Christos Salis

Short-term memory treatment: Patterns of learning and generalisation to sentence comprehension in a person with aphasia

Auditory-verbal short-term memory deficits (STM) are prevalent in aphasia and can contribute to sentence comprehension deficits. This study investigated the effectiveness of a novel STM treatment in improving STM (measured with span tasks) and sentence comprehension (measured with the Token Test and the Test for the Reception of Grammar, TROG) in a person with severe aphasia (transcortical motor). In particular, the research questions were: (1) Would STM training improve STM? (2) Would improvements from the STM training generalise to improvements in comprehension of sentences? STM was trained using listening span tasks of serial word recognition. No other language or sentence comprehension skills were trained. Following treatment, STM abilities improved (listening span, forward digit span). There was also evidence of generalisation to untreated sentence comprehension (only on the TROG). Backward digit span, phonological processing and single word comprehension did not improve. Improvements in sentence comprehension may have resulted from resilience to rapid decay of linguistic representations within sentences (words and phrases). This in turn facilitated comprehension.

Comprehension of wh-questions and declarative sentences in agrammatic aphasia: The set partition hypothesis

Abstract Problematic trace-antecedent relations between deep and surface structure have been a dominant theme in sentence comprehension in agrammatism. We challenge this view and propose that the comprehension in agrammatism in declarative sentences and wh-questions stems from impaired processing in logical form. We present new data from wh-questions and declarative sentences and advance a new hypothesis which we call the set partition hypothesis. We argue that elements that signal set partition operations influence sentence comprehension while trace-antecedent relations remain intact.

Assessment and Treatment of Short-Term and Working Memory Impairments in Stroke Aphasia: A Practical Tutorial.

BACKGROUND Aphasia following stroke refers to impairments that affect the comprehension and expression of spoken and/or written language, and co-occurring cognitive deficits are common. In this paper we focus on short-term and working memory impairments that impact on the ability to retain and manipulate auditory-verbal information. Evidence from diverse paradigms (large group studies, case studies) report close links between short-term/working memory and language functioning in aphasia. This evidence leads to the hypothesis that treating such memory impairments would improve language functioning. This link has only recently been acknowledged in aphasia treatment but has not been embraced widely by clinicians. AIMS To examine the association between language, and short-term and working memory impairments in aphasia. To describe practical ways of assessing short-term and working memory functioning that could be used in clinical practice. To discuss and critically appraise treatments of short-term and working memory reported in the literature. METHODS & PROCEDURES Taking a translational research approach, this paper provides clinicians with current evidence from the literature and practical information on how to assess and treat short-term and working memory impairments in people with aphasia. Published treatments of short-term and/or working memory in post-stroke aphasia are discussed through a narrative review. MAIN CONTRIBUTIONS This paper provides the following. A theoretical rationale for adopting short-term and working memory treatments in aphasia. It highlights issues in differentially diagnosing between short-term, working memory disorders and other concomitant impairments, e.g. apraxia of speech. It describes short-term and working memory assessments with practical considerations for use with people with aphasia. It also offers a description of published treatments in terms of participants, treatments and outcomes. Finally, it critically appraises the current evidence base relating to the treatment of short-term and working memory treatments. CONCLUSIONS The links between short-term/working memory functioning and language in aphasia are generally acknowledged. These strongly indicate the need to incorporate assessment of short-term/working memory functioning for people with aphasia. While the supportive evidence for treatment is growing and appears to highlight the benefits of including short-term/working memory in aphasia treatment, the quality of the evidence in its current state is poor. However, because of the clinical needs of people with aphasia and the prevalence of short-term/working memory impairments, incorporating related treatments through practice-based evidence is advocated.

The use of standardised short-term and working memory tests in aphasia research: a systematic review

ABSTRACT Impairments of short-term and working memory (STM, WM), both verbal and non-verbal, are ubiquitous in aphasia. Increasing interest in assessing STM and WM in aphasia research and clinical practice as well as a growing evidence base of STM/WM treatments for aphasia warrant an understanding of the range of standardised STM/WM measures that have been utilised in aphasia. To date, however, no previous systematic review has focused on aphasia. Accordingly, the goals of this systematic review were: (1) to identify standardised tests of STM and WM utilised in the aphasia literature, (2) to evaluate critically the psychometric strength of these tests, and (3) to appraise critically the quality of the investigations utilising these tests. Results revealed that a very limited number of standardised tests, in the verbal and non-verbal domains, had robust psychometric properties. Standardisation samples to elicit normative data were often small, and most measures exhibited poor validity and reliability properties. Studies using these tests inconsistently documented demographic and aphasia variables essential to interpreting STM/WM test outcomes. In light of these findings, recommendations are provided to foster, in the future, consistency across aphasia studies and confidence in STM/WM tests as assessment and treatment outcome measures.

Short-Term and Working Memory Treatments for Improving Sentence Comprehension in Aphasia: A Review and a Replication Study

Although the roles of verbal short-term and working memory on spoken sentence comprehension skills in persons with aphasia have been debated for many years, the development of treatments to mitigate verbal short-term and working memory deficits as a way of improving spoken sentence comprehension is a new avenue in treatment research. In this article, we review and critically appraise this emerging evidence base. We also present new data from five persons with aphasia of a replication of a previously reported treatment that had resulted in some improvement of spoken sentence comprehension in a person with aphasia. The replicated treatment did not result in improvements in sentence comprehension. We forward recommendations for future research in this, admittedly weak at present, but important clinical research avenue that would help improve our understanding of the mechanisms of improvement of short-term and working memory training in relation to sentence comprehension.

Tests of syntactic comprehension in aphasia: An investigation of task effects

Background: Consistency of performance across tasks that assess syntactic comprehension in aphasia has clinical and theoretical relevance. In this paper we add to the relatively sparse previous work on how sentence comprehension abilities are influenced by the nature of the assessment task. Aims: Our aims are: (1) to compare linguistic performance across sentence–picture matching, enactment, and truth‐value judgement tasks; (2) to investigate the impact of pictorial stimuli on syntactic comprehension. Methods & Procedures: We tested a group of 10 aphasic speakers (3 with fluent and 7 with non‐fluent aphasia) in three tasks (Experiment 1): (i) sentence–picture matching with four pictures, (ii) sentence–picture matching with two pictures, and (iii) enactment. A further task of truth‐value judgement was given to a subgroup of those speakers (n = 5, Experiment 2). Similar sentence types across all tasks were used and included canonical (actives, subject clefts) and non‐canonical (passives, object clefts) sentences. We undertook two types of analyses: (a) we compared canonical and non‐canonical sentences in each task; (b) we compared performance between (i) actives and passives, (ii) subject and object clefts in each task. We examined the results of all participants as a group and as case‐series. Outcomes & Results: Several task effects emerged. Overall, the two‐picture sentence–picture matching and enactment tasks were more discriminating than the four‐picture condition. Group performance in the truth‐value judgement task was similar to two‐picture sentence–picture matching and enactment. At the individual level performance across tasks contrasted to some group results. Conclusions: Our findings revealed task effects across participants. We discuss reasons that could explain the diverse profiles of performance and the implications for clinical practice.

Aphasia in an Internet age: wider perspectives on digital inclusion

Background: Aphasia is likely to impact adversely on the ability to use the Internet successfully, as linguistic skills are important for many aspects of Internet use. Despite this, there exists limited evidence on how best to support people with aphasia to benefit from the Internet. Whilst linguistic impairments in aphasia will have an impact on Internet use, there are other important factors such as other cognitive or physical impairments. There are also differences in digital skills between social groups in the UK, creating inequalities. People with aphasia and those who support them are likely to have varying levels of Internet use. These aspects are relevant in improving our understanding of factors relevant to supporting people with aphasia to use the Internet. Aims: The main aim is to discuss the key areas related to supporting people with aphasia to achieve equality of access to and use of the Internet. This paper focuses on three questions related to Internet use: (1) What do we know about access and use of the Internet by populations who share characteristics with people with aphasia and may experience similar disabilities?, (2) Based on that knowledge, what types of difficulties with Internet use might be predicted for people with aphasia? and (3) How has Internet use or support with Internet skills been studied in relation to people with aphasia. If not directly studied, what does relevant related work tell us? Main Contribution: This paper discusses factors that might act as barriers or facilitators to Internet use by people with aphasia, viewed from within the conceptual frameworks of the International Classification of Disability and Functioning and the Communications Consumer Panel Framework on Digital Participation. It considers the relevant literature on digital exclusion in the wider population and on aphasia and technology, in order to present a wide perspective on the range of issues involved in mitigating digital exclusion. Conclusions: The interrelationships between the complex demands imposed by aphasia and factors thought to contribute to digital exclusion are complex and multifactorial. The literature directly relating to aphasia and technology and from wider evidence on digital exclusion all contribute to understanding of key barriers and facilitators to Internet use. Consideration of these wider factors and of the contributions from a range of disciplines, historically not involved in aphasia rehabilitation, is helpful in understanding the needs of people with aphasia in a digital age and to develop future interventions.

Treatment of written verb and written sentence production in an individual with aphasia: A clinical study

Background: Although the efficacy of treatments for spoken verb and sentence production deficits in aphasia has been documented widely, less is known about interventions for written verb and written sentence production deficits. Aims: This study documents a treatment aiming to improve production of (a) written subject-verb sentences (involving intransitive verbs) and (b) written subject-verb-object sentences (involving transitive verbs). Methods & Procedures: The participant, a 63-year-old female aphasic speaker, had a marked language comprehension deficit, apraxia of speech, relatively good spelling abilities, and no hemiplegia. The treatment involved intransitive verbs producing subject-verb active sentences and transitive verbs producing subject-verb-object active non-reversible sentences. The treatment was undertaken in the context of current UK clinical practice. Outcomes & Results: Statistical improvements were noted for the trained sets of verbs and sentences. Other improvements were also noted in LWs ability to retrieve some non-treated verbs and construct written sentences. Treatment did not generalise to sentence comprehension and letter spelling to dictation. Conclusions: Our participants ability to write verbs and sentences improved as a result of the treatment.

Digital technology and aphasia

Holland and Matthews (1970) used the term “teaching machines” in the first report of applying digital technology to help people with communication impairments to overcome their difficulties. Significant changes have taken place since those early days of using digital technologies in clinical practice. In the 1980s and 1990s, the availability of personal computers opened new opportunities for aphasiologists and software engineers to design and research treatments for improving language functioning (e.g., Bruce & Howard, 1987; Crerar, Ellis, & Dean, 1996; Katz & Nagy, 1984). More recently, advances in smartphones, tablets, and Internet connectivity, for example, have contributed to the integration of technology into many aspects of daily life, offering new possibilities for communication and working practices. Making the most of technology to enhance the lives of people with aphasia, and understanding and removing barriers of accessing digital technology requires an interdisciplinary approach. A key aim of this special issue is to bring together authors and reviewers from aphasiology and human–computer interaction, to help build a crossdisciplinary knowledge base. Several of the papers describe collaborative projects and processes, and we hope this will inform and inspire further interdisciplinary work. The papers in this issue span a range of topics, which reflect the diversity of challenges and interests in digital technology and aphasia. In an earlier, related special issue of Aphasiology, Petheram (2004) presented examples of how technology was being used to deliver aphasia treatment, discussed the need to critically evaluate these forms of treatment, and explored ways in which people with aphasia could benefit from and engage fully in an “information society.” Now, just over 10 years later, we see that these issues remain just as important. At the same time, technologies that were not widely available then are now providing new opportunities and challenges. In addition, the proliferation of technology in today’s society has made the topic of digital inclusion even more important. For example, the very nature of communication through popular digital media is primarily verbal. This means that people affected by aphasia, that is, a primarily verbal disability, are likely to be excluded to a greater or lesser extent by the wonders of these media. Along this theme, the following papers grapple with challenges of digital inclusion and the “digital divide.” Menger, Morris, and Salis (2015) discuss key factors that might act as barriers or enablers to Internet use by people with aphasia. Kelly, Kennedy, Britton, McGuire, and Law (2015) describe a training seminar aimed to improve computer literacy in a group of people with aphasia (cf., Egan, Worrall, & Oxenham, 2004). The authors also discuss the barriers encountered by people with aphasia that prevent access and use of technology to independently self-manage their daily lives. In addition to improving access to “mainstream” technologies, work on designing technology specifically for people with aphasia and speech-language pathologists is also important. Interdisciplinary collaboration is particularly important here. Messamer, Ramsberger, and Atkins (2015) argue for adopting inclusive design principles in rehabilitation software development. They describe a versatile application for anomia treatment and discuss the decision-making process that influenced the design of the application, Aphasiology, 2016 Vol. 30, Nos. 2–3, 109–111, http://dx.doi.org/10.1080/02687038.2015.1109052

Processing of wh-questions in a case of posterior cortical atrophy

Posterior cortical atrophy (PCA) is a type of dementia that is characterized by visuo-spatial and memory deficits, dyslexia and dysgraphia, relatively early onset and preserved insight. Language deficits have been reported in some cases of PCA. Using an off-line grammaticality judgement task, processing of wh-questions is investigated in a case of PCA. Other aspects of auditory language are also reported. It is shown that processing of wh-questions is influenced by syntactic structure, a novel finding in this condition. The results are discussed with reference to accounts of wh-questions in aphasia. An uneven profile of other language abilities is reported with deficits in digit span (forward, backward), story retelling ability, comparative questions but intact abilities in following commands, repetition, concept definition, generative naming and discourse comprehension.