Catherine Mackenzie

Adult spoken discourse: the influences of age and education

Spoken discourse is regarded as an important component of communication assessment, but data on the discourse characteristics of the adult population, and in particular those who fall into the fastest growing section of the population (those aged over 75), are scant. Therefore, detection of deficit is commonly dependent on the assessors opinion as to what constitutes normal performance. To determine the effects of age, education and gender on spoken discourse, the conversational interaction and picture description skills of 189 neurologically normal adults were examined. Conversation was appraised with reference to five parameters (initiation, topic maintenance, verbosity, turn taking, reference). Picture description was assessed for relevant content, length, efficiency and the inclusion of extraneous information. Level of education did not affect conversational interaction but in picture description those not educated beyond minimal school leaving produced shorter and less complete descriptions. Picture description content and length were not affected by advancing age but the older elderly (aged 75+) conveyed information with reduced efficiency. Conversational interaction style altered with advancing age, with some suggestion of change in the young elderly (age 60-74), but highly significant differences in respect of the old elderly. Gender had no effect on the parameters of conversation and no significant picture description differences were present in males and females though there were trends towards longer and higher content descriptions in females. The results have important diagnostic implications for those concerned with establishing whether pathology such as stroke has affected communication. On a wider scale, awareness of the effects of advancing age and limited education may facilitate successful communication for all who communicate with the public in a professional capacity.

Behavioural intervention effects in dysarthria following stroke: communication effectiveness, intelligibility and dysarthria impact

BACKGROUND Dysarthria is a common post-stroke presentation. Its management falls within the remit of the speech and language therapy profession. Little controlled evaluation of the effects of intervention for dysarthria in stroke has been reported. AIMS The study aimed to determine the effects of a period of behavioural communication intervention on communication effectiveness and intelligibility, and of the speech disorders impact on the person with dysarthria. METHODS & PROCEDURES Eight people with dysarthria following stroke received individually tailored intervention programmes of 16 sessions during an 8-week period. Conversation, and reading aloud of connected speech and of single words were sampled at four points, at intervals of around 2 months: two before intervention and two after intervention. The data were perceptually evaluated by ten listeners, blind to assessment point, for the overall effectiveness of communication (conversation) and for single-word and reading intelligibility. The impact of dysarthria was assessed at the beginning and end of the intervention period. OUTCOME & RESULTS The level of reliability of listener ratings was high. There was no evidence of group change between assessment points for measures of communication effectiveness during conversation, or for reading and word intelligibility. Individual participant analysis indicated that five speakers improved in at least one of these three measures. In all cases this followed either stability or deterioration during the 2-month pre-intervention period. There was very little evidence of deterioration during the 2 months after withdrawal of treatment. For three participants no intervention-related speech benefit was demonstrated. Age, dysarthria severity or lesion information did not appear to differentiate those who improved from those who did not. Improvement occurred in all who began the intervention phase between 5 and 8 months following stroke onset. Group data indicated no change in the Dysarthria Impact Profile in respect of three sections (The effect of dysarthria on me as a person; How I feel others react to my speech; and How dysarthria affects my communication with others). There was a significant difference between the start and end of intervention for Accepting my dysarthria, suggesting a reduction in the negative impact of dysarthria. CONCLUSIONS The results demonstrate that some individuals with dysarthria have a capacity to respond positively to intervention, some months after stroke, and to maintain this improvement following 2 months of no intervention. Consideration is given to how the results of the present study may inform subsequent phases of dysarthria stroke research.

Non-speech oro-motor exercise use in acquired dysarthria management: regimes and rationales

BACKGROUND Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy manuals and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. AIMS The investigation sought to collect development-phase data, in accordance with the Medical Research Council (MRC) evaluation of complex interventions. The aims were to establish the extent of use of NSOMExs in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. METHODS & PROCEDURES Speech and language therapists throughout Scotland, Wales, and Northern Ireland, working with adult-acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. OUTCOME & RESULTS One hundred and ninety-one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of speech and language therapy experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute teaching. More experienced speech and language therapists were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended Higher Education Institute was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but also included improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were four to six repetitions of each exercise, during three practice periods daily, each of 6–10 min. CONCLUSIONS & IMPLICATIONS NSOMExs are a frequent component of dysarthria management in the UK-devolved government countries. This confirmation, along with the details of speech and language therapy practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. Speech and language therapy practice may be guided by evidence that speech outcome is or is not affected by NSOMExs.

Dysarthria in stroke : a narrative review of its description and the outcome of intervention

Dysarthria is a frequent and persisting sequel to stroke and arises from varied lesion locations. Although the presence of dysarthria is well documented, for stroke there are scant data on presentation and intervention outcome. A literature search was undertaken to evaluate (a) the features of dysarthria in adult stroke populations relative to the conventional Mayo system for classification, which was developed from diverse pathological groups, and (b) the current status of evidence for the effectiveness of intervention in dysarthria caused by stroke. A narrative review of results is presented. The limited data available indicate that, regardless of stroke location, imprecise articulation and slow speaking rate are consistent features, and voice disturbances, especially harshness, and reduced prosodic variation are also common. Dysarthria is more prevalent in left than in right hemisphere lesions. There is a need for comprehensive, thorough analysis of dysarthria features, involving larger populations, with stroke and other variables controlled and with appropriate age-referenced control data. There is low level evidence for benefits arising from intervention in stroke-related dysarthria. Because studies involve few participants, without external control, and sometimes include stroke with other aetiologies, their results lack the required weight for confident evidence-based practice.

An examination over time of language and discourse production abilities following right hemisphere brain damage

Abstract Although it is common for descriptions of communication ability in people with right hemisphere brain damage (RHBD) to include discourse deficits that affect pragmatic effectiveness, reports of these deficits are often made from subjective observations based on single cases. To date there is also very little objective information about spontaneous change over time in a representative clinical population in either discourse-specific or other aspects of language ability. In this study a group of eight individuals with post-stroke RHBD were assessed at 1 month and 6 months post-onset. The Discourse Comprehension Test was administered and seven discourse samples were elicited (three conversational, three procedural and a picture description). Detailed analyses of these samples included length, syntactic complexity, physical and illustrative gestures, verbal disruption, cohesion and topic coherence. A high level of intra-rater reliability was achieved in the analyses. Very few significant differences were evident over time in the language and discourse features measured and there were no apparent task effects. Reasons for this lack of ‘spontaneous recovery’ are discussed and some research implications drawn from this exploratory study.

Picture description in neurologically normal adults: Concepts and topic coherence

Background: Evaluation of discourse is recognised as an important component in the diagnosis and management of adult acquired communication disorders. Picture description is a common and practical data elicitation procedure that has provided insights into the discourse of many adult groups. Such data may be analysed from several linguistic and pragmatic perspectives and, as is commonly the case with discourse measures, the usefulness of such data is limited by a paucity of relevant normative information. Aim: To determine the influences of age, education, and gender on the concepts and topic coherence of the picture description of non‐brain‐damaged adults. Methods & Procedures: A total of 225 adults described the “cookie theft” picture (Goodglass, Kaplan, & Barresi, 2001). Responses were analysed for presence and completeness of concepts (Nicholas & Brookshire, 1995) and topic coherence (Mentis & Prutting, 1991), modified (Brady, Mackenzie, & Armstrong 2003). Outcomes & Results: Both analyses, concept and topic coherence, confirmed education level as a highly important variable affecting the performance of non‐brain‐damaged adults. The number of concepts used accurately and completely, and the amount of topic subdivision, increased with amount of education (both with and without adjustment for age and gender). Clear influences of age or gender were not demonstrated, although some trends in favour of women and younger age were noted, and for one of the seven assessed concepts there was a steady reduction in the odds of being accurate and complete with every 5‐year age increase. Conclusions: Recognition of the impact of education is essential in the assessment and diagnosis of communication difficulty. The authors are grateful to all who participated in this study.

The relevance of education and age in the assessment of discourse comprehension

Elderly people, the majority of whom completed education at age 14, comprise an increasingly significant proportion of the population. Neurological disorders which affect language processing are particularly associated with older age. To detect mild or subtle deficits, assessment is required to extend beyond decontextualized units which permit only literal interpretation. A lack of elderly normative data limits the usefulness of such measures. The influences of age, education and gender on comprehension were assessed in adults aged between 40 and 88. Clear advantage for those educated beyond minimum school leaving age and disadvantage for those over age 75 was evident in all measures: discourse, metaphor and inference. In particular the scores of very elderly subjects whose education was completed at the then minimum age of 14 show similarity to the published test data for pathological populations. Age and education are relevant to interpretation of language test performance of those with known pathology but also to everyday communication.

The effects on verbal communication skills of right hemishere stroke in middle age

Abstract Eighty-one right-handed middle-aged subjects (64 non-brain-damaged and 17 right hemisphere stroke) were assessed on a series of verbal comprehension and spoken discourse tasks. Educational level was found to affect the performance of the non-brain-damaged subjects who represented three standards of education. Comparison of the stroke subjects with the appropriate educational controls showed the stroke group to be weaker in several aspects of spoken language comprehension, particularly metaphor and inference. In picture description the non-brain-damaged groups used more words, spoke for longer and produced more information. In conversation, limited facial expression and eye contact and monotonous intonational pattern were characteristic of the stroke subjects, but other discourse parameters such as verbosity and topic maintenance did not distinguish these right-brain-damaged and non-brain-damaged groups. The results highlight first the requirement for language task control data to be education ref...

Cognitive–linguistic deficit and speech intelligibility in chronic progressive multiple sclerosis

BACKGROUND Multiple sclerosis is a disabling neurological disease with varied symptoms, including dysarthria and cognitive and linguistic impairments. Association between dysarthria and cognitive-linguistic deficit has not been explored in clinical multiple sclerosis studies. AIMS In patients with chronic progressive multiple sclerosis, the study aimed to investigate the presence and nature of cognitive-linguistic deficit, the association between levels of cognitive-linguistic ability and speech intelligibility, and of both of these with functional disability and time since onset of multiple sclerosis symptoms. METHODS & PROCEDURES The Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles and Tomoeda 1993 ), The Assessment of Intelligibility of Dysarthric Speech (AIDS) Sentence Intelligibility Task (Yorkston and Beukelman 1984 ), and the Modified Barthel Activities of Daily Living Index (MBADLI) (Shah 1998 ) were administered to 24 chronic progressive multiple sclerosis participants with dysarthria. A total of 24 non-neurologically impaired participants, matched for gender, age and education, formed a control group. OUTCOMES & RESULTS For multiple sclerosis participants, linear regression analysis showed a strong association between ABCD and AIDS (beta = 0.89, p = 0.005), no association between ABCD and either MBADLI or time since onset, a strong association between AIDS and MBADLI (beta = 0.60, p = 0.001), and a trend towards an association between AIDS and time since onset (beta = -0.29, p = 0.08). Correlations between the four included ABCD construct scores and between these and the total ABCD score were significant (r>0.60, p<0.01). For each of the 15 included ABCD measures and for the four construct scores and the overall ABCD score, multiple sclerosis and control group performances were significantly different (p<0.01) and effect sizes were large (d>0.80). CONCLUSIONS & IMPLICATIONS The results revealed a strong association between dysarthria, as measured by connected speech intelligibility testing, and cognitive-linguistic deficit, in people with chronic progressive-type multiple sclerosis. While some of the impairments that are associated with multiple sclerosis, including motor speech disorder, may influence performance on the ABCD, the data support the conclusion that marked cognitive-linguistic deficit is present in chronic progressive-type multiple sclerosis patients with dysarthria. Deterioration was global, rather than being indicative of a construct specific deficit, and encompassed language, both expression and comprehension. Episodic memory and linguistic expression were especially affected. Speech and language therapists who work with dysarthric patients with chronic progressive multiple sclerosis should monitor cognitive-linguistic impairment. An awareness of this might influence assessment, intervention and management, including the information and advice given to patients and their relatives.

The communication effects of right brain damage on the very old and the not so old

Abstract Communication descriptions of right brain damaged (RBD) subjects have usually involved groups heterogeneous in time since incident, age and education and the older elderly, who comprise an increasing proportion of the population, have received little specific attention. The paper describes the one month post stroke communication behaviour of two RBD groups, aged