Examining inhibition during spoken word production in aphasia

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Effects of Phonomotor Treatment on the Reading Abilities of Individuals with Aphasia and Phonological Alexia

A left hemisphere stroke often results in aphasia characterized by impaired reading (Cherney, 2004; Webb & Love, 1983) and phonological processing abilities (Blumstein, Baker, & Goodglass, 1977; den Ouden & Bastiaanse, 2005). Research has shown that treatment focused at the level of the phoneme improves reading abilities in persons with aphasia (PWA) and phonological alexia (Conway et al., 1998; Kendall et al., 1998; Kendall et al., 2003). These findings are theoretically supported by a connectionist model of phonology (Nadeau, 2001), and a multimodal model of phonological processing and reading (Alexander & Slinger, 2004)

Using error type on confrontation naming as an indicator of improved linguistic processing following phonomotor treatment

This paper presents initial data on the influence of phonomotor treatment on word retrieval accuracy and error type from pre- and post-treatment confrontation naming probe responses produced by 10 individuals with aphasia. This study is part of a Phase II clinical rehabilitation research program which trains real- and non-words, comprised of low phonotactic probability and high neighborhood density phoneme sequences, to improve word retrieval in 30 subjects with left hemisphere lesion and aphasia. The treatment program is a logical advance on existing Phase I and Phase II clinical rehabilitation research (Kendall et al 2003, Kendall et al 2006a, Kendall et al 2006b, Kendall et al 2006c, Kendall et al 2008) and is motivated by a parallel distributed processing model of phonology (Nadeau, 2001)

Modifying and validating a measure of chronic stress for people with aphasia

PURPOSE : Chronic stress is likely a common experience among people with the language impairment of aphasia. Importantly, chronic stress reportedly alters the neural networks central to learning and memory—essential ingredients of aphasia rehabilitation. Before we can explore the influence of chronic stress on rehabilitation outcomes, we must be able to measure chronic stress in this population. The purpose of this study was to (a) modify a widely used measure of chronic stress (Perceived Stress Scale [PSS]; Cohen & Janicki-Deverts, 2012) to fit the communication needs of people with aphasia (PWA) and (b) validate the modified PSS (mPSS) with PWA. METHOD : Following systematic modification of the PSS (with permission), 72 PWA completed the validation portion of the study. Each participant completed the mPSS, measures of depression, anxiety, and resilience, and provided a sample of the stress hormone cortisol extracted from the hair. Pearson's product–moment correlations were used to examine associations between mPSS scores and these measures. Approximately 30% of participants completed the mPSS 1 week later to establish test–retest reliability, analyzed using an interclass correlation coefficient. RESULTS : Significant positive correlations were evident between the reports of chronic stress and depression and anxiety. In addition, a significant inverse correlation was found between reports of chronic stress and resilience. The mPSS also showed evidence of test–retest reliability. No association was found between mPSS score and cortisol level. CONCLUSION : Although questions remain about the biological correlates of chronic stress in people with poststroke aphasia, significant associations between chronic stress and several psychosocial variables provide evidence of validity of this emerging measure of chronic stress.VA Rehabilitation Research & Development Career Development Award (1IK1RX001934).http://jslhr.pubs.asha.orghj2019Speech-Language Pathology and Audiolog

Exploring associations between a biological marker of chronic stress and reported depression and anxiety in people with aphasia

PURPOSE : Living with the communication impairment of aphasia can be stressful. Chronic stress, depression, and anxiety are intimately linked, may be more pervasive in people with poststroke aphasia than the general population, and may influence cognitive function and treatment outcomes. In this project, we explored the psychological constructs of depression and anxiety and their associations with a biomarker measure of chronic stress in people with aphasia. METHOD : Fifty-seven participants with aphasia completed measures of depression and anxiety and provided a hair sample from which to extract the stress hormone cortisol. Pearson product–moment correlational analyses were used to identify associations between depression, anxiety, and long-term level of cortisol via hair sample. RESULTS : While cortisol level was not associated with depression and anxiety across this sample of people with aphasia, a post hoc analysis showed a significant, positive correlation between a subset of participants with moderate and higher levels of depression and elevated cortisol level. CONCLUSIONS : Chronic stress, depression, and anxiety have been little explored in people with aphasia to date, yet they are associated with future health consequences and impaired cognitive function, motivating further research as well as consideration of these factors in aphasia rehabilitation.VA Rehabilitation Research and Developmenthttps://pubs.asha.org/journal/jslhrgl2020Speech-Language Pathology and Audiolog

Exploring the relationship between high level anomia, attention and automatic vs. controlled processing: a retrospective data analysis

This retrospective data analysis examined non-linguistic, cognitive functions that may play a role in mild anomia: selective attention and automatic vs. controlled processing. Participants with mild anomia and typical controls were tested using the Covert Orienting of Visuospatial Attention Test, alone and with linguistic interference, at two ISIs representing automatic and controlled processing. Participants with anomia showed deficits in automatic but not controlled processing on the COVAT alone, and deficits in selective attention on the COVAT with interference. Results suggest these cognitive abilities should be assessed in individuals reporting anomia who score near or within normal limits on language assessments

Varieties of linguistic complexity in a standardized assessment of language performance

This study examined the comprehension of linguistically complex sentences among unimpaired adults and adults with aphasia. Participants completed a self-paced reading version of the Computerized Revised Token Test (CRTT-R) containing passive sentences, sentences with adverbial clauses, and sentences with discontinuous adjective-noun dependencies. Off-line measures revealed clear effects of linguistic complexity for passive and discontinuous-dependency sentences, with more complex sentences eliciting lower scores for impaired and aphasic groups, but not for sentences with adverbial clauses. In contrast, on-line measures revealed the opposite pattern: less complex sentences elicited slower reading times. Off-line measures appear more sensitive to linguistic complexity in this task

Evolution of aphasic naming errors following phonomotor treatment

The primary outcome measures for aphasia treatment investigations targeting anomia typically include naming accuracy of trained and untrained words. Recently, several treatment investigations have also included error analyses that closely look at the way in which word retrieval breaks down pre-treatment vs. post-treatment (Gordon, 2007; Kendall, Pompon, Brookshire, Minkina, & Bislick, 2013; Kiran & Johnson, 2008, Kiran & Thompson, 2003). In one such analysis, Kendall et al. (2013) investigated treatment-induced changes in aphasic naming errors following a phonomotor treatment for anomia. The study was rooted in an interactive two-stage model of word retrieval, in which world retrieval is initiated with activation of semantic representations, allowing for access of the word’s lemma (which holds grammatical properties), while phonological representations are accessed in the second stage (Dell, 1986). In the analyses of confrontation naming errors in ten people with aphasia, several trends were noted immediately following treatment: a decrease in the proportion of omissions on trained words, and an increase in the proportion of mixed (phonologically and semantically related) errors on untrained words. These results suggested that treatment led to more precise activation of nodes supporting word retrieval. The present study sought to replicate this error proportion analysis in a larger group of participants and expand the analysis to explore changes in raw numbers of errors. The following research questions were asked both for trained and untrained words: Preliminary research question 1) Is there a significant difference between picture naming accuracy pre-treatment vs. immediately post-treatment, and pre-treatment vs. three months post-treatment? Main research questions 2) Is there a significant difference in raw numbers of various error types made during picture naming pre-treatment vs. immediately post-treatment, and pre-treatment vs. three months post-treatment? 3) Is there a significant difference in error type proportions (the number of each error type divided by the total errors made) observed during picture naming pre-treatment vs. immediately post-treatment, and pre-treatment vs. three months post-treatment

Examining inhibition during spoken word production in aphasia

Thesis (Ph.D.)--University of Washington, 2013The nature of selective attention in people with aphasia (PWA) is currently unknown. Selective attention, or our ability to focus on relevant information and ignore distractions, is essential for everyday communication. Inhibition, or suppression of unwanted information, is an important part of selective attention. This study explored components of inhibition in spoken word production in aphasia, a language disorder impacting more than a million people across the U.S. Specifically, this study examined both interference effects and subsequent reactive inhibition, or the carryover suppression of a previous distraction. Nineteen PWA and 20 age- and education-matched controls participated in a spoken word production task involving Stroop and negative priming experimental paradigms. Stroop color-word stimuli were used to evoke interference and facilitation effects as baseline conditions. Stroop stimuli were also used in negative priming prime-probe pairs, where the prime distractor becomes the probe target, a method of testing reactive inhibition. Response latency and accuracy data were recorded for participants. Research questions were addressed by group-by-condition interactions, analyzed via repeated measures ANOVA and nonparametric/Mann-Whitney tests. Results showed that while both groups demonstrated interference effects, the effects were significantly greater for PWA, as reported in previous research. Interestingly, PWA demonstrated no significant facilitation effects; Controls demonstrated significant reverse facilitation effects. This result was interpreted as PWA's inability to take advantage of contextual cues of proportion. Neither group showed statistically significant evidence of inhibitory rebound, though both groups showed surprisingly similar individual variability, suggesting inhibitory rebound for some and repeated interference facilitation for others. Lastly, PWA demonstrated a near-significant response slowing when a congruent probe had just served as prime distractor, potentially indicating diminished conflict adaptation. These results underscore the challenges interference presents for PWA during spoken word production and indicates potentially diminished executive inhibition. However, PWA's automatic/reactive inhibition appears equivalent to controls, and therefore not a contributing factor in word retrieval impairments of aphasia. However, PWA may have difficulty adapting to contextual information compared to their neurologically healthy counterparts. These results provide direction for future research of selective attention in aphasia -- aimed to improve clinical protocols for people with this language impairment

Effects of Phonomotor Treatment on Discourse Production

Background: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with all people with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse. Aims: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment (PMT), on discourse production. Methods & Procedures: Twenty-six PWA participated in 60 h of PMT, which focuses on building a person’s ability to recognize, produce, and manipulate phonemes in progressively longer nonword and real-word contexts. Language samples were collected prior to, immediately after, and 3 months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated. Outcomes & Results: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and 3 months later, as well as significantly improved percent CIUs, relative to baseline, 3 months following treatment. Conclusions: PMT, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production