Kelly Knollman-Porter

Acquired Apraxia of Speech: A Review

Abstract Apraxia of speech (AOS) is an acquired adult neurogenic communication disorder that often occurs following stroke. The purpose of this article is to review current research studies addressing the diagnostic and therapeutic management of AOS. Traditional definitions and characteristics are compared with current features that assist in the differential diagnosis of AOS. Prognostic indicators are reviewed in addition to how neuroplasticity may impact treatment in chronic AOS. Treatment techniques discussed include the articulatory kinematic approach (AKA), use of augmentative/alternative communication devices, intersystemic facilitation/reorganization, and constraint-induced therapy. Finally, the need to address functional communication through support groups, outside the therapeutic environment, is discussed.

Reading experiences and use of supports by people with chronic aphasia

Background: Reading comprehension and efficiency limitations associated with chronic aphasia can negatively influence performance of essential, functional, and pleasure reading activities. Aims: The purpose of this phenomenological study was to describe the pre- and post-aphasia reading experiences of adults with chronic, acquired reading challenges and to understand the feelings and preferences of these individuals regarding various supports and strategies. Methods & Procedures: Six individuals with chronic reading comprehension deficits associated with aphasia completed written questionnaires, participated in semi-structured interviews, and were observed engaging with reading materials typical of those preferred pre- and post-aphasia. Outcomes & Results: Two major themes emerged from the data analysis: (1) changes in reading experiences post-aphasia and (2) use of supports and strategies to facilitate improved reading comprehension and efficiency. Although reading limitations prevented participants from resuming pre-aphasia occupations or reading activities, all continued to access personally relevant information through the written modality. All participants implemented supports and strategies to improve comprehension and efficiency as much as possible when performing functional reading tasks. Conclusions: Reading limitations can negatively impact life participation in functional and pleasurable activities post-aphasia. Although consistent themes appeared across participants, individualised preferences emerged regarding reading activities and use of supports and strategies.

High-context images: Comprehension of main, background, and inferential information by people with aphasia

Background: Professionals often recommend using high-context images as expressive and receptive communication supports, even though researchers know little about the information people with aphasia can extract from these images. Aims: This study’s purposes were to compare the accuracy and speed with which people with and without aphasia derive main action, background, and inferential information from high-context images. Methods & Procedures: Twenty people with and 20 people without neurological impairment selected high-context images to match spoken sentences conveying main action, background, or inferential information. Participants listened to each sentence presented twice and selected the target image from a field of four. Computation of nonparametric statistics allowed accuracy and speed comparisons between participant groups and among the three stimulus sentence conditions. Additionally, the researchers computed correlations between participants’ standardised test scores and their accuracy and speed when performing the experimental task. Outcomes & Results: Task performance by participants without aphasia was more accurate and faster than that of participants with aphasia regardless of sentence condition. Both groups were most accurate and fastest given sentences conveying main actions. The participants with aphasia were significantly slower and less accurate when selecting high-context images to match sentences relaying background and inferential information than ones relaying main action information. This pattern differed from that of participants without aphasia who demonstrated a significant decrease in accuracy only for inferential sentences; they demonstrated significantly different response speeds among all sentence conditions. No significant correlations emerged between Western Aphasia Battery-Revised Aphasia Quotient scores or Cognitive Linguistic Quick Test Executive Functioning or Visual Spatial Domain scores and participants’ accuracy or speed of experimental task performance. However, accuracy and speed in some of the sentence stimulus conditions correlated significantly with auditory comprehension subtest scores of the Comprehensive Aphasia Test. All significant correlations indicated that accuracy increased and response speed decreased as auditory comprehension scores increased. Conclusions: Participants with aphasia performed with less accuracy and were slower at responding than participants without aphasia. The fact that participants with aphasia took about twice as long to respond on average as participants without aphasia highlights the need for ample processing time when interacting with people with aphasia. However, despite their aphasia severity as measured by standardised testing, some participants performed well regardless of whether a stimulus sentence referenced main action, background, or inferential information. The results suggest that many people with aphasia can derive substantial information from high-context images.

Preferred Visuographic Images to Support Reading by People with Chronic Aphasia

Background: Written materials used both clinically and in everyday reading tasks can contain visuographic images that vary in content and attributes. People with aphasia may benefit from visuographic images to support reading comprehension. Understanding the image type and feature preferences of individuals with aphasia is an important first step when developing guidelines for selecting reading materials that motivate and support reading comprehension. Objective: The study purposes were to determine the preferences and explore the perceptions of and opinions provided by adults with chronic aphasia regarding various image features and types on facilitating the reading process. Methods: Six adults with chronic aphasia ranked visuographic materials varying in context, engagement, and content regarding their perceived degree of helpfulness in comprehending written materials. Then, they participated in semi-structured interviews that allowed them to elaborate on their choices and convey opinions about potential benefits and detriments associated with preferred and non-preferred materials. Results/Conclusions: All participants preferred high-context photographs rather than iconic images or portraits as potential supports to facilitate reading activities. Differences in opinions emerged across participants regarding the amount of preferred content included in high context images.

Comprehension of synthetic speech and digitized natural speech by adults with aphasia

Using text-to-speech technology to provide simultaneous written and auditory content presentation may help compensate for chronic reading challenges if people with aphasia can understand synthetic speech output; however, inherent auditory comprehension challenges experienced by people with aphasia may make understanding synthetic speech difficult. This studys purpose was to compare the preferences and auditory comprehension accuracy of people with aphasia when listening to sentences generated with digitized natural speech, Alex synthetic speech (i.e., Macintosh platform), or David synthetic speech (i.e., Windows platform). The methodology required each of 20 participants with aphasia to select one of four images corresponding in meaning to each of 60 sentences comprising three stimulus sets. Results revealed significantly better accuracy given digitized natural speech than either synthetic speech option; however, individual participant performance analyses revealed three patterns: (a) comparable accuracy regardless of speech condition for 30% of participants, (b) comparable accuracy between digitized natural speech and one, but not both, synthetic speech option for 45% of participants, and (c) greater accuracy with digitized natural speech than with either synthetic speech option for remaining participants. Ranking and Likert-scale rating data revealed a preference for digitized natural speech and David synthetic speech over Alex synthetic speech. Results suggest many individuals with aphasia can comprehend synthetic speech options available on popular operating systems. Further examination of synthetic speech use to support reading comprehension through text-to-speech technology is thus warranted.

Use of Visual Cues by Adults With Traumatic Brain Injuries to Interpret Explicit and Inferential Information.

Objective:Concomitant visual and cognitive impairments following traumatic brain injuries (TBIs) may be problematic when the visual modality serves as a primary source for receiving information. Further difficulties comprehending visual information may occur when interpretation requires processing inferential rather than explicit content. The purpose of this study was to compare the accuracy with which people with and without severe TBI interpreted information in contextually rich drawings. Participants:Fifteen adults with and 15 adults without severe TBI. Design:Repeated-measures between-groups design. Main Measures:Participants were asked to match images to sentences that either conveyed explicit (ie, main action or background) or inferential (ie, physical or mental inference) information. The researchers compared accuracy between participant groups and among stimulus conditions. Results:Participants with TBI demonstrated significantly poorer accuracy than participants without TBI extracting information from images. In addition, participants with TBI demonstrated significantly higher response accuracy when interpreting explicit rather than inferential information; however, no significant difference emerged between sentences referencing main action versus background information or sentences providing physical versus mental inference information for this participant group. Conclusions:Difficulties gaining information from visual environmental cues may arise for people with TBI given their difficulties interpreting inferential content presented through the visual modality.

Comprehension of Single Versus Combined Modality Information by People With Aphasia

Purpose Every adult with aphasia displays a unique constellation of language comprehension skills and varies in the benefit derived from different content presentation formats. For many, multiple modality presentation enhances comprehension. This studys purpose was to determine the comprehension benefits for people with mild, moderate, and severe aphasia when hearing, reading, or simultaneously hearing and reading single sentences. Method Twenty-seven adults with aphasia performed a repeated-measures experiment across 3 conditions. Participants read and/or listened to sentence stimuli and selected from 4 images the 1 matching the sentence. Participants also indicated condition preference. Results Participants demonstrated significantly greatest accuracy during simultaneous written and auditory stimulus presentation. Performance patterns varied within aphasia severity groups. Individuals with mild and moderate aphasia demonstrated minimal performance differences across conditions, and people with severe aphasia were significantly more accurate in the combined modality than the written-only modality. Overall, participants required the longest response time in the written-only condition; however, participants were most efficient with auditory content. Condition preferences did not always mirror accuracy; however, the majority reported a preference for combined content presentation. Conclusions Results suggest some people with aphasia may benefit from combined auditory and written modalities to enhance comprehension efforts.

Narrative comprehension by people with aphasia given single versus combined modality presentation

ABSTRACT Background: People with aphasia experience comprehension impairments that hinder participation in daily activities. Presenting information through more than one modality may reduce demands on cognitive resources and promote improved comprehension by people with aphasia. Previous researchers have documented improved comprehension of sentence-length material given simultaneous auditory and written presentation. However, less is known about the potential benefits people with aphasia derive from combined auditory and written presentations when processing paragraph-length narratives. Aims: This study’s purpose was to examine comprehension accuracy and reviewing time for people with aphasia when processing short and long paragraph-length narratives in auditory only, written only, and combined auditory and written conditions. Additionally, we documented participants’ preferred presentation modality. Methods and Procedures: Twenty adults with chronic aphasia listened to, read, or listened to and read (combined) six short and six long narratives. After each narrative, participants answered 10 multiple-choice questions presented via the Written Choice Strategy. After reviewing all narratives, participants indicated their most and least preferred presentation modalities. Outcomes and Results: No significant comprehension differences emerged across presentation conditions. However, when considering only long narratives, participants performed with significantly greater accuracy given the combined auditory and written condition compared to either the written only or the auditory only condition. Reviewing time was shortest given auditory only presentation of short narratives; however, interpretation of this result warrants caution given that the auditory condition had a fixed rate of presentation but the other two conditions did not. Greatest efficiency occurred in the auditory only condition, followed by the combined condition, and then the written only condition. Most participants preferred the combined auditory and written condition, and the majority least preferred the auditory only condition. Conclusions: Results suggest that presenting multi-sentence narratives through more than one modality may support comprehension for some people with aphasia; however, the effect is not universal and differs depending on the length of material presented. Researchers need to investigate further response differences from people with varying aphasia severities and profiles.

Intensive Auditory Comprehension Treatment for Severe Aphasia: A Feasibility Study

Background Severe auditory comprehension impairments secondary to aphasia can adversely influence rehabilitative outcomes and quality of life. Studies examining intensive rehabilitative treatments for severe single-word auditory comprehension impairments are needed. Objectives Our purpose was to examine the feasibility and influence of a high-intensity word-picture verification treatment on high-frequency, word response accuracy. Research questions: (a) Can people with severe aphasia tolerate an intensive comprehension treatment? (b) Does an intensive intervention increase auditory comprehension response accuracy of spoken high-frequency words? Method This single-case ABA design study included 2 participants with chronic, severe auditory comprehension deficits secondary to stroke. A high-frequency, word-picture verification treatment was administered 2 hr/day, 5 days/week for 4 weeks and required participants to match the spoken word of the examiner to a picture representing an object. Results Preliminary results suggest that some people with severe chronic aphasia can tolerate an intensive auditory comprehension treatment and demonstrate improvements in high-frequency, word-level response accuracy with large effect sizes suggesting generalization to untrained stimuli. Conclusions An intensive auditory comprehension treatment protocol can contribute to improvements in response accuracy for some people with severe aphasia. Larger sample size studies are needed to further examine the influence of intensity on improvements in auditory comprehension.