More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme
The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience.
Noun and Verb Impairment in Single-Word Naming and Discourse Production in Mandarin-English Bilingual Adults with Aphasia
Previous studies on bilingualism and aphasia have identified a similar pattern of verb-noun dissociation in single-word naming (i.e., lower accuracy for verbs than nouns) in both languages. However, whether a similar pattern of verb and noun dissociation emerges in discourse production remains unknown, particularly in typologically dissimilar languages.
Evaluating Fluency in Aphasia: Fluency Scales, Trichotomous Judgements, or Machine Learning
Speech-language pathologists (SLPs) and other clinicians often use aphasia batteries, such as the Western Aphasia Battery-Revised (WAB-R), to evaluate both severity and classification of aphasia. However, the fluency scale on the WAB-R is not entirely objective and has been found to have less than ideal inter-rater reliability, due to variability in weighing the importance of one dimension (e.g. articulatory effort or grammaticality) over another. This limitation has implications for aphasia classification. The subjectivity might be mitigated through the implementation of machine learning to identify fluent and non-fluent speech.
Priming Sentence Production in Older Adults: Evidence for Preserved Implicit Learning
Structural priming- speakers' unconscious tendency to echo previously encountered message-structure mappings - is thought to reflect the processes of implicit language learning that occur throughout the lifespan. Recently, structural priming has also been used as a means to facilitate language re-learning in age-related language disorders such as aphasia. However, little evidence is available on whether structural priming remains effective in healthy aging, limiting clinical translation of the structural priming paradigm. This study examined the impact of aging on the strength and longevity of abstract structural priming and lexical boost effects.
Evaluating circumlocution in naming as a predictor of communicative informativeness and efficiency in discourse
Discourse analyses yield quantitative measures of functional communication in aphasia. However, they are historically underutilized in clinical settings. Confrontation naming assessments are used widely clinically and have been used to estimate discourse-level production. Such work shows that naming accuracy explains moderately high proportions of variance in measures of discourse, but proportions of variance remain unexplained. We propose that the inclusion of circumlocution productions into predictive models will account for a significant amount more of the variance. Circumlocution productions at the naming-level, while they may not contain the target word, are similar to the content that contributes to discourse informativeness and efficiency. Thus, additionally measuring circumlocution may improve our ability to estimate discourse performance and functional communication.
Cerebellar tDCS Enhances Functional Communication Skills in Chronic Aphasia
Transcranial direct current stimulation (tDCS) has emerged as a possible neuromodulatory tool to augment language therapy in post-stroke aphasia. However, there is limited information on whether tDCS may help to improve everyday functional communication.
Core lexicon in aphasia: A longitudinal study
General consensus exists between clinicians as to the incorporation of discourse outcome measures into language assessment for persons with aphasia (PWA). The development of core lexicon measures (CoreLex) has enabled clinicians to reduce time and labor intensive preparatory work for discourse analysis, which has been considered as an alternative measure to quantify word retrieval ability in discourse in a clinical context. Although previous studies have investigated the quality of the measure, CoreLex has rarely been longitudinally explored.
Agrammatic output in non-fluent, including Broca's, aphasia as a rational behavior
Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser extent, verbs and lacks function words, like articles and prepositions, and correct morphological endings. Among the earliest accounts of agrammatic output in the early 1900s was the "economy of effort" idea whereby agrammatic output is construed as a way of coping with increases in the cost of language production. This idea resurfaced in the 1980s, but in general, the field of language research has largely focused on accounts of agrammatism that postulated core deficits in syntactic knowledge.
Muddles and puzzles: Metaphor use associated with disease progression in Primary Progressive Aphasia
Primary Progressive Aphasia describes a language-led dementia and its variants. There is little research exploring the experiences of living with this disease. Metaphor, words that represent something else, have been studied extensively in health-related narratives to gain a more intimate insight into health experiences.
Differences in Connected Speech Outcomes Across Elicitation Methods
Connected speech is often used to assess many aspects of an individual's language abilities after stroke. However, it is unknown the degree to which elicitation methods differ in generating structural and syntactic aspects of connected speech, two critical components of successful communication. Quantifying the degree to which elicitation methods differ in eliciting structurally, syntactically, and lexically complex connected speech at the earliest stage of stroke before reorganization and rehabilitation of function independent of clinical diagnosis of aphasia has not been examined to date. Addressing this gap has implications for early clinical intervention as well as empirical studies of connected speech production.
Recursive Self-feedback Improved Speech Fluency in Two Patients with Chronic Nonfluent Aphasia
Previous studies have demonstrated that people with nonfluent aphasia (PWNA) improve their language production after repeating personalized scripts, modeled by speech-language pathologists (SLPs). If PWNA could improve by using their own self-feedback, relying less on external feedback, barriers to aphasia treatment, such as a dearth of clinicians and mobility issues, can be overcome. Here we examine whether PWNA improve their language production through an automated procedure that exposes them to playbacks of their own speech, which are updated recursively, without any feedback from SLPs.
Shave, shear, shred, or cut: PPA variant differentially impacts erroneous responses produced in a confrontation naming test of verbs
All common variants of primary progressive aphasia (PPA) exhibit naming deficits. Variants are distinguished by relative deficits in repetition (logopenic; lvPPA), object knowledge (semantic; svPPA), and agrammatism or articulation (non-fluent/agrammatic; nfavPPA; Gorno-Tempini et al., 2011). The Hopkins Action Naming Assessment (HANA) is a 30-item verb naming task that can distinguish between variants (Stockbridge et al., 2021). Item-level accuracy is driven by target verb frequency, semantic information density, and conceptual concreteness of the target word (Stockbridge, Venezia, et al., 2022).
An electrophysiological and behavioral investigation of feedback-based learning in aphasia
Feedback is a fundamental aspect of aphasia treatments. However, learning from feedback is a cognitively demanding process. At the most basic level, individuals must detect feedback and extract outcome-related information (i.e., feedback processing). Neuroanatomical and neuropsychological differences associated with post-stroke aphasia may influence feedback processing and potentially how people with aphasia (PWA) respond to feedback-based treatments. To better understand how post-stroke aphasia affects feedback-based learning, the current study leverages event-related potentials (ERPs) to (1) characterize the relationship between feedback processing and learning, (2) identify cognitive skills that are associated with feedback processing, and (3) identify behavioural correlates of feedback-based learning in PWA.
Revealing Linguistic and Verbal Short-Term and Working Memory Abilities in People with Severe Aphasia
The assessment of aphasia in people with severe deficits is hampered by a paucity of tests that are appropriate for this population and that are sensitive to their underlying linguistic and short-term and working memory (STM/WM) strengths and weaknesses. The Temple Assessment of Language and Short-Term Memory in Aphasia (TALSA) provides a means of assessing people with severe aphasia (PWSA).
Baseline Conceptual-Semantic Impairment Predicts Longitudinal Treatment Effects for Anomia in Primary Progressive Aphasia and Alzheimer's Disease
An individual's diagnostic subtype may fail to predict the efficacy of a given type of treatment for anomia. Classification by conceptual-semantic impairment may be more informative.
Structural priming from production to comprehension in aphasia
Many people with aphasia (PWA) show deficits in sentence production and comprehension, in part, due to an inefficient mapping between messages and syntactic structures. Structural priming-the tendency to repeat previously encountered sentence structures-has been shown to support implicit syntactic learning within and across production and comprehension modalities in healthy adults. Structural priming is also effective in facilitating sentence production and comprehension in PWA. However, less is known about whether priming in one modality changes PWA's performance in the other modality, crucial evidence needed for applying structural priming as a cost-effective intervention strategy for PWA.
Assessment of verb and sentence processing deficits in stroke-induced aphasia: the Italian version of the Northwestern Assessment of Verbs and Sentences (NAVS-I)
The Northwestern Assessment of Verbs and Sentences (NAVS) assesses verb and sentence production and comprehension in aphasia. Results from the original English version and from its adaptation to German have shown that the NAVS is able to capture effects of verb-argument structure (VAS) complexity (i.e., lower accuracy for two- and three-argument vs. one-argument verbs) and syntactic complexity (i.e., lower accuracy for non-canonical vs. canonical sentences) in both agrammatic participants and individuals with mild (residual) forms of aphasia. The NAVS has been recently adapted to Italian (NAVS-I) and tested on a group of healthy participants, with results showing longer reaction times to complex vs. simple verbs and sentences.
Verb Frequency and Density Drive Naming Performance in Primary Progressive Aphasia
Recent work has highlighted the utility of the Boston Naming Test and Hopkins Action Naming Assessment (HANA) for distinguishing between semantic (svPPA), logopenic (lvPPA) and non-fluent agrammatic (nfavPPA) variants of primary progressive aphasia (PPA).
Mary has a little chair: Eliciting noun-modifier phrases in individuals with acute post-stroke aphasia
Aphasia assessment primarily examines an individual's syntax, nouns, and verbs. However, modifiers, such as adjectives and number words, and bound morphemes can be the subject of considerable difficulty for individuals with aphasia. The Morphosyntactic Generation (MorGen) targets nouns, modifiers, and bound inflectional morphemes in two-word phrases among people with aphasia.
Implementing a telehealth-delivered psychoeducational support group for care partners of individuals with primary progressive aphasia
Primary progressive aphasia (PPA) is a language-prominent dementia that fundamentally impacts the lives of not only the person with the diagnosis, but also their family members. While assuming a caregiving role, care partners are vulnerable to negative health and psychosocial consequences of their own. Support groups are one way to meet the needs of care partners, providing opportunities for individuals with common experiences to socialize, obtain knowledge about disorders, and learn coping strategies. Given that PPA is rare and that in-person support groups are sparse in the United States, there is a need for alternative meeting modalities, to overcome the limitations imposed by relative scarcity of potential participants, lack of appropriately-trained clinical professionals, and the logistical demands faced by overburdened care providers. Telehealth-based support groups provide care partners with opportunities to connect virtually with other care partners; however, research regarding their feasibility and benefit is limited.
Gesture profiles distinguish primary progressive aphasia variants: A preliminary study
Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by progressive language deficits. The main variants of PPA -semantic (svPPA), logopenic (lvPPA), and nonfluent (nfvPPA)- can be challenging to distinguish. Limb apraxia often co-occurs with PPA, but it is unclear whether PPA variants are associated with different gesture deficits. Prior evidence from stroke indicates that temporal lobe lesions are associated with reduced benefit from meaning in gesture performance. Temporal lesions are also associated with greater deficits in hand postures compared to arm kinematics in gesture imitation.