication and can lead to mutism in severe cases. Oral communication may be impaired by phonetic-motor disorders, such as apraxia of speech (AOS), or by language disorders, such as aphasia. Therefore, the identification of manifestations of AOS and phonemic paraphasias in patients with AD is critical to understanding the communication changes and determining the therapeutic planning.

Aims: To identify the distribution of phonetic–phonological manifestations in older patients with AD and healthy older subjects and assess whether these manifestations indicate the origin of the changes, including a predominantly phonetic-motor origin, a predominantly phonological–linguistic origin, or both.

Methods & Procedures: This cross-sectional study evaluated 90 patients with AD and 30 healthy older volunteers. All of the participants underwent the same repetition task for phonetic and phonological assessments using the current classification of phonetic–phonological manifestations; this classification distinguishes characteristics that are mostly related to AOS from other signs that are mostly related to aphasia. Negative binomial regression analysis was conducted to compare the amount of each manifestation presented by the two groups.

Outcomes & Results: The patients with AD showed significantly more signs of aphasia (self-correction, and vowel and consonant substitutions), AOS (prolonged intervals and extended vowel duration), and AOS or aphasia (distortion, omission, attempts at the syllable level, distorted substitutions, and additions) than the healthy older volunteers.

Conclusions: Older adults with AD presented phonetic and phonological changes of aphasia and AOS and, consequently, limitations in symbolic–linguistic planning and motor planning.     

Semantic priming in anomic aphasia: a focused investigation using cross-modal methodology

Background: Semantic priming in individuals with anomic aphasia has never been the primary focus of an investigation. To date, one study investigated the effects of semantic priming in individuals with fluent aphasia (including anomic aphasia), revealing an inconsistency in semantic priming in the anomic group. Parallels from Broca’s aphasia and Wernicke’s aphasia literature may be drawn. However, due to the heterogeneity of anomic aphasia, a focused investigation was necessary.

Aims: Semantic priming effects were investigated using a cross-modal pairwise paradigm. It was hypothesised that participants with anomic aphasia would demonstrate priming patterns at a stimulus onset asynchrony (SOA) of 500 ms with slower overall reaction times (RTs) than the control participants. It was further hypothesised that the participants with anomic aphasia might show less inhibition effects than the control participants.

Methods & Procedures: Participants with anomic aphasia (n = 11) and healthy control participants (n = 16) completed a lexical decision task where prime–target pairs were present in equal proportions (related, unrelated, and nonwords). A neutral prime condition was also incorporated. Using a cross-modal pairwise paradigm, participants heard a spoken word 500 ms later, a written word appeared on screen (for 4000 ms). Participants were required to make a decision as to whether the written word was real, and RTs were recorded.

Outcomes & Results: Linear mixed model analysis was undertaken and revealed no significant two-way interaction effect, indicating both groups showed priming patterns. A main effect of group was evident, showing faster RTs by the control participant group, confirming our hypothesis that people with anomic aphasia primed at an SOA of 500 ms in a similar manner to the control participants, with slower RTs.

Conclusions: Semantic priming effects were present in anomic aphasia at relatively short SOAs and may be contributed to by automatic processes. Several parameters are proposed that should be adopted for further investigation into semantic priming in anomic aphasia including electrophysiological measures and manipulation of SOAs and relatedness proportions (RPs) to more precisely measure the effects of controlled versus automatic processes. Such investigation has the potential to inform new assessment and management techniques.     

Age and aphasia: a review of presence,type, recovery and clinical outcomes

Background: Each year approximately 100,000 stroke survivors are diagnosed with aphasia. Although stroke is associated with age, the relationship between age and aphasia is less clear.

Objectives: To complete a review of the literature to examine the relationship between age and: (a) presence or likelihood of aphasia after stroke, (b) aphasia type, (c) aphasia recovery patterns, and (d) aphasia clinical outcomes.

Data Sources: Articles were identified by a comprehensive search of “OneSearch,” PubMed, and individual journals: Aphasiology, Stroke and the Journal of Stroke and Cerebrovascular Diseases.

Study Selection: Inclusion criteria included: age and incidence of aphasia, likelihood of aphasia, aphasia recovery, and aphasia clinical outcome.

Data Extraction: Independent searches were completed by the authors. Each author independently assessed the full text of reports meeting inclusion criteria. Differences regarding study eligibility and need to proceed with data extraction were resolved by consensus.

Results: 1617 articles were identified during the initial search. Forty studies including 14,795 study participants were included in the review. The review generally demonstrated that: (a) stroke patients with aphasia are typically older than stroke with patients without aphasia and (b) aphasia type and age are associated as younger patients with aphasia are more likely to exhibit non-fluent or Broca’s type of aphasia. In contrast, studies examining aphasia recovery and aphasia clinical outcomes did not demonstrate a positive relationship between age and recovery or clinical outcomes.

Conclusions: Stroke is a condition of the elderly. However, age appears to only influence likelihood of aphasia and aphasia type.     

Operationalizing discourse therapy

Abstract

The integration of artificial intelligence (AI) programming and computer-assisted instruction (CAI) as presented by Guyard, Masson and Quiniou represents a new stage in the development of treatment software for the rehabilitation of aphasic patients. The authors propose a logical extension of contemporary treatment software, the current state of which ‘continues to perseverate at the drill level’ (Lover0 1987, p. 158). A1 programs could expand the scope, responsiveness and flexibility of aphasia treatment software so that the computer program would determine the type, sequence and rate of stimuli presented based on evaluation of the patient's responses. Researchers (e. g. Barr and Geigenbaum 1982) describe this union between A1 and CAI as ‘intelligent CAI’ (ICAI). While valued in education, the appIication of ICAI has not been successfully adopted by rehabilitation primarily due to two related factors fundamental to the nature of aphasia treatment: the heterogeneity of the aphasic population and the complexity of aphasia therapy.     

Acoustic analyses of two recovered cases of foreign accent syndrome

Recently, a growing number of studies have been published involving phonetic and acoustic analyses on the rare motor-speech disorder known as Foreign Accent Syndrome (FAS). These studies have relied on pre- and post-trauma speech samples to investigate the acoustic and phonetic properties of individual cases of FAS speech. This study presents detailed acoustic analyses of the speech characteristics of two new cases of FAS using identical pre- and post-recovery speech samples, thus affording a new level of control in the study of Foreign Accent Syndrome. Participants include a 48-year-old female who began speaking with an “Eastern European” accent following a traumatic brain injury, and a 45-year-old male who presented with a “British” accent following a subcortical cerebral vascular accident (CVA). The acoustic analysis was based on 18 real words comprised of the stop consonants /p/, /t/, /k/; /b/, /d/, /g/ combined with the peripheral vowels /i/, /a/ and /u/ and ending in a voiceless stop. Computer-based acoustic measures included: (1) voice onset time (VOT), (2) vowel durations, (3) whole word durations, (4) first, second and third formant frequencies, and (5) fundamental frequency. Formant frequencies were measured at three points in the vowel duration: (a) 20%, (b) 50%, and (c) 80% to assess differences in vowel ‘onglides’ and ‘offglides’. The acoustic analysis allowed precise quantification of the major phonetic features associated with the foreign quality of participants' FAS speech. Results indicated post-recovery changes in both duration and frequency measures, including a tendency toward more normal VOT production of voiced stops, changes in average vowel durations, as well as evidence from formant frequency values of vowel backing for both participants. The implications of this study for future research and clinical applications are also considered.     

Factors that influence Australian speech-language pathologists’ self-reported uptake of aphasia rehabilitation recommendations from clinical practice guidelines

Background: There are clinical practice guidelines for speech-language pathologists’ aphasia management practices. However, reported adherence to aphasia guideline recommendations is variable. The barriers and facilitators to meeting aphasia management recommendations are not well understood. In order to develop theory-informed strategies to improve implementation of aphasia management practices, a better understanding of these barriers and facilitators is required.

Aims: This study aimed to describe barriers and facilitators to speech-language pathologists’ uptake and implementation of five prioritised recommended practices for aphasia management.

Methods & Procedures: An online survey sought information from Australian speech-language pathologists working with clients with aphasia. The survey focused on five practices including goal setting, information provision, constraint-induced language therapy, timing, and intensity of intervention. The Theoretical Domains Framework was used to design the survey, with several statements generated about factors influencing practice for each domain.

Outcomes & Results: Surveys were completed by 63 respondents. The theoretical domain “environmental context and resources” (e.g., “I have insufficient time to engage in…”) was the main perceived barrier for the majority of practices being investigated, whilst the theoretical domain “social/professional role and identity” (e.g., “It is part of my role with the multidisciplinary stroke team to engage in…”) was the main perceived implementation facilitator for all practices. The top three barriers and facilitators varied for each of the five recommended practices being investigated. Across clinical settings, there were commonalities and differences in the perceived barriers and facilitators to implementation. There was a significant correlation between self-reported uptake of all of the aphasia rehabilitation recommendations we investigated and participants’ total barrier scores. Total barrier scores were also significantly different between clinical settings in the area of goal setting, with acute settings having a higher number of reported barriers to goal setting than rehabilitation settings (p = 0.011).

Conclusions: Implementation interventions that seek to overcome the barriers of environmental context and resources (time, competing priorities and resources) are likely to have the most effect on aphasia best practice uptake. Encouraging behaviour change in the “social professional role and identity” domain by emphasising the role of the speech-language pathologist in aphasia rehabilitation within the multidisciplinary stroke team should further improve uptake of recommended practices. At a local level, departments or individual speech pathologists need to identify their own barriers and facilitators and choose effective implementation interventions using the Behaviour Change Wheel. Both strategies should help close the evidence-practice gap in aphasia rehabilitation.     

Effects of noun–verb conceptual/phonological relatedness on verb production changes in Broca's aphasia

Background: Individuals with Broca's aphasia show better performance on nouns than on verbs, but the distinction between nouns and verbs is not always clear; some verbs are conceptually and/or phonologically related to nouns, while others are not. Inconsistent results on effects of noun–verb relatedness on verb production have been reported in the literature.

Aims: We investigated (1) whether verb instrumentality (a conceptual relationship to nouns) or homonymy (a phonological relationship to nouns) would affect verb production in individuals with Broca's aphasia and (2) whether conceptual/phonological noun–verb relationship would affect responsiveness to aphasia therapy that focused on verb production.

Methods & Procedures: Three English-speaking individuals with Broca's aphasia produced 96 verbs in sentences in response to picture stimuli. The target verbs included those that use an instrument and those that do not (e.g., to hammer vs. to yawn) and verbs that are phonologically identical to a related noun (e.g., to comb vs. a comb), morpho-phonologically related to a noun (e.g., to grind vs. a grinder) and those that are not morphologically related to a noun (e.g., to lean). The participants’ verb retrieval ability was assessed before and after a 4-week period of aphasia therapy.

Outcomes & Results: The participants produced more accurate instrumental than non-instrumental verbs both pre- and post-treatment. They also produced more verbs correctly that are homonyms with nouns than verbs that are phonologically related or unrelated to nouns before treatment. However, the effect of homonymy was not observed following treatment.

Conclusion: Individuals with Broca's aphasia were more accurate in their production of verbs that were conceptually and phonologically related to nouns than on verbs that were not. The performance of verb production improved significantly after therapy. We interpret the results to indicate that, whereas prior to treatment, the participants relied on phonologically related nouns to retrieve the target verbs, this reliance on knowledge of nouns decreased following therapy that was designed to improve verb production.