Variations in language use:The influence of linguistic and social factors

One of the significant characteristics of language is flexibility. On the one hand, people have various ways to convey certain information to a given addressee. For example, when quoting previous utterances, people can use direct quotations (direct speech) or indirect quotations (indirect speech), depending on which perspective they are taking. On the other hand, people talk about the same things in different ways depending on with whom they are communicating with. For instance, people talk more politely when communicating with individuals who are more powerful compared to individuals who are peers or less powerful. In this dissertation, I focused on factors that contribute to decisions between different ways of communication. To investigate this question, I took the use of direct and indirect speech as a cut-in point. I first examined how linguistic and social factors influenced the use of direct and indirect speech in a narrative task. I further explored the influence of social factors on language production in other contexts (e.g., offline vs. online communication). Taken together, findings from this dissertation suggest that both intrinsic characteristics of the utterance itself and extrinsic characteristics, such as psychological distance between speaker and listener and the listener’s knowledge level, play a role in language production processes

An exploration of the friendship experiences of working-age adults with aphasia

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Aphasia impairs using and understanding language, and thus impacts on communication, identity and relationships. However, little research has investigated how people with aphasia understand friends and friendship. This Participatory Action Research (PAR) study explored how younger adults with aphasia experience friendship. Participants were 28 people with aphasia, some of whom were members of the Research Group. Data from 12 initial interviews in Phase 1 of the study led to a model of friendship and aphasia. This underpinned development of peer-led Friendship Events in Phase 2 of the study, after which 16 additional participants with aphasia were interviewed, contributing to elaboration of the model. Within the context of living with aphasia, which was central for all participants, eight inter-connected themes emerged. Friends could be anchors in a time of change and trusted stabilising influences while reconfiguring identity. Participants described the hard work of friendship, the place of communication in supporting friendship, and the challenge of equality within post-aphasia friendships. Time, humour and two-way flexibility were crucial in developing new kinds of friendship. Participants categorised a wide variety of relationships as friendship. These findings elucidate understandings of friendship loss and change as well as strategies to maintain friendship post-onset of aphasia. The study sheds new light on social connectedness and social support provided by friends, family and peers with aphasia. It emphasises the role of friendship in reconfiguring identity, and offers practical recommendations for harnessing the benefits of friends and friendship in life with aphasia. PAR methodology facilitated creation of accessible tools to support conversations and awareness-raising about friendship. The study highlights the strengths of relational methods for researching friendship and the transformative potential of doing PAR with marginalised groups such as people with aphasia

Computational Language Assessment in patients with speech, language, and communication impairments

Speech, language, and communication symptoms enable the early detection, diagnosis, treatment planning, and monitoring of neurocognitive disease progression. Nevertheless, traditional manual neurologic assessment, the speech and language evaluation standard, is time-consuming and resource-intensive for clinicians. We argue that Computational Language Assessment (C.L.A.) is an improvement over conventional manual neurological assessment. Using machine learning, natural language processing, and signal processing, C.L.A. provides a neuro-cognitive evaluation of speech, language, and communication in elderly and high-risk individuals for dementia. ii. facilitates the diagnosis, prognosis, and therapy efficacy in at-risk and language-impaired populations; and iii. allows easier extensibility to assess patients from a wide range of languages. Also, C.L.A. employs Artificial Intelligence models to inform theory on the relationship between language symptoms and their neural bases. It significantly advances our ability to optimize the prevention and treatment of elderly individuals with communication disorders, allowing them to age gracefully with social engagement.Comment: 36 pages, 2 figures, to be submite

Interactions between a Speech Pathologist and people with aphasia in the first 6 weeks post stroke: A qualitative study of assessment experiences

This study examines clinician and client interactions in the context of an acute care unit in a small urban Western Australian Hospital. The study involved audiovisual recordings and observations of assessment sessions, and in-depth interviews with the assessing Speech Pathologist and her clients. Analysis used Discourse Analysis of assessment sessions and Thematic Analysis of interviews. There is growing evidence as to how less formal non-traditional assessment might be more supportive of people with aphasia—for instance, by using concepts and techniques drawn from Dynamic Assessment and principles of Adult Learning. Surveys of Australian and New Zealand Speech Pathologists reflect a move away from standardised tests in acute settings, finding Speech Pathologists are more likely to use informal and/or unstandardised assessment tools. However, little research has been conducted about the assessment experiences of people with aphasia, particularly in the early stages post- stroke. The purpose of this study is to describe and analyse typical contemporary speech pathology practices in assessment of people with aphasia in the early stages post-stroke, and explore how assessment is experienced by both the assessing clinician and the person assessed

Mechanisms of change in the evolution of jargon aphasia

Background: The evolution of jargon aphasia may reflect recovery in the speech production processes. Alternatively or additionally there may be improved self-monitoring, enabling the person to suppress jargon errors. Previous case reports offer evidence for both mechanisms of change, and suggest that they can co-occur. Aims: This longitudinal study aimed to uncover mechanisms of change in an individual with jargon aphasia. Four predictions of production processing recovery were examined against test data. The study also looked for evidence of improved error awareness, in both test and connected speech data, and explored the relationship between this improvement and the production gains. Methods & Procedures: The participant (TK) undertook tests of single word naming, reading and repetition eight times over a 21-month period, with matched sets of nouns and verbs. Analyses of correct responses and errors were conducted, in order to test predictions of processing recovery. Changes in self-monitoring behaviours were also investigated, to uncover evidence of increased error awareness. Finally, longitudinal changes in samples of connected speech were explored. Outcomes & Results: Two predictions of production processing recovery were upheld: there was a significant increase in the number of correct responses over time, and a significant decrease in the proportion of nonword errors. The error analysis also revealed a trend towards increased target-relatedness and decreased perseveration, but neither was significant. There was an increase in self-monitoring behaviours during testing, in that there were more null responses and attempted self-corrections. This increase correlated very strongly with the production gains. Connected speech showed little evidence of improved production, since the range of vocabulary employed by TK reduced as time progressed. However, self-monitoring behaviours were increasingly evident in this context. Conclusions: The origin of the production and monitoring gains experienced by TK are discussed. Implications are drawn out for further research

Perspectives on quality of life by people with aphasia and their family: Suggestions for successful living

Understanding the client's perspective is essential for good practitioner care in rehabilitation after stroke, and nothing is more relevant than enquiring directly about our clients' quality of life to inform our management. Relatively little is known about how older people with aphasia consider the quality of their current lives, and this article seeks to explore this issue. Four women's accounts of their life quality are presented, as well as their husbands' or daughter's accounts of their lives. Their stories share some common elements. Who you love or share your life with; where you live; feeling independent and/or in control; and engaging in satisfying activities mattered to these women's life quality. The impact of aphasia varies across the cases, and the need to accept change for successful living is illustrated in all accounts

What do people with aphasia want from the Queen Square Intensive Comprehensive Aphasia Programme and do they achieve it? A quantitative and qualitative analysis of their short, medium, long-term and economic goals

Background: The most effective model for achieving therapist-delivered, high-dose SLT for People with Aphasia (PWA) is through Intensive Comprehensive Aphasia Programmes (ICAPs). ICAPs are often assessed using standardised outcome measures; however, as SLT is personalised, it is of interest to examine individualised goal-based outcome measures as well. In the Queen Square ICAP, we use a goal-setting approach (Goal Attainment Setting [GAS]) where the PWA and their therapist negotiate which goals to work on and over what timescales. This process involves recording and scoring the agreed goals, which makes them amenable to formal quantitative and qualitative analysis. Aims: The aim of this study was twofold. Firstly, to test the hypothesis that a pre- versus post- ICAP analysis of individual’s goal scores would show statistically significant and clinically meaningful improvements. Secondly, to better understand what PWA wanted to achieve from the ICAP service, we performed a qualitative analysis across all agreed goals. Methods & Procedures: Forty-four PWA who varied in aphasia severity from mild to severe took part. PWA jointly set goals with their therapists using the SMART framework (Specific, Measurable, Achievable, Relevant, and Time-Bound). The goals were split into four categories: short (3 weeks), medium (3-6 months), long-term (12 months) and economic, (defined as any outcome that will improve, either directly or indirectly, the economic system that the PWA lives within). Quantitative scores were obtained for each PWA both pre- and post- ICAP and were analysed using paired t-tests, with subsequent ANOVAs to investigate possible confounding factors. The qualitative analysis was carried out by two researchers not involved in delivering the ICAP. Data was collapsed across all goal categories and analysed using thematic analysis. Outcomes & Results: Quantitatively, statistically significant gains were made across all four goal categories (ps < 0.001). Unstandardized effect-sizes were clinically significant (ΔGAS ~16). Qualitatively, we identified five main themes: staying connected with the world, understanding aphasia better, raising awareness, the importance of having a work identity and managing personal relationships. Conclusions: Quantitative goal-setting for PWA in the context of an ICAP provides robust evidence that PWA can achieve a variety of aspirational goals given high enough doses of specialist input from SLTs and a clinical psychologist. Although the ICAP only spanned 3 weeks, PWA continued to reach medium, long-term and even economic goals up to a year post-recruitment. This is the first time that economic goals have been captured in PWA using GAS. The qualitative analysis describes what the PWA wanted to achieve from participating in our ICAP, while the quantitative analyses demonstrate how much they succeeded in doing so

An investigation into the effect of a novel non-linguistic cognitive intervention on functional communication in global aphasia

Background: Global aphasia is a severe communication disorder affecting all language modalities, commonly caused by stroke. Evidence as to whether the functional communication of people with global aphasia (PwGA) can improve after speech and language therapy is limited and conflicting. This is partly because cognition is essential for successful functional communication and in global aphasia it can be severely impaired. Cognitive treatments aimed at improving functional communication in people with aphasia exist, but few have been trialled with PwGA and none have robustly demonstrated gains. This study explored the effect of a novel cognitive intervention on the functional communication skills of PwGA. Method: A survey investigated the practices, challenges and research priorities of UK based speech and language therapists. Intervention for PwGA was found to commonly target choice-making or non-verbal communication. However, co-occurring cognitive difficulties were reported to limit progress and present a challenge when engaging clients. Synthesising these findings with a review of the literature, a non-linguistic intervention targeting the cognitive skills underpinning functional communication was developed and delivered to six participants (recruited from NHS and independent neurorehabilitation services), three times weekly for up to 6 weeks. A multiple baseline case series design investigated changes in functional communication (as measured by a proxy rating of communication independence and quality, and a new scenario-based observational tool), cognition and auditory comprehension. Results: Participants completed this novel intervention programme in an average of nine sessions. Five out of six participants made significant gains in functional communication as measured by a proxy, and non-verbal semantics. Auditory comprehension also significantly improved in two individuals. Conclusion: There is preliminary evidence that this intervention can improve functional communication in some PwGA. Findings add to the evidence that cognition is critical to functional communication and highlight the benefit of treating cognition via non- linguistic means in PwGA