Language mixing patterns in a bilingual individual with non-fluent aphasia

Background: Language mixing in bilingual speakers with aphasia has been reported in a number of research studies, but the reasons for the mixing and whether it reflects typical or atypical behaviour has been a matter of debate.

Aims: In this study, we tested the hypothesis that language mixing behaviour in bilingual aphasia reflects lexical retrieval difficulty.

Methods & procedures: We recruited a Hebrew-English bilingual participant with mild-moderate non-fluent agrammatic aphasia and assessed his languages at three timepoints. We analysed the participant’s Hebrew and English production for retrieval during single-word naming, sentences, and discourse, and identified all instances of language mixing.

Outcomes & Results: We found that there was a greater frequency of language mixing during production of more difficult lexical items, namely the post-morbidly less proficient language (compared to the more proficient language), function words (compared to content words), and single-word naming (compared to retrieval in the context of connected speech tasks), but not for verbs (compared to nouns).

Conclusions: In this bilingual participant with non-fluent aphasia, language mixing behaviour closely resembles lexical retrieval difficulty. Thus, we suggest that bilingual speakers with aphasia may mix their languages as a strategy to maximise communication.     

Mental health symptoms and verbal fluency in elderly people: Evidence from the Spanish longitudinal study of aging

Objectives: Depression and loneliness are highly prevalent in old age. Moreover these mental health symptoms adversely affect the verbal fluency of the elderly. We examined the relationship between depression and loneliness with verbal fluency in people aged 50 years or older.

Method: Research data were collected during the pilot study of the Longitudinal Aging Study in Spain (ELES) in which a representative sample of non-institutionalized Spanish older people was assessed. Here, the cross-sectional data for 962 participants were analysed using hierarchical regressions, controlling for age, education level, overall cognitive functioning, social networks and satisfaction with family.

Results: Higher levels of cognitive functioning were associated with higher verbal fluency. Females showed higher levels of phonological fluency. Neither depression nor loneliness were significant predictors of phonological fluency but loneliness was a significant predictor of semantic fluency. For mild levels of loneliness, the rate of decline in semantic fluency slows in the oldest ages. In contrast, for severe loneliness the rate of decline in semantic fluency increases in the oldest ages.

Conclusions: Depressive symptoms, loneliness and cognitive impairment are all prominent in ageing and therefore their impact on ageing needs to be better understood. Early detection of loneliness, along with the implementation of intervention for individuals diagnosed with loneliness is advisable in order to avoid negative repercussions for the verbal fluency of these individuals.     

Investigating the language,cognition and self-monitoring abilities of speakers with jargon output

Background: Jargon aphasia is a complex acquired language disorder which is characterised by fluent verbal output and usually accompanied by poor error monitoring. Written or graphemic jargon may or may not co-occur with spoken jargon. Intervention to address jargon behaviour is difficult to design due to the presence of poor self-monitoring of errors.

Aims: This study investigated the potential underpinning language and cognitive systems in the production of jargon behaviour and the ability to monitor spoken errors. We propose that jargon behaviour – poor language monitoring and jargon output – arise from an intersection of impaired language and cognitive systems.

Methods & Procedures: Six individuals with jargon aphasia participated in the study. A range of background language and cognition tests were selected. Experimental tests were designed to measure participants’ abilities to monitor their spoken and written output.

Outcomes & Results: Only three of the six participants were able to complete the full assessment battery, with each participant demonstrating a different profile of results across the experimental language monitoring tests. Participants who were better at monitoring their speech (AJ, AE, and LS) scored on the higher end of tests on access to auditory discrimination and repetition. Results from the background cognitive tests identified a range of cognitive impairments including difficulties with attention, problem solving, and sequencing.

Conclusions: Participants with relatively well-preserved skills in auditory discrimination and repetition were better at monitoring their spoken output. This suggests that language competence has a contribution to self-monitoring. All participants were found to have previously unidentified significant cognitive deficits. The significance of this is discussed in relation to language monitoring skills and potential treatment approaches.     

Cross-language generalisation in bilingual aphasia: what are we missing when we do not analyse discourse?

Background: Cross-language generalisation has been reported in about half of all published cases of bilingual aphasia treatment. However, many of those studies report data from only single-word naming tasks. In unbalanced bilinguals with aphasia, treating the post-morbidly less proficient language may result in apparent improvement to only the treated language.

Aims: To investigate whether when tools are used to measure language abilities beyond the single-word and sentence levels, such as analysing discourse production, improvement in the post-morbidly more proficient language may be observed.

Methods & Procedures: A Hebrew-English bilingual person with mild-moderate non-fluent agrammatic aphasia was recruited. He received 36 h of Verb Network Strengthening Treatment (VNeST) in English only, with pre- and post- treatment assessment of his language abilities in both English and Hebrew.

Outcome & Results: Significant improvement was observed in the treated language (English) for noun and verb retrieval in object and action picture naming and within sentence production, but not for the untreated language (Hebrew). In discourse, greater and more widespread improvement was observed in the untreated language (Hebrew) than in the treated language (English).

Conclusions: We advocate for more wide-ranging measurement tools in the field to reduce the risk of missing valuable information regarding generalisation. Only with a more representative understanding of the effects of language treatment in bilinguals with aphasia can we better understand the mechanisms behind cross-language generalisation.     

Effects of phonomotor treatment on discourse production

Background: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with all people with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse.

Aims: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment (PMT), on discourse production.

Methods & Procedures: Twenty-six PWA participated in 60 h of PMT, which focuses on building a person’s ability to recognize, produce, and manipulate phonemes in progressively longer nonword and real-word contexts. Language samples were collected prior to, immediately after, and 3 months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated.

Outcomes & Results: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and 3 months later, as well as significantly improved percent CIUs, relative to baseline, 3 months following treatment.

Conclusions: PMT, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production.     

A how-to guide to aphasia services: celebrating Professor Linda Worrall’s contribution to the field

Background: This article recognises Professor Linda Worrall’s contribution to aphasiology and discusses research themes which have grown from her work.

Aims: To review, summarise, and discuss literature relating to four themes which have emerged from the work of Professor Worrall: (1) Research capacity building; (2) Implementation of research evidence in clinical practice; (3) Meaningful outcome measurement; and (4) Improvement of psychological and emotional outcomes.

Main contribution: A review of the literature, with examples of practical applications.

Conclusions: The work of Professor Worrall has greatly influenced the field of aphasia; her legacy is the research capacity she has built in Australia and around the world.     

Life activity choices by people with aphasia: repeated interviews and proxy agreement

Background: Person-centered rehabilitation requires that meaningful life activities are identified on a case-by-case basis, but the discovery process can be inaccessible for clients with aphasia. Card-sorting methodology addresses core barriers and help clients communicate their preferences.

Aims: To characterize life activities that people with aphasia want to do, to estimate consistency in selections over time, and to replicate previous findings about the ability of family members and friends to identify their loved ones’ activity preferences.

Methods & Procedures: We administered the Life Interests and Values (LIV) Cards to 26 people with aphasia, asking them which of 95 depicted life activities they wanted to do more in their lives. Half the activity cards were presented again one to ten weeks later. Twenty family members or friends responded as proxies by selecting from a questionnaire with the same items.

Outcomes & Results: Participants with aphasia selected diverse activities, though as a group they identified significantly more activities from the “social” activity category than from the “home and community”, “creative and relaxing”, or “physical” categories. Across the repeated interviews, they selected identical activities on average 78% of the time. Item-to-item agreement between people with aphasia and their proxy responders was significantly lower at 69%.

Conclusions: People with aphasia have diverse activity interests and are reliable informants about their preferences. Because significant others have limited ability to predict these choices, their impressions are inadequate substitutes for direct interviews.     

Self-management of aphasia: a scoping review

Background: Self-management approaches are routinely used in chronic conditions to enable patients to take responsibility for their own care. A self-management approach may be appropriate for individuals with aphasia, but this has not been systematically investigated. The purpose of this review was to explore self-management in relation to aphasia.

Aims: The study aimed to explore existing research and intervention approaches for aphasia that incorporate self-management principles. A secondary aim was to examine the presence of the term self-management in the research literature and online resources relating to aphasia.

Methods & Procedures: A scoping review methodology was selected to explore literature relating to self-management of aphasia. Five databases were systematically searched in May 2017: PubMed, Embase, CINAHL, PsycINFO, and Linguistics & Language Behaviour Abstracts. Search terms used were aphasia OR dysphasia AND self-management OR self-directed OR self-care OR self-efficacy OR independence OR independent AND intervention OR treatment OR rehabilitation. A structured website search of aphasia, speech pathology and stroke associations from four English-speaking countries was performed in September 2017.

Outcomes & Results: A total of 43 studies met inclusion criteria for the literature review. Analysis of eligible studies showed three areas of aphasia intervention which incorporated principles self-management: 1) technology-based interventions, 2) group/community-based interventions, and 3) communication partner training. The structured website search revealed no information relating specifically to aphasia self-management.

Conclusions: Principles of self-management are being used in some aphasia interventions, but there is little evidence of a self-management approach being applied in aphasia. The term self-management is not widely present in aphasia literature and when it has been used tends to refer to self-administered treatment rather than a structured self-management approach.     

Use of co-verbal gestures during word-finding difficulty among Cantonese speakers with fluent aphasia and unimpaired controls

Background: Co-verbal gestures refer to hand or arm movements made during speaking. Spoken language and gestures have been shown to be tightly integrated in human communication.

Aims: The present study investigated whether co-verbal gesture use was associated with lexical retrieval in connected speech in unimpaired speakers and persons with aphasia (PWA).

Methods & Procedures: Narrative samples of 58 fluent PWA and 58 control speakers were extracted from Cantonese AphasiaBank. Based on the indicators of word-finding difficulty (WFD) in connected speech adapted from previous research and a gesture annotation system with independent coding of gesture forms and functions, all WFD instances were identified. The presence and type of gestures accompanying each incident of WFD were then annotated. Finally, whether the use of gesture was accompanied by resolution of WFD (i.e., the corresponding target word could be retrieved) was examined.

Outcomes & Results: Employment of co-verbal gesture did not seem to be related to the success of word retrieval. PWA’s naming ability at single-word level and their overall language ability (as reflected by the aphasia quotient of the Cantonese version of the Western Aphasia Battery) were found to be the two strongest predictors of success rate of resolving WFD.

Conclusions: The Lexical Retrieval Hypothesis highlighting the facilitative functions of iconic and metaphoric gestures in lexical retrieval was not supported. Challenges in conducting research related to WFD, and the clinical implications in gesture-based language intervention for PWA were discussed.     

Reading comprehension treatment in aphasia: a systematic review

Background: Reading difficulties often present as a consequence of aphasia. The specific nature of reading deficits varies widely in manifestation, and the cause of these deficits may be the result of a phonological, lexical semantic, or cognitive impairment. Several treatments have been developed to address a range of impairments underlying reading difficulty.

Aims: The purpose of this review is to describe the current research on reading comprehension treatments for persons with aphasia, assess the quality of the research, and summarize treatment outcomes.

Methods & Procedures: A systematic review of the literature was conducted based on a set of a priori questions, inclusion/exclusion criteria, and pre-determined search parameters. Results were summarized according to treatment type, methodologic rigor, and outcomes.

Outcomes & Results: Fifteen studies meeting criteria were identified. A variety of reading comprehension treatments was implemented including: oral reading, strategy-based, cognitive treatment, and hierarchical reading treatments. Quality ratings were highly variable, ranging from 3 to 9 (on a 12-point scale). Overall, 14 of the 18 individuals for whom individual data were provided demonstrated some degree of improvement (oral reading 4/5 participants, strategy based 4/6, and cognitive treatment 6/7). Gains were also evident for hierarchical reading treatment administered to participant groups via computer; however, the degree to which improvement reached statistical significance varied among studies.

Conclusions: Reading comprehension treatments have the potential to improve reading comprehension ability in persons with aphasia; however, outcomes were variable within and among treatment methods. We suggest focusing future research on factors such as participant candidacy and treatment intensity using increased methodological rigor.     

Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.

Design: A randomised, controlled, assessor-blinded trial.

Setting: Rehabilitation institute.

Participants: Thirty-six chronic poststroke (15.89?±?9.01 months) hemiparetic subjects (age: 46.44?±?7.89 years, 30 men and functional ambulation classification of median level 3).

Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.

Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).

Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference?=?3.29, 95% CI?=?1.23–5.35, p?=?.003) and RVGA (mean difference?=?5.41, 95% CI?=?1.12–9.71, p?=?.015) in comparison to the control group. No considerable changes were observed on 10-MWT.

Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.     

Public awareness of aphasia – results of a Swedish sample

Background: Public awareness of a condition like aphasia may affect service provision and everyday life communication for people affected by the condition. Nevertheless, studies have shown that the public awareness of aphasia is low in many countries.

Aims: This study explores awareness and knowledge of aphasia among the general public in Sweden.

Methods & Procedures: We describe two surveys on the public awareness of aphasia undertaken using convenience samples in four different cities in southern Sweden. The questionnaire was closely based on those used in previous studies of aphasia awareness around the world. A total of 372 participants were recruited. Results are presented in terms of whether participants had heard of aphasia or not, and in the case that they had heard of it, whether they had a basic knowledge of the condition. Further analyses were undertaken on these three groups of participants: their gender and age distributions, educational background, what they knew about aphasia, and where they had learnt about it.

Outcomes & Results: The results are discussed in comparison with similar surveys elsewhere, and we note the comparatively high percentage of participants who have heard of aphasia in our survey though, mirroring previous surveys, the amount of knowledge was often limited or incorrect. Unlike in other surveys, no clear relation was found between gender and awareness of aphasia, or education and awareness of aphasia. Age profiles and the source of participants’ information about aphasia were similar to earlier studies: that is, older people seem to have more aphasia awareness than younger people do. Further, media like TV, radio, newspapers, and magazines were the most often reported source for knowledge of aphasia.

Conclusions: There is a need for further work to increase public awareness of aphasia and different forms of public media may play an important role in this endeavour.     

Relations between executive function,language, and functional communication in severe aphasia

Background: Intervention in severe aphasia often means aiming for access to meaningful social interaction in spite of linguistic barriers that might not be treatable. This demands knowledge about the different factors that influence functional communication. Apart from linguistic ability, executive functions are thought to play an important role.

Aims: To expand the understanding of the relations of executive functions and linguistic ability to functional communication in severe aphasia.

Methods and Procedures: Executive functions, linguistic ability, and functional communication were assessed in 47 participants with severe aphasia. The results were analysed for the total sample and for a verbal and a nonverbal subgroup.

Outcomes and Results: Impairment of executive function was found in 85% of the participants. There were moderate to strong correlations between all subtests of executive functions and linguistic ability. In the total sample, significant partial correlation was found between functional communication and verbal output. In the nonverbal subgroup, there was a significant partial correlation between executive function and functional communication, when controlling for linguistic ability. In the verbal subgroup, no relations were found between executive functions or language and functional communication.

Conclusions: Impairments of executive functions are common in people with severe aphasia, and executive function and linguistic ability are closely related. The ability to produce verbal output is strongly related to functional communication, but in people with extreme limitation or total absence of verbal output, executive functions seem to be an important factor for functional communication. There is a large variation of executive functions and functional communication in people with severe aphasia, especially in the nonverbal subgroup. It is important that people with severe aphasia are given a complete and proper evaluation of their abilities, and that the possible importance of executive function to communication is considered in communication intervention.     

Semantic processing in children with cochlear implants: Evidence from event-related potentials

Introduction: Existing research has shown that children with significant hearing loss who use cochlear implants (CIs) perform worse than their hearing peers on behavioral measures of spoken language. The present study sought to examine how children with CIs process lexical–semantic incongruence, as indexed by electrophysiological evidence of the N400 effect.

Method: Twelve children with CIs, aged between 6 and 9 years, participated in a spoken word–picture matching task while event-related potentials (ERPs) were recorded. To determine whether the N400 effect elicited in this group deviated from normal, independent samples t tests and analysis of variance (ANOVA) analyses were used to compare the results of children with CIs against those of a similarly aged typically hearing (TH) group (n = 30). Correlational analyses were also conducted within each group to gauge the degree to which the N400 effect related to behavioral measures of spoken language.

Results: An N400 effect was elicited in both groups of CI and TH children. The amplitude and latency of the N400 effect did not differ significantly between groups. Despite the similarity in ERP responses, children with CIs scored significantly lower on behavioral measures of spoken word- and sentence-level comprehension. No significant correlations between ERP and behavioral measures were found, although there was a trending relationship between sentence-level spoken language comprehension and the TH group’s N400 effect mean amplitude (p = .060).

Conclusions: The results suggest that, at a neural level, children with CIs can process lexical–semantic incongruence, and that other underlying processes not measured by the N400 effect contribute to this population’s spoken language difficulties.     

Neighborhood social cohesion and cognitive function in U.S. Chinese older adults—findings from the PINE study

Objectives: The projected increase in the population of older adults in the United States entails a pressing need to examine risk and protective factors associated with cognitive function. This study aims to examine the association between neighborhood social cohesion and cognitive function among older Chinese adults in the United States.

Method: Using the first epidemiological survey of older Chinese Americans and applying ordinary least squares and quantile regressions, this study examines the association between neighborhood social cohesion and various domains of cognitive function.

Results: Results show that neighborhood social cohesion is independently associated with most domains of cognitive function (i.e. global cognition score, and its components such as the Chinese Mini-Mental State Examination and executive function and episodic memory measures).

Conclusion: This study represents one of a few initial efforts that examined the association between neighborhood social cohesion and cognitive function for Chinese older adults in the United States. Our findings suggest that socially cohesive neighborhoods can provide enriched environments where active lifestyles can be encouraged, and cognitive skills and abilities can be stimulated, practiced, and preserved for older adults.     

Service encounter interactions of people living with moderate-to-severe post-stroke aphasia in their community

Background: Access to the community is recognised as a need as well as a right for people living with a disability, including people living with aphasia (PLWA). Although studies have shown factors that hinder or support participation of PLWA, few examined naturally occurring interactions outside the home.

Aims: This qualitative study aimed to describe the structure of natural interactions occurring between people with aphasia and individuals at the checkout in service encounters.

Methods and Procedure: Six participants with moderate-to-severe expressive post-stroke aphasia were video-recorded during commercial interactions within their community environment. Data collection took place in grocery stores, supermarkets, restaurants, drug stores, coffee shops, specialised shops, and a movie theatre. A total of 20 commercial interactions were analysed using conversation analysis.

Outcomes and Results: The interactions between PLWA and checkout assistants during payment were characterised by a sequence of four communication stages based on mutual agreement of (1) their availability for the commercial transaction, (2) the item(s) that would be purchased, (3) the price, and (4) the fact that the interaction was over. The second and third parts of the sequence were more challenging in terms of physical access to the desired item(s) or its representation in stage two and access to a visual display of the price in stage three influenced the communication accessibility of the stores.

Conclusions: The present findings suggest that PLWA can successfully participate in interactions involving the purchase of goods, even if aphasia is severe, as these interactions are structured by communication and four stages of mutual agreement. During rehabilitation, speech–language pathologists could help prepare PLWA to carry out commercial transactions in self-selected shops to support active community participation post-rehabilitation.     

“I don’t know”: a usage-based approach to familiar collocations in non-fluent aphasia

Background: Familiar collocations (e.g., “it’s alright”) are an important part of everyday conversation. Such word combinations are often retained in speakers with Broca’s aphasia. However, only few investigations have studied the forms and functions of familiar collocations available to speakers with Broca’s aphasia.

Aims: We first apply a frequency-based perspective to word combinations produced by speakers with Broca’s aphasia and their conversation partners (CPs), and compare the frequency characteristics of word combinations in dyadic and non-dyadic speech. Second, we investigate the conversational functions of one prominent familiar collocation, “I don’t know” (IDK).

Methods & Procedures: In the first analysis, speech samples from interactions of nine dyads (each a speaker with Broca’s aphasia and their CP) were examined. Non-dyadic samples were selected from 39 speakers with Broca’s aphasia from AphasiaBank (MacWhinney et al., 2011). The Frequency in Language Analysis Tool (FLAT; Zimmerer & Wibrow, 2015) was used to estimate collocation strength (the degree of association between words in a combination) of well-formed bigrams (two-word combinations) and trigrams (three-word combinations). The second analysis presents a qualitative investigation of uses of IDK in dyadic exchanges.

Outcomes & Results: Analysis 1 revealed that residual trigrams in Broca’s aphasia were more strongly collocated in comparison to language produced by CPs. There was no difference in frequency-based profiles between dyadic and non-dyadic aphasic speech. Analysis 2 indicated that speakers with Broca’s aphasia and CPs used IDK to achieve a variety of communicative functions. However, patterns specific to each participant group were found.

Conclusions: These findings highlight that frequency-based analysis is useful in explaining residual, grammatically well-formed word combinations in Broca’s aphasia. This study provides evidence that IDK can aid turn construction in aphasia.