Using AphasiaBank for Discourse Assessment.

AphasiaBank is a shared, multimedia database for the study of communication in aphasia. This article describes a variety of discourse measurement tools and teaching resources available at the AphasiaBank website. The discourse measurement tools include main concept analysis, core lexicon checklists, correct information unit computation techniques, and other automated analyses using the CLAN program. These tools can be used to measure a variety of aspects of language production for assessment as well as treatment evaluation and clinical research purposes. Importantly, they are intended to help make the discourse analysis process more efficient and reliable. Teaching resources include an online tutorial on aphasia, videos of typical behaviors seen in aphasia, group treatment videos, classroom activities, tutorial screencasts, and conference posters. These resources can be used for a variety of clinical and educational purposes. The AphasiaBank website is part of the larger TalkBank project which provides many other shared databases and resources that are relevant to professionals interested in communication and communication disorders.

Discourse recovery after severe traumatic brain injury: exploring the first year.

OBJECTIVES: Although much is known about discourse impairment, little is known about discourse recovery after severe traumatic brain injury (TBI). This paper explores discourse recovery across the critical first year, controlling for pre-injury, injury and post-injury variables. DESIGN AND METHODS: An inception cohort comprising 57 participants with severe TBI was examined at 3, 6, 9 and 12 months post-injury and compared to a cross-section of matched healthy control participants. A narrative discourse task was analyzed with main concept analysis (MCA). A mixed linear model approach was used to track recovery controlling for pre-injury, injury and post-injury variables. RESULTS: An upward trajectory of recovery was observed, with peak periods of improvement between 3-6 and 9-12 months and all time points were significantly below controls. Years of education and PTA duration were significant covariates in the recovery model. Presence of aphasia also influenced the recovery model. CONCLUSIONS: Individuals with TBI typically improve over the first year, however many will continue to have discourse deficits at 12 months. Years of education, PTA duration and aphasia should be considered when planning services. The 3-6- and 9-12-month periods may offer optimal periods for discourse recovery and increased supports may be beneficial between 6-9 months.

Patterns of early conversational recovery for people with traumatic brain injury and their communication partners.

PRIMARY OBJECTIVE: To investigate whether the degree of participation by people with severe Traumatic Brain Injury (TBI), and the degree of support by their communication partners (CPs) changes in conversation during subacute recovery. METHODS AND PROCEDURES: Seventeen pairs of participants with TBI and their CPs were video-recorded during a 10 min casual conversation at 3 and 6 months post-injury. Communication behaviors were rated using the adapted Measure of Participation in Conversation (MPC) and the adapted Measure of Support in Conversation (MSC) at both time points and compared. RESULTS: Inferential analyses showed that there was no significant change in the degree of participation in conversation by participants with TBI and the degree of conversation support by their CPs from 3 to 6 months post. Comparison of qualitative field notes revealed that specific conversational behaviors changed over time, including better turn-taking and topic maintenance. CONCLUSION: Documenting early communication recovery is a complex and challenging endeavor. The lack of change in conversational effectiveness during the sub-acute period using global rating scales highlights the need for social communication tools that are sensitive to communication recovery following severe TBI.

Conversational topics discussed by individuals with severe traumatic brain injury and their communication partners during sub-acute recovery.

PRIMARY OBJECTIVE: To investigate the nature and patterns of conversational topics discussed by individuals with severe TBI and familiar communication partners at 3 and 6 months post-injury, and to examine changes occurring in conversational topics during sub-acute recovery. RESEARCH DESIGN: Qualitative content analysis was used to explore the nature of topics and generate conversational themes. Topic analysis provided an understanding of conversational topic management by identifying patterns of topic initiation and maintenance. METHODS: Twenty-two people with severe TBI and a familiar communication partner engaged in a 10-minute casual conversation on self-selected topics at 3 and 6 months post-injury. MAIN OUTCOMES AND RESULTS: Three main conversational themes were identified: connecting; re-engaging; and impacts of injury. The nature of topics related to these themes changed over time to reflect participants' sub-acute rehabilitation experiences. Most conversational dyads maintained similar conversational and topic patterns during sub-acute recovery. CONCLUSIONS: Qualitative analysis provides a new insight into the conversational topics of individuals with severe TBI. Many participants engaged in appropriate conversations and discussed mutually important topics with familiar communication partners. Findings may inform speech-language pathology intervention in sub-acute recovery to improve conversational discourse abilities of individuals with severe TBI and support their communication partners.

Optimizing the quality of breast cancer biomarker use at Duke Cancer Institute.

Advances in identifying biomarker profiles in patients with early-stage breast cancer have improved 5-year curative rates. Identification of the HER2 receptor provides valuable information that has been shown to extend survival in adjuvant and metastatic settings. Current clinical guidelines discuss when confirmatory testing may be inappropriate. Using a quality improvement approach, the team at Duke Cancer Institute determined HER2 ordering practices in a large academic cancer center. HER2 ordering using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) was abstracted from the charts of 314 patients with early-stage breast cancer. Qualitative responses to current clinical practices were obtained from clinicians. Of the patients included, duplicate IHC was performed for 36% and in triplicate for 6%; repeat testing resulted in clinically significant change in HER2 status for approximately 20%. Repeat biomarker testing on metastatic biopsy sites "all of the time" was favored by the surveyed physicians. FISH was ordered for each grade of IHC: 0+ (>20% of cases), 1+ (>20%), 2+ (99%), 3+ (54%). Most physicians "strongly" or "somewhat" favored solutions that integrate order sets and care pathways into the electronic medical record. This quality improvement project identified root causes and solutions to practice variance in breast cancer biomarker ordering and interpretation. Further investigations are planned to standardize best practices while appreciating the clinical challenges posed by discordant test results.

Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia.

Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia, the two most common kinds of non-fluent aphasia. In summary, the current results suggest that the anterior segment of the left arcuate fasciculus, a white matter tract that lies deep to posterior portions of Broca's area and the sensory-motor cortex, is a robust predictor of impaired speech fluency in aphasic patients, even when motor speech, lexical processing, and executive functioning are included as co-factors. Simply put, damage to those regions results in non-fluent aphasic speech; when they are undamaged, fluent aphasias result.

Neuroimaging in aphasia treatment research: quantifying brain lesions after stroke.

New structural and functional neuroimaging methods continue to rapidly develop, offering promising tools for cognitive neuroscientists. In the last 20 years, advanced magnetic resonance imaging (MRI) techniques have provided invaluable insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Current functional MRI (fMRI) approaches have also allowed researchers to purposefully investigate how individuals recover language after stroke. This paper presents recommendations for quantification of brain lesions derived from discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). Methods for detailing and characterizing the brain damage that can influence results of fMRI studies in chronic aphasic stroke patients are discussed. Moreover, we aimed to provide the reader with a set of general practical guidelines and references to facilitate choosing adequate structural imaging strategies that facilitate fMRI studies in aphasia treatment research.

Speech entrainment enables patients with Broca's aphasia to produce fluent speech.

A distinguishing feature of Broca's aphasia is non-fluent halting speech typically involving one to three words per utterance. Yet, despite such profound impairments, some patients can mimic audio-visual speech stimuli enabling them to produce fluent speech in real time. We call this effect 'speech entrainment' and reveal its neural mechanism as well as explore its usefulness as a treatment for speech production in Broca's aphasia. In Experiment 1, 13 patients with Broca's aphasia were tested in three conditions: (i) speech entrainment with audio-visual feedback where they attempted to mimic a speaker whose mouth was seen on an iPod screen; (ii) speech entrainment with audio-only feedback where patients mimicked heard speech; and (iii) spontaneous speech where patients spoke freely about assigned topics. The patients produced a greater variety of words using audio-visual feedback compared with audio-only feedback and spontaneous speech. No difference was found between audio-only feedback and spontaneous speech. In Experiment 2, 10 of the 13 patients included in Experiment 1 and 20 control subjects underwent functional magnetic resonance imaging to determine the neural mechanism that supports speech entrainment. Group results with patients and controls revealed greater bilateral cortical activation for speech produced during speech entrainment compared with spontaneous speech at the junction of the anterior insula and Brodmann area 47, in Brodmann area 37, and unilaterally in the left middle temporal gyrus and the dorsal portion of Broca's area. Probabilistic white matter tracts constructed for these regions in the normal subjects revealed a structural network connected via the corpus callosum and ventral fibres through the extreme capsule. Unilateral areas were connected via the arcuate fasciculus. In Experiment 3, all patients included in Experiment 1 participated in a 6-week treatment phase using speech entrainment to improve speech production. Behavioural and functional magnetic resonance imaging data were collected before and after the treatment phase. Patients were able to produce a greater variety of words with and without speech entrainment at 1 and 6 weeks after training. Treatment-related decrease in cortical activation associated with speech entrainment was found in areas of the left posterior-inferior parietal lobe. We conclude that speech entrainment allows patients with Broca's aphasia to double their speech output compared with spontaneous speech. Neuroimaging results suggest that speech entrainment allows patients to produce fluent speech by providing an external gating mechanism that yokes a ventral language network that encodes conceptual aspects of speech. Preliminary results suggest that training with speech entrainment improves speech production in Broca's aphasia providing a potential therapeutic method for a disorder that has been shown to be particularly resistant to treatment.

How to use apps clinically in the treatment of aphasia.

This article is designed to provide aphasia clinicians with some general guidelines for selecting apps that are appropriate for individuals on their caseloads. Further, it provides a template, consisting of some things we have learned while we have instituted the use of apps at the Adler Aphasia Center in Maywood, NJ and at the Carondelet Aphasia Program in Tucson, AZ, in the hopes that clinicians who are interested in using this technology can profit from our experiences.

Treatment fidelity monitoring, reporting and findings in a complex aphasia intervention trial: a substudy of the Very Early Rehabilitation in SpEech (VERSE) trial.

BACKGROUND: Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial. METHODS: VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. PRIMARY OUTCOME: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups. RESULTS: Two hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations. CONCLUSIONS: We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies. TRIAL REGISTRATION: ACTRN 12613000776707.

Aphasia centers in North America: a survey.

There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services.

A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study.

BACKGROUND: Effectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care. METHODS: Prospective, randomized, single-blinded trial conducted at 17 acute-care hospitals across Australia/New Zealand from 2014 to 2018. Participants with aphasia following acute stroke were randomized to receive usual care (direct usual care aphasia therapy), or one of two higher intensity regimens (20 sessions of either non-prescribed (usual care-plus or prescribed (VERSE) direct aphasia therapy). The primary outcome was improvement of communication on the Western Aphasia Battery-Revised Aphasia Quotient (AQ) at 12 weeks after stroke. Our pre-planned intention to treat analysis combined high intensity groups for the primary outcome. FINDINGS: Among 13,654 acute stroke patients screened, 25% (3477) had aphasia, of whom 25% (866) were eligible and 246 randomized to usual care (n = 81; 33%), usual care-plus (n = 82; 33%) or VERSE (n = 83; 34%). At 12 weeks after stroke, the primary outcome was assessed in 217 participants (88%); 14 had died, 9 had withdrawn, and 6 were too unwell for assessment. Communication recovery was 50.3% (95% CI 45.7-54.8) in the high intensity group (n = 147) and 52.1% (95% CI 46.1-58.1) in the usual care group (n = 70; difference -1.8, 95% CI -8.7-5.0). There was no difference between groups in non-fatal or fatal adverse events (p = 0.72). INTERPRETATION: Early, intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care.

Communication partner training in aphasia: a systematic review.

OBJECTIVES: To describe the effects of communication partner training on persons with aphasia and their communication partners. Specifically the systematic review addressed 3 clinical questions regarding the impact of partner training on language, communication activity and participation, psychosocial adjustment, and quality of life for adults with aphasia and their communication partners. DATA SOURCES: Twenty-three terms were used to search 12 electronic databases (eg, PubMed, CINAHL, PsychINFO, PsychArticles, CSA Linguistics and Language Behavior Abstracts, Social Sciences Citation Index [Web of Science], SUMSearch, TRIP, EMBASE, REHABDATA, National Library for Health, Cochrane Database of Systematic Reviews) and the journal "Aphasiology." References from all relevant articles were hand-searched. STUDY SELECTION: Two reviewers independently applied inclusion criteria to select potential relevant articles from the titles and abstracts of references retrieved by the literature search. The full text of the remaining articles was reviewed by a 5-member panel, resulting in a corpus of 31 studies that met the final inclusion criteria. DATA EXTRACTION: Two independent reviewers extracted the descriptive data related to the participants, the intervention, the outcome measures, and the results. DATA SYNTHESIS: The 5-member review team by consensus classified the studies using the American Academy of Neurology system for classification of evidence (2004). CONCLUSIONS: Evidence shows that communication partner training is effective in improving communication activities and/or participation of the communication partner and is probably effective in improving communication activities and/or participation of persons with chronic aphasia when they are interacting with trained communication partners. There is insufficient evidence to make recommendations related to the impact of partner training on persons with acute aphasia or the impact of training on language impairment, psychosocial adjustment, or quality of life for either the person with aphasia or the communication partner.

Lessons from a clinical life in aphasia.

Not only do clinicians play a role in shaping the lives of their clients, but they are shaped by the individuals they work with. This article interweaves selected aspects from the stories of 12 aphasic individuals into a story about some of the things they have taught me about my clinical life.

A Survey of Counseling Curricula Among Accredited Communication Sciences and Disorders Graduate Student Programs.

Purpose The purpose of this article is to examine the current state of counseling curriculum within the discipline. The last systematic survey of counseling curriculum within the disciplines of communication sciences and disorders was completed with data from 1983 (McCarthy et al., 1986). The Council on Academic Accreditation in Audiology and Speech-Language Pathology (2017) states that counseling should be included in accredited programs but does not specify to what extent. Currently, there are no standards to specify number of credits, need for a stand-alone course, or guidance regarding content delivered. Method The present investigation collected data on the status of counseling curricula in accredited communication sciences and disorders graduate programs. A Qualtrics survey was distributed to identify counseling curriculum practices across accredited programs. Quantitative data such as percentages and frequency counts were compiled to summarize program offerings. Qualitative analyses were used to characterize written responses. Survey responses were also cross-validated with a review of offerings listed on program websites. Results Of programs currently accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, 42.4% responded to the current survey. Fifty-nine percent of programs offer a stand-alone course. Review of curricula from program websites indicated that only 40% of accredited programs offer a stand-alone counseling course. Quantitative details about requirements, number of credits, and embedding counseling within other courses were compared to data from the 1983 survey. Qualitative analyses identified common learner outcomes and the nature of course or curricular content. Conclusions Investigators found a lack of consistency in incorporating counseling across programs and discussed implications of this in speech-language pathology practice. A decrease in the number of programs that offer a stand-alone counseling course was identified as compared to offerings in 1983, as well as a disparity regarding how programs provide training in counseling. Furthermore, survey responses differed from curriculum listings on program websites. Information derived from this study may serve as a starting point for the development of flexible standards that provide direction for achieving consistent preparation of counseling skills. Supplemental Material https://doi.org/10.23641/asha.12149703.

Communicative Strengths in Severe Aphasia: The Famous People Protocol and Its Value in Planning Treatment.

Purpose This clinical focus article describes the development and use of the Famous People Protocol (FPP), a clinical tool for observing the strategies people with severe aphasia (PWSA) can use to communicate when speech is limited. Its goal is to provide a systematic approach to identifying individually appropriate communication strategies for PWSA. Method Though not a test, the FPP's development and pilot testing were consonant with qualitative approaches to test development. Eighty-one people with aphasia and 37 nonaphasic participants were given the current version of FPP and the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2006). This clinical focus article reports on the 36 PWA who scored near or below the mean WAB score of the larger group. Results The FPP has a maximum score of 100 based on (a) identification of famous people in different categories, entertainers, athletes, U.S. presidents, sports figures, and internationally famous people, and (b) responses to additional questions about the famous people. Identification is scored quantitatively on a 3-point scale, and question responses are scored correct (1) or incorrect (0). Mean scores for the PWSA and control groups were 54.6 and 95.2, respectively. FPP and WAB-R scores were moderately correlated (r = .67). Qualitative results describe the variety of strategies that PWSA used on the FPP. Conclusions The FPP is a way for clinicians to engage PWSA in an activity that can reveal personally relevant strategies to help PWSA communicate more effectively. The strategies can then become the basis for subsequent training on using them conversationally. Appendixes provide examples of clinical approaches.

Initial validity and reliability of the SCCAN: using tailored testing to assess adult cognition and communication.

PURPOSE: The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN; L. Milman & A. Holland, 2007) was developed in the hospital setting to address changes in assessment practice. The SCCAN was designed to provide an overview of impairment and activity limitations across 8 cognitive scales (Speech Comprehension, Oral Expression, Reading, Writing, Orientation, Attention, Memory, and Problem Solving). The scales were developed using item response theory so that tailored testing could be implemented to reduce test administration time. This research investigated the validity and reliability of the SCCAN. METHOD: A battery of neuropsychological tests was administered to 40 neurologically healthy control participants and 51 participants diagnosed with left-hemisphere pathology, right-hemisphere pathology, or probable Alzheimer's disease. Analyses were performed to assess test sensitivity and specificity, construct validity, administration time, and reliability. RESULTS: The test accurately classified 95% of the control participants and 98% of the participants diagnosed with neurological disorders. Results indicate that the test also differentiated the performance profiles of the 3 clinical populations. In addition, test scores correlated significantly with external measures of the same cognitive areas. Mean administration time was 34 min. Test-retest stability (r = .96, p < .001) and internal consistency (r = .99, p < .001) coefficients were both significant, indicating that tailored testing procedures generated reliable test scores.

Translational research in aphasia: from neuroscience to neurorehabilitation.

PURPOSE: In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005. METHOD: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles. CONCLUSION: Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.