Carolyn Bruce

Computer‐generated phonemic cues: an effective aid for naming in aphasia

This study investigates whether computer-generated phonemic cues can be used in improving naming in Brocas aphasics, either in treatment or as a prosthesis. Five patients who were able to indicate the initial letters of words which they could not produce, and who responded to phonemic cues given by a therapist, were taught to use a microcomputer as an aid to generate phonemic cues over five sessions. All the patients benefited; four of the subjects were significantly better in naming with the aid, and improvement generalised to names which had not been involved in treatment. Four of the subjects were better at indicating the first letters of names of items in the treatment set than untreated control pictures; it appears that treatment teaches patients about the initial letters in the words. We conclude that microcomputer-generated phonemic cues are a promising approach to treatment of word retrieval difficulties in aphasia.

THERAPY USING CONVERSATION ANALYSIS : HELPING COUPLES ADAPT TO APHASIA IN CONVERSATION

This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.

Writing with voice: an investigation of the use of a voice recognition system as a writing aid for a man with aphasia.

BACKGROUND People with aphasia may experience difficulties that prevent them from demonstrating in writing what they know and can produce orally. Voice recognition systems that allow the user to speak into a microphone and see their words appear on a computer screen have the potential to assist written communication. AIM This study investigated whether a man with fluent aphasia could learn to use Dragon NaturallySpeaking to write. METHODS & PROCEDURES A single case study of a man with acquired writing difficulties is reported. A detailed account is provided of the stages involved in teaching him to use the software. The therapy tasks carried out to develop his functional use of the system are then described. Outcomes included the percentage of words accurately recognized by the system over time, the quantitative and qualitative changes in written texts produced with and without the use of the speech-recognition system, and the functional benefits the man described. OUTCOMES & RESULTS The treatment programme was successful and resulted in a marked improvement in the subjects written work. It also had effects in the functional life domain as the subject could use writing for communication purposes. CONCLUSIONS The results suggest that the technology might benefit others with acquired writing difficulties.

Why don't Broca's aphasics cue themselves? An investigation of phonemic cueing and tip of the tongue information.

This study investigates whether Brocas aphasics have the information processing abilities necessary to generate and use their own phonemic cues. Twenty patients were studied; ten benefited from phonemic cues given by the therapist. Phonemic cues were most effective with the patients whose naming was most severely impaired. Six patients could indicate the initial letter of words which they could not produce; three of these patients had no knowledge of any relationship between orthography and phonology, so information about the initial letter must be orthographic and not phonological. Only two patients had any success in giving the sounds of written letters. None of the 20 patients had all three abilities needed to use their own cues: giving the first letter of the name, sounding the letter, and utilizing a phonemic cue. The possibility of relearning letter-to-sound correspondences is considered.

Profiling text comprehension impairments in aphasia

Background: Research in aphasia has focused on acquired dyslexias at the single word level, with a paucity of assessment techniques and rehabilitation approaches for individuals with difficulty at the text level. A rich literature from research with paediatric populations and healthy non-brain damaged, skilled adult readers allows the component processes that are important for text reading to be defined and more appropriate assessments to be devised. Aims: To assess the component processes of text reading in a small group of individuals with aphasia who report difficulties in reading at the text level. Do assessments of component processes in reading comprehension reveal distinct profiles of text comprehension? To what extent are text comprehension difficulties caused by underlying linguistic and/or cognitive deficits? Methods & Procedures: Four individuals with mild aphasia who reported difficulties in reading at the text level took part in a case-series study. Published assessments were used to confirm the presence of text comprehension impairment. Participants completed a range of assessments to provide a profile of their linguistic and cognitive skills, focusing on processes known to be important for text comprehension. We identified the following areas for assessment: reading speed, language skills (single word and sentence), inferencing, working memory and metacognitive skills (monitoring and strategy use). Outcomes & Results: Performance was compared against age-matched adult control data. One participant presented with a trend for impaired abilities in inferencing, with all other assessed skills being within normal limits. The other three had identified linguistic and working memory difficulties. One presented with a residual deficit in accessing single word meaning that affected text comprehension. The other two showed no clear link between sentence processing difficulties and text comprehension impairments. Across these three, data suggested a link between verbal working memory (VWM) capacity and specific inferencing skills. Conclusions: Successful text reading relies on a number of component processes. In this paper we have made a start in defining those component processes and devising tasks suitable to assess them. From our results, assessment of VWM and inferencing appears to be critical for understanding text comprehension impairments in aphasia. It is possible that rehabilitation input can capitalise on key meta-cognitive skills (monitoring, strategy use) to support functional reading in the face of existing linguistic, text comprehension and memory impairments.

Operativity and animacy effects in aphasic naming

This paper investigates the extent to which operativity and animacy affect naming accuracy in 18 aphasic patients. Both operativity and animacy have significant effects on naming accuracy when confounding variables are not properly controlled. However, with sets of items matched for length, frequency, familiarity, imageability, concreteness and rated age-of-acquisition, only one subject showed a significant animacy effect (with better performance for animate items), and two subjects showed significant reversed operativity effects. The original definition of operativity included four elements: separability from the surrounding context, manipulability, firmness to the touch and availability to multiple senses. When the effects of these variables were investigated individually, it was found that, in general, patients are better at naming separable items, and those available to multiple senses but worse at naming manipulable items. It is concluded that operativity is not a single property but a set of variabl...

Investigating the impact of unfamiliar speaker accent on auditory comprehension in adults with aphasia

BACKGROUND In an increasingly multicultural society, all individuals are likely to come into contact with speakers with unfamiliar accents. Recent figures suggest that such accent variation may be particularly apparent within the healthcare workforce. Research on accent variation has demonstrated that an unfamiliar speaker accent can affect listener comprehension, but the impact of speaker accent on the comprehension skills of listeners with neurological impairment has not been widely explored. AIMS To investigate the effect of an unfamiliar accent on the sentence comprehension of individuals with aphasia following stroke. METHODS & PROCEDURES The impact of two different accents (south-east England and Nigerian) on accuracy and response time for 16 individuals with aphasia and 16 healthy control subjects was measured. Participants were presented with a computerized sentence-to-picture matching task and their accuracy and response times were recorded. OUTCOMES & RESULTS Results showed that individuals with aphasia made significantly more errors in comprehension of sentences spoken in an unfamiliar accent than in a familiar accent, a finding that was not demonstrated by the control group when outliers were excluded. Individuals with aphasia were slower overall; however, response times did not show significant effects of speaker accent for either group. CONCLUSIONS & IMPLICATIONS The impact of speaker accent should be considered in the rehabilitation of individuals with aphasia following stroke. Clinical implications include the possibility of underestimating an individuals language abilities on assessment, and the potential errors in comprehension that may occur.

Accent on communication: the impact of regional and foreign accent on comprehension in adults with aphasia

Purpose: This study explored whether an unfamiliar non-native accent, differing in both segmental and prosodic features was more difficult for individuals with aphasia to understand than an unfamiliar native accent, which differed in segmental features only. Method: Comprehension, which was determined by accuracy judgments on true/false sentences, and speed of response were assessed in the following three conditions: a familiar Southern Standard British English (SSBE) accent, an unfamiliar native Grimsby accent, and an unfamiliar non-native Chinese accent. Thirty-four English speaking adults (17 people with and 17 people without aphasia) served as listeners for this study. Results: All listeners made significantly more errors in the unfamiliar non-native accent, although this difficulty was more marked for those with aphasia. While there was no affect of speaker accent on the response times of listeners with aphasia, listeners without aphasia were significantly slower with the unfamiliar non-native accent. Conclusion: The results indicate that non-native accented speech affects comprehension even on simple tasks in ideal listening conditions. The findings suggest that speaker accent, especially accents varying in both segmental and prosodic features, can be a barrier to successful interactions between non-native accented speakers and native listeners, particularly those with aphasia. Implications for Rehabilitation Aphasia is an acquired language disorder, often occurring after stroke, which affects an individual’s understanding and use of language. People with and without aphasia find an unfamiliar accent more difficult to understand than a familiar accent, and these problems are more significant for those with aphasia. Problems are greater when the accent differs from the familiar accent by both individual sounds and prosody. Health professionals need to be aware that their accent is likely to affect an individual’s performance on assessments as well as their understanding of information, and could consider the use of other mediums to present information (e.g. drawing) and minimizing other variables that might compromise comprehension (e.g. background noise).

The development of a self-directed and peer-based clinical training programme.

A reflective learning approach for clinical training with final year students is described. The training programme aims to promote the development of independent and reflective practitioners. The theories and ideas that have influenced the structure of the programme are described and an outline of the programme is provided. The views of students who have participated in the process are discussed. Most students were positive about their experiences, but some problems were reported. Suggestions for improving the supervisory process are considered.

Hearing loss and auditory processing ability in people with aphasia

Background: Hearing loss can add to the linguistic deficits present in aphasia to make comprehension of speech difficult. Although some studies document a relatively high prevalence of hearing loss in adults with aphasia, many people with aphasia do not have their hearing tested. Self-reported disability measures offer a possible alternative to pure-tone audiometry when this service is not readily available. Aims: This study aims to investigate the prevalence of hearing loss in a group of people with aphasia and to determine the usefulness of self-reported measures to screen for hearing impairment. Methods & Procedures: Hearing ability was measured using pure-tone audiometry and five measures of auditory processing, which looked at speech perception in quiet and noise, for 21 individuals with aphasia recruited from a community clinic and 21 age-matched individuals without aphasia. The Speech, Spatial and Qualities of Hearing Scale (SSQ) and a brief questionnaire exploring whether they had experienced hearing difficulties were used to measure self-perception of hearing acuity. Differences in scores between the groups were analysed. Correlations and regressions were used to establish the relationship between self-perception of hearing and measures of hearing ability. Outcomes & Results: Despite minimal impairment and a non-significant difference between performance on pure-tone audiometry for participants with and without aphasia, participants with aphasia performed significantly worse on measures of speech perception in noise than participants without aphasia. They also had a significantly greater degree of perceived hearing disability. Although SSQ scores were correlated with some behavioural measures for the participants with aphasia, the SSQ only predicted the hearing status and speech in noise performance of control participants. Conclusions: The results suggest that the prevalence of hearing loss for people with aphasia (at least for this group) is no greater than the general population. However, they are significantly more affected in their recognition of speech in noise and experience greater disability in listening situations than people without aphasia. The latter problems were not predicted by pure-tone audiograms or sound-in-noise performance. The brief questionnaire was not effective in identifying hearing impairment, indicating the need for a regular hearing screen to ensure provision of the most effective rehabilitation. Ideally, the screen should include disability and behavioural measures, as our results suggest they cannot replace each other. These findings should assist clinicians in setting realistic goals and delivering interventions in the most effective way for people with aphasia.