Elizabeth Spencer

Linguistic analysis of discourse in aphasia: A review of the literature.

ABSTRACT This review examined previous research applications of linguistic discourse analysis to assess the language of adults with aphasia. A comprehensive literature search of seven databases identified 165 studies that applied linguistic measures to samples of discourse collected from people with aphasia. Analysis of methodological applications revealed an increase in published research using linguistic discourse analysis over the past 40 years, particularly to measure the generalisation of therapy outcomes to language in use. Narrative language samples were most frequently subject to analysis though all language genres were observed across included studies. A total of 536 different linguistic measures were applied to examine language behaviours. Growth in the research use of linguistic discourse analysis and suggestions that this growth may be reflected in clinical practice requires further investigation. Future research directions are discussed to investigate clinical use of discourse analysis and examine the differences that exist between research and clinical practice.

Speech pathologists’ current practice with cognitive-communication assessment during post-traumatic amnesia: A survey

Abstract Primary objective: To investigate speech pathologists’ current practice with adults who are in post-traumatic amnesia (PTA). Method: Speech pathologists with experience of adults in PTA were invited to take part in an online survey through Australian professional email/internet-based interest groups. Results: Forty-five speech pathologists responded to the online survey. The majority of respondents (78%) reported using informal, observational assessment methods commencing at initial contact with people in PTA or when patients’ level of alertness allowed and initiating formal assessment on emergence from PTA. Seven respondents (19%) reported undertaking no assessment during PTA. Clinicians described using a range of techniques to monitor cognitive-communication during PTA, including static, dynamic, functional and impairment-based methods. Conclusions: The study confirmed that speech pathologists have a key role in the multidisciplinary team caring for the person in PTA, especially with family education and facilitating interactions with the rehabilitation team and family. Decision-making around timing and means of assessment of cognitive-communication during PTA appeared primarily reliant on speech pathologists’ professional experience and the culture of their workplace. The findings support the need for further research into the nature of cognitive-communication disorder and resolution over this period.

A preliminary investigation of the impact of stuttering on language use

This paper reflects on the application of Systemic Functional Linguistics (SFL) to the field of stuttering. It is argued that the SFL theory may offer insight into the impact that stuttering has on language use. Two case studies are presented to illustrate the application of SFL theory. The two SFL analyses found to be of most use in this pilot study were the analysis of how language is modulated in response to interpersonal aspects of communication (modality) and the analysis of how information is foregrounded (theme). The implications of applying the SFL model to consideration of the utilisation of language resources in people who stutter are discussed.

Propositional Idea Density in women's written language over the lifespan: Computerized analysis

The informativeness of written language, as measured by Propositional Idea Density (PD), has been shown to be a sensitive predictive index of language decline with age and dementia in previous research. The present study investigated the influence of age and education on the written language of three large cohorts of women from the general community, born between 1973 and 1978, 1946-51 and 1921-26. Written texts were obtained from the Australian Longitudinal Study on Womens Health in which participants were invited to respond to an open-ended question about their health. The informativeness of written comments of 10 words or more (90% of the total number of comments) was analyzed using the Computerized Propositional Idea Density Rater 3 (CPIDR-3). Over 2.5 million words used in 37,705 written responses from 19,512 respondents were analyzed. Based on a linear mixed model approach to statistical analysis with adjustment for several factors including number of comments per respondent and number of words per comment, a small but statistically significant effect of age was identified for the older cohort with mean age 78 years. The mean PD per word for this cohort was lower than the younger and mid-aged cohorts with mean age 27 and 53 years respectively, with mean reduction in PD 95% confidence interval (CI) of .006 (.003, .008) and .009 (.008, .011) respectively. This suggests that PD for this population of women was relatively more stable over the adult lifespan than has been reported previously even in late old age. There was no statistically significant effect of education level. Computerized analyses were found to greatly facilitate the study of informativeness of this large corpus of written language. Directions for further research are discussed in relation to the need for extended investigation of the variability of the measure for potential application to the identification of acquired language pathologies.

The effect of stuttering on communication: A preliminary investigation

This paper describes a study in which Systemic Functional Linguistics was applied to describe how people who stutter use language. The aim of the study was to determine and describe any differences in language use between a group of 10 adults who stutter and 10 matched normally‐fluent speakers. In addition to formal linguistic analyses, analyses drawn from Systemic Functional Linguistics were used to further investigate the expression of both syntactic and semantic complexity. The findings from this study replicated previous findings of Packman et al. in which they found that the language used by people who stutter was significantly less complex than the control group. Another major finding was that adults who stuttered used the linguistic resource of modality significantly less than the normally‐fluent matched peers. The implications these strategies have on communication and social participation will be discussed.

Clinicians’ management of young children with co-occurring stuttering and speech sound disorder

Abstract Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants’ main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload.

Propositional Idea Density in aphasic discourse

Background: Measuring and describing the effects of aphasia on the informativeness of language is a complex process. Due to technological advances in the recent years, the processes involved in the measurement of language can be automated through the use of computerised analyses. In the present research, the Computerized Propositional Idea Density Rater (CPIDR 3.2) provides an automated method for calculating Propositional Idea Density (PD), a measure which has been shown to be sensitive to the effects of ageing and dementia. The measure of PD quantifies the proportion of words within a text that are semantically intrinsic to its overall meaning. Aims: This research investigated the extent to which PD measures were different in aphasic and non-aphasic discourse, and the extent to which PD correlated with the severity of aphasia and with the established measures of other aspects of informativeness. Given the previously reported high levels of agreement between the computerised analysis and human raters, it was hypothesised that there would be high levels of agreement between the computerised analysis and human judgements for aphasic (as well as non-aphasic) discourse. Methods & Procedures: Data from the Goals in Aphasia Project were analysed for the purposes of the present research. De-identified transcriptions of 50 interviews with individuals with aphasia and 49 interviews with their family members were stripped of all interviewer data, leaving only conversational contributions made by the participants. These formatted transcripts were analysed using two automated, computerised language analysis tools: CPIDR 3.2) and Systematic Analysis of Language Transcripts (SALT Version 8) for a range of other discourse measures. Outcomes & Results: Results showed a significant difference in PD (p < .001) between aphasic and non-aphasic discourse, and PD decreased significantly as aphasia increased in severity (p < .001). The concurrent validity of these findings was supported by the findings of relationships with established discourse measures. The total percent agreement between the computerised analysis and human judgments for aphasic discourse was 99.57% and for non-aphasic discourse was 99.74%. Conclusions: The findings indicated that PD has the potential to be used as a measure of discourse informativeness in aphasia and that further research into this approach to analysis is warranted.

Language and ageing – exploring propositional density in written language – stability over time

This study investigated the stability of propositional density (PD) in written texts, as this aspect of language shows promise as an indicator and as a predictor of language decline with ageing. This descriptive longitudinal study analysed written texts obtained from the Australian Longitudinal Study of Womens Health in which participants were invited to respond to an open-ended question about their health. The 635 texts used for this study were taken from 127 middle-aged women who responded to this question on each of the five surveys conducted at 3-year intervals over a 16-year period. The study made use of an automated PD rater (CPIDR-3) for the analysis. PD was found to be a stable measure over time when comparing the grouped data, but there was between- and within-subject variation over time. Further research is needed to explore the valid use of this measure in research into language and ageing.

Clinical use of linguistic discourse analysis for the assessment of language in aphasia

ABSTRACT Background: Linguistic discourse analysis is an assessment method widely applied within aphasia research literature to examine impairments as they affect the language of daily function—discourse. Although this literature suggests that clinical applications do occur, it also identifies barriers that may inhibit the translation of research to practice. Aims: This study aimed to identify the frequency of use and methods of linguistic discourse analysis application by speech pathologists when assessing their clients with aphasia. Methods & Procedures: A survey was distributed electronically to speech pathologists in five English-speaking countries using the online survey management tool Survey Monkey®. Clinical applications of linguistic discourse analysis were examined using descriptive statistics and cross-tabulation analyses. Outcomes & Results: Of 123 valid survey results, 106 clinicians reported use of linguistic discourse analysis to assess language in aphasia. Respondents collected language elicited in conversational contexts and expositional discourse samples most often, and subjected these samples to a range of linguistic measures. Most clinicians applied a judgement-based method of analysis based on clinical observation. Clinicians reported positive attitudes towards the use of linguistic discourse analysis, but were limited from widespread use by barriers such as a lack of available clinical time. Conclusions: Results revealed that speech pathologists defined and therefore implemented linguistic discourse analysis in a variety of ways. The methods used to elicit, prepare and analyse discourse varied among respondents. Further investigation is warranted to examine the effectiveness of clinical discourse analysis applications and to support the translation of evidence-based research methods to clinical practice.

Language and cognitive communication during post-traumatic amnesia: A critical synthesis

BACKGROUND There is minimal speech pathology literature on communication presentation during post-traumatic amnesia (PTA) and the early recovery period after traumatic brain injury. While a body of research reports on other cognitive and behavioural functions during PTA, language and/or cognitive communication are not routinely the primary focus of current research literature. OBJECTIVE This critical synthesis provides an overview of research to date on communication during PTA to inform speech pathology assessment practice and to assist with information provision to the multidisciplinary team and family members. METHODS A search was conducted of studies reporting on language, cognition, and cognitive communication during the acute, inpatient and early recovery period after TBI. These were examined for relevance to speech pathology practice during PTA and acute confusional state. RESULTS Historic and recent literature has described types of language and communication impairment during PTA and early recovery after TBI. Recently, aspects of communication impairment during PTA have been found relevant for outcome prediction. Few studies were found originating from speech pathology on communication during PTA. CONCLUSIONS Communication disruption forms a key feature of PTA. Existing literature indicates that speech pathology monitoring of communication during PTA may be of benefit as part of multidisciplinary team management during early recovery.