Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire-German version.

BACKGROUND: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal-setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person-centred tool to find out the individual perception of reading functions, reading-related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. AIMS: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. METHODS & PROCEDURES: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self-reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German-speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. OUTCOMES & RESULTS: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy-induced change. We found moderate correlations between outcomes of the questionnaire and text-level reading speed. CONCLUSIONS & IMPLICATIONS: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal-setting with German-speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self-reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal-setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person-centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German-speaking PWA. We demonstrated that the German version is accessible for German-speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self-reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work? The German version of the questionnaire could be a valuable self-reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions.

Measuring communication as a core outcome in aphasia trials: Results of the ROMA-2 international core outcome set development meeting.

BACKGROUND: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AIM: To establish consensus on a communication OMI for inclusion in the ROMA COS. METHODS & PROCEDURES: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. OUTCOMES & RESULTS: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living-3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. CONCLUSIONS & IMPLICATIONS: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS: What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.

Beyond narrative: Is there an implicit structure to the way in which adults organise their discourse?

Understanding the structure of discourse in healthy adults is fundamental to the assessment and diagnosis of discourse level impairments in clinical populations and the development of effective treatment regimes. Exploring discourse genre in healthy speakers that extend beyond the traditional narrative is equally paramount in facilitating maximum impact of clinical interventions in everyday speaking contexts. This study aimed to characterise the discourse of 30 healthy adult speakers across three age groups (20-39, 40-59 and 60+ years) and four discourse genres (recount, procedural, exposition and narrative), drawing on discourse frameworks used in classroom teaching. A clinically useful discourse protocol and analytic procedure using SALT was developed that profiled the macrostructure and key aspects of linguistic microstructure of the different genres, exploring coherence and cohesion within and across genre in a systematic manner. Analyses considered whether there were differences in coherence and cohesion among the different age groups, different genres and specific topics. Results showed that, while individual variability was present, healthy adults structured their discourse consistently, adhering to the frameworks described in the developmental literature, across all four genres. Significant age differences were only seen in the amount of information contained in the body of the discourse (i.e. events, steps or statements offered) with older participants offering less information. This dataset will enable comparisons to be drawn with clinical populations to determine the utility and the feasibility of the use of this framework for diagnosis and intervention.

Reading for Meaning: The Influence of Reader Characteristics on Paragraph Understanding in Aphasia.

PURPOSE: The study improves our understanding of the reading comprehension difficulties seen in people with aphasia. It investigates the influence of reader characteristics, including personal demographic variables, and linguistic and wider cognitive skills, on text comprehension. METHOD: Seventy-five people with aphasia and 87 neurologically typical readers completed a test of paragraph comprehension. People with aphasia also completed background tests of language, attention, recognition memory, and executive functions. The influence of demographic variables (age, gender, and level of education) was analyzed separately in the group of people with aphasia and the typical readers using analyses of variance. In the people with aphasia, the relationship between paragraph comprehension and the language and cognitive tests was explored using correlational analyses. RESULTS: In the typical readers, there was a significant effect of gender and level of education and a significant three-way interaction. For the people with aphasia, there were no significant effects of demographic variables. Significant positive correlations were found between performance on paragraph comprehension and each of the language tests and with tests of auditory attention, executive functions, and recognition memory for words. CONCLUSIONS: In people with aphasia, the effects of demographic variables were overshadowed by the effect of their language difficulties. The association seen across language measures reflects the shared semantic representations across single-word, sentence, and text levels, across modalities. The study emphasizes the importance of attention, executive functions, and short-term memory in the comprehension of and memory for what we read. The contribution of both language difficulties and wider cognitive skills needs to be considered when planning intervention. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24695451.

Treating verbs in aphasia: exploring the impact of therapy at the single word and sentence levels.

BACKGROUND: In recent years there has been significant interest in the differential processing of nouns and verbs in people with aphasia, but more limited consideration about whether the differences have implications for therapy. It remains unclear whether verbs can be treated in a similar way to nouns or should be treated using approaches that recognize the relationship between verb retrieval and sentence production. AIMS: This paper reviews studies focusing on therapy for spoken verb retrieval, considering the impact of therapy on treated and untreated verbs, sentence production and connected speech. It explores whether there are differential gains across therapy paradigms and whether verbs respond to therapy in the same way as nouns. METHOD & PROCEDURES: Studies were identified using a systematic search. A total of 26 studies were reviewed and classified under four headings: (1) studies that treated verbs in a single-word context, (2) studies that compared treatment for nouns and verbs, (3) studies that treated verbs in a sentence context, and (4) studies that treated verb retrieval and argument structure. MAIN CONTRIBUTION: Findings from the review demonstrate that verb therapy, irrespective of whether verbs are treated within a single-word or sentence context, is effective in improving the retrieval of treated verbs, but with limited generalization to untreated verbs. Verbs respond very similarly to nouns when treated using the same techniques, but improving verb retrieval may be harder to achieve than improving noun retrieval. The impact on sentence production is more varied. The gains in sentence production are discussed in relation to the different therapy types, the rationale for therapy and the presence of co-occurring sentence difficulties. CONCLUSIONS: The review highlights the need for more systematic evaluation of different types of verb therapy, measuring the impact of therapy on verb retrieval, sentence production and connected speech. Only through the judicious assessment and monitoring of change across different contexts will an understanding of how verbs respond to therapy be developed and what generalization patterns can be predicted. This will lead to increased confidence in the selection of therapy approaches for people with verb difficulties in aphasia.

Category norm data and relationships with lexical frequency and typicality within verb semantic categories.

The aim of the present study was to expand the scope of category norm and typicality data to include verbs for use when investigating semantic memory in fields such as linguistics, psychology, and aphasiology. Two experiments were conducted. In the first, participants were asked to list verbs within 10 semantic categories (e.g. breaking, cleaning, cooking, etc.) and 10 noun categories (e.g. animals, fruit, tools, etc.). In the second experiment, participants were asked to rate the typicality of verbs within 8 of the previously investigated verb categories. Although participants listed fewer verbs in verb categories than nouns in noun categories, the overall patterns with regard to correlation analyses between production frequency, mean rank of responses, lexical frequency, and typicality were consistent with those observed in noun categories. These patterns are also consistent with those observed in previous research. Potential similarities and differences between nouns and verbs, as well as future applications of such data, are discussed.

Re-evaluation of Phytophthora Species Isolated During 30 Years of Vegetation Health Surveys in Western Australia Using Molecular Techniques.

For 30 years, large-scale aerial photography has been used to map the extent of Phytophthora dieback disease in native forests in the southwest of Western Australia, with validation of the observations involving routine testing of soil and root samples for the presence of Phytophthora cinnamomi. In addition to P. cinnamomi, six morpho-species have been identified using this technique: P. citricola, P. megasperma, P. cryptogea, P. drechsleri, P. nicotianae, and P. boehmeriae. In recent years, many new Phytophthora species have been described worldwide, often with similar morphology to existing species; thus, as many of the isolates collected in Western Australia have been difficult to identify based on morphology, molecular identification of the morpho-species is required. Based on amplification of the internal transcribed spacer (ITS) region of the rDNA gene, sequence data of more than 230 isolates were compared with those of existing species and undescribed taxa. P. inundata, P. asparagi, P. taxon PgChlamydo, P. taxon personii, and P. taxon niederhauserii were identified based on sequence data. Phylogenetic analysis revealed that nine potentially new and undescribed taxa can be distinguished. Several of the new taxa are morphologically indistinguishable from species such as P. citricola, P. drechsleri, and P. megasperma. In some cases, the new taxa are closely related to species with similar morphology (e.g., P.sp.4 and P. citricola). However, the DNA sequences of other new taxa such as P.sp.3 and P.sp.9 show that they are not closely related to morphologically similar species P. drechsleri and P. megasperma, respectively. Most of the new taxa have been associated with dying Banksia spp., while P.sp.2 and P.sp.4 have also been isolated from dying Eucalyptus marginata (jarrah). Some taxa (P.sp.3, 6, and 7) appear to have limited distribution, while others like P.sp.4 are widespread.

Communicative Informativeness in Aphasia: Investigating the Relationship Between Linguistic and Perceptual Measures.

Purpose Informativeness refers to how successfully a person is able to convey their intended message. This study explores the relationship between perceptual ratings of informativeness and selected linguistic measures of lexical and structural content. It considers which linguistic measures have ecological validity in terms of what listeners view as important. Method Two complex picture description samples from 20 people with aphasia were analyzed. Linguistic measures included number of correct information units (NCIU), percentage of correct information units, number of propositions (NP), propositional idea density (PID), and mean length of utterance in words (MLU-w). Eleven naïve listeners produced direct magnitude estimation (DME) ratings of informativeness. A correlational design was used to investigate the relationship between mean DME informativeness ratings and each of the linguistic measures. Results The 2 picture description samples elicited similar informativeness ratings. Positive significant correlations were identified between mean DME informativeness ratings and NCIU, percentage of correct information units, NP, and MLU-w; the strength of correlation differed across variables. No significant correlation was found between mean DME informativeness ratings and PID. Significant correlations were also seen between the linguistic variables, particularly between NP and PID as well as NP and MLU-w. Conclusions Overall, the linguistic measures corresponded to rated informativeness, highlighting their ecological validity. The strongest relationship was between NCIU and rated informativeness, emphasizing the importance of complete and accurate production of lexical information, particularly nouns. Less strong, but still significant, relationships were seen with variables looking at the efficiency of information giving and the connection of ideas within sentences. The importance of different types of informative measures is considered in relation to the elicitation stimuli.

Bilingual aphasia: Assessing cross-linguistic asymmetries and bilingual advantage in sentence comprehension deficits.

People with aphasia frequently have difficulties understanding semantically reversible sentences presented in derived word order. This impairment may be related to the inconsistent processing of morphological information, as well as to difficulties inhibiting the inverse interpretation of the sentence. Studies on bilingual aphasia may contribute to our understanding of these issues by shedding light on i) differences in processing of morphology across languages; ii) enhanced control mechanisms. We studied early Basque-Spanish bilingual speakers with aphasia and monolingual Spanish speakers with aphasia, as well as unimpaired individuals. Using comparable sets of materials across languages, we combined behavioural and eye-tracking methods. Results indicate that i) at the group level, bilingual speakers perform better in Spanish than in Basque, particularly in sentences with Theme-Agent argument order. Individual case analysis shows a pattern of weak dissociation across languages in several participants; ii) bilingual people with aphasia do not outperform monolingual people with aphasia in comprehension accuracy, although gaze data suggests that bilingual speakers exhibit higher inhibition and monitoring abilities.

A core outcome set for aphasia treatment research: The ROMA consensus statement.

BACKGROUND: A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. OBJECTIVE: The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment studies. METHODS: This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. RESULTS: Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist). DISCUSSION: Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined. CONCLUSION: The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I-IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.

Reading for Meaning: What Influences Paragraph Understanding in Aphasia?

Purpose: The current study investigated the effect of text variables including length, readability, propositional content, and type of information on the reading comprehension of people with aphasia. Method: The performance of 75 people with aphasia was compared with 87 healthy, age-matched control participants. Reading comprehension was considered in terms of both accuracy in responding to questions tapping comprehension and reading time. Participants with aphasia (PWA) were divided into 2 groups (no reading impairment [PWA:NRI] and reading impairment [PWA:RI]) depending on whether their performance fell within the 5th percentile of control participants. Results: As groups, both PWA:NRI and PWA:RI differed significantly from control participants in terms of reading time and comprehension accuracy. PWA:NRI and PWA:RI differed from each other in terms of accuracy but not reading time. There was no significant effect of readability or propositional density on comprehension accuracy or reading time for any of the groups. There was a significant effect of length on reading time but not on comprehension accuracy. All groups found main ideas easier than details, stated information easier than inferred, and had particular difficulty with questions that required integration of information across paragraphs (gist). Conclusions: Both accuracy of comprehension and reading speed need to be considered when characterizing reading difficulties in people with aphasia.

Contribution of chlorophyll to photooxidation of soybean oil at specific visible wavelengths of light.

Photosensitizers in foods and beverages are important considerations when selecting packaging materials. Chlorophyll is found at low concentrations in many food products. The objective of this study was to determine the photosensitizing effect of chlorophyll on soybean oil (SO) using broad-spectrum light and 3 visible wavelength regions of light. SO with added chlorophyll (0, 1, or 2 µg chlorophyll added/mL SO) was exposed to 5 light conditions, using a photochemical reactor (10 °C; 4 h). Light treatments included broad-spectrum (BS; no filter; 157.6 ± 4.7 mW intensity), 430 nm (10 nm; 1.8 ± 0.7 mW), and 660 nm (10 nm; 0.332 ± 0.05 mW) wavelengths compared to a no-light control. Chlorophyll a (but not b) absorbs light in the selected visible wavelength regions. Chlorophyll degradation was evaluated. Oxidative changes in SO were assessed by peroxide value (PV) and thiobarbituric acid-reactive substances (TBARS) assay, which measures malondialdehyde (MDA). Chlorophyll was completely degraded at BS and 430 nm conditions and degraded to 36% of original concentration at 660 nm wavelength. PV and MDA concentration significantly increased with chlorophyll addition (1 µg/mL) at BS and 430 nm wavelengths compared to no-light control. Lower light intensity at 660 nm initiated oxidation reactions as measured by PV, but not significantly. There were differences in PV (BS, 430 nm) and TBARS (BS) between the no-light and light-exposed SO without chlorophyll added. There was very little effect at 450 nm. This study suggests that broad-spectrum light and at least light wavelengths at or near 430 nm and 660 nm excite chlorophyll, resulting in initiation of oxidation reactions. Packaging material selection for foods and beverages should consider blocking excitation wavelengths of photosensitizing molecules, including chlorophyll, to protect product quality.

Protecting soymilk flavor and nutrients from photodegradation.

Five different packaging treatments were studied over a 36-day period to determine if they protected soymilk from photo-oxidation. Soymilk was packaged in high-density polyethylene (HDPE) bottles with and without light protective additives (LPA). Two controls [(1) no LPA (translucent appearance); (2) a light-protected control (foil overwrap over no LPA control)] and three LPA-containing treatments, Low (0.6% TiO2), Medium (1.3% TiO2), High (4.3% TiO2) were studied. Bottles were stored in a lighted refrigerated display case (average light intensity between 800 to 2200 lux; 3°C) for 36 days and evaluated weekly. Soymilk packaged in high LPA bottles was protected from developing light-oxidized off-flavors and odors for a minimum of 15 days. High LPA bottles provided protection for riboflavin and controlled development of photooxidative products for approximately 29 days.

Sensory impacts of food-packaging interactions.

Sensory changes in food products result from intentional or unintentional interactions with packaging materials and from failure of materials to protect product integrity or quality. Resolving sensory issues related to plastic food packaging involves knowledge provided by sensory scientists, materials scientists, packaging manufacturers, food processors, and consumers. Effective communication among scientists and engineers from different disciplines and industries can help scientists understand package-product interactions. Very limited published literature describes sensory perceptions associated with food-package interactions. This article discusses sensory impacts, with emphasis on oxidation reactions, associated with the interaction of food and materials, including taints, scalping, changes in food quality as a function of packaging, and examples of material innovations for smart packaging that can improve sensory quality of foods and beverages. Sensory evaluation is an important tool for improved package selection and development of new materials.

Improved Recovery of Stressed Bifidobacterium from Water and Frozen Yogurt.

A roll-tube repair-detection procedure was developed to enumerate injured and noninjured cells of Bifidobacterium species from water and food samples. This procedure combined the Virginia Polytechnic Institute and State University's anaerobic roll-tube procedure and the repair-detection technique for detecting stressed cells. Mara and Oragui's human bifid sorbitol agar medium was modified for use in the roll-tube procedure by replacing the indicator bromocresol purple with phenyl red (0.027 g/l), adding 0.0006 g of methylene blue per 1, increasing the agar content to 25 g/l and adjusting the pH of the medium to 7.1 ± 0.1. The repair-detection roll-tube technique was shown to recover Bifidobacterium cells significantly (P < 0.01) better than pour plates, using the same medium incubated in anaerobe jars, even when a repair-detection system was used. Most repair in the roll tubes occurred in the first hour. B. adolescentis had a poor survival rate after 96 hours in water. Glucose was substituted for sorbitol in the medium used for enumeration of B. longum added to frozen yogurt, because this organism cannot utilize sorbitol. This medium, when used as part of a repair detection system, significantly (P < 0.01) recovered more cells than anaerobic pour plate techniques and was able to separate Bifidobacterium species and Lactobacillus acidophilus by colony morphology. Bifidobacterium cells were 1mm or larger, round and yellow, while the L. acidophilus colonies were so small (< 1/4 mm) their detection and enumeration was difficult.