Richard K. Peach

Dysarthria impact profile: development of a scale to measure psychosocial effects

BACKGROUND The psychosocial impact of acquired dysarthria on the speaker is well recognized. To date, speech-and-language therapists have no instrument available to measure this construct. This has implications for outcome measurement and for planning intervention. This paper describes the Dysarthria Impact Profile (DIP), an instrument that has the potential to meet this need in clinical practice. AIMS To describe the development of the DIP, which was devised as part of a larger study to measure psychosocial impact of acquired dysarthria from the speakers perspective. METHODS & PROCEDURES The current psychometric properties of the DIP are examined. The scale was administered to 31 participants with acquired dysarthria. The internal consistency of the scale items and their intra-rater reliability were investigated. Concurrent validity was assessed for the portion of the scale (Section A) assessing impact of acquired dysarthria on self-perception, self-concept and self-esteem by comparing the results with changes in self-concept as determined by the Head Injury Semantic Differential Scale (HISD II). OUTCOMES & RESULTS The DIP shows good internal consistency and strong intra-rater reliability overall. There was a strong, statistically significant, correlation between results on Section A of the DIP and the results of the HISD II suggesting convergent validity for this portion of the scale. There are some limitations to the scale in its current format and these are highlighted. CONCLUSIONS & IMPLICATIONS The scale is now ready for further refinement and development. Once validated, it should act as a robust outcome measure for clinicians.

Integrating the message level into treatment for agrammatism using story retelling

Background: Treatments for agrammatic production generally target sentence forms, inflectional morphology, verb retrieval, thematic roles, or underlying grammatical forms. Reviews of these and related methods suggest that they address Garretts functional and positional levels of sentence processing. Such reviews also demonstrate that little attention has been given to developing treatments that emphasise the message level of sentence production. Message‐level representations appear to have robust potential for influencing sentence‐level processes following aphasia, since varying levels of language representation are thought to influence their downstream counterparts. Aims: The study aimed to determine whether functional and positional‐level syntactic training applied in a context requiring structuring of message‐level representations would improve expressive syntax in a patient with agrammatism. Methods & Procedures: A 10‐week programme was divided into two 5‐week phases requiring story retelling of three fables in each phase with critical oral and written feedback. Story retellings were analysed along three dimensions: grammaticality, complexity, and content. The programme was evaluated using a multiple‐baseline across behaviours single‐subject design. Outcomes & Results: Overall, this treatment programme appeared to produce highly beneficial outcomes with regard to improved expressive syntax. Substantial generalisation of treatment effects was observed in post‐treatment testing, while long‐term maintenance of the gains achieved in treatment was observed. Conclusions: The story‐retelling procedure, with oral and written feedback, stimulated and improved the participants expressive syntax. Unlike treatment approaches that simply target surface grammar, the story retelling approach appears to be rich with regard to stimulating conceptual syntax as well as lower‐level syntactic processes. Functional communication also benefited by treating discourse‐level behaviours to improve linguistic processing.

Perception of Dynamic Acoustic Patterns by an Individual with Unilateral Verbal Auditory Agnosia

Previous studies have found that subjects diagnosed with verbal auditory agnosia (VAA) from bilateral brain lesions may experience difficulties at the prephonemic level of acoustic processing. In this case study, we administered a series of speech and nonspeech discrimination tests to an individual with unilateral VAA as a result of left-temporal-lobe damage. The results indicated that the subjects ability to perceive steady-state acoustic stimuli was relatively intact but his ability to perceive dynamic stimuli was drastically reduced. We conclude that this particular aspect of acoustic processing may be a major contributing factor that disables speech perception in subjects with unilateral VAA.

Sentence planning following traumatic brain injury.

BACKGROUND Current descriptions of the language problems following traumatic brain injury (TBI) generally emphasize evaluating discourse production and explaining the observed outcomes in terms of disruptions to executive processes. The notion of sentence production impairments at the sentence level has generally been ignored. To respond to this issue, we examined patterns of intrasentential pausing and sentence planning during sentences produced by normal and TBI speakers. METHODS Seven individuals with TBI functioning at Rancho Level V-VI and seven age-matched controls participated in this pilot experiment. Group performances were compared for pause time and verbal initiation time during the production of sentences varying in syntactic complexity under two conditions (reading and repetition). RESULTS Significant group differences were observed in pausing during both conditions. Pausing patterns of the participants with TBI were strongly correlated with the syntactic complexity of sentences. No significant group differences were observed on verbal initiation time of repeated sentences, although increased initiation times were present among the TBI participants. CONCLUSIONS These findings of this pilot project suggest that the deficits in language production following TBI may include specific impairments to sentence planning. This evidence suggests that the language profile of TBI may be one of both microlinguistic and macrolinguistic impairments.

Verb preference effects in the sentence comprehension of fluent aphasic individuals

Abstract This investigation examined sentence processing of fluent aphasic subjects with varying severity levels. Subjects performed a cross-modal lexical decision task for transitive and intransitive verbs in preferred and non-preferred frameworks. Verb processing was measured by reaction times during on-line sentence comprehension. Reaction times to the cross-modal lexical decision (CMLD) task indicated that the subjects with aphasia were insensitive to preference information associated with the processing of verbs in sentences. Severity level did not alter the pattern observed regarding verb type and preferences.

Acquired apraxia of speech: features, accounts, and treatment.

Abstract The features of apraxia of speech (AOS) are presented with regard to both traditional and contemporary descriptions of the disorder. Models of speech processing, including the neurological bases for apraxia of speech, are discussed. Recent findings concerning subcortical contributions to apraxia of speech and the role of the insula are presented. The key features to differentially diagnose AOS from related speech syndromes are identified. Treatment implications derived from motor accounts of AOS are presented along with a summary of current approaches designed to treat the various subcomponents of the disorder. Finally, guidelines are provided for treating the AOS patient with coexisting aphasia.

Clinical Intervention for Aphasia in the United States of America

This chapter provides an American perspective regarding the clinical management of aphasia. Similar to the charge given to all contributors to this volume, the editors have sought a practical overview of clinical aphasiology in the United States by asking me to provide a summary of my approach to aphasia rehabilitation. It should be stressed, therefore, that mine is not the American perspective on aphasia treatment, but simply one which has developed from the many influences that have been prominent in this country over approximately the past two decades and the personal experiences that have shaped my own philosophies with regard to clinical practice with this population.

Measuring processing load during sentence comprehension: Visuomotor tracking

This investigation examined processing load during aspects of sentence comprehension in non-brain-damaged subjects. Our goals were to begin the process of quantifying the loads associated with on-line and off-line aspects of sentence processing and to evaluate the utility of visuomotor tracking as an index of the resource demand associated with elements of sentence comprehension. Subjects were required to track an unpredictable visual target with their forefinger while listening to sentences and answering Yes-No comprehension questions. In general, tracking performance declined during the off-line task of responding to questions compared to the on-line task of listening to sentences and questions. Performance was also poorer during the beginning and end of the sentence compared to the middle of the sentence. Results are discussed in relation to resource theories of normal and aphasic sentence comprehension.

Treatment for phonological dyslexia targeting regularity effects

Background: A treatment programme for an adult case of acquired phonological dyslexia is described. In addition to disproportionate difficulty in reading nonwords and predominately visual errors for real words, this case of phonological dyslexia demonstrated clear regularity effects (fewer irregular than regular words read aloud and regularised pronunciations for irregular words) on testing. Based on Hillis and Caramazzas summation hypothesis (1991, 1995), it was assumed that the participants difficulty with irregular words arose from an impaired semantic system that produced equal activation of both the target and related lexical representations. With an impaired grapheme to phoneme conversion mechanism (as suggested by his inability to read nonwords), the phonological information associated with the target was insufficient to cause the correct lexical representation to reach threshold from among the alternatives. In this situation, the participants phonological impairment formed the basis for his difficulty with reading irregular words aloud. The treatment programme for this participant therefore targeted GPC processes to strengthen the phonological information necessary for producing irregular words. Aims: The study aimed to determine whether the accuracy and promptness of oral reading for irregular words could be improved by targeting grapheme to phoneme conversion processes, and whether any effects would be observed on other standardised reading tasks. Methods & Procedures: The treatment programme focused on improving grapheme to phoneme conversion for irregular words controlled for frequency of occurrence and imageability through repeated exposures to multiple exemplars demonstrating target phonological contrasts. Written production and syllable parsing followed oral productions. A multiple-baseline across-behaviours single-subject design was used to evaluate the effects of the programme. Outcome & Results: Increased sensitivity to the production of two graphemes in low-frequency conditions was suggested by the participants performance. Clear treatment effects could not be demonstrated, however, because of ceiling effects and unstable baselines. Improvements in reading comprehension, reading rate, and nonword reading were observed post-treatment. Conclusions: As the theory used to guide this participants treatment also implicates increased thresholds for the semantic activation of target lexical items as a basis for difficulty in reading irregular words, future work should continue to assess the relative contributions of treating lexical semantic versus GPC processes in these participants. Studies should persist in attempting to circumvent the experimental problems that might arise during the early stages of recovery while continuing to exploit more recent theoretical accounts of reading to identify effective treatments.

Language-Specific Attention Treatment for Aphasia: Description and Preliminary Findings

Abstract The need for a specific, language‐based treatment approach to aphasic impairments associated with attentional deficits is well documented. We describe language‐specific attention treatment, a specific skill‐based approach for aphasia that exploits increasingly complex linguistic tasks that focus attention. The program consists of eight tasks, some with multiple phases, to assess and treat lexical and sentence processing. Validation results demonstrate that these tasks load on six attentional domains: (1) executive attention; (2) attentional switching; (3) visual selective attention/processing speed; (4) sustained attention; (5) auditory‐verbal working memory; and (6) auditory processing speed. The program demonstrates excellent inter‐ and intrarater reliability and adequate test‐retest reliability. Two of four people with aphasia exposed to this program demonstrated good language recovery whereas three of the four participants showed improvements in auditory‐verbal working memory. The results provide support for this treatment program in patients with aphasia having no greater than a moderate degree of attentional impairment.