Linda Armstrong

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.

New word learning in people with aphasia

Background: The theory of speech and language therapy intervention for people with aphasia is still under‐articulated, and some people with aphasia respond better to therapy than others. The reasons for individual variation in response to therapy have not yet been fully established but may partially reflect a person with aphasias ability to utilise a range of cerebral mechanisms, such as re‐accessing damaged neural pathways and establishing new ones. Most current therapies aim to help the person with aphasia access their previously available language abilities. New learning may offer an alternative therapy approach. However, there is little evidence to date on the effect of aphasia on a persons capability to learn new linguistic information. Aim: To explore the new vocabulary learning potential of people with aphasia. Methods & Procedures: Twelve participants, under the age of 65 years and with a range of aphasia severity and personal backgrounds, were taught 20 novel words over four consecutive days. Their learning of this new vocabulary was measured via a range of single‐word processing tasks based on the cognitive neuropsychological model. Ten participants repeated the tasks a few days later to establish whether the new vocabulary had been retained in long‐term memory. Outcomes & Results: All of the participants demonstrated some ability to learn the new vocabulary (both novel word forms and novel word meanings), with scores ranging from 15% to 99% on the various assessments. At the follow‐up session, the ten participants retained between 49% and 83% of their previous scores. Conclusions: This study has important implications for aphasia rehabilitation as it has shown that people with aphasia have the potential to learn new linguistic material, even in the presence of severe language impairments. This capacity could be exploited in therapy. Previously known words could be taught as new. Pre‐therapy assessment of the person with aphasias learning capacity and style would promote individually‐tailored learning experiences and so, potentially, more effective therapy and better clinical outcomes.

Further evidence on topic use following right hemisphere brain damage: Procedural and descriptive discourse

Background : In a previous report of topic use in semi-structured conversations (Brady, Mackenzie, & Armstrong, 2003), we did not find the often-described gross topic deficit in participants with right hemisphere brain damage (RHBD) when compared to non-brain-damaged participants (NBD). Discourse genre is known to affect the production of discourse, so topic use was further explored in this population using procedural discourse and picture description tasks. Aims : To explore topic coherence and management in procedural and descriptive discourse in individuals with RHBD as a result of stroke. Methods & Procedures : Four discourse samples (three procedural and one picture description) were elicited from 17 individuals with RHBD at 1 and 6 months post-stroke and from a matched NBD group of 51. The samples were transcribed and analysed in terms of topic coherence and management. T-tests were used to compare the groups on a variety of measures of topic use. Intra-rater, inter-rater, and test–retest reliability were evaluated. Outcomes & Results : As in our study of topic use in semi-structured conversations, no widespread or consistent difference between NBD and RHBD individuals was indicated in their procedural and descriptive discourse data. Some differences in subdivision of topic structure and in the use of fillers may be worthy of further exploration. There was no notable task effect. Conclusions : Again there is little support in our data for the perception that, as a group, people with RHBD experience significant topic use deficits. Over seven discourse tasks, including semi-structured conversation, procedures, and picture description, no consistent topic use deficit was noted among the individuals with RHBD in our analyses. Reasons for this apparent lack of difference/difficulty are discussed. Clinical implications and some indications for possible further experimental study in the area of topic use in people with RHBD post-stroke are described.

Parkinson's disease and aided AAC: some evidence from practice

Clinical observation that people with Parkinsons disease (PD) seem to have different training needs from other adult client-groups in developing effective use of aided augmentative and alternative communication (AAC) was the catalyst for this study. There is little good-quality research evidence available on the effectiveness (or lack of effectiveness) of aided AAC use by those with PD. One of the main aims of this preliminary study, therefore, was to elicit the experiences and attitudes of speech and language therapists in this specific area of their practice as the basis for future efficacy research and clinical practice. Thirty speech and language therapists were questioned about their experience of introducing low- and high-tech AAC devices to this client-group. Of particular interest was the discovery of the factors identified by the therapists as influencing their introduction of aided AAC to someone with PD and affecting implementation and successful use. The factors reported were both disease-specific (e.g. motor problems) and more general factors (e.g. carer support) relevant to the process of introducing aided AAC to other adult client-groups. Implications for future research and practice are discussed. Some research questions are posed and the inclusion of people with PD and their carers in practice development is promoted.

Aiding chronic written language expression difficulties: a case study.

This paper describes some progress made in helping a young aphasic man (MD) to overcome what had appeared to be intractable written language expression difficulties, which continued to be significant for him. Traditional therapy methods based on cognitive neuropsychological assessment had failed to help MD to generalize improvement in his spelling particularly, but not exclusively, of longer and irregular words. Both a splint which allowed him to use his dominant hand for writing directly onto a computer screen and a simple word-processing programme with synthesized auditory feedback and lexical and grammatical prediction (Write:OutLoud and Co:Writer) enabled him to produce more normal written output (increased quantity and more normal quality). The discussion also focuses on how effectiveness of language therapy can be measured in this man with chronic aphasia.

Disordered communicative interaction: Current and future approaches to analysis and treatment

In 2004, the Nursing, Midwifery and Allied Health Professions Research Unit (funded by the Chief Scientist Office, Department of Health, Scottish Executive) had an opportunity to host a specialist colloquium as part of the ongoing programme of stroke and communication research within the unit. The aim of the colloquium was to act as a forum for researchers, academics, and clinicians, with a specialist interest in the field of discourse analysis and its applications to disordered communicative interaction, to share their experiences and expertise. The Stirling Discourse Colloquium took place in October 2004 at the University of Stirling and was designed to provide an opportunity to pause and reflect on past work, to encourage a review of established facts, and to communicate current interests. We hoped that by gathering participants with a shared knowledge of the analysis and treatment of disordered communicative interaction, we could distil our thoughts on current and future directions that theory development and empirical efforts might take. Participants were working with a wide range of population groups, although the focus on the analysis and treatment of disordered communicative interaction was shared by all. The colloquium was centred around two themed sessions: Quantitative versus Qualitative – Coinciding or Colliding Approaches and Clinical Considerations – the Pragmatics of Theory and Practice. In each session, participants presented recent or ongoing work. The presentations were followed by a lengthy discussion of the issues arising. The collaborative approach that all participants took enabled two very productive discussions. The perception of a tension between qualitative and quantitative approaches to the analysis of discourse interaction was considered, as were the specific advantages and disadvantages of the two approaches. The relevance and feasibility of theoryand research-based tools in clinical practice, the evidence for the use of such approaches, and the generation of future developments through pioneering clinical practice were also discussed.

Content Analysis of the Professional Journal of the Royal College of Speech and Language Therapists, III: 1966-2015--Into the 21st Century.

BACKGROUND Following content analyses of the first 30 years of the UK speech and language therapy professional bodys journal, this study was conducted to survey the published work of the speech (and language) therapy profession over the last 50 years and trace key changes and themes. AIM To understand better the development of the UK speech and language therapy profession over the last 50 years. METHODS & PROCEDURES All volumes of the professional journal of the Royal College of Speech and Language Therapists published between 1966 and 2015 (British Journal of Communication Disorders, European Journal of Communication Disorders and International Journal of Language and Communication Disorders) were examined using content analysis. The content was compared with that of the same journal as it appeared from 1935 to 1965. OUTCOMES & RESULTS The journal has shown a trend towards more multi-authored and international papers, and a formalization of research methodologies. The volume of papers has increased considerably. Topic areas have expanded, but retain many of the areas of study found in earlier issues of the journal. CONCLUSIONS & IMPLICATIONS The journal and its articles reflect the growing complexity of conditions being researched by speech and language therapists and their professional colleagues and give an indication of the developing evidence base for intervention and the diverse routes which speech and language therapy practice has taken over the last 50 years.