The Efficacy of Structural Priming in the Production of Sentences with Prepositions in Persian Patients with Poststroke Aphasia.

INTRODUCTION: Problems with the production of sentences with prepositions are one of the most common language problems in people with aphasia (PWA). Structural priming (SP) is one of the theory-based therapeutic approaches to improve these deficits. Although several studies have been conducted on the sentence construction problems of PWA, there is no study on the SP protocol for the production of sentences with Persian prepositions. This study aimed to investigate the effectiveness of SP in the production of these sentences among Persian-speaking PWA. METHODS: This study, with a single-subject ABA design, evaluated the efficacy of SP in the production of trained and untrained sentences containing Persian prepositions in four aphasic individuals with agrammatism and investigated the maintenance effects at 4 weeks post-training. RESULTS: Two subjects (A.G. and M.S.) showed notable changes in the production of trained sentences with Persian prepositions (50% to 91.67% for A.G. and 0% to 66.67% for M.S.). This significant improvement was generalized to sentences with untrained prepositions (50% to 91.67% for A.G. and 0% to 83.33% for M.S.). The treatment effects were also maintained in the 4-week follow-up (d2 = 10.3 for A.G. and d2 = 19.06 for M.S.). However, the other two participants only showed a slight increase in these variables after treatment. CONCLUSION: The findings of the present study revealed that SP for sentences with prepositions could be useful to varying degrees for Persian-speaking PWA with agrammatism and lead to improved language skills in producing these sentences. Overall, individuals with better language skills and cognitive status in early assessments showed better treatment outcomes than others.

Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis.

BACKGROUND: This study is to evaluate swallowing problems (dysphasia) in multiple sclerosis (MS) patients; the importance of using tools that are durable and appropriate is well understood. One of the most trusted tools is the dysphagia in multiple sclerosis (DYMUS) test. The aim of this study was to prepare a Persian version and to evaluate the validity and reliability of the test. MATERIALS AND METHODS: This methodological study was conducted on 236 MS patients in Southeast of Iran from August 2015 to February 2016. After translation and cultural adaptation of the test in Persian, the validity of this test was determined using expert opinions accordance with the International Quality of Life Assessment Project. In addition, exploratory factor analysis (EFA) was performed with varimax rotation. The confirmatory factor analysis (CFA) was conducted and the goodness of fit indices was calculated. Moreover, to test the reliability, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used. RESULTS: In total, 236 MS patients were included in the study (81 males and 155 females). All the questions in the test's Persian version obtained an acceptable face and content validity (content validity ratio = 1, Scale content validity index/Ave = 1). EFA revealed that the scale has two factors (solid-liquid) with 67.5% cumulative variance. CFA indicated a good fit to the intended two-factor structure, and the ratio of Chi-square to the degree of freedom was 1.79, and the root mean square error of approximation was 0.058. The internal consistency of total test indicated the appropriate level (Cronbach's alpha coefficient = 0.775), and test-retest reliability total questionnaire was found to be ICC = 0.985, indicating its high reliability. CONCLUSION: The results of this study indicated that the Persian version of the DYMUS questionnaire had good reliability and validity for patients with MS.

A Systematic Review on methods of evaluate sentence production deficits in agrammatic aphasia patients: Validity and Reliability issues.

BACKGROUND: The grammar assessment in aphasia has been done by few standard tests, but today these tests cannot precise evaluate the sentence production in agrammatic patients. In this study, we review structures and contents of tests or tasks designed to find more frequent methods for sentence production ability in aphasia patients. MATERIALS AND METHODS: We searched the Cochrane library, Medline by PubMed, Science Direct, Scopus, and Google Scholar from 1980 to October 1, 2013 and evaluated all of exist tests or tasks included in the articles and systematic reviews. The sentence production has been studied in three methods. It contains the use of sentence production in spontaneous speech, tasks designed and both methods. The quality of studies was assessed using Critical Appraisal Skills Program. RESULTS: The 160 articles were reviewed and 38 articles were studied according to inclusion and exclusion criteria. They were classified into three categories based on assessment methods of sentence production. In 39.5% studies, researchers have used tasks designed, 7.9% articles have applied spontaneous speech and 52.6% articles have used both methods for evaluation production. Inter-rater reliability was between 90% and 100% and intra-rater reliability was between 96% and 98% in studied. CONCLUSION: Agrammatic aphasia has syntax disorders, especially in sentence production. Most researchers and clinicians used both methods for evaluation production.

The effects of adding attention training to naming treatment for individuals with aphasia.

AIM: Given the ever-increasing evidence for the co-occurrence of attention impairments and language disorders in chronic aphasia, this study aimed to compare the effects of two naming treatment programs, one with and one without attention training components, on the naming performance of participants with aphasia. MATERIALS AND METHODS: This was a single-subject crossover study in which six people with chronic aphasia and different degrees of naming and attention impairments participated. Two treatment programs were implemented for each participant, with the sequence of the treatments with crossover design. Each program consisted of 12 treatment sessions plus pre- and post-treatment assessment sessions (15 weeks for each participant). The visual analysis and WEighted STatistics methods were employed for data analysis. RESULTS: Based on visual analysis, both treatments improved in comparison to the baseline phase. Statistical analysis revealed that the number of participants with significant naming improvement following combined program (5 participants) was larger than the number of participants showing improvement following completion of the single, program. CONCLUSION: Although integrating attention training into a conventional treatment for anomia can increase the effect of treatment on naming ability, more studies are required to clarify the role of attention in remediating naming impairments in aphasia.

Treatment of verb tense inflection and sentence production in Persian individuals with agrammatism.

Production of verb morphology, especially tense inflection, is usually impaired in individuals with agrammatism. There have been relatively few studies on treatment of verb tense inflection in agrammatic aphasia. In this study we adapted ACTION (a linguistically motivated treatment) to Persian language, to treat the production of regular and irregular verbs separately in sentence context. A single-subject multiple-baseline across behaviors design was used to establish the treatment effect. Using a non-probable convenience sampling, four Persian agrammatic patients with Broca's aphasia resulting from cerebrovascular accident (CVA) were recruited for this study. Two participants received treatment first for regular verbs (Phase 1, 4 weeks), and then for irregular verbs (Phase 2, 4 weeks). The other two participants received treatment in reverse order. In the final phase of treatment (Phase 3, 4 weeks), all 4 participants underwent a sentence construction treatment. All participants showed improvement in the production of trained tenses. Treatment also generalized to production of untrained regular verbs while generalization to irregular verbs was modest. Furthermore, improvement was found on narrative scores (e.g. MLU) after treatment. These findings suggest that Persian individuals with agrammatism could be trained to correctly apply temporal information to verb inflection in elicited speech.

Developing Verb Picture Naming Test for Persian adults and determining its psychometric properties.

There are a few standardized assessment tools in Persian language. The present study was carried out to develop a Verb Picture Naming Test and assessing its psychometric properties. In this cross-sectional study, a total of 230 verbs were selected based on their frequency, familiarity, age of acquisition, visual complexity, name agreement, image agreement, syllable length, transitivity, and compound or simple verbs. To determine content and face validity, 230 pictures of verbs were given to 15 experts, and then 180 final pictures were divided into original and parallel versions. Both versions of the test were performed on 50 healthy adults and 20 patients with Alzheimer's diseases. Results showed that face and content validity of these versions was more than .85 and .98. Intraclass Correlation Coefficient (ICC) for total scores was equal to .98 (p < .001, 95%CI: .97-.99) and .96 (p < .001, 95%CI: .93-.98). Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) of total scores were equal to .93 and 2.66 in version1 and 1.27 and 3.12 in version 2, respectively. The two versions of Persian Verb Picture Naming Test were found to be valid and reliable, so the clinicians can use it in clinical settings.

Translation and Cross-cultural Adaptation of the Aphasia Check List in Persian Speakers With Aphasia.

INTRODUCTION: The Aphasia Check List (ACL) is a comprehensive, time-saving tool for language evaluation in aphasia, including a cognitive assessment part. This cross-sectional study aimed to translate ACL into Persian and analyze the psychometric features of the translated version. The original version of the ACL was translated and adapted from German; its psychometric features were then determined. METHODS: Twenty People With Aphasia (PWA) and 50 age- and education-matched, cognitively healthy controls participated in this research. Possible floor and ceiling effects, discriminant validity, test-retest reliability, and internal consistency of the test were analyzed in addition to the evaluation of internal correlations between the test parts (language & cognition). RESULTS: Regarding the performance of PWAs in the language section and the cognitive subtests assessing attention, memory, and reasoning, there were no floor and ceiling effects. Adequate discriminant validities for the language section of the test [i.e., total score: (Mann-Whitney U= 6.000, P<0.001); diagnostic subtests scores: (Mann-Whitney U= 3.000, P<0.001), and each subtest individually. Besides, the attention subtest of the cognition section (Mann-Whitney U= 16.500, P<0.001) was also observed. There was no difference between the control and patient groups in the subtests of memory (Mann-Whitney U= 497.500, P=0.973) and reasoning (Mann-Whitney U= 3.000, P= 308). The test-retest reliability was acceptable in all subtests (ICC agreement= 0.573-0.984). The ACL-P suggested appropriate internal consistency (Cronbach's alpha coefficient= 0.761 for test & retest scores). There were also significant correlations between language and cognition in the control and patient groups. CONCLUSION: The ACL-P test indicated sufficient reliability and validity for the evaluation of Persian-speaking PWAs and is suggested to be used in studies on this population.

Normative data for the Pyramids and Palm Trees Test in literate Persian adults.

Background: Semantic test of Pyramids and Palm Trees (PPT) is the most common test for assessing memory. Since this test is related to language and culture, normative data in different populations are needed. Methods: This study was conducted on 270 literate men and women Persian adults aged from 20 to 69 years. Subjects must select a picture or word between two pictures or words that was closer to target. Results: The word score was significantly positively correlated with the picture score (r = 0.508, P < 0.001). Word scores (median = 50, Q1-Q3 = 49-51) were higher than the picture scores (median = 50, Q1-Q3 = 48-51), although the difference was small (P < 0.001). Conclusion: Demographic variables such as age, gender, and level of education were not significant predictors for both versions in Persian population.

Comparing the production of complex sentences in Persian patients with post-stroke aphasia and non-damaged people with normal speaking.

BACKGROUND: Cerebrovascular disease leading to stroke is the most common cause of aphasia. Speakers with agrammatic non-fluent aphasia have difficulties in production of movement-derived sentences such as passive sentences, topicalized constituents, and Wh-questions. To assess the production of complex sentences, some passive, topicalized and focused sentences were designed for patients with non-fluent Persian aphasic. Afterwards, patients' performance in sentence production was tested and compared with healthy non-damaged subjects. METHODS: In this cross sectional study, a task was designed to assess the different types of sentences (active, passive, topicalized and focused) adapted to Persian structures. Seven Persian patients with post-stroke non-fluent agrammatic aphasia (5 men and 2 women) and seven healthy non-damaged subjects participated in this study. The computed tomography (CT) scan or magnetic resonance imaging (MRI) showed that all the patients had a single left hemisphere lesion involved middle cerebral artery (MCA), Broca`s area and in its white matter. In addition, based on Bedside version of Persian Western Aphasia Battery (P-WAB-1), all of them were diagnosed with moderate Broca aphasia. Then, the production task of Persian complex sentences was administered. RESULTS: There was a significant difference between four types of sentences in patients with aphasia [Degree of freedom (df) = 3, P < 0.001]. All the patients showed worse performance than the healthy participants in all the four types of sentence production (P < 0.050). CONCLUSION: In general, it is concluded that topicalized and focused sentences as non-canonical complex sentences in Persian are very difficult to produce for patients with agrammatic non-fluent aphasia. It seems that sentences with A-movement are simpler for the patients than sentences involving A`-movement; since they include shorter movements in compare to topicalized and focused sentences.

The Validity and Reliability of Autism Behavior Checklist in Iran.

OBJECTIVES: The aim of this study was to evaluate the psychometric features of the Persian version of the Autism Behavior Checklist (ABC). METHOD: The International Quality of Life Assessment (IQOLA) approach was used to translate the English ABC into Persian. A total sample of 184 parents of children including 114 children with autism disorder (mean age =7.21, SD =1.65) and 70 typically developing children (mean age = 6.82, SD =1.75) completed the ABC. Internal consistency, test-retest reliability, concurrent and discriminant validity, and cut-off score were assessed. RESULTS: The results of this study revealed that the Persian version of the ABC has an acceptable degree of internal consistency (.73). Test-retest comparisons using interclass correlation confirmed the instrument's time stability (.83). The instrument's concurrent validity with Gilliam Autism Rating Scale (GARS) was verified; the correlation between total scores was .94. In the discriminant validity, the autism group had significantly higher scores compared to the normal group. Receiver Operating Characteristic (ROC) analysis revealed that individuals with total scores below 25 are less likely to be in the autism group. CONCLUSION: The Persian version of the ABC can be used as an initial screening tool in clinical contexts.