Margaret Forbes

AphasiaBank: Methods for studying discourse

Background: AphasiaBank is a computerised database of interviews between persons with aphasia (PWAs) and clinicians. By February 2011 the database had grown to include 145 PWAs and 126 controls from 12 sites across the United States. The data and related analysis programs are available free over the web. Aims: The overall goal of AphasiaBank is the construction of a system for accumulating and sharing data on language usage by PWAs. To achieve this goal we have developed a standard elicitation protocol, and systematic automatic and manual methods for transcription, coding, and analysis. Methods & Procedures: We present sample analyses of transcripts from the retelling of the Cinderella story. These analyses illustrate the application of our methods for the study of phonological, lexical, semantic, morphological, syntactic, temporal, prosodic, gestural, and discourse features. Outcomes & Results: AphasiaBank will allow researchers access to a large, shared database that can facilitate hypothesis testing and increase methodological replicability, precision, and transparency. Conclusions: AphasiaBank will provide researchers with an important new tool in the study of aphasia. This project is funded by NIH_NIDCD grant R01-DC008524 (2007-2012).

Predictors of decline in Alzheimer's disease.

Age of onset and aphasia are frequently proposed as predictors of decline in Alzheimers disease (AD). We compared longitudinally the neuropsychological test performance of AD patients classified as Fast Decliners (FD, N = 18) based on the rate of change of their scores on the Mini-Mental State Examination (MMS) and a group classified as Slow Decliners (SD, N = 15). There was no statistical difference in the age of onset of AD or in severity of dementia at first visit. Performance on verbal tests was the best predictor of rapid cognitive decline, even after the influence of the overall degree of dementia had been accounted for. Among the language tasks, performance on a naming test was the best predictor. The results of this study do not support age of onset as a predictor of the course of AD. On the other hand, poor performance on language tests does predict a more rapid rate of decline in AD.

Automated analysis of the Cinderella story

Background: AphasiaBank is a collaborative project whose goal is to develop an archival database of the discourse of individuals with aphasia. Along with databases on first language acquisition, classroom discourse, second language acquisition, and other topics, it forms a component of the general TalkBank database. It uses tools from the wider system that are further adapted to the particular goal of studying language use in aphasia. Aims: The goal of this paper is to illustrate how TalkBank analytic tools can be applied to AphasiaBank data. Methods &Procedures: Both aphasic (n = 24) and non-aphasic (n = 25) participants completed a 1-hour standardised videotaped data elicitation protocol. These sessions were transcribed and tagged automatically for part of speech. One component of the larger protocol was the telling of the Cinderella story. For these narratives we compared lexical diversity across the groups and computed the top 10 nouns and verbs across both groups. We then examined the profiles for two participants in greater detail. Conclusions: Using these tools we showed that, in a story-retelling task, aphasic speakers had a marked reduction in lexical diversity and a greater use of light verbs. For example, aphasic speakers often substituted “girl” for “stepsister” and “go” for “disappear”. These findings illustrate how it is possible to use TalkBank tools to analyse AphasiaBank data.

Rehabilitation of aphasia.

Aphasia is one of the most striking cognitive sequels of strokes and other cerebral lesions, and attempts to rehabilitate aphasic patients have been undertaken for many years. Following a brief overview of the epidemiology and the clinical characteristics of aphasia, the chapter presents the major traditional approaches to rehabilitation. They include the stimulation approach (also called classic), the behavior modification approach, Lurias approach (functional reorganization), the pragmatic approach, as well as the neurolinguistic approach. The next section illustrates some of the current approaches to aphasia rehabilitation, specifically the syndromic approach (also called neoassociationist), the cognitive neuropsychological approach, and the social approach. The chapter then provides examples of specific methods. While all intervention strategies may be classified, more or less correctly, into one or another of the above categories, it is not possible to mention the hundreds of specific interventions to be found in the literature, some of which have been described only briefly and in reference to a single case. The chapter concludes with a review of efficacy studies on aphasia therapy. Despite some opinions to the contrary, the current consensus is that sufficient experimental evidence of efficacy exists to recommend treatment of aphasia.

AphasiaBank: A resource for clinicians

AphasiaBank is a shared, multimedia database containing videos and transcriptions of ~180 aphasic individuals and 140 nonaphasic controls performing a uniform set of discourse tasks. The language in the videos is transcribed in Codes for the Human Analysis of Transcripts (CHAT) format and coded for analysis with Computerized Language ANalysis (CLAN) programs, which can perform a wide variety of language analyses. The database and the CLAN programs are freely available to aphasia researchers and clinicians for educational, clinical, and scholarly uses. This article describes the database, suggests some ways in which clinicians and clinician researchers might find these materials useful, and introduces a new language analysis program, EVAL, designed to streamline the transcription and coding processes, while still producing an extensive and useful language profile.

“Better but no cigar”: Persons with aphasia speak about their speech

Background: This study examined responses of persons with aphasia (PWAs) to a general question about their speech. Aims: The goal was to describe their evaluative responses as positive, negative, or neutral/mixed and determine if responses differed, based on time post-onset, aphasia severity, and aphasia type. Methods & Procedures: A total of 71 participants from the AphasiaBank project were included. As part of a larger protocol, investigators asked, “How do you think your speech is these days?” Responses were videotaped and transcribed using CLAN. Two authors coded the evaluative responses and categorised themes in the elaborative content provided by the participants. Outcomes & Results: Positive responses accounted for 59% of all responses, followed by neutral/mixed (18%), and negative (17%). Participants also mentioned specific speech problems (35%), improvement (31%), and therapy (8%) in their responses. Time post- onset and aphasia type were not significantly associated with nature of response. Aphasia severity was significantly associated with nature of response, with higher AQ scores in the positive group and vice versa. Conclusions: The responses are discussed in the context of self-image and self-expression in PWA and social models in aphasia therapy. Results are also compared with those of others with chronic disabilities and research on resilience, positive affect, and optimism.

Long-term recovery in stroke accompanied by aphasia: a reconsideration

ABSTRACT Background: This work focuses on the 26 individuals who provided data to AphasiaBank on at least two occasions, with initial testing between 6 months and 5.8 years post onset of aphasia. The data are archival in nature and were collected from the extensive database of aphasic discourse in AphasiaBank. Aims: The aim is to furnish data on the nature of long-term changes in both the impairment of aphasia as measured by the Western Aphasia Battery-Revised (WAB-R) and its expression in spoken discourse. Methods & Procedures: AphasiaBank’s demographic database was searched to discover all individuals who were tested twice at an interval of at least a year with either (a) the AphasiaBank protocol or (b) the AphasiaBank protocol at first testing, and the Famous People Protocol (FPP) at second testing. The FPP is a measure developed to assess the communication strategies of individuals whose spoken language limitations preclude full participation in the AphasiaBank protocol. The 26 people with aphasia (PWA) who were identified had completed formal speech therapy before being seen for AphasiaBank. However, all were participants in aphasia centres where at least 3 hr of planned activities were available, in most cases, twice weekly. WAB-R Aphasia Quotient scores (AQ) were examined, and in those cases where AQ scores improved, changes were assessed on a number of measures from the AphasiaBank discourse protocol. Outcomes & Results: Sixteen individuals demonstrated improved WAB-R AQ scores, defined as positive AQ change scores greater than the WAB-R AQ standard error of the mean (WAB-SEM); seven maintained their original WAB quotients, defined as AQ change scores that were not greater than the WAB-SEM; and the final three showed negative WAB-R change scores, defined as a negative WAB-R AQ change score greater than the WAB-SEM. Concurrent changes on several AphasiaBank tasks were also found, suggesting that the WAB-R improvements were noted in more natural discourse as well. Conclusions: These data are surprising since conventional wisdom suggests that spontaneous improvement in language is unlikely to occur beyond 1 year. Long-term improvement or maintenance of early test scores, such as that shown here, has seldom been demonstrated in the absence of formal treatment. Speculations about why these PWA improved, maintained, or declined in their scores are considered.

Discourse Characteristics in Aphasia Beyond the Western Aphasia Battery Cutoff

Purpose This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia. Method Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density. Results Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia. Conclusion Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.

Procedural discourse performance in adults with severe traumatic brain injury at 3 and 6 months post injury

ABSTRACT Background: There is limited research on communicative recovery during the early stages after a severe traumatic brain injury (TBI) in adults. Methods and procedures: In the current study 43 people with severe TBI described a simple procedure at 3 and 6 months post injury and this was compared to the description provided by 37 healthy speakers. Linguistic productivity and the presence of macrostructural discourse elements were analysed. Main outcomes and results: No change occurred in productivity in the TBI group between the two time points. There was increased use of relevant information (macrostructure) over time for the TBI group, reflecting improvement. People with TBI differed from controls in speech rate and in two out of three macrostructural categories at both time points, indicating difficulties even after 12 weeks of recovery. Conclusions: Overall, the quality, rather than the quantity of discourse was disordered for participants with TBI. Findings indicate that procedural discourse is sensitive to discourse deficits of people with TBI and can be used to map recovery during the sub-acute phase.

The Relationship Between Confrontation Naming and Story Gist Production in Aphasia

Purpose The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007) aphasia subtype. Method Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately. Results We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype. Conclusions Picture naming may accurately predict gist production for individuals with Brocas and Wernickes aphasia, but not for other WAB-R subtypes. Given the current reprioritization of outcome measurement, picture naming may not be an appropriate surrogate measure for functional communication for all persons with aphasia. Supplemental Materials https://doi.org/10.23641/asha.5851848.