Measuring the coherence of healthy and aphasic discourse production in Chinese using Rhetorical Structure Theory (RST)

INTRODUCTION: Discourse coherence refers to the semantic connectedness of propositions in a connected speech. Various theoretical bases, narrative elicitation tasks, and sample quantifications as well as small sample sizes in most studies resulted in a substantial disparity in findings regarding the micro-linguistic and macro-linguistic aspects of aphasic discourse (Armstrong, 2000). Specifically, while some reports claimed macro-linguistic skills in aphasia to be well-preserved despite lexical, grammatical, and phonological impairments, other studies demonstrated reduced discourse coherence due to omission of important content and higher proportion of irrelevant propositions. In this study we analyzed the discourse structure in aphasic ...postprin

Complex speech-language therapy interventions for stroke-related aphasia: The RELEASE study incorporating a systematic review and individual participant data network meta-analysis

Background: People with language problems following stroke (aphasia) benefit from speech and language therapy. Optimising speech and language therapy for aphasia recovery is a research priority. Objectives: The objectives were to explore patterns and predictors of language and communication recovery, optimum speech and language therapy intervention provision, and whether or not effectiveness varies by participant subgroup or language domain. Design: This research comprised a systematic review, a meta-analysis and a network meta-analysis of individual participant data. Setting: Participant data were collected in research and clinical settings. Interventions: The intervention under investigation was speech and language therapy for aphasia after stroke. Main outcome measures: The main outcome measures were absolute changes in language scores from baseline on overall language ability, auditory comprehension, spoken language, reading comprehension, writing and functional communication. Data sources and participants: Electronic databases were systematically searched, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Linguistic and Language Behavior Abstracts and SpeechBITE (searched from inception to 2015). The results were screened for eligibility, and published and unpublished data sets (randomised controlled trials, non-randomised controlled trials, cohort studies, case series, registries) with at least 10 individual participant data reporting aphasia duration and severity were identified. Existing collaborators and primary researchers named in identified records were invited to contribute electronic data sets. Individual participant data in the public domain were extracted. Review methods: Data on demographics, speech and language therapy interventions, outcomes and quality criteria were independently extracted by two reviewers, or available as individual participant data data sets. Meta-analysis and network meta-analysis were used to generate hypotheses. Results: We retrieved 5928 individual participant data from 174 data sets across 28 countries, comprising 75 electronic (3940 individual participant data), 47 randomised controlled trial (1778 individual participant data) and 91 speech and language therapy intervention (2746 individual participant data) data sets. The median participant age was 63 years (interquartile range 53-72 years). We identified 53 unavailable, but potentially eligible, randomised controlled trials (46 of these appeared to include speech and language therapy). Relevant individual participant data were filtered into each analysis. Statistically significant predictors of recovery included age (functional communication, individual participant data: 532, n = 14 randomised controlled trials) and sex (overall language ability, individual participant data: 482, n = 11 randomised controlled trials; functional communication, individual participant data: 532, n = 14 randomised controlled trials). Older age and being a longer time since aphasia onset predicted poorer recovery. A negative relationship between baseline severity score and change from baseline (p < 0.0001) may reflect the reduced improvement possible from high baseline scores. The frequency, duration, intensity and dosage of speech and language therapy were variously associated with auditory comprehension, naming and functional communication recovery. There were insufficient data to examine spontaneous recovery. The greatest overall gains in language ability [14.95 points (95% confidence interval 8.7 to 21.2 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.78 points (95% confidence interval 0.48 to 1.1 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with receiving speech and language therapy 4 to 5 days weekly; for auditory comprehension [5.86 points (95% confidence interval 1.6 to 10.0 points) on the Aachen Aphasia Test-Token Test], the greatest gains were associated with receiving speech and language therapy 3 to 4 days weekly. The greatest overall gains in language ability [15.9 points (95% confidence interval 8.0 to 23.6 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.77 points (95% confidence interval 0.36 to 1.2 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with speech and language therapy participation from 2 to 4 (and more than 9) hours weekly, whereas the highest auditory comprehension gains [7.3 points (95% confidence interval 4.1 to 10.5 points) on the Aachen Aphasia Test-Token Test] were associated with speech and language therapy participation in excess of 9 hours weekly (with similar gains notes for 4 hours weekly). While clinically similar gains were made alongside different speech and language therapy intensities, the greatest overall gains in language ability [18.37 points (95% confidence interval 10.58 to 26.16 points) on the Western Aphasia Battery-Aphasia Quotient] and auditory comprehension [5.23 points (95% confidence interval 1.51 to 8.95 points) on the Aachen Aphasia Test-Token Test] were associated with 20-50 hours of speech and language therapy. Network meta-analyses on naming and the duration of speech and language therapy interventions across language outcomes were unstable. Relative variance was acceptable (< 30%). Subgroups may benefit from specific interventions. Limitations: Data sets were graded as being at a low risk of bias but were predominantly based on highly selected research participants, assessments and interventions, thereby limiting generalisability. Conclusions: Frequency, intensity and dosage were associated with language gains from baseline, but varied by domain and subgroup

Use of the BAT with a Cantonese-Putonghua speaker with aphasia

The aim of this article is to illustrate the use of the Bilingual Aphasia Test (BAT) with a Cantonese-Putonghua speaker. We describe G, who is a relatively young Chinese bilingual speaker with aphasia. G's communication abilities in his L2, Putonghua, were impaired following brain damage. This impairment caused specific difficulties in communication with his wife, a native Putonghua speaker, and was thus a priority for investigation. Given a paucity of standardised tests of aphasia in Putonghua, our goal was to use the BAT to assess G's impairments in his L2. Results showed that G's performance on the BAT subtests measuring word and sentence comprehension and production was impaired. His pattern of performance on the BAT allowed us to generate hypotheses about his higher-level language impairments in Putonghua, which were subsequently found to be impaired. We argue that the BAT is able to capture the primary language impairments in Chinese-speaking patients with aphasia when Putonghua is the second language. We also suggest some modifications to the BAT for testing Chinese-speaking patients with bilingual aphasia. © 2011 Informa UK, Ltd.link_to_subscribed_fulltex

A Cantonese Linguistic Communication Measure for Evaluating Aphasic Narrative Production: Normative and Preliminary Aphasic Data

This paper describes the use of a Cantonese linguistic communication measure (CLCM) to quantify narrative production of Cantonese aphasic speakers. Four new pictures containing local characteristics were developed, including revised pictures from the BDAE (Goodglass and Kaplan, 1993), WAB (Kertesz, 1982) and its Cantonese version (Yiu, 1992), and a picture depicting a Chinese restaurant. The development of pictorial stimuli was motivated by the lack of culturally appropriate pictures for eliciting speech from Cantonese speakers. The CLCM contains eight indices reflecting the amount, efficiency, and rate of information conveyed, the grammaticality and extent of elaboration of sentences produced, as well as the degree of error production and lexical diversity in the speech output. Normative data from 30 native Cantonese speakers were collected. Results of preliminary pathological data from 10 Cantonese aphasic patients revealed significant differences between normal and aphasic speakers on most of the indices

A linguistic communication measure for monitoring changes in Chinese aphasic narrative production

This study investigated the usefulness of the Cantonese Linguistic Communication Measure (CLCM) in monitoring changes of narrative production in five Chinese adults with aphasia in the period of spontaneous recovery (SR group) and four who underwent anomia therapies (Tx group). Language samples elicited from a picture description task were collected among SR participants at regular intervals within the first 6 months post-onset and among Tx participants before and after treatment. Results showed that the CLCM indices could reflect changes of language production in these individuals over time. The changes of index values were consistent with the expectations of performance during early stages after stroke for the SR participants and treatment outcomes of the Tx participants. While the CLCM has previously been shown to be useful in measuring aphasic narratives on a single occasion, this study has provided further evidence of its capability to monitor changes of language production over time.link_to_subscribed_fulltex

Using the Cantonese linguistic communication measure to monitor changes of narrative production in aphasic patients

link_to_subscribed_fulltex

External validation of the Cantonese linguistic communication measure

link_to_subscribed_fulltex

Can co-verbal gestures facilitate word finding difficulties during production of spontaneous discourse?

Poster 3: Discours

An investigation of the use of co-verbal gestures in oral discourse among Chinese speakers with fluent versus non-fluent aphasia and healthy adults

Poster Session 3: no. 9Gesture refers to the arm and hand movements that synchronize with speech (McNeill, 1992). They can facilitate word production among persons with aphasia (PWA) (Rose, Douglas, & Matyas, 2002) and play a communicative role for PWA to convey ideas (Sekine & Rose, 2013). Kong, Law, Kwan, Lai, and Lam (2015) reported a systematic approach to independently analyze gesture forms and functions in spontaneous oral discourse produced by 119 unimpaired speakers. In particular, there were six specific forms of gestures, modified based on McNeill’s (1992) classification, including: (1) iconic gestures (hand movements related to semantic content of the speech), (2) metaphoric gestures (hand movements that show pictorial content but with abstract idea), (3) deictic gestures (pointing movements that indicate objects in conversational space), (4) emblems (gestures with standard of well-formed properties and language-like features in a specific culture, such as the OK sign), (5) beats (hand movements along with rhythmical pulsation of speech), and (6) non-identifiable gestures (uncodable gestures due to ambiguity or visual obstruction). The first four forms were considered as content-carrying gestures, while the latter two were non-content-carrying. Eight functions of gestures, adopted from several previous studies, were also proposed. They included (1) providing additional information to message conveyed (Goldin-Meadow, 2003), (2) enhancing the speech content (Beattie & Shovelton, 2000), (3) providing alternative means of communication (Le May, David, & Thomas, 1988), (4) guiding and controlling the flow of speech (Jacobs & Garnham, 2007), (5) reinforcing the intonation or prosody of speech, (6) assisting lexical retrieval (Krauss & Hadar, 1999), (7) assisting sentence re-construction (Alibali, Kita, & Younhg, 2000), and (8) no specific function. Using the above gesture annotation framework, Kong, Law, Wat, & Lai (2013) compared speech-accompanying gestures used by PWA and unimpaired speakers in oral discourse tasks. It was found that PWA used significantly more gestures per word than controls. There were a higher proportion of content-carrying gestures in PWA, which functioned mainly to enhance speech content. A negative correlation between aphasia quotients and frequency of gesture use was reported, suggesting speakers with more severe aphasia used more co-verbal gestures. Moreover, PWA who produced a higher percentage of complete sentences or simple sentences in their narratives tended to use fewer gestures. Finally, verbal-semantic processing impairment, but not the degree of hemiplegia, was found to affect the employment of gestures in aphasia.link_to_OA_fulltex

Naming and discourse production: a bilingual case study

link_to_subscribed_fulltex