Object and action picture naming in brain-damaged Persian speakers with aphasia

Background: Individuals with aphasia can be impaired in action and object naming and most typically are more impaired when naming actions than objects. However, it is not clear if effects of grammatical class are language-general as assumed by some theories of speech production.

Aims: We predicted greater impairments to action than object naming in persons with aphasia (PWA) in Persian. However, we expected any effect of grammatical class to be reduced when highly correlated variables are accounted for using generalised linear mixed-effects analysis.

Methods & Procedures: PWA (n = 57) were presented with pictured actions (n = 80) and objects (n = 100) rated by 100 Persian speakers in a preparatory study for psycholinguistic variables such as familiarity, age of acquisition (AoA), imageability, name agreement and visual complexity.

Outcomes & Results: 95% of PWA were more impaired on action naming than object naming. Rated AoA, name agreement, visual complexity and word length also significantly predicted naming accuracy for PWA and, there was an interaction between imageability and grammatical class such that imageability predicted object naming but not action naming.

Conclusions: The effect of grammatical class on picture naming for PWA in Persian might be accounted for by differences in psycholinguistic characteristics of actions and objects. Although we doubt an independent effect of grammatical class on naming in Persian, we acknowledge that psycholinguistic variables can have differential effects on action and object naming in aphasia. We offer an account of spoken word production in Persian that assumes a functionally common pathway for naming actions and objects with no obvious constraint given by grammatical class.     

Validation of the assessment of living with aphasia in Singapore

Background: The Assessment of Living with Aphasia (ALA) is a pictographic, self-report measure of aphasia-related quality of life (QoL). It has yet to be used in the Singapore population or adapted to other languages.

Aims: To examine the reliability and validity of the ALA and develop a Mandarin Chinese adaptation, the ALA-C, in the Singapore context.

Methods & procedures: Linguistic validation of the ALA was conducted to derive the ALA-C. People with aphasia (PWA) who were at least 6 months post-onset underwent the ALA/ALA-C and a series of reference measures in their dominant language (English/Mandarin). Test–retest reliability was evaluated using intra-class correlations and internal consistency using Cronbach’s alpha. Eight reference measures were administered to assess construct validity.

Outcomes & results: Sixty-six PWA were recruited to the study. Both the ALA and ALA-C showed excellent internal consistency (α = 0.97/0.96) and test–retest reliability (intraclass correlation = 0.97/0.98), and acceptable convergent (r = 0.63–0.83 and 0.70–0.83 respectively) and discriminant (r = 0.45–0.60 and 0.39–0.53, respectively) validity.

Conclusions: Both ALA and ALA-C demonstrated excellent reliability and good validity. Further research is warranted to examine use by more practicing clinicians and with more participants of varying degrees of aphasia severity to enable additional investigation of its psychometric properties.     

Listener perceptions of simulated fluent speech in nonfluent aphasia

Background: People with aphasia (PWA) are frequently perceived less favourably by listeners than their peers. These perceptions include incorrect assumptions that can prevent successful social interactions. While communication partner training has been shown to improve social outcomes related to the listener, changing the verbal output of PWA may also yield more favourable listener perceptions about the speech, speaker, and their own affective response. We investigated the effects of artificially altered fluency (i.e., simulated fluency) on listeners’ subjective impressions.

Aims: The purpose of the study was to (1) confirm that listeners perceive PWA less favourably than their neurologically healthy peers and (2) determine the effects of simulated fluency on listener perceptions about PWA.

Methods & Procedures: Thirty-eight listeners heard nine narrative monologue language samples from three conditions (i.e., speakers with nonfluent aphasia, simulated fluent samples from the same speakers, and neurologically healthy speakers). Listeners responded to a nine-item questionnaire that probed perceptions about speech output, speaker attributes, and listener feelings.

Outcomes & Results: Listeners perceived PWA less favourably than their neurologically healthy peers. Simulated fluency yielded more positive listener perceptions for all questionnaire items except speech intelligibility, which was unchanged by simulated fluency.

Conclusions: Simulated fluency improved listener perceptions of PWA significantly, indicating that speech fluency may be a socially valid treatment target in aphasia. Beyond direct training of communication partners, changing the verbal output of aphasic speech can also yield more positive listener perceptions of PWA.     

A pilot study examining the impact of aphasia camp participation on quality of life for people with aphasia

Objectives: For people with aphasia (PWA), attending an aphasia camp can result in increased confidence, social relationships, and greater participation in activities. Although much anecdotal evidence of the benefits of aphasia camps exists, systematic studies on outcomes from aphasia camp participation are lacking. The purpose of this pilot study was to examine the effect of attending the Alberta Aphasia Camp on quality of life for people with aphasia.

Methods: Nine PWA who attended the inaugural Alberta Aphasia Camp completed the Assessment for Living with Aphasia-2 before and after camp. A subset of their caregivers (n = 4) completed the Communicative Effectiveness Index, a rating scale evaluating their PWA’s communication, and were interviewed about their experiences and perceptions of camp participation.

Results: Significant changes were observed on total scores on the ALA-2, and in particular the Personal and Participation subtests. These improvements were corroborated by themes identified from interviews with caregivers.

Discussion: This study provides preliminary evidence that aphasia camp participation can result in improved outcomes for PWA across a range of domains. Aphasia camps provide a unique intervention for PWA and caregivers to experience therapeutic and recreational activities, respite and create social connections in a supported communication environment. Future studies should recruit a greater number of participants, employ control groups, and examine outcomes for caregivers.     

Semantic knowledge use in discourse produced by individuals with anomic aphasia

Background: Researchers have demonstrated that people with aphasia (PWA) have preserved semantic knowledge. However, some PWA have impaired access to certain types of knowledge more than others. Yet, all these studies used single concepts. It has not been demonstrated whether PWA have difficulty accessing certain types of features within a discourse sample.

Aims: The main goals of this study were to determine whether semantic knowledge and two category types were used differently within discourse produced by participants with anomic aphasia and healthy controls.

Methods & Procedures: Participants with anomic aphasia (n = 19) and healthy controls (n = 19) told stories that were transcribed and coded for 10 types of semantic knowledge and two category types, living and non-living things.

Outcomes & Results: A Poisson regression model was conducted. The results indicated a significant difference between the groups for the semantic knowledge types, sound and internal state, but no difference was found for category types. Yet the distribution of semantic knowledge and category types produced within the discourse samples were similar between the groups.

Conclusions: PWA might have differential access to certain types of semantic knowledge within discourse production, but it does not rise to the level of categorical deficits. These findings extend single-concept research into the realm of discourse.     

A pre–post intervention study investigating the confidence and knowledge of health professionals communicating with people with aphasia in a metropolitan hospital

Background: Communication partner training (CPT) is a social intervention approach that can be used to educate and train volunteers, family members, significant others and professionals, in addition to providing skills and strategies for people with aphasia (PWA). This body of CPT research extends the current research in the area by implementing CPT with health professionals (HPs) in using PWA as trainers in a sub-acute care setting, but some previous research in acute care setting has primarily focused on caregivers and volunteers in a community setting.

Aims: The aim of this study was to investigate implementing a CPT programme in an Australian metropolitan hospital by training professionals and utilising PWA as a key component of the training to facilitate “real-time” practical skill acquisition.

Method & Procedures: Fifty-two HPs from multidisciplinary teams (allied health assistants, audiology, dietetics, occupational therapy, pharmacy, physiotherapy, social work and nursing staff in a rehabilitation unit) participated in a pre–post intervention study. HPs completed a questionnaire to collect demographic information, identify current knowledge of aphasia-related communication strategies and ascertain their confidence levels (using a 100-mm visual analogue scale) related to interacting with people with communication impairments and list any strategies/resources that could be used as an adjunct to facilitate exchanges with PWA. These open-ended responses were categorised into four main groups using content analysis. The CPT component, adapted from two programmes run by “Connect—Communication Disability Network” in the United Kingdom, consisted of an educational lecture on communicating with PWA given by a speech-language pathologist and a practical conversation with a person with aphasia. The PWA provided “expert” practical feedback to the professionals participating in the training.

Outcomes & Results: HPs reported mean confidence levels of 46.56 mm (SD = 15.71) prior to training and 75.81 mm (SD = 12.16) post-training, t(51) = 12.479 (p < .001). More HPs were able to identify relevant strategies to assist with communication following the training (median total responses = 52, interquartile range [IQR] = 50–52), than prior to the training (median total responses = 15, IQR = 9–38).

Conclusions: The results provide preliminary evidence to suggest that a CPT programme may be an effective method to increase the confidence and knowledge of communication strategies of HPs, in an acute care setting, when interacting with PWA.     

Preliminary psychometric analyses of two assessment measures quantifying communicative and social activities: the COMACT and SOCACT

Background: There is a need for clinical tools that capture the real-life impact of aphasia. This study reports on a psychometric investigation of two self-report tools: the Communicative Activities Checklist and the Social Activities Checklist (COMACT; SOCACT), which assess the dimensions of communication activity and social participation in aphasia.

Aims: (1) To investigate internal consistency (IC), convergent, and known validity of the COMACT and SOCACT and (2) to investigate the impact of personal contextual factors: gender, age, years in education, linguistic ability, and emotional health on communicative and social activities.

Methods & Procedures: Thirty participants with mild-moderate chronic aphasia (people with aphasia (PWA); mean age 71 years, mean time post onset 41 months, mean years in education 10.77) and 75 control neurologically healthy participants (NHP; mean age 74 years, mean years in education 13.18) completed the COMACT and SOCACT reporting how frequently they engaged in particular activities. The COMACT has 45 communication activities with subscales of Talking, Listening, Reading, and Writing. The SOCACT contains 20 social activities with subscales of Leisure, Informal, and Formal. IC was examined using Cronbach’s alpha (α). Correlations with published assessments, Western Aphasia Battery (WAB) and Communication Activities of Daily Living were computed for COMACT only. Multiple regression models were examined for differences in participant (PWA vs. NHP) performance on COMACT and SOCACT.

Outcomes & Results: Total COMACT IC was 0.83 (PWA) and 0.84 (NHP). Following deletion of four items, to further improve subscale ICs, total COMACT IC was 0.83 (PWA) and 0.86 (NHP). COMACT total score and WAB AQ were moderately correlated (r = 0.55). Total SOCACT IC was 0.58 (PWA) and 0.63 (NHP). Following single item deletion, total IC was 0.65 (PWA) and 0.64 (NHP). Statistical analysis revealed PWA, in comparison to NHP, participated in significantly fewer communication and social activities. Personal contextual factors impacted both groups differently; particular aspects were associated with communication activity (age and language severity) and social activity (age only). For NHP, ageing, emotional health and years in education were significant predictors of social and communication activity.

Conclusions: This study finds the COMACT to be a reliable, valid measure of communication activity. The SOCACT had “questionable” IC and requires further psychometric investigation. Both tools demonstrate known group validity. Relationships between impairment-level and personal contextual factors for communication activity and social participation are highlighted.     

The efficacy of an inter-disciplinary community aphasia group for living well with aphasia

Background: Community aphasia groups (CAGs) are argued to have various benefits for people with chronic aphasia. However, there is a paucity of evidence regarding the feasibility of conducting an interdisciplinary programme with content and outcome measures encompassing ICF domains, making it difficult to ascertain the full potential of this service option. As another key population living with aphasia, family members have received little attention in CAG research to date.

Aim: To determine potential efficacy of a speech-language pathologist- and social worker-led CAG model for four people with aphasia (PWA) and their spouses on living well with aphasia within a proof-of-concept trial.

Methods & Procedures: Informed by extensive study of the existing CAG literature, we developed a comprehensive 12-week interdisciplinary CAG model and trial protocol (the InterD-CAG). We used a Phase I pre-post design with a follow-up phase. The group was co-facilitated by a speech-language pathologist and social worker with support from aide staff. The group met at a university clinic for 2 h per week over 12 consecutive weeks. The protocol comprised a combination of communication therapy; conversation practice; social, peer, and psychological support; stroke and aphasia information; and participation in meaningful and accessible activities. Group session time was split into two formats: (1) concurrent sessions dedicated to members with aphasia alone/spouses alone and (2) mixed sessions with both members with aphasia and spouses together. The Therapeutic Factors Inventory was administered at regular intervals during the programme to ascertain participants’ perceptions of group process. Pre, post, and follow-up outcome measures spanned all WHO ICF domains for PWA, with measures for spouses addressing supported conversation skills, psychological health, and carer burden.

Outcomes & Results: Both PWA and spouses perceived the presence of therapeutic factors to be medium or high by Week 12 in the programme. Our hypotheses for significant improvement for PWA in quality of life, aphasia impairment, activity & participation, and contextual factors were partially supported and maintenance of gains was observed in some cases. No clear changes were evident for spouses.

Conclusions: This study contributes preliminary evidence for the efficacy of the InterD-CAG model for people with chronic aphasia. Larger-scale studies with comparison groups are required to build on the present findings with specific attention to spouse support needs.     

Investigating comprehension of nouns and verbs: is there a difference?

Background: There is growing evidence that verbs are often more difficult to process than nouns and that verb retrieval is more commonly affected in aphasia. However, existing observations are largely based on naming and semantic judgment tasks. The extent to which this processing difficulty is modality-general has yet to be established. In addition, most of the present language batteries do not allow direct comparison between noun and verb comprehension deficits. To fill this gap, a test was developed for the assessment of noun and verb lexical-semantic comprehension.

Aims: The current study investigates whether verb processing difficulties are modality-general by administering novel balanced noun and verb comprehension tasks to participants with and without aphasia.

Methods & Procedures: In this study, we directly compare the difficulty of comprehension of verbs versus nouns in a group of participants with aphasia (PWA, n = 32) and non-brain-damaged, age-matched participants (NBD, n = 20). The word comprehension task was implemented on a tablet measuring accuracy and reaction times (RTs). Participants were required to listen to an aurally presented word and match it to one of four pictures (a target and three distractors: semantic, phonological, and irrelevant) by tapping on it with the non-dominant hand. In total, 30 nouns and 30 verbs were presented. The verbal stimuli in the two tasks were matched on relevant psychometric properties such as familiarity, age of acquisition, subjective visual complexity, imageability, image agreement, and frequency.

Outcomes & Results: Both groups experienced more difficulties in the verb comprehension task, indicated by lower accuracy and longer RTs in PWA and longer RTs in NBD. PWA who were performing the task within normal limits (i.e., demonstrated no difference in accuracy compared to the control group) still showed significantly longer RTs in the verb task than controls. Also, PWA who demonstrated similar accuracy in both tasks had longer RTs in the verb task relative to the noun task. The pattern was general and no differences were observed in performance between participants with fluent and non-fluent aphasia types. Moreover, the observed dissociations in RTs were greater for PWA than for NBD, indicating that a damaged language system experiences even more difficulties in processing verbs.

Conclusions: Overall, the study demonstrated the relative difficulty of verb processing in a comprehension task, supporting the hypothesis that verb processing difficulties are modality-general. The new test allows researchers to compare performance on noun and verb comprehension and registers even subtle differences by measuring RTs.     

Top 10 research priorities relating to aphasia following stroke

Background: Pollock et al. (2014, Top 10 research priorities relating to life after stroke – Consensus from stroke survivors, caregivers, and health professionals, International Journal of Stroke, 9, 313–320) applied the James Lind Alliance methodology to derive the top 10 priorities for research relating to life after stroke. Many of the initial Treatment Uncertainties related to aphasia.

Aim: The current study uses these Treatment Uncertainties to derive the shared top 10 research priorities of people with aphasia (PWA), their carers and speech and language therapists (SLTs)

Methods & Procedures: Treatment Uncertainties relating to aphasia were identified from the 226 unique unanswered questions relating to life after stroke generated by Pollock et al. Using these 34 Treatment Uncertainties relating to aphasia, the last two stages of the JLA method (survey followed by consensus meeting) were carried out with PWA, their carers and SLTs. Participants ranked the top 10 priorities from the 34 given in the survey. Communication ramps were used with the PWA. The 16 highest ranked uncertainties were presented at the consensus meeting, where the final shared top 10 priorities were agreed, merging some statements and refining the wording in others.

Outcomes & Results: Participants included PWA with severely affected communication. The methodology produced consensus on a range of priorities including the best treatments and most effective service delivery, management of psychosocial issues, helping volunteers and carers, and research into treating severe forms of aphasia.

Conclusions: PWA are able to participate fully in research priority setting. These shared research priorities represent an excellent base for the development of clinically important research in aphasia, addressing issues which are of greatest importance to key stakeholders.     

Stress and depression scales in aphasia: relation between the aphasia depression rating scale,stroke aphasia depression questionnaire-10, and the perceived stress scale

Background: Assessment and diagnosis of post-stroke depression (PSD) among patients with aphasia presents unique challenges. A gold standard assessment of PSD among this population has yet to be identified.

Objectives: The first aim was to investigate the association between two depression scales developed for assessing depressive symptoms among patients with aphasia. The second aim was to evaluate the relation between these scales and a measure of perceived stress.

Method: Twenty-five (16 male; 9 female) individuals with history of left hemisphere cerebrovascular accident (CVA) were assessed for depression and perceived stress using the Stroke Aphasic Depression Questionnaire-10 (SADQ-10), the Aphasia Depression Rating Scale (ADRS), and the Perceived Stress Scale (PSS).

Results: SADQ-10 and ADRS ratings were strongly correlated with each other (r = 0.708, p < 0.001). SADQ-10 ratings were strongly correlated with PSS ratings (r = 0.620, p = 0.003), while ADRS ratings were moderately correlated (r = 0.492, p = 0.027). Item analysis of each scale identified items which increased both inter-scale correlation and intra-scale consistency when excluded.

Conclusions: The SADQ-10 and ADRS appear to be acceptable measures of depressive symptoms in aphasia patients. Measurements of perceived stress may also be an important factor in assessment of depressive symptoms.     

A comparison of two working memory tasks in aphasia

Background: Overall, there is growing consensus that working memory (WM) should be routinely assessed in individuals with aphasia as it can contribute significantly to their level of language impairment and be an important factor in treatment planning. However, there is still no consensus in the field as to which tasks should be used to assess WM in aphasia. The two main alternatives are adapted complex span tasks and N-back tasks. Both have been used interchangeably in previous studies of WM in aphasia, even though the correspondence between the two tasks has not been properly established.

Aims: The current study investigates the relationship between two WM tasks—complex span and N-back tasks—in a large sample of individuals with aphasia. The relationships of these tasks to measures of language comprehension are also explored, as well as differences in performance patterns between individuals with non-fluent and fluent aphasia.

Methods & Resources: Forty-four participants with aphasia (non-fluent: n = 27; fluent: n = 13; mixed: n = 4) were examined with a modified listening span task (Ivanova & Hallowell, 2014), an auditory verbal 2-back task, and a standardised Russian language comprehension test.

Outcomes & Results: Results revealed a moderate relationship between the two WM measures, but demonstrated a divergence in terms of their relationship to language comprehension. Performance on the modified listening span task was related to language comprehension abilities, but performance on the 2-back task was not, suggesting that the two tasks primarily index different underlying cognitive mechanisms. Furthermore, the relationship between the modified listening span task and language comprehension was significant for individuals with non-fluent aphasia, but not for those with fluent aphasia.

Conclusions: Overall, the data demonstrate that while performance of individuals with aphasia was related on the two tasks, the two tasks cannot be substituted for one another without further inquiries into their underlying differences.     

Understanding semantic and phonological processing deficits in adults with aphasia: effects of category and typicality

Background: Semantic and phonological processing deficits are often present in aphasia. The degree of interdependence between the deficits has been widely studied with variable findings. Semantic variables such as category and typicality have been found to influence semantic processing in healthy individuals and persons with aphasia (PWA), but their influence on phonological processing is unknown.

Aims: This study examined the nature of semantic and phonological access in aphasia by comparing adults with aphasia to healthy control participants. Semantic and phonological tasks were used to assess the difference in processing requirements between and within each group as well as examine the effects of category and typicality on different stages of semantic and phonological processing.

Methods & Procedures: Thirty-two PWA and 10 neurologically healthy adults were administered nine tasks: Category Superordinate, Category Coordinate, Semantic Feature, Rhyme Judgment (No-Name), Syllable Judgment (No-Name), Phoneme Verification (No-Name), Rhyme Judgment (Name-Provided), Syllable Judgment (Name-Provided), and Phoneme Verification (Name-Provided). Accuracy and reaction time (RT) data were collected for each of these tasks and between-group and within-group differences were analysed via MANOVA/MANCOVA and hierarchical clustering analyses.

Outcomes & Results: PWA performed with significantly lower accuracy than controls on phonological tasks but performed comparably on semantic tasks. Participants with aphasia were significantly slower than controls on all semantic and phonological tasks. Clustering of the nine tasks by accuracy revealed different processing requirements in the participants with aphasia compared to the control group while clustering by RT revealed similar trends in both groups in that phonological (no-name) items required the most processing time. Significant effects of category and typicality were noted in the semantic tasks but not in any of the phonological tasks.

Conclusions: Individuals with aphasia demonstrated overall impaired phonological processing with relatively preserved semantic processing as compared to controls. Per accuracy and RT measures, distinct trends in processing load for semantic tasks versus phonological tasks were seen in the individuals with aphasia whereas only speed of processing and not accuracy was impacted by phonological processing load in the control group. The results align most closely with discrete serial processing models of lexical processing as category and typicality effects were robust in the semantic tasks but not in any of the phonological tasks. Alternative explanations for these results also are discussed.     

Motor recovery in post-stroke patients with aphasia: the role of specific linguistic abilities

Background: Aphasia is a serious consequence of stroke but aphasics patients have been routinely excluded from participation in some areas of stroke research.

Objective: To assess the role of specific linguistic and non-verbal cognitive abilities on the short-term motor recovery of patients with aphasia due to first-ever stroke to the left hemisphere after an intensive rehabilitation treatment.

Methods: 48 post-acute aphasic patients, who underwent physiotherapy and speech language therapy, were enrolled for this retrospective cohort-study. Four types of possible predictive factors were taken into account: clinical variables, functional status, language and non-verbal cognitive abilities. The motor FIM at discharge was used as the main dependent variable.

Results: Patients were classified as follows: 6 amnestic, 9 Broca’s, 7 Wernicke’s, and 26 global aphasics. Motor FIM at admission (p = 0.003) and at discharge (p = 0.042), all linguistic subtests of Aachener AphasieTest (p = 0.001), and non-verbal reasoning abilities (Raven’s CPM, p = 0.006) resulted significantly different across different types of aphasia. Post-hoc analyses showed differences only between global aphasia and the other groups. A Multiple Linear Regression shows that admission motor FIM (p = 0.001) and Token test (p = 0.040), adjusted for clinical, language, and non-verbal reasoning variables, resulted as independent predictors of motor FIM scores at discharge, while Raven’s CPM resulted close to statistical significance.

Conclusions: Motor function at admission resulted as the variable that most affects the motor recovery of post-stroke patients with aphasia after rehabilitation. A linguistic test requiring also non-linguistic abilities, including attention and working memory (i.e. Token test) is an independent predictor as well.     

Displays and claims of understanding in conversation by people with aphasia

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA.

Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs.

Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs.

Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former.

Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff.     

Long-term recovery in stroke accompanied by aphasia: a reconsideration

Background: This work focuses on the 26 individuals who provided data to AphasiaBank on at least two occasions, with initial testing between 6 months and 5.8 years post onset of aphasia. The data are archival in nature and were collected from the extensive database of aphasic discourse in AphasiaBank.

Aims: The aim is to furnish data on the nature of long-term changes in both the impairment of aphasia as measured by the Western Aphasia Battery-Revised (WAB-R) and its expression in spoken discourse.

Methods & Procedures: AphasiaBank’s demographic database was searched to discover all individuals who were tested twice at an interval of at least a year with either (a) the AphasiaBank protocol or (b) the AphasiaBank protocol at first testing, and the Famous People Protocol (FPP) at second testing. The FPP is a measure developed to assess the communication strategies of individuals whose spoken language limitations preclude full participation in the AphasiaBank protocol. The 26 people with aphasia (PWA) who were identified had completed formal speech therapy before being seen for AphasiaBank. However, all were participants in aphasia centres where at least 3 hr of planned activities were available, in most cases, twice weekly. WAB-R Aphasia Quotient scores (AQ) were examined, and in those cases where AQ scores improved, changes were assessed on a number of measures from the AphasiaBank discourse protocol.

Outcomes & Results: Sixteen individuals demonstrated improved WAB-R AQ scores, defined as positive AQ change scores greater than the WAB-R AQ standard error of the mean (WAB-SEM); seven maintained their original WAB quotients, defined as AQ change scores that were not greater than the WAB-SEM; and the final three showed negative WAB-R change scores, defined as a negative WAB-R AQ change score greater than the WAB-SEM. Concurrent changes on several AphasiaBank tasks were also found, suggesting that the WAB-R improvements were noted in more natural discourse as well.

Conclusions: These data are surprising since conventional wisdom suggests that spontaneous improvement in language is unlikely to occur beyond 1 year. Long-term improvement or maintenance of early test scores, such as that shown here, has seldom been demonstrated in the absence of formal treatment. Speculations about why these PWA improved, maintained, or declined in their scores are considered.     

An examination of changes in spoken productions within constraint-induced aphasia therapy

Background: Researchers are continuing to investigate the impact of constraint-induced aphasia therapy (CIAT) programs on the spoken language capabilities of people with aphasia at the utterance and discourse level. Currently, there is a lack of consensus on how spoken productions should be measured and there are no investigations that explore the spoken language that people with aphasia use during a CIAT program. Therefore, clinicians and researchers cannot truly know if they are utilizing the most revealing outcome measures to illuminate treatment induced gains in spoken production.

Aims: The purpose of this investigation was to examine the within treatment learning of people with aphasia in a CIAT program, by exploring the sensitivity of measures of content, length, syntax, and efficiency at the utterance level and reveal linguistic gains.

Methods & Procedures: A repeated measures design was employed to examine 200 utterance samples from eight participants with various types and severity of chronic aphasia between early and late treatment sessions. The measures of correct information units (CIUs), counted words, T-Units, CIUs per utterance, mazes, and mean length of utterance were compared.

Outcomes & Results: Nonparametric analyses revealed significant positive gains for the participants in the number of produced CIUs (p = 0.035), counted words (p = 0.012), T-Units, (p = 0.025), and CIUs per utterance (p = 0.012). A significant decrease in the amount of mazes (p = 0.028) was also found. No significant increase was detected in the participants’ mean length of utterance (p = 0.161).

Conclusions: The participants displayed advances in the content, syntax, and efficiency of their spoken utterances during the course of a 10-day CIAT program. Specifically, the measures of CIUs, counted words, mazes, and CIUs per utterance emerged as being the most sensitive to capture the within treatment changes made by the participants. The utility of these measures should be further explored to establish treatment baselines, demonstrate within treatment learning, and show posttreatment gains.     

Assessing chronic stroke survivors with aphasia sheds light on prevalence of spatial neglect

Background: Stroke is a chronic disease. Standardized assessment is essential in order to determine areas for treatment. Individuals with aphasia are often excluded from research, because it is believed that their language impairments may impact their ability to provide informed consent. Thus, right spatial neglect could be under-diagnosed.

Objective: This study was developed to (1) determine the frequency of spatial neglect in chronic left-brain stroke survivors with aphasia, (2) determine the clinical utility of an aphasia-friendly consent form, and (3) determine any differences between neglect and no-neglect groups regarding activities of daily living (ADL) performance and community independence.

Methods: Forty-six people were consented at community center. Three were screen failures secondary to the exclusion criteria. A novel, aphasia-friendly consent form was developed to facilitate participation of individuals with aphasia. This enabled 93% or 40 out of the 43 recruited participants to be included in this study. The Behavioral Inattention Test-conventional and the Catherine Bergego Scale via Kessler Foundation Neglect Assessment Process (CBS via KF-NAP) were utilized to determine neglect. The Life Space Questionnaire was used to determine community mobility and independence. The Barthel Index (BI) was used for objective clarification of performance in ADL.

Results: Successful use of the consent form resulted in determination that five out of 40 (12.5%) met criteria for spatial neglect; (on the CBS via KF-NAP). The neglect group had lower scores on the Life Space, suggesting less community mobility and independence, however, it was not statistically significant (p = 0.16). Differences in BI scores were also not significant (p = .013) but the neglect group did have reduced independence.

Conclusions: This study demonstrates the need to administer functional neglect assessments in left-brain stroke and to include individuals with aphasia in research.