Brooke Hallowell

A multinational comparison of aphasia management practices

The effect of restructuring of healthcare on the quality, quantity, and nature of aphasia management is largely unknown. The current study is the first to examine access, diagnostic, treatment, and discharge patterns of patients with aphasia in Australia, Canada, the UK, the US private sector (US-Private), and the US Veterans Health Administration in the Department of Veterans Affairs (US-VA). The authors developed a 37-item survey to be completed by clinicians working with aphasic patients. The survey focused on eight areas: access to care, evaluation procedures, group treatment, number and duration of treatment sessions, limitations of the number of sessions, termination of treatment, follow-up practices, and resumption of treatment. 394 surveys were distributed and 175 were returned completed (44% return rate). Respondents represented a range of ages, work experiences, and work settings. There was considerable consistency among respondents from our five healthcare systems. Results suggest that patients may be routinely denied treatment in direct contradiction to the research literature. Just as we carefully monitor the progress of patients receiving our treatment, we are obliged to monitor the effects of managed care on our patients, fellow clinicians, and our profession.

Validity of an eye-tracking method to index working memory in people with and without aphasia

Background: Working memory (WM) is essential to auditory comprehension; thus understanding of the nature of WM is vital to research and clinical practice to support people with aphasia. A key challenge in assessing WM in people with aphasia is related to the myriad deficits prevalent in aphasia, including deficits in attention, hearing, vision, speech, and motor control of the limbs. Eye-tracking methods augur well for developing alternative WM tasks and measures in that they enable researchers to address many of the potential confounds inherent in tasks traditionally used to study WM. Additionally, eye-tracking tasks allow investigation of trade-off patterns between storage and processing in complex span tasks, and provide on-line response measures. Aims: The goal of the study was to establish concurrent and discriminative validity of a novel eye movement WM task in individuals with and without aphasia. Additionally we aimed to explore the relationship between WM and general language measures, and determine whether trade-off between storage and processing is captured via eye-tracking measures. Methods & Procedures: Participants with (n = 28) and without (n = 32) aphasia completed a novel eye movement WM task. This task, incorporating natural response requirements, was designed to circumvent potential confounds due to concomitant speech, motor, and attention deficits. The task consisted of a verbal processing component intermixed with presentation of colours and symbols for later recall. Performance on this task was indexed solely via eye movements. Additionally, participants completed a modified listening span task that served to establish concurrent validity of the eye-tracking WM task. Outcomes & Results: Performance measures of the novel eye movement WM task demonstrated concurrent validity with another established measure of WM capacity: the modified listening span task. Performance on the eye-tracking task discriminated effectively between participants with and without aphasia. No consistent relationship was observed between WM scores and Western Aphasia Battery aphasia quotient and subtest scores for people with aphasia. Additionally, eye-tracking measures yielded no trade-off between processing and storage for either group of participants. Conclusions: Results support the feasibility and validity of employing a novel eye-tracking method to index WM capacity in participants with and without aphasia. Further research is required to determine the nature of the relationship between WM, as indexed through this method, and specific aspects of language impairments in aphasia.

A new modified listening span task to enhance validity of working memory assessment for people with and without aphasia

UNLABELLED Deficits in working memory (WM) are an important subset of cognitive processing deficits associated with aphasia. However, there are serious limitations to research on WM in aphasia largely due to the lack of an established valid measure of WM impairment for this population. The aim of the current study was to address shortcomings of previous measures by developing and empirically evaluating a novel WM task with a sentence-picture matching processing component designed to circumvent confounds inherent in existing measures of WM in aphasia. The novel WM task was presented to persons with (n=27) and without (n=33) aphasia. Results demonstrated high concurrent validity of a novel WM task. Individuals with aphasia performed significantly worse on all conditions of the WM task compared to individuals without aphasia. Different patterns of performance across conditions were observed for the two groups. Additionally, WM capacity was significantly related to auditory comprehension abilities in individuals with mild aphasia but not those with moderate aphasia. Strengths of the novel WM task are that it allows for differential control for length versus complexity of verbal stimuli and indexing of the relative influence of each, minimizes metalinguistic requirements, enables control for complexity of processing components, allows participants to respond with simple gestures or verbally, and eliminates reading requirements. Results support the feasibility and validity of using a novel task to assess WM in individuals with and without aphasia. LEARNING OUTCOMES Readers will be able to (1) discuss the limitations of current working memory measures for individuals with aphasia; (2) describe how task design features of a new working memory task for people with aphasia address shortcomings of existing measures; (3) summarize the evidence supporting the validity of the novel working memory task.

A tutorial on aphasia test development in any language: Key substantive and psychometric considerations

Background: There are a limited number of aphasia language tests in the majority of the worlds commonly spoken languages. Furthermore, few aphasia tests in languages other than English have been standardised and normed, and few have supportive psychometric data pertaining to reliability and validity. The lack of standardised assessment tools across many of the worlds languages poses serious challenges to clinical practice and research in aphasia. Aims: The current review addresses this lack of assessment tools by providing conceptual and statistical guidance for the development of aphasia assessment tools and establishment of their psychometric properties. Main Contribution: A list of aphasia tests in the 20 most widely spoken languages is included. The pitfalls of translating an existing test into a new language versus creating a new test are outlined. Factors to be considered in determining test content are discussed. Further, a description of test items corresponding to different language functions is provided, with special emphasis on implementing important controls in test design. Next, a broad review of principal psychometric properties relevant to aphasia tests is presented, with specific statistical guidance for establishing psychometric properties of standardised assessment tools. Conclusions: This article may be used to help guide future work on developing, standardising and validating aphasia language tests. The considerations discussed are also applicable to the development of standardised tests of other cognitive functions.

Short form of the Bilingual Aphasia Test in Russian: Psychometric data of persons with aphasia

Background: There is currently a lack of standardised aphasia batteries available in the Russian language. The psychometric properties of a short form of the Russian version of the Bilingual Aphasia Test (BAT) (Paradis, 1987) were examined. The BAT (Paradis & Zeiber, 1987) is one of the few published tests in Russian. Aims: The primary aims were: (1) to describe the psychometric properties of a modified short form of the BAT in Russian by analysing the data collected on a large sample of Russian‐speaking adults with aphasia; (2) to identify needs for further modification, validation, and standardisation; and (3) to provide a preliminary evidence base for clinicians and investigators using the test. Methods & Procedures: The modified short form of the Russian BAT was administered to 83 patients with mild to severe aphasia. All were native speakers of Russian. Outcomes & Results: The test was effective in discriminating patients according to level of severity of language impairment. Most of the tasks constituting the short form of the test had strong internal consistency. These results support the utility of each assessed component of the BAT in quantifying language deficits in speakers of Russian with aphasia. However, problems with the internal consistency and the validity of some items were identified. Conclusions: The study provides preliminary data on the psychometric properties of an aphasia test in Russian. Needs for modification of the test, suggestions for further development of the test, and recommendations for further study of its psychometric properties are discussed.

A New Way of Looking at Auditory Linguistic Comprehension

Methods currently being developed for the use of eye movements in the assessment of linguistic comprehension have important clinical and research applications. These methods may be particularly useful for the assessment of severely neurologically impaired patients whose motoric response capabilities are limited to the degree that-regardless of linguistic involvement-they would demonstrate poor or even no responses on traditional tests of linguistic comprehension. Recent methodological developments have been focused on stimulus design, testing protocols, dependent measures, and instrumentation.

Control and description of visual function in research on aphasia and related disorders

Background: Most experimental and assessment tasks in studies of neurogenic language disorders rely on visual information processing. Failure to describe and/or control for visual function may lead to invalid data collection and interpretation. Aims: An empirical study was initiated to describe current practice and needs for improvement in the description of and control for visual acuity, colour perception, visual fields, visual attention, and oculomotor functions. Methods & Procedures: Data were collected from all articles (N = 668) on aphasia (subsequent to left hemisphere damage) and related language disorders (subsequent to TBI and right hemisphere damage) in adults published during a 10‐year period in each of 17 journals. Outcomes & Results: Few authors control for or describe even basic aspects of vision. Conclusions: Specific needs and strategies for improvement are discussed. The need for improved continuing education concerning means of screening for various forms of visual function is highlighted. Researchers are encouraged to employ basic screenings corresponding to the visual functions implemented in their assessment and experimental tasks for a given study. Improved feedback to manuscript authors and those seeking grant funding regarding appropriate control for and description of visual function is advocated.

A Novel Pupillometric Method for Indexing Word Difficulty in Individuals With and Without Aphasia.

PURPOSE Cognitive effort is a clinically important facet of linguistic processing that is often overlooked in the assessment and treatment of people with aphasia (PWA). Furthermore, there is a paucity of valid ways to index cognitive effort in PWA. The construct of cognitive effort has been indexed for decades via pupillometry (measurement of pupil dilation and constriction during a cognitive task), yet pupillometry has not been implemented in studies including PWA. In the present study, we tested a novel method for indexing cognitive effort during linguistic processing in people with and without aphasia. METHOD Forty control participants and 39 PWA listened to semantically easy and difficult single nouns and looked at images while their pupillary responses were monitored. Mean pupil dilation in response to easy versus difficult nouns was calculated to index cognitive effort. RESULTS Larger mean pupil dilation values were obtained for difficult compared with easy nouns for both groups. CONCLUSION Results provide preliminary evidence that pupillometry can be used to index cognitive effort during linguistic processing of single nouns in people with and without aphasia. Methods for indexing cognitive effort will be a valuable addition to existing assessment methods. Suggestions for further research are offered.

Where Children With ADHD Direct Visual Attention During Emotion Knowledge Tasks: Relationships to Accuracy, Response Time, and ADHD Symptoms:

Objective: Inattention may contribute to emotion recognition deficits in children with ADHD. In the current study, we compared the viewing patterns for emotion stimuli between children with and without ADHD and examined the relationship between viewing patterns, emotion knowledge accuracy, response time, and ADHD symptoms. Method: Eye-tracking technology recorded viewing patterns for emotion stimuli among 45 children (60% male; control n = 26, ADHD n = 19). Results: Overall, viewing patterns of children with and without ADHD were strikingly similar; however, small to large effect sizes (Cohen’s d = −0.73 to 0.93) across emotions suggest that, for some emotions, children with ADHD spend less time viewing relevant areas of images and take longer to respond (i.e., detect an emotion) compared with children without ADHD. Conclusion: Children with ADHD view some emotions differently from children without ADHD. The results provide an important foundation for additional work in this area.

Eighteen years on: what next for the PALPA?

The Psycholinguistic Assessments of Language Processing Abilities (PALPA) is a battery of tests designed to assess language processing abilities in individuals with acquired aphasia. Published in 1992, the battery was well-received by both clinicians and researchers, yet no revised version has been published to date. In this paper, we examine contemporary usage of the PALPA in both clinical and research settings, to inform decisions regarding future developments of the resource. First, we carried out a literature search to identify all published papers that have cited the PALPA since 2003, and compared our findings to those from an earlier search covering the period from 1991 to 2002. Second, we created an online survey that examined current usage of the PALPA in both clinicians and researchers. Our findings suggest the PALPA continues to be a well-used tool in both clinical and research settings, but could benefit from some improvements in its content and presentation. Further, there are time constraints in administering the PALPA, indicating an additional component for general-screening purposes would be a welcome extension to the battery.