Main Concepts for Two Picture Description Tasks: An Addition to Richardson and Dalton, 2016

Background: Proposition analysis of the discourse of persons with aphasia (PWAs) has a long history, yielding important advancements in our understanding of communication impairments in this population. Recently, discourse measures have been considered primary outcome measures, and multiple calls have been made for improved psychometric properties of discourse measures. Aims: To advance the use of discourse analysis in PWAs by providing Main Concept Analysis checklists and descriptive statistics for healthy control performance on the analysis for the Cat in the Tree and Refused Umbrella narrative tasks utilized in the AphasiaBank database protocol. Methods & Procedures: Ninety-two control transcripts, stratified into four age groups (20–39 years; 40–59; 60–79; 80+), were downloaded from the AphasiaBank database. Relevant concepts were identified, and those spoken by at least one-third of the control sample were considered to be a main concept (MC). A multilevel coding system was used to determine the accuracy and completeness of the MCs produced by control speakers. Outcomes & Results: MC checklists for two discourse tasks are provided. Descriptive statistics are reported and examined to assist readers with evaluation of the normative data. Conclusions: These checklists provide clinicians and researchers with a tool to reliably assess the discourse of PWAs. They also help address the gap in available psychometric data with which to compare PWAs to healthy controls

A Large-Scale Comparison of Main Concept Production Between Persons with Aphasia and Persons Without Brain Injury

Purpose: The purposes of this study are to provide clinicians and researchers with introductory psychometric data for the main concept analysis (MCA), a measure of discourse informativeness, and specifically, to provide descriptive and comparative statistical information about the performance of a large sample of persons not brain injured (PNBIs) and persons with aphasia (PWAs) on AphasiaBank discourse tasks. Method: Transcripts of 5 semi-spontaneous discourse tasks were retrieved from the AphasiaBank database and scored according to detailed checklists and scoring procedures. Transcripts from 145 PNBIs and 238 PWAs were scored; descriptive statistics, median tests, and effect sizes are reported. Results: PWAs demonstrated overall lower informativeness scores and more frequent production of statements that were inaccurate and/or incomplete. Differences between PNBIs and PWAs were observed for all main concept measures and stories. Comparisons of PNBIs and aphasia subtypes revealed significant differences for all groups, although the pattern of differences and strength of effect sizes varied by group and discourse task. Conclusions: These results may improve the investigative and clinical utility of the MCA by providing descriptive and comparative information for PNBIs and PWAs for standardized discourse tasks that can be reliably scored. The results indicate that the MCA is sensitive to differences in discourse as a result of aphasia

Moving Toward Non-transcription Based Discourse Analysis in Stable and Progressive Aphasia

Measurement of communication ability at the discourse level holds promise for predicting how well persons with stable (e.g., stroke-induced), or progressive aphasia navigate everyday communicative interactions. However, barriers to the clinical utilization of discourse measures have persisted. Recent advancements in the standardization of elicitation protocols and the existence of large databases for development of normative references have begun to address some of these barriers. Still, time remains a consistently reported barrier by clinicians. Non-transcription based discourse measurement would reduce the time required for discourse analysis, making clinical utilization a reality. The purpose of this article is to present evidence regarding discourse measures (main concept analysis, core lexicon, and derived efficiency scores) that are well suited to non-transcription based analysis. Combined with previous research, our results suggest that these measures are sensitive to changes following stroke or neurodegenerative disease. Given the evidence, further research specifically assessing the reliability of these measures in clinical implementation is warranted

A Compendium of Core Lexicon Checklists

Core Lexicon (CoreLex) is a relatively new approach assessing lexical use in discourse. CoreLex examines the specific lexical items used to tell a story, or how typical lexical items are compared with a normative sample. This method has great potential for clinical utilization because CoreLex measures are fast, easy to administer, and correlate with microlinguistic and macrolinguistic discourse measures. The purpose of this article is to provide clinicians with a centralized resource for currently available CoreLex checklists, including information regarding development, norms, and guidelines for use

Main Concept Production in Persons with Aphasia: A Comparison of Subtypes

Narrative abilities are negatively impacted in persons with aphasia (PWAs), with even the mildest PWAs producing narratives that, though well-structured, are characterized by reduced lexical diversity, complexity, content, length, coherence, and more (e.g., Andreetta, Cantagallo, & Marini, 2012; Capilouto, Wright, and Wagovich, 2006; Fergadiotis & Wright, 2011; Nicholas & Brookshire, 1995; Ulatowska, North, & Macaluso-Haynes, 1981). Even those categorized as “not aphasic by WAB” (NABW) produce significantly different story retell narratives compared to typical and aphasic peers (Author2, Dillow, & Author1, 2013). Diminished narrative abilities, and associated reduced functional communication, have a marked negative impact on quality of life (QoL) in PWAs, more so than physical limitations that accompany stroke (Hilari, 2011; Northcott & Hilari, 2011). Indeed, narrative ability may be a better predictor of life participation and QoL than traditionally administered outcome measures (Ross & Wertz, 1999), making imperative the advancement of narrative assessment and treatment. Three primary barriers to narrative assessment impede widespread use - standardization, norm-reference, and time constraints. AphasiaBank developers (http://talkbank.org/AphasiaBank/) addressed the first barrier by making available a standard discourse protocol. Regarding the second barrier, norm-referenced Main Concept (MC) lists based on 150+ control transcripts for three different types of discourse were recently developed using AphasiaBank (Author2, Campbell, Williams, Dillow, & Author1, 2013). The MC lists included concepts spoken by 50% of the control population. The authors elected to develop MC lists primarily because 1) MC analysis is a reliable and valid method of assessing narrative adequacy in PWAs (Nicholas & Brookshire, 1995), and 2) generation of standardized, norm-referenced, non-transcription-based MC lists would reduce the amount of time required for narrative assessment (third barrier). Previous MC research has revealed differences between controls and PWAs, and between fluent and non-fluent PWAs (Kong, 2009, 2011; Nicholas & Brookshire, 1995). Previous MC studies have also combined certain codes (see Discussion), which may lead to inaccurate representation of communicative abilities and/or masking of differences between subtypes. We extracted lengthy narrative samples of a large group of PWAs and analyzed the samples with a multi-level MC coding system using norm-referenced MCs in order to determine 1) if there were significant differences in MC production between different aphasia subtypes, and 2) if so, which subtypes were significantly different from each othe

Core Lexicon and Main Concept Production during Picture Description

Discourse is a highly complex and individualized communication act wherein individuals not only transmit and receive information for survival and cooperation, but also use spoken language for ritual purposes (e.g., relationships, fellowship, co-participation; Carey, 1988; Dimbleby & Burton, 1998). Discourse in typical and clinical populations has been investigated with a variety of structuralist, functionalist, and hybrid techniques (see Armstrong, 2000), and is known to be a good predictor of quality of life and life participation in persons with aphasia (PWAs). Discourse analysis, however, generally requires specialized training and can be time-consuming. MacWhinney, Fromm Holland, Forbes, & Wright (2010) suggested that analysis of a core lexicon during structured narrative tasks could provide a time-efficient and informative index of functional communication abilities. For example, clinicians could bypass lengthy transcriptions, instead generating a list of words spoken during narration for later comparison to a core lexicon (CoreLex). Using various methods, CoreLex has so far been investigated for the Cinderella story, a monologic story retell narrative task (Author1, Dillow, & Author2, 2013; MacWhinney et al., 2010) and a procedural narrative task where patients describe how to make a PB&J sandwich (Fromm, Forbes, Holland, & MacWhinney, 2013). CoreLex performance is strongly correlated with main concept (MC) production, a measure of narrative adequacy, during Cinderella retelling (Author1, Dillow, & Author2, 2013). Similar investigations for other narrative tasks are needed. The aims of this study were to 1) determine the CoreLex of a picture sequence description task included in the AphasiaBank protocol (Breaking Window), 2) calculate a CoreLex score for controls and PWAs, and 3) determine how well CoreLex predicts narrative adequacy, as judged by MC analysis

Story Grammar Analysis in Persons with Mild Aphasia

Narratives are often the basis of daily conversational interactions. When narrative skills are compromised, functional conversation is negatively impacted. Narrative coherence can be impacted even in clinical populations with mild word-finding deficits, such as anomic aphasia (Andreetta, Cantagallo, & Marini, 2012). The narrative abilities of those individuals who have had a stroke (and perhaps a previous aphasia diagnosis) but who perform within the normal range on standardized aphasia assessment measures have not been characterized. As every clinician/clinical researcher knows, this subgroup still includes individuals who have difficulty in conversation, who cannot return to work, and whose life participation is negatively impacted. Using AphasiaBank categorization (as this study relies on AphasiaBank transcripts), we refer to this subgroup as “not aphasic by WAB” (NABW). In both persons with anomic aphasia (PWaAs) and NABWs, deficits may be so minor that they are not apparent on traditional standardized assessment measures, but it should not be assumed that they do not exist and do not affect functional communication abilities. Unfortunately, there is often very little help to be offered for this population. In order to continue progressive development of interventions for PWaAs and NABWs, more information regarding narrative strengths and weaknesses in this population is needed. Story grammar analysis is a well-known method of analyzing narrative discourse in several clinical populations and is likely to be sensitive to differences between closely matched groups. The specific aims of this study are to 1) determine if there are differences between PWaAs, NABW, and non-brain injured controls (NBIs) on production of story grammar components during retelling of the Cinderella story, and 2) to examine the relationship between story grammar measures and an easily and quickly derived discourse measure called CoreLex to further characterize the relationship between micro- and macro-level processes in persons with mild aphasia

Spectral Resting-State EEG (rsEEG) in Chronic Aphasia Is Reliable, Sensitive, and Correlates With Functional Behavior

We investigated spectral resting-state EEG in persons with chronic stroke-induced aphasia to determine its reliability, sensitivity, and relationship to functional behaviors. Resting-state EEG has not yet been characterized in this population and was selected given the demonstrated potential of resting-state investigations using other neuroimaging techniques to guide clinical decision-making. Controls and persons with chronic stroke-induced aphasia completed two EEG recording sessions, separated by approximately 1 month, as well as behavioral assessments of language, sensorimotor, and cognitive domains. Power in the classic frequency bands (delta, theta, alpha, and beta) was examined via spectral analysis of resting-state EEG data. Results suggest that power in the theta, alpha, and beta bands is reliable for use as a repeated measure. Significantly greater theta and lower beta power was observed in persons with aphasia (PWAs) than controls. Finally, in PWAs theta power negatively correlated with performance on a discourse informativeness measure, while alpha and beta power positively correlated with performance on the same measure. This indicates that spectral rsEEG slowing observed in PWAs in the chronic stage is pathological and suggests a possible avenue for directly altering brain activation to improve behavioral function. Taken together, these results suggest that spectral resting-state EEG holds promise for sensitive measurement of functioning and change in persons with chronic aphasia. Future studies investigating the utility of these measures as biomarkers of frank or latent aphasic deficits and treatment response in chronic stroke-induced aphasia are warranted

Perceptually Salient Sound Distortions and Apraxia of Speech: A Performance Continuum

We sought to characterize articulatory distortions in apraxia of speech and aphasia with phonemic paraphasia and to evaluate the diagnostic validity of error frequency of distortion and distorted substitution in differentiating between these disorders

Macrostructural Analyses of Cinderella Narratives in a Large Nonclinical Sample

Purpose: Macrostructural narrative analyses are important clinical measures, revealing age-related declines and disorder-related impairments in the accuracy, completeness, logical sequencing, and organization of content. The current study aims to provide preliminary data on typical aging and psychometric evidence supporting multilevel Main Concept, Sequencing, and Story Grammar (MSSG) analyses that capture these aspects of narratives. Method: Transcripts of Cinderella narratives for 92 healthy control participants stratified across four age brackets from the online database AphasiaBank were coded by Richardson and Dalton (2016) for main concept (MC) analysis. In the current study, MSSG analyses were completed for (a) logical sequencing, independently and in combination with Mc accuracy and completeness (MC + sequencing), and (b) story grammar organization (i.e., inclusion of episodic components and complexity of episodes). Interrater agreement (99%-100%) revealed highly reliable scoring. Results: Descriptive statistics for the typically aging sample are presented for sequencing, MC + sequencing, total episodic components, and episodic complexity. Scores for participants over 60 years of age were lower (poorer) than scores for those 20-59 years of age, supporting the construct validity of score use for identifying age-related declines in performance. Conclusions: This study\u27s novel MSSG analyses of narrative production efficiently assess the logical sequencing and story grammar organization of content in healthy controls. Preliminary reliability and validity evidence support the use of all scores to measure age-related changes in narrative macrostructure. Data from this typically aging sample provide a foundation for future research and clinical assessment aimed at quantifying narrative deficits in adults with communication disorders