Anthony Pak-Hin Kong

Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF

Abstract Purpose: To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference. Methods: The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important treatment outcomes from aphasia rehabilitation. People with aphasia identified outcomes for themselves; and family members identified outcomes for themselves and for the person with aphasia. Outcomes were analysed using qualitative content analysis and ICF linking. Results: A total of 39 people with aphasia and 29 family members participated in one of 16 nominal groups. Inductive qualitative content analysis revealed the following six themes: (1) Improved communication; (2) Increased life participation; (3) Changed attitudes through increased awareness and education about aphasia; (4) Recovered normality; (5) Improved physical and emotional well-being; and (6) Improved health (and support) services. Prioritized outcomes for both participant groups linked to all ICF components; primary activity/participation (39%) and body functions (36%) for people with aphasia, and activity/participation (49%) and environmental factors (28%) for family members. Outcomes prioritized by family members relating to the person with aphasia, primarily linked to body functions (60%). Conclusions: People with aphasia and their families identified treatment outcomes which span all components of the ICF. This has implications for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family-centred approach to rehabilitation. These results will be combined with other stakeholder perspectives to establish a core outcome set for aphasia treatment research. Implications for Rehabilitation Important outcomes for people with aphasia and their families span all components of the ICF. The relevancy and translation of research findings may be increased by measuring and reporting research outcomes which are important to people living with aphasia. The results of this study indicate that important treatment outcomes for people living with aphasia most frequently link to the activity/participation and body function components of the ICF. The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families.

The Use of Main Concept Analysis to Measure Discourse Production in Cantonese-Speaking Persons with Aphasia: A Preliminary Report.

UNLABELLED Discourse produced by speakers with aphasia contains rich and valuable information for researchers to understand the manifestation of aphasia as well as for clinicians to plan specific treatment components for their clients. Various approaches to investigate aphasic discourse have been proposed in the English literature. However, this is not the case in Chinese. As a result, clinical evaluations of aphasic discourse have not been a common practice. This problem is further compounded by the lack of validated stimuli that are culturally appropriate for language elicitation. The purpose of this study was twofold: (a) to develop and validate four sequential pictorial stimuli for elicitation of language samples in Cantonese speakers with aphasia, and (b) to investigate the use of a main concept measurement, a clinically oriented quantitative system, to analyze the elicited language samples. Twenty speakers with aphasia and ten normal speakers were invited to participate in this study. The aphasic group produced significantly less key information than the normal group. More importantly, a strong relationship was also found between aphasia severity and production of main concepts. While the results of the inter-rater and intra-rater reliability suggested the scoring system to be reliable, the test-retest results yielded strong and significant correlations across two testing sessions one to three weeks apart. LEARNING OUTCOMES Readers will demonstrate better understanding of (1) the development and validation of newly devised sequential pictorial stimuli to elicit oral language production, and (2) the use of a main concept measurement to quantify aphasic connected speech in Cantonese Chinese.

Executive and Language Control in the Multilingual Brain

Neuroimaging studies suggest that the neural network involved in language control may not be specific to bi-/multilingualism but is part of a domain-general executive control system. We report a trilingual case of a Cantonese (L1), English (L2), and Mandarin (L3) speaker, Dr. T, who sustained a brain injury at the age of 77 causing lesions in the left frontal lobe and in the left temporo-parietal areas resulting in fluent aphasia. Dr. Ts executive functions were impaired according to a modified version of the Stroop color-word test and the Wisconsin Card Sorting Test performance was characterized by frequent perseveration errors. Dr. T demonstrated pathological language switching and mixing across her three languages. Code switching in Cantonese was more prominent in discourse production than confrontation naming. Our case suggests that voluntary control of spoken word production in trilingual speakers shares neural substrata in the frontobasal ganglia system with domain-general executive control mechanisms. One prediction is that lesions to such a system would give rise to both pathological switching and impairments of executive functions in trilingual speakers.

Automatic speech recognition for acoustical analysis and assessment of cantonese pathological voice and speech

This paper describes the application of state-of-the-art automatic speech recognition (ASR) systems to objective assessment of voice and speech disorders. Acoustical analysis of speech has long been considered a promising approach to non-invasive and objective assessment of people. In the past the types and amount of speech materials used for acoustical assessment were very limited. With the ASR technology, we are able to perform acoustical and linguistic analyses with a large amount of natural speech from impaired speakers. The present study is focused on Cantonese, which is a major Chinese dialect. Two representative disorders of speech production are investigated: dysphonia and aphasia. ASR experiments are carried out with continuous and spontaneous speech utterances from Cantonese-speaking patients. The results confirm the feasibility and potential of using natural speech for acoustical assessment of voice and speech disorders, and reveal the challenging issues in acoustic modeling and language modeling of pathological speech.

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.

Co-verbal gestures among speakers with aphasia: Influence of aphasia severity, linguistic and semantic skills, and hemiplegia on gesture employment in oral discourse

UNLABELLED The use of co-verbal gestures is common in human communication and has been reported to assist word retrieval and to facilitate verbal interactions. This study systematically investigated the impact of aphasia severity, integrity of semantic processing, and hemiplegia on the use of co-verbal gestures, with reference to gesture forms and functions, by 131 normal speakers, 48 individuals with aphasia and their controls. All participants were native Cantonese speakers. It was found that the severity of aphasia and verbal-semantic impairment was associated with significantly more co-verbal gestures. However, there was no relationship between right-sided hemiplegia and gesture employment. Moreover, significantly more gestures were employed by the speakers with aphasia, but about 10% of them did not gesture. Among those who used gestures, content-carrying gestures, including iconic, metaphoric, deictic gestures, and emblems, served the function of enhancing language content and providing information additional to the language content. As for the non-content carrying gestures, beats were used primarily for reinforcing speech prosody or guiding speech flow, while non-identifiable gestures were associated with assisting lexical retrieval or with no specific functions. The above findings would enhance our understanding of the use of various forms of co-verbal gestures in aphasic discourse production and their functions. Speech-language pathologists may also refer to the current annotation system and the results to guide clinical evaluation and remediation of gestures in aphasia. LEARNING OUTCOMES None.

Analysing speech problems in a longitudinal case study of logopenic variant PPA

Background: Primary progressive aphasia (PPA) is a neurodegenerative form of dementia in which gradually worsening language impairments are the prominent feature in the initial stages. PPA is commonly differentiated into three variants: nonfluent agrammatic (PPA-NVF), semantic (PPA-SV), and logopenic (PPA-LV). Aims: This article provides a longitudinal description of changes in picture description produced by a woman with PPA-LV, introduces a reliable new measure that captures those changes, and relates the measured changes to raters’ perceptions of changes in discourse quality. Method & Procedures: Seven oral descriptions of the Boston Diagnostic Aphasia Examination (BDAE) Cookie Theft picture were digitally recorded over the course of 27 months and later transcribed. Transcriptions were analysed using a new adaptation of the Linguistic Communication Measure (LCM) and the Linguistic Communication Measure-Revised Cantonese (LCM-RC) designed to be sensitive to the features of PPA-LV. We have named this third form the LCM, the Linguistic Communication Measure–-Speech Sounds (LCM-SS). Audio recordings of the seven picture descriptions plus three produced by typical speakers of similar age were rated for goodness by 15 raters. Outcomes & Results: Goodness ratings of the participants’ speech samples decreased steadily over the 27 months. Although our previous measures of discourse quality (LCM, LCMC-RC) appeared to work well for capturing many of the speakers with vascular aphasia, they failed to capture the nature of this participant’s decline: Her lexical access slowed over time, but did not become more error-prone, and morphosyntactic components did not worsen, with errors remaining low to almost absent. However, speech sound errors and repetitions increased steadily over the 27 months. The new measure, LCM-SS, succeeded in capturing this pattern of decline: Several of the LCM-SS measures were highly correlated to ratings of goodness, and two of the LCM-SS indices (sound errors and grammatical errors) accounted for 98% of the variance in the goodness ratings. Conclusions: Over the course of 27 months, the most significant change in this participant’s Cookie Theft descriptions was the steady increase in sound errors, in the context of decreased efficiency in lexical retrieval and relatively stable grammatical form. This pattern was also highly related to listeners’ perceptions of the quality of discourse. Neither of the previous versions of the LCM captured this debilitating increase in sound errors, but adding the index of sound errors to those previous versions resulted in an analysis method that was sensitive to the linguistic features exhibited by this participant with PPA-LV.

The Main Concept Analysis: Validation and sensitivity in differentiating discourse produced by unimpaired English speakers from individuals with aphasia and dementia of Alzheimer type

Purpose. Discourse from speakers with dementia and aphasia is associated with comparable but not identical deficits, necessitating appropriate methods to differentiate them. The current study aims to validate the Main Concept Analysis (MCA) to be used for eliciting and quantifying discourse among native typical English speakers and to establish its norm, and investigate the validity and sensitivity of the MCA to compare discourse produced by individuals with fluent aphasia, non-fluent aphasia, or dementia of Alzheimers type (DAT), and unimpaired elderly. Method. Discourse elicited through a sequential picture description task was collected from 60 unimpaired participants to determine the MCA scoring criteria; 12 speakers with fluent aphasia, 12 with non-fluent aphasia, 13 with DAT, and 20 elderly participants from the healthy group were compared on the finalized MCA. Results. Results of MANOVA revealed significant univariate omnibus effects of speaker group as an independent variable on each main concept index. MCA profiles differed significantly between all participant groups except dementia versus fluent aphasia. Correlations between the MCA performances and the Western Aphasia Battery and Cognitive Linguistic Quick Test were found to be statistically significant among the clinical groups. Conclusions. The MCA was appropriate to be used among native speakers of English. The results also provided further empirical evidence of discourse deficits in aphasia and dementia. Practitioners can use the MCA to evaluate discourse production systemically and objectively.

Conducting Cognitive Exercises for Early Dementia with the Use of Apps on iPads.

A list of iTunes apps was compiled for usage with early stage or mild dementia participants. The method in choosing these apps and determining salient features of the most successful apps was reported. The results will advance the knowledge base on innovative use of smart technology in clinical settings.

Effects of context and word class on lexical retrieval in Chinese speakers with anomic aphasia

Background: Differences in processing nouns and verbs have been investigated intensely in psycholinguistics and neuropsychology in past decades. However, the majority of studies examining retrieval of these word classes have involved tasks of single-word stimuli or responses. Although the results have provided rich information for addressing issues about grammatical class distinctions, it is unclear whether they have adequate ecological validity for understanding lexical retrieval in connected speech that characterises daily verbal communication. Previous investigations comparing retrieval of nouns and verbs in single-word production and connected speech have reported either discrepant performance between the two contexts with presence of word class dissociation in picture naming but absence in connected speech, or null effects of word class. In addition, word finding difficulties have been found to be less severe in connected speech than picture naming. However, these studies have failed to match target stimuli of the two word classes and between tasks on psycholinguistic variables known to affect performance in response latency and/or accuracy. Aims: The present study compared lexical retrieval of nouns and verbs in picture naming and connected speech from picture description, procedural description, and storytelling among 19 Chinese speakers with anomic aphasia and their age, gender, and education matched healthy controls, to understand the influence of grammatical class on word production across speech contexts when target items were balanced for confounding variables between word classes and tasks. Methods & Procedures: Elicitation of responses followed the protocol of the AphasiaBank consortium (http://talkbank.org/AphasiaBank). Target words for confrontation naming were based on well-established naming tests, whereas those for narrative were drawn from a large database of normal speakers. Selected nouns and verbs in the two contexts were matched for age-of-acquisition (AoA) and familiarity. Influence of imageability was removed through statistical control. Outcomes & Results: When AoA and familiarity were balanced, nouns were retrieved better than verbs, and performance was higher in picture naming than connected speech. When imageability was further controlled for, only the effect of task remained significant. Conclusions: The absence of word class effects when confounding variables are controlled for is similar to many previous reports; however, the pattern of better word retrieval in naming is rare but compatible with the account that processing demands are higher in narrative than naming. The overall findings have strongly suggested the importance of including connected speech tasks in any language assessment and evaluation of language rehabilitation of individuals with aphasia.