Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study.

Aphasic patients who met stringent selection criteria were assigned randomly to three groups: clinic treatment by a speech pathologist for 12 weeks, followed by 12 weeks of no treatment; home treatment by a trained volunteer for 12 weeks, followed by 12 weeks of no treatment; or deferred treatment for 12 weeks, followed by 12 weeks of treatment by a speech pathologist. At 12 weeks after entry, language measures indicated that the clinic-treatment patients made significantly more improvement than did the deferred-treatment patients, and improvement in home-treatment patients did not differ significantly from either clinic- or deferred-treatment patients. At 24 weeks after entry, after deferred-treatment patients had received clinic treatment, there were no significant differences among the groups. These results suggest that clinic treatment for aphasia is efficacious, and delaying treatment for 12 weeks does not compromise ultimate improvement.

Handwriting and speech changes across the levodopa cycle in Parkinson's disease.

Levodopa treatment is used to reduce rigidity and bradykinesia in Parkinson's disease (PD). This study tracked the handwriting and speech performance of 10 PD patients at 30-minute intervals across one levodopa drug cycle to evaluate levodopa-related changes in temporal and spatial measures that are assumed to correspond to changes in rigidity and bradykinesia. The handwriting measures included l and e upstroke duration and size. The speech measures included duration of the vowels /i/, /u/, /ae/, and /[symbol: see text]/ and the quadrilateral area produced by these vowels, and the slope of the diphthong /aI/. Levodopa significantly improved handwriting upstroke duration but not upstroke size. Speech measures did not show a significant trend across the levodopa cycle. The results suggest that upstroke duration is sensitive to the presumed effects of levodopa and that handwriting analysis may hold promise in helping to estimate an optimum levodopa regimen for PD patients.

Comprehension of directly and indirectly stated main ideas and details in discourse by brain-damaged and non-brain-damaged listeners.

Aphasic, right-hemisphere-damaged, and non-brain-damaged subjects heard short narrative paragraphs. Each paragraph contained four main ideas and one or more details related to each main idea. After each paragraph was presented, subjects' comprehension and retention of main ideas and details from the paragraph were tested. Some of the test items directly restated information from paragraphs and others paraphrased information from paragraphs. All groups of subjects remembered main ideas better than they remembered details, and no group of subjects was significantly affected by whether test items directly or indirectly stated information from paragraphs. Disfluent aphasic and right-hemisphere-damaged subjects' overall paragraphs comprehension scores were not significantly poorer than those of non-brain-damaged subjects. Fluent and mixed aphasic subjects' overall paragraph comprehension scores were significantly worse than those of non-brain-damaged and right-hemisphere-damaged subjects. Token Test and Boston Diagnostic Aphasia Examination auditory comprehension scores did not predict aphasic subjects' paragraph comprehension scores. right-hemisphere-damaged subjects' overall paragraph comprehension scores were not significantly those of non-brain-damaged and right-hemisphere-damaged subjects. Token Test and Boston Diagnostic Aphasia Examination auditory comprehension scores did not predict aphasic subjects' paragraph comprehension scores.

Aphasic and non-brain-damaged adults' knowledge of scripts for common situations.

This study was designed to determine whether script knowledge (mental representations of event sequences for situations that have been experienced in daily life) is compromised by aphasia. Aphasic and non-brain-damaged adults participated in several tasks designed to test their knowledge of scripts for common situations. The tasks included discrimination, in which subjects separated printed phrases identifying test scripts from phrases identifying foil scripts, centrality judgment, in which subjects identified the most typical and frequently occurring events in test scripts, and sequencing, in which subjects arranged the central events from test scripts in the order in which they would be expected to occur in the scripts. Error rates for both non-brain-damaged and aphasic subjects were low in all three tasks, and aphasic subjects generally performed as well as non-brain-damaged subjects did, except that aphasic subjects were significantly poorer at sequencing central events from scripts. However, the actual differences between groups in the sequencing task were quite small. These results suggest that knowledge of scripts is not seriously compromised by aphasia, at least when the aphasia is mild to moderate.

Comprehension of main ideas and details in coherent and noncoherent discourse by aphasic and nonaphasic listeners.

Aphasic and nonaphasic listeners' comprehension of main ideas and details within coherent and noncoherent narrative discourse was examined. Coherent paragraphs contained one topic to which all sentences in the paragraph related. Noncoherent paragraphs contained a change in topic with every third or fourth sentence. Each paragraph contained four main ideas and one or more details that related to each main idea. Listeners' responses to yes/no questions following each paragraph yielded the following results: (1) Nonaphasic listeners comprehended the paragraphs better than aphasic listeners. (2) Both aphasic and nonaphasic listeners comprehended main ideas better than they comprehended details. (3) Coherence did not affect comprehension of main ideas for either group. (4) Coherence did not affect comprehension of details by nonaphasic subjects. (5) Coherence affected comprehension of details by aphasic subjects, and their comprehension of details in coherent paragraphs was worse than their comprehension of details in noncoherent paragraphs. There was no significant correlation between Token Test scores and measures of paragraph comprehension.

Effects of task difficulty on sentence comprehension performance of aphasic subjects.

Twenty aphasic subjects participated in an auditory comprehension task in which they were asked to point to pictures named by the examiner. The spoken commands delivered to each subject were either "easy" or "difficult," as determined by the subject's performance in a preexperimental session. Difficulty was determined by the number of items that the subject was asked to point to in sequence. Each subject performed in two conditions. In the Low Error Condition, a small number of difficult commands (as determined in the preexperimental session) was interspersed in a larger number of easy commands (as determined in the preexperimental session). In the High Error Condition, a small number of easy commands was interspersed in a larger number of difficult commands. Analysis of the results indicated that presentation of a series of difficult commands interfered with subject's subsequent performance to commands that would ordinarily be very easy.

Recognition of auditory sequences by aphasic, right-hemisphere-damages and non-brain-damaged subjects.

Non-brain-damaged, nonaphasic right-hemisphere-damaged and aphasic left-hemisphere-damaged subjects performed in a task in which they reported whether pairs of sequences of one, two or four pure tones were the "same" or "different" in pitch. Brain-damaged subjects performed less well than non-brain-damaged subjects. Subjects with right hemisphere damage performed progressively less well as the number of tones within tone sequences increased, but non-brain-damaged and aphasic subjects more accurately reported four-tone than two-tone sequences. The results suggested that the deficits in temporal sequencing by aphasic subjects previously reported in the literature do not result from output disorders, and that subjects with hemisphere lesions exhibit deficits that are consistent with deficits in the ability to process melodic materials.

Effects of response delay and token relocation on token test performance of aphasic subjects.

Performance of 12 aphasic subjects was analyzed on a delayed response task using commands similar to those found in the Token Test, under Relocation, and Nonvisual conditions. In Standard Condition, subjects could see the tokens as commands were presented and during delay intervals that were interposed between the end of the command and the subject's response. In Relocation Condition, subjects could see the tokens during command presentation and delay intervals, but the tokens were repositioned before the subject was allowed to respond. In Nonvisual Condition, no visual information was available to the subject until the delay interval was over. Results suggested that performance was not significantly affected by the presence of delay except in Part III of the test. The effects of delay appeared only in Part III, where most aphasic subjects began making errors. No appreciable differences in performance were found across conditions. These results suggest that aphasic subjects did not rely to any great extent on visual or visual-spatial strategies to perform successfully on the delayed response task. It appears that subjects may have been using some type of verbal strategy to mediate the delay interval, in spite of their impaired language systems.

The effects of pause time on auditory comprehension of aphasic subjects.

Aphasic subjects performed a modified version of the Token Test, in which 5 sec pauses were placed at various points in some of the spoken commands in the test. Insertion of pauses generally resulted in substantial improvements in the subjects' ability to carry out the commands. The location of the pauses in the commands did not appear to substantially affect subjects' performance. The results suggest that an insertion of a 5 sec pause may facilitate processing of color, size, and shape information, but not processing of locational or relational information.

Error analysis and passage dependency of test items from a standardized test of multiple-sentence reading comprehension for aphasic and non-brain-damaged adults.

Aphasic and non-brain-damaged adults were tested with two forms of the Nelson Reading Skills Test (NRST; Hanna. Schell, & Schreiner, 1977). The NRST is a standardized measure of silent reading for students in Grades 3 through 9 and assesses comprehension of information at three levels of inference (literal, translational, and higher level). Subjects' responses to NRST test items were evaluated to determine if their performance differed on literal, translational, and higher level items. Subjects' performance was also evaluated to determine the passage dependency of NRST test items--the extent to which readers had to rely on information in the NRST reading passages to answer test items. Higher level NRST test items (requiring complex inferences) were significantly more difficult for both non-brain-damaged and aphasic adults than literal items (not requiring inferences) or translational items (requiring simple inferences). The passage dependency of NRST test items for aphasic readers was higher than those reported by Nicholas, MacLennan, and Brookshire (1986) for multiple-sentence reading tests designed for aphasic adults. This suggests that the NRST is a more valid measure of the multiple-sentence reading comprehension of aphasic adults than the other tests evaluated by Nicholas et al. (1986).

Consistency of effects of slow rate and pauses on aphasic listeners' comprehension of spoken sentences.

The effects of intrasentence pauses and slow speaking rate on aphasic listeners' comprehension of spoken low- and high-difficulty sentences were investigated. Aphasic subjects heard commands spoken at a normal rate, at a slower than normal rate, and with inserted 4-s pauses. Subjects' performance was measured weekly for 4 consecutive weeks. The effects of pauses and slow rate on subjects' performance were not consistent across subjects or within subjects across sessions. Type of aphasia, time postonset of aphasia, and overall severity of comprehension deficit were not strongly related to aphasic listeners' responses to pauses or slow rate.

Verification of active and passive sentences by aphasic and nonaphasic subjects.

Aphasic and nonaphasic subjects participated in a sentence verification task in which they were asked to judge whether spoken sentences correctly described pictures presented with the sentences. True active and true passive sentences were presented, as well as, false active and passive sentences in which agents and objects were reversed. In addition, false active sentences in which either the subject, verb, or object did not match the picture were presented. Subjects' response accuracy and reaction times were recorded. Passive sentences were more difficult than active sentences for both groups of subjects, and false sentences were verified more quickly than true sentences for both groups. Both groups appeared to be processing sentences for meaning as they were received, rather than waiting for the entire sentence before beginning to process it for meaning. In general, performance of aphasic subjects resembled that of nonaphasic subjects, except that aphasic subjects consistently took longer to verify sentence meaning than nonaphasic subjects.

Consistency of the effects of rate of speech on brain-damaged adults' comprehension of narrative discourse.

An experiment was carried out to assess the effects of slow and fast speech rate on comprehension of narrative discourse by aphasic, right-hemisphere-damaged, and non-brain-damaged adults. Aphasic subjects were divided into a high-comprehension group and a low-comprehension group based on their performance on the auditory comprehension subtests from the Boston Diagnostic Aphasia Examination. Subjects listened to 10 narrative stories. Half the stories were presented at slow speech rate (110-130 wpm) and half were presented at fast speech rate (190-210 wpm). After each story, subjects' comprehension and retention of stated and implied main ideas and details were tested. Brain-damaged subjects were tested twice, with at least 2 weeks intervening between sessions. Results demonstrated that salience had strong effects on comprehension for all groups of subjects--main ideas consistently were comprehended better than details. Directness affected subjects' comprehension of details, but not their comprehension of main ideas--stated details consistently were comprehended better than implied details. Non-brain-damaged subjects' comprehension was unaffected by differences in speech rate. Brain-damaged subjects comprehended details better in slow rate than in fast rate condition in the first test session, but the effects of rate on brain-damaged subjects' comprehension essentially disappeared by the second test. Furthermore, there were many instances in which individual subjects failed to demonstrate rate effects exhibited by their group.