Comparing linguistic complexity and efficiency in conversations from Stimulation Therapy and Conversation Therapy in Aphasia

The ultimate goal for speech language pathology interventions for people with aphasia (PWA) is to be able to converse as normally as possible (Armstrong & Mortensen, 2006). However, there are numerous approaches to aphasia therapy as well as various outcome measures. For instance, Stimulation therapy (ST) relies on structured repetition and drill to elicit language, while conversation therapy (CT) uses client-clinician conversation and conversation analysis to improve everyday language. Most speech language pathologists use standardized tests or rating forms to measure treatment progress rather than measuring conversations (Boles, 1998). We aimed to compare differences in linguistic complexity and efficiency in conversational outcomes in two treatment types, ST and CT. Researchers have examined the verbal abilities of PWA and aging adults by analyzing language samples (Capilouto et al., 2005; Kemper & Sumner, 2001); however few people have examined linguistic complexity in conversation as a treatment outcome measure. Conversational efficiency measured in Correct Information Units (CIUs)/minute is a valid and reliable way to measure improvement in connected speech (Nicholas and Brookshire, 1993). Efficiency can be measured by calculating CIUs/minute or % CIUs. Researchers have used %CIUs to measure efficiency in conversations (Doyle, Goda & Spencer, 1995) and CIUs/minute in story-telling (Jacobs, 2001). However, no one has reported using CIUs/minute to measure efficiency during conversational interactions. To address this we asked the following questions: 1. Does CT lead to a greater increase in linguistic complexity than ST based on the following measures of linguistic complexity: a) Mean length of utterance (in words) (MLU)? b) Type/token ratio (TTR)? c) Number of different words (NDW)? d) Percent of utterance responses? e) Percent of simple utterances? f) Percent of complex utterances? g) Propositional density? 2. Does ST lead to improved efficiency of conversation? 3. Does CT lead to improved efficiency of conversation? 4. Is conversational efficiency different when ST is compared to CT? 5. Is there a difference between clinician and participant total talk time during conversation probes taken during both treatments

Comparing the Treatment Effectiveness of Conversational and Traditional Aphasia Treatments Based on Conversational Outcome Measures

Background: Few studies have investigated conversation therapy between a person with aphasia and a clinician. Furthermore, little information exists on traditional stimulation treatment’s effect on conversational outcomes. Methods: Prospective single-subject (ABABA) study repeated across 4 participants, with quasi-randomized treatment order, investigated the treatment effects of conversation and traditional stimulation treatments on conversational outcomes. Primary outcomes included 6-minute conversations coded for pragmatic behaviors, percent CIUs; and auditory comprehension, lexical retrieval, and syntax probe performance. Results: Conversational abilities were highest during conversation therapy regardless which treatment was administered first. These results provide a template for conducting and measuring conversational therapy

Examining the Item-level Psychometric Properties of the Self-Efficacy Questionnaire (SEQ) for Students in Communication Sciences and Disorders

The purpose of this study was to examine the psychometric properties of the Self-Efficacy Questionnaire (SEQ), a self-reported questionnaire using Rasch analysis, a one-parameter logistic probability model based on scientific measurement principles. Rasch analysis was completed using the rating scale model. The various analyses allow researchers to examine the item-level psychometric properties of the SEQ, which result in measures that provide evidence for validity, reliability, and sensitivity of the instrument. Rasch analysis demonstrated that the latent trait established by the SEQ, Perceived Self-efficacy (called self-efficacy from here on), was a unidimensional construct that could be measured on a linear scale. The instrument demonstrated sound item-level psychometric properties, including a wide span of item difficulty, along with limited ceiling and no floor effects. Person reliability was good, and the SEQ separated raters into at least three statistically different levels of self-efficacy. These results provide evidence for the SEQ\u27s validity, reliability, and sensitivity. Based on this preliminary analysis, the SEQ demonstrated more than adequate item-level psychometric properties for use, although more research needs to be done. Further, instructors could use the SEQ to give preliminary information on whether or not a class assignment leads to increased self-efficacy in undergraduate and graduate students

Clinical Utility of the Two-Factor FOQ-A Based on Item-Level Psychometric Analysis

Introduction: Exploratory factor analysis of the Functional Outcome Questionnaire for Aphasia (FOQ-A) revealed two factors. We sought to determine the item level psychometrics of the two-factor FOQ-A using Rasch analysis and develop computer scoring to enhance its clinical utility. Method: 127 FOQ-A caregiver ratings were retrieved from an approved research database and analyzed using Winsteps. Results: The two-factor FOQ-A demonstrated sound psychometric properties. Item difficulty/person ability were calibrated on interval scales. Conclusions: Results provide further evidence for the FOQ-A’s validity. Item difficulty calibrated on interval scales provide guidance for treatment planning and computer scoring allows efficient documentation of functional change

Item Response Theory Analysis of the Western Aphasia Battery

The purpose of this investigation was to improve the validity of the Western Aphasia Battery for measuring aphasia severity and change over time by examining its fit to an item response theory (IRT) measurement model. The advantages of IRT include interval scaling, potential for equating scores across aphasia tests, and more veridical reporting of score reliability. Despite reasonable overall fit to the model, a small number of WAB items demonstrated substantial misfit, suggesting that they do not productively contribute to the measurement of aphasia severity. Potential explanations for this misfit, and implications of IRT for aphasia testing will be discussed

Measurement Properties of the Functional Outcomes Questionnaire for Aphasia

Aphasia often results in negative social, emotional, and financial consequences endorsing rehabilitation efforts that influence communication beyond the level of impairment. The FOQ-A assesses the impact of aphasia treatment on functional communication, extending measurement into activity and participation. The purpose of this study is to evaluate the measurement properties of the FOQ-A in a sample of 127 individuals with moderate to severe aphasia subsequent to stroke. Results of Rasch analysis indicate that the FOQ-A is unidimensional, has good internal consistency, and contains adequate person separation for measuring change after rehabilitation; however, revisions to the scale may improve its usefulness

Development of a Social Communication construct for a Computerized Adaptive Measure of Functional Cognition for Traumatic Brain Injury

The study investigated the item-level psychometrics of the Social Communication (SC) construct, one of six constructs that comprise the Computer Adaptive Measure of Functional Cognition for Traumatic Brain Injury (TBI) (CAMFC-TBI). Sixty-nine individuals with TBI (outpatients and 1-year post injury) and 68 caregivers participated. Rasch analysis demonstrated that the SC had sound psychometrics for both groups. Items conformed to the theoretical difficulty hierarchy. Person reliability (comparable to Cronbach’s alpha) was high. Respondents were separated into at least 3 significantly different ability levels. Differential item functioning showed no statistically significant differences between patients and caregivers. These results are promising for inclusion of the SC items in the CAMFC-TBI

Objective measurement of vocal parameters in older people with and without Parkinson\u27s disease in their natural environments: a pilot study

Purpose: The purpose of this study was to explore whether significant differences existed in mean amplitude and total phonation time between a group of older individuals with idiopathic Parkinson’s disease (PD) and an age- and gender-matched control group (NO PD) in their natural environments, based on data collected by the ambulatory phonation monitor (APM; KayPENTAX). Method: In this prospective, between-groups study, 5 individuals with PD and 5 NO PD controls wore the APM on 3 typical 8-hr days. The dependent variables included mean amplitude and total phonation time as measured by the APM. All of the participants also completed a self-estimated talk time log and an APM- use questionnaire. Data analysis included descriptive statistics and a repeated measures analysis of variance. Results: The NO PD group exhibited significantly higher mean amplitudes than the group with PD. The 2 groups did not differ in total phonation time. The group with PD significantly overestimated talk time compared to the NO PD group. Conclusion: These preliminary data suggest that the APM may be used to objectively measure specific vocal parameters in a person’s natural communica- tion environment. However, larger sample sizes are needed to better understand the device’s usefulness

Identifying an Appropriate Picture Stimulus for a Bangla Picture Description Task

The absence of culture- and language-specific aphasia assessment in Bangla underscores a critical problem in communication sciences and disorders. Aphasia occurs in ~41% of Bangla-speaking stroke survivors. In the past 40 years, stroke incidence has doubled in low- and middle-income countries, such as Bangladesh and India, where there are ~250 million native Bangla speakers. This study aims to initiate the first step toward identifying an appropriate picture stimulus for the Bangla picture description task (PDT) intended for inclusion in a Bangla aphasia assessment. Researchers have reported the importance of cultural relevance and three visuographic variables of a picture (high-context, color, and photograph vs. black-and-white line drawing) for faster comprehension and comprehensive language production in people with aphasia and neurologically healthy adults

Are People With Poststroke Aphasia Receptive to Transcranial Direct Current Stimulation? A Survey

PURPOSE: The objective of this study was to explore receptiveness of people with poststroke aphasia to receiving transcranial direct current stimulation (tDCS), including preferences for the treatment setting and schedule of tDCS delivery. METHOD: An online survey was distributed via e-mail, flyers, social media, and online newsletters to reach people with aphasia. Fisher's exact test examined the relationship of self-reported tDCS receptiveness to demographic, clinical, and other factors. RESULTS: Fifty-seven surveys were returned, and 50 complete surveys were analyzed. Twenty-eight percent of respondents had previously heard of tDCS. Sixty-six percent reported they would receive tDCS if it could help their aphasia, and only 6% reported that they definitely would not. There were statistically significant relationships between being receptive to tDCS and (a) not currently working, (b) being receptive to speech-language therapy, and (c) greater acceptance of potential temporary risks associated with tDCS. Most individuals (73%) who would consider tDCS were equivalently open to receiving it in the clinic or at home, yet the majority (64%) were open to more frequent sessions at home than in the clinic. Most respondents indicated that they would consider having tDCS “forever if it helped” (clinic: 51%; home: 68%). CONCLUSIONS: This is the first study to query individuals with aphasia about their receptiveness to tDCS outside the context of an intervention study. Responses suggest that a large majority of people with poststroke aphasia might be open to receiving tDCS if it can ameliorate their aphasia. Limitations include the small sample size, which does not adequately represent the broader population of people with aphasia, and that the survey did not provide the level of tDCS education crucial to inform shared decision making and person-centered care. However, future work may benefit from considering the practical implications of research designs (e.g., high intensity treatment outside the home) that may not, in application, be widely acceptable to primary stakeholders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.1961177