Mary Boyle

Semantic feature analysis as a treatment for aphasic dysnomia: A replication

Semantic Feature Analysis (SFA) is a treatment technique designed to improve lexical retrieval by increasing the level of activation within a semantic network. The purpose of this study was to replicate the Boyle and Coelho (1995) study in which SFA was applied with a mild non-fluent aphasic individual resulting in improved confrontation naming of trained and untrained items but no generalization to connected speech. The present study investigated whether a comparable treatment effect could be demonstrated, and to what extent severity and type aphasia might impact overall outcome. SFA was applied to an individual with a moderate fluent aphasia secondary to a closed head injury. Gains in confrontation naming of both trained and untrained stimulus pictures were noted as well as measures of connected speech. Potential explanations for these findings are discussed.

Discourse treatment for word retrieval impairment in aphasia: The story so far

Background: Impairment-focused aphasia treatment has an ultimate goal of improving language production in connected speech and communication in daily life. Although impairment-based treatment has typically been carried out in words or sentences, investigations have begun to explore the efficacy of treatment during discourse production. Focusing treatment on an impaired linguistic process during discourse production is a complex and challenging endeavour. Aims: This paper aims to review investigations of discourse treatment for word retrieval impairment in aphasia in order to identify and discuss variables that emerge as being important considerations in clinical practice and continued research. Main Contribution: Seven investigations that applied treatments during structured discourse production to improve word retrieval in participants with aphasia were reviewed. Treatment methods used in the investigations included phonologic and orthographic cues, semantic feature analysis, contingency-based cueing hierarchies, and repeated conversational engagement. The discourse contexts used for treatment were structured conversations or structured narrative discourse. All investigations reported positive outcomes for improved word retrieval abilities. Although treated vocabulary items did not improve in all cases, improvements in general processes of word retrieval were reported. Focusing treatment on the linguistic process of word retrieval resulted in changes to discourse macrostructure, at least in terms of the informativeness of the discourse. When attitudes and perceptions of the participants with aphasia or of naïve judges were assessed, the outcomes were generally favourable. One investigation provided evidence that treatment in structured discourse was related to improved word retrieval in real-life conversations. Conclusions: There are several promising discourse treatment approaches for word retrieval impairments in aphasia. Systematic analysis of changes in the macrolinguistic processes of discourse, in real-life conversations, and in the attitudes and perceptions of participants with aphasia and others in future discourse treatment studies would enhance our insights about their efficacy.

Test–Retest Stability of Word Retrieval in Aphasic Discourse

PURPOSE This study examined the test-retest stability of select word-retrieval measures in the discourses of people with aphasia who completed a 5-stimulus discourse task. METHOD Discourse samples across 3 sessions from 12 individuals with aphasia were analyzed for the stability of measures of informativeness, efficiency, main concepts, noun and verb retrieval, word-finding difficulty, and lexical diversity. Values for correlation coefficients and the minimal detectable change score were used to assess stability for research and clinical decision making. RESULTS Measures stable enough to use in group research studies included the number of words; the number of correct information units (CIUs); the number of accurate-complete, accurate-incomplete, and absent main concepts; the percentage of T-units that had word-finding behaviors of any kind; the percentage of T-units that contained empty words; and a lexical diversity measure. Words per minute, CIUs per minute, and the percentage of T-units that contained time fillers or delays were sufficiently stable to use when making clinical decisions about an individual. CONCLUSION Although several of the measures demonstrated acceptable stability for group research studies, relatively few were sufficiently stable for making clinical decisions about individuals on the basis of a single administration.

Stability of Word-Retrieval Errors With the AphasiaBank Stimuli

PURPOSE This study examined the test-retest reliability of select measures of word-retrieval errors in narrative discourses of individuals with aphasia assessed with the AphasiaBank stimuli. METHOD Ten participants with aphasia were video recorded during 2 sessions producing narratives elicited with pictures. Discourses were transcribed and coded using AphasiaBank procedures, then analyzed for the stability of rates of phonological errors, semantic errors, false starts, time fillers, and repetitions per minute. Values for correlation coefficients and the minimal detectable change score were used to assess stability for research and clinical decision making. RESULTS There was poor test-retest reliability when the discourses were analyzed by each narrative subgenre. When the narrative discourses were combined for analysis, several measures appeared to be sufficiently stable across sessions for use in group studies, and 1 could be adequately stable for making clinical decisions about an individual. CONCLUSIONS Because the short speech samples yielded by the subgenre narrative analyses demonstrated poor test-retest reliability, it is recommended that all of the picture-based narrative discourse tasks be combined for analysis of word-retrieval impairments when the AphasiaBank stimuli are used. However, the confidence intervals associated with the reliability coefficients obtained in this study suggest caution in using the measures if they are based on performance in a single session. More investigations of the test-retest reliability of measures used to study language impairment in discourse contexts are essential.

Discourse measurement in aphasia research: have we reached the tipping point?

ABSTRACT Background: Over the past few decades, clinical aphasiologists have increasingly included various measures of discourse, across a variety of genres, to assess treatment effects and to understand spoken language in people with aphasia. The paradigm shift from assessing language at the word and sentence level to assessing at the discourse level shows an increased awareness of capturing meaningful outcomes; however, this has led to a proliferation of new discourse metrics. These new metrics often lack reliability, validity, and stability data to support their use. In fact, we propose that a tipping point has been reached. Aims: To review the recent move toward establishing a basic core outcome set (COS) for aphasia. In support of this effort, we make a strong argument for the need to dovetail these efforts with the development of a core outcome set for discourse (D-COS). Main contribution: We make a case that the current state of the art in aphasia-related discourse research leaves researchers unsure of the most representative outcomes to include in future investigations and clinicians with little guidance on best practice. We applaud and support the recent efforts toward the development of a general COS for aphasia; however, we propose that the need for a D-COS is urgent because the increasing numbers of discourse measures make it difficult to replicate and compare outcomes across studies. Moreover, these issues likely interfere with adaptation of the use of discourse measurement in clinical practice. Conclusions: Many health-related fields have adopted a COS to guide their research and ensure that the field’s data can be compiled, compared, and contrasted for a better overall understanding of how treatments address targeted illnesses. We argue that, in addition to the recent progress toward a COS for aphasia, a D-COS is also required to improve our understanding of how our treatments improve the discourse of people with aphasia, which in turn will aid in evoking a paradigm shift in clinical practice. To be successful, it is essential that the development of a D-COS includes a process by which all stakeholders are included: people with aphasia, caregivers, clinicians, and clinical researchers.

Discourse measurement in aphasia: consensus and caveats

Our intention was to use this clinical forum to start a dialogue regarding the multitude of discourse outcome measures currently used in studies of aphasia. Based on the commentary papers, it is ob...

Semantic Treatments for Word and Sentence Production Deficits in Aphasia

Abstract The cognitive domains of language and memory are intrinsically connected and work together during language processing. This relationship is especially apparent in the area of semantics. Several disciplines have contributed to a rich store of data about semantic organization and processing, and several semantic treatments for aphasic word and sentence production impairments have been based on these data. This article reviews the relationships between semantics and memory as they relate to word and sentence production, describes the aphasic language impairments that result from deficits in these areas, and summarizes treatment approaches that capitalize on what we have learned about these domains and how they work together.