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

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

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

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

Vocal acoustic analysis as a biometric indicator of information processing: Implications for neurological and psychiatric disorders

Vocal expression reflects an integral component of communication that varies considerably within individuals across contexts and is disrupted in a range of neurological and psychiatric disorders. There is reason to suspect that variability in vocal expression reflects, in part, the availability of “on-line” resources (e.g., working memory, attention). Thus, understanding vocal expression is a potentially important biometric index of information processing, not only across but within individuals over time. A first step in this line of research involves establishing a link between vocal expression and information processing systems in healthy adults. The present study employed a dual attention experimental task where participants provided natural speech while simultaneously engaged in a baseline, medium or high nonverbal processing-load task. Objective, automated, computerized analysis was employed to measure vocal expression in 226 adults. Increased processing load resulted in longer pauses, fewer utterances, greater silence overall and less variability in frequency and intensity levels. These results provide compelling evidence of a link between information processing resources and vocal expression, and provide important information for the development of an automated, inexpensive and uninvasive biometric measure of information processing