Self-Reported Home Program Adherence by People With Aphasia: Exploring Construct Validity.

PURPOSE: The study purpose was to compare the practice patterns captured by self-reported logbook data and those recorded by a computerized home program application. The current study is part of a larger single-case research design study aimed at investigating the effect of logbook use on home program adherence in people with aphasia poststroke. METHOD: Data from six adults with chronic aphasia with interest in improving their reading were used in this secondary analysis. Participants completed reading comprehension therapy tasks using a mobile application and tablet. The activities were self-directed and designed for people with aphasia to complete independently. We created an aphasia-friendly logbook based on best practices to allow participants to record their estimated total minutes practiced. Participants received instructions to practice the reading therapy application 80 min a day 7 days a week for the duration of the study. We calculated the difference in the total time per day recorded by each participant to the application data collected. RESULTS: All participants used the logbook to record their practice. There was a strong relationship between self-reported logbook practice and application-recorded practice for four of the six participants. Individual differences were noted and explored. CONCLUSION: These results suggest that some people with aphasia can use logbooks with aphasia-friendly modifications to accurately estimate the amount of practice completed outside of therapy sessions.

Understanding Health Professionals' Experiences of Interprofessional Mentored Research During Clinical Training: A Qualitative Descriptive Study.

BACKGROUND: Interprofessional education is recognized as an important part of the training of future health professionals. Limited investigation has been done on the experiences of students who have completed interprofessional mentored research during their clinical training. PURPOSE: To explore if this experience provided meaningful training in key areas of interprofessional education. METHOD: Using a qualitative descriptive framework, one-on-one interviews were conducted with eight healthcare providers (three occupational therapists and five speech language pathologists) who engaged in interprofessional research during their clinical training. Qualitative content analysis was completed with triangulation by analyst and member checking. CONCLUSION: Three main themes were identified: 1) interprofessional research project collaboration, 2) professional development, and 3) recommendations for student-oriented interprofessional research collaborations. The results illustrated that the health practitioners found their student experiences valuable to their current interprofessional practice and provided salient training on roles and responsibilities, teamwork, and communication.

Modality Synchronization When People With Aphasia Read With Text-to-Speech Support.

PURPOSE: Text-to-speech (TTS) technology potentially benefits people with aphasia by presenting content through two modalities simultaneously; however, for this to help, eye fixations must synchronize with the auditory rendition of words. Researchers have yet to explore how often and to what extent people with aphasia achieve modality synchronization. This retrospective analysis examined the percent of words people with aphasia see and hear concurrently when reading passages presented via TTS technology. Text-to-speech (TTS) technology potentially benefits people with aphasia by presenting content through two modalities simultaneously; however, for this to help, eye fixations must synchronize with the auditory rendition of words. Researchers have yet to explore how often and to what extent people with aphasia achieve modality synchronization. This retrospective analysis examined the percent of words people with aphasia see and hear concurrently when reading passages presented via TTS technology. METHOD: Nine adults with aphasia had their eye movements tracked while processing TTS passages at a preselected default rate of 150 words per minute. Modality synchronization occurred whenever fixation on a written word occurred during the time span beginning 300 ms before auditory presentation and ending at the next word's initiation. Correlations between standardized test scores, unsupported reading rate, and modality synchronization percentages were informative about the association of aphasia and reading impairment severity with achievement of synchronicity. RESULTS: Three participants demonstrated consistent modality synchronization; average synchronicity ranged from 67% to 76% of passage words. One participant displayed inconsistent synchronization within passages and achieved an average of 58%. The remaining five participants rarely achieved synchronization, with fixations typically lagging substantially behind the auditory presentation. A significant positive correlation occurred between paragraph reading comprehension test scores and modality synchronization percentages. CONCLUSIONS: A default TTS presentation rate does not result in dual modality synchronization for most people with aphasia. This lack of synchronization may contribute to inconsistencies in the benefit people with aphasia experience when provided with TTS support.

Generalization in Aphasia Treatment: A Tutorial for Speech-Language Pathologists.

PURPOSE: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24714399.

Variations in Eye-Gaze Behaviors Evident When Five Adults With Aphasia-Based Alexia Read Multisentence Passages.

PURPOSE: The problems that people with aphasia encounter when reading passages are poorly understood. This study's purpose was in-depth examination of eye-gaze behaviors exhibited by five people with aphasia-based alexia. METHOD: Five adults with aphasia-based alexia and five neurotypical adults (NAs) read paragraphs while having their eye movements recorded. Acquired data included descriptive characterization of overall eye-gaze behaviors and determination of the (a) percent of fixated words, (b) average fixation duration, (c) average initial and total summed fixation durations of processing attempts on individual words, and (d) effects of word length and frequency on fixation durations. Careful examination of these data allowed examination of consistencies and discrepancies among people with aphasia and supported speculation about underlying deficits. RESULTS: Case participants exhibited unique fixation behaviors in comparison to one another and to neurotypical adults. Case participants' total reading time, percent of fixated words, average fixation duration, and average initial and total summed fixation durations on passage words exceeded those of neurotypical adults. Four of five exhibited positive word length and negative word frequency correlations with fixation durations. CONCLUSIONS: People with aphasia display eye-gaze behaviors unique to them and differing from those of NAs when reading texts. Better understanding of the connection between specific eye-gaze behaviors and problems decoding words, linking them with lexical-semantic information, and constructing meaning from written content is necessary to further progress in developing effective assessment tools and treatments.

A Mixed-Methods Exploration of the Experience of People With Aphasia Using Text-to-Speech Technology to Support Virtual Book Club Participation.

PURPOSE: This mixed-methods research sought to examine the experience of people with aphasia who used text-to-speech (TTS) support to read a novel for virtual book club participation. METHOD: Six people with chronic aphasia used a TTS system to review portions of a novel about which they conversed during eight virtual book club meetings occurring over 5 weeks. During one-on-one interactions prior to each meeting, participants answered comprehension questions and provided feedback about reading experiences. Then, during group meetings, they reviewed and discussed relevant book content and predicted upcoming content. During a structured individual interview, participants reflected on their supported reading and book club experience. RESULTS: Participants reported a range of reading confidence prior to study participation, mostly influenced by decreased comprehension or reading speed. After book club participation, four participants expressed increased confidence. Some reported searching for key words and skipping difficult words as strategies additional to TTS support. All reviewed at least some book sections more than once either with or without TTS support. Highly motivated participants expressed low frustration and high reading ease and enjoyment. Perceived comprehension was roughly consistent with actual comprehension across participants. Most believed TTS support promoted faster reading than otherwise possible. Participants liked adjustable features affecting speech output rate, word or sentence highlighting, and font size. Psychosocial benefits included decreased isolation and increased friendship. CONCLUSIONS: The findings extend previous evidence about perceived and actual benefits associated with TTS support. People with aphasia express positive experiences when given TTS support during book club participation.

Aphasia and friendship: Stroke survivors' self-reported changes over time.

INTRODUCTION: Friendships are an important contributor to quality of life. Due to communication and other stroke-related challenges, people with aphasia (PWA) can experience negative friendship changes, which have been linked with increased physiological distress. This study examined friendship experiences over time for PWA to understand how friendships evolve throughout the course of stroke and aphasia recovery. METHODS: Fifteen stroke survivors with chronic aphasia completed language testing and a friendship questionnaire created by the researchers. The friendship questionnaire was composed of open and closed-ended questions that asked PWA to reflect back on their friendship satisfaction, support, activities, and communication during the time before aphasia and during the acute stage of recovery. The questionnaire also addressed their current friendships in the present-day chronic stage of recovery, as well as questions about an ideal friendship. Quantitative and qualitative methods were used to examine the data, with quantitative findings reported in this study. RESULTS: The majority of PWA reported maintaining some friendships and developing new friendships, often with a fellow stroke survivor with aphasia; however, a few PWA in this study were not able to maintain or develop any new friendships. Average ratings of perceived friendship satisfaction and support improved from the acute to chronic stage, nearing those of the ratings pre-stroke, yet there was greater variability in the chronic stage with some currently feeling dissatisfied and not well supported. Aphasia severity, as measured by a standardized assessment, had a negative relationship with perceived friendship support. In contrast, perception of communicative participation had a positive relationship with friendship support. CONCLUSIONS: This work highlights lasting social implications of aphasia. The overall health of PWA deserves greater attention, including interventions targeting friendship maintenance and development. Continued stakeholder-engaged research and clinical practice focused on the social and emotional consequences of aphasia on PWA, as well as their friends and family, is needed to assist all involved in aphasia recovery achieve better friendships and well-being.

Eye Fixation Behaviors and Processing Time of People With Aphasia and Neurotypical Adults When Reading Narratives With and Without Text-to-Speech Support.

BACKGROUND: Researchers have used eye-tracking technology to investigate eye movements in neurotypical adults (NAs) when reading. The technology can provide comparable information about people with aphasia (PWA). Eye fixations occurring when PWA do and do not have access to text-to-speech (TTS) technology are of interest because the support improves reading comprehension and decreases processing time for at least some PWA. AIMS: This study's purpose was to examine forward, regressive, and off-track eye fixations when PWA and NAs read narratives in read-only (RO) and TTS conditions. A secondary aim was to examine the influence of eye fixations on processing time. METHOD AND PROCEDURE: A Tobii Dynavox Pro Spectrum eye tracker recorded eye movements of nine PWA and nine NAs while reading narratives in two conditions. Movements of interest were forward fixations; within-word, within-sentence, and previous-sentence regressive fixations; and off-track fixations. OUTCOMES AND RESULTS: PWA exhibited significantly more forward and regressive fixations in the RO than TTS condition, whereas NAs showed opposite behaviors. NAs had significantly more off-track fixations in the TTS than RO condition, whereas PWA exhibited no difference across conditions. PWA took significantly longer to process content in the RO condition, whereas NAs took longer in the TTS condition. CONCLUSIONS: PWA and NAs differ in important ways when processing texts with and without TTS support. Examining eye-tracking data provides a means of gaining insight into the decoding and reading comprehension challenges of PWA and helps elucidate how assistive technology can mediate these challenges.

Auditory Comprehension Interventions for People With Aphasia: A Scoping Review.

PURPOSE: This scoping review examined studies reporting restorative treatments designed to improve auditory comprehension in people with aphasia. METHOD: We searched eight databases using keywords aphasia, auditory comprehension, treatment, intervention, and rehabilitation, for studies published between 1970 and 2020. Searches returned 170 records, and after applying exclusionary criteria, 28 articles remained. For each article, two authors independently extracted data on study design parameters, participant characteristics, treatment protocol, and treatment outcomes, including generalization. RESULTS: Studies were categorized by treatment focus: direct auditory (n = 7), mixed auditory (n = 13), or indirect (n = 8). Study designs were group (n = 12), single-subject experimental design (n = 11), or case study (n = 5). Fifteen studies had a control condition and/or a control group. Thirteen studies included two to 10 participants. Aphasia severity and auditory comprehension severity were infrequently reported, and most participants were greater than 1-year poststroke. Treatment targets and tasks varied. Sessions ranged from 8 to 240 min, once or more per week, for eight to 60 total sessions over 2-20 weeks. Impairment-based outcome measures were typically used. Improvement and generalization were regularly reported; however, authors frequently did not report statistical significance. CONCLUSIONS: A variety of treatments have addressed auditory comprehension deficits in people with aphasia, with many reporting improvements in auditory comprehension for some people. However, the variability in treatment tasks and delivery and outcome measurements preclude confidently offering specific clinical recommendations for implementing auditory comprehension treatments. Gaps identified by the current study may guide the development and exploration of transparent, repeatable, patient-centered treatments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21291345.

Comprehension, Processing Time, and Modality Preferences When People With Aphasia and Neurotypical Healthy Adults Read Books: A Pilot Study.

BACKGROUND: Many people with aphasia (PWA) want to read books. Text-to-speech (TTS) technology sometimes provides comprehension and processing time benefits when PWA read short, multisentence passages. Currently, no research examines the effect of TTS support when PWA read books. AIMS: This study's primary purpose was to examine comprehension accuracy and total processing time of PWA and neurotypical healthy adults (NHAs) when reading book sections in read-only versus TTS-supported conditions. A secondary aim was to examine condition preference and perceived degree of understanding by people in both participant groups. METHOD AND PROCEDURE: Ten PWA and 10 NHAs alternated between read-only and TTS-supported conditions to read a book. Participants answered comprehension questions and provided feedback about their reading experience, condition preference, and desire to use TTS technology for future book reading. Outcomes and Result: Overall, PWA exhibited less accurate comprehension and slower processing times compared to NHAs in both conditions. No significant comprehension accuracy difference occurred between conditions for either group. However, four PWA exhibited a 10% or greater increase in comprehension accuracy when receiving TTS support. A significant processing time difference occurred with PWA processing text faster with TTS support, whereas NHAs did not demonstrate processing time differences. Most PWA preferred the TTS condition and expressed a desire to use TTS technology in the future. Most NHAs expressed the opposite preference. CONCLUSIONS: TTS support during book reading promotes faster processing without compromising comprehension for PWA. Clinicians should discuss with PWA the relative importance of comprehension accuracy, processing time, and comfort with technology when determining whether using TTS support during book reading is desirable.

Speech-language pathologists' perspectives of interprofessional collaboration.

This study aims to provide insight into speech-language pathologists' experiences of and preparation for interprofessional collaborative practice across various settings and geographical locations in the United States. We disseminated an online survey via Qualtrics© to reach a representative sample of speech-language pathologists. We questioned respondents about the extend to which they engage in interprofessional collaborative practice, professionals with whom they engage in interprofessional collaborative practice, preparation for interprofessional collaborative practice, and barriers to engaging in interprofessional collaborative practice. Responses from 296 participants were analyzed to describe details regarding speech-language pathologists' experiences in interprofessional collaboration. Quantitative data included means, ranges, standard deviations, and frequency counts. Open-ended responses underwent analysis through a consensual qualitative approach. Most speech-language pathologists in this study (59%) reported feeling prepared for interprofessional collaboration. Participants reported that they engage in interprofessional collaborative practice with other professionals from disciplines such as nursing, occupational therapy, teaching, physical therapy, and school psychology. To best prepare students for future speech-language pathology practice, participants recommended that students engage in interprofessional education to learn about collaborating with these disciplines. These results could have implications for future design and implementation of interprofessional education activities for students and practicing clinicians.

Reading behaviors and text-to-speech technology perceptions of people with aphasia.

People with aphasia often have reading impairments that affect participation in daily activities. Text-to-speech (TTS) devices are technology-based supports that can facilitate processing of written materials. The purpose of this study was to gather information about the reading behaviors and TTS technology perceptions of people with aphasia who had first learned about system features and options. Sixteen people with chronic aphasia participated in single, one-on-one instructional and guided practice sessions using TTS systems. They answered close-ended questions about current reading behaviors and materials and ways they believed these would change given TTS system access. Participants reported reading at home and community locations. Most read calendars, newspapers, magazines, and mail. Participants who did not read lengthy materials - such as newspapers, magazines, and novels - indicated their interest in these materials would likely increase given TTS support. Although participants did not predict substantial comprehension changes given TTS support, most expressed interest in the technology after learning about it. Thus, people with aphasia perceive TTS systems as helpful for comprehending lengthy materials. Given modest predictions about comprehension benefits, presenting TTS as one of several support strategies is an appropriate recommendation.

Reading Comprehension and Processing Time When People With Aphasia Use Text-to-Speech Technology With Personalized Supports and Features.

BACKGROUND: Person-centered approaches promote consistent use of supportive technology and feelings of empowerment for people with disabilities. Feature personalization is an aspect of person-centered approaches that can affect the benefit people with aphasia (PWA) derive from using text-to-speech (TTS) technology as a reading support. AIMS: This study's primary purpose was to compare the comprehension and processing time of PWA when performing TTS-supported reading with preferred settings for voice, speech output rate, highlighting type, and highlighting color versus unsupported reading. A secondary aim was to examine initial support and feature preference selections, preference changes following TTS exposure, and anticipated functional reading activities for utilizing TTS technology. METHOD AND PROCEDURE: Twenty PWA read passages either via written text or text combined with TTS output using personally selected supports and features. Participants answered comprehension questions, reevaluated their preference selections, and provided feedback both about feature selections and possible future TTS technology uses. OUTCOMES AND RESULTS: Comprehension accuracy did not vary significantly between reading conditions; however, processing time was significantly less in the TTS-supported condition, thus suggesting TTS support promoted greater reading speed without compromising comprehension. Most participants preferred the TTS condition and several anticipated benefits when reading lengthy and difficult materials. Alterations to initial settings were relatively rare. CONCLUSIONS: Personalizing TTS systems is relevant to person-centered interventions. Reading with desired TTS system supports and features promotes improved reading efficiency by PWA compared with reading without TTS support. Attending to client preferences is important when customizing and implementing TTS technology as a reading support.

Speech-Language Pathologists' Practice Patterns When Designing Home Practice Programs for Persons With Aphasia: A Survey.

Purpose We aimed to describe the current practices of speech-language pathologists regarding the creation and implementation of home practice programs for persons with poststroke aphasia. Method Survey participants were American Speech-Language-Hearing Association-certified speech-language pathologists, had 30% of their caseload include persons with aphasia, and had recently created at least two home programs for persons with aphasia. Respondents completed a web-based survey on home program creation, training, technology, and methods for tracking adherence with closed and open-ended questions. Results We analyzed 80 complete surveys. Most of the participants (n = 56) created home programs for greater than 75% of their caseload. Common interventions in home programs addressed functional practice and spoken expression. Participants describe instructional techniques including building skill practice in daily routines and guided practice. Applications of technology and formal mechanisms to monitor adherence were less frequently reported. Various factors were identified as facilitators and barriers to home program creation with environmental support from others and client factors (i.e., motivation, impairments) most evident. Conclusions This study provides insight into speech-language pathologists' home program creation and implementation. Results can be used to consider mechanisms to improve use of and adherence to home programs to further support recovery. Supplemental Material https://doi.org/10.23641/asha.16840204.

Aphasia and Friendship: The Role and Perspectives of Speech-Language Pathologists.

Purpose Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.15032217.

Metacognitive Strategy Training Is Feasible for People With Aphasia.

Metacognitive strategy training shows promise for reducing disability following stroke, but previous trials have excluded people with aphasia. Considering the high incidence of poststroke aphasia, it is important to determine whether people with aphasia can benefit from strategy training. The purpose of this study was to determine the feasibility of an adapted strategy training protocol for people with aphasia. We recruited 16 adults with mild-moderate aphasia from inpatient stroke rehabilitation. We examined recruitment and retention, intervention delivery and fidelity, participant engagement and communication, participant strategy mastery, and change in disability. Therapists demonstrated good fidelity to intervention elements. Participants demonstrated good engagement and fair communication. The sample achieved a mean Functional Independence Measure change of 21.8 (SD = 16.2, Cohen's d = .95), similar to matched controls without aphasia from previous trials. An adapted strategy training protocol appears feasible for people with aphasia in inpatient stroke rehabilitation. Future studies should examine the efficacy of this approach in larger samples.

Effect of Digital Highlighting on Reading Comprehension Given Text-to-Speech Technology for People with Aphasia.

BACKGROUND: Many people with aphasia have a strong desire to participate in reading activities despite persistent reading challenges. Digital reading devices and text-to-speech (TTS) technology are increasing in popularity and have the potential to help people with aphasia. Systematic investigation of modifiable TTS features provides a means of exploring this potential. AIMS: This study's aim was to evaluate the effect of digital highlighting synchronised with TTS auditory and written output on reading comprehension by people with aphasia and to determine their highlighting preferences. METHODS & PROCEDURES: This work was registered with clinicaltrials.gov and assigned the clinical trial registry number 01446r prior to initiation of data collection. Twenty-five adults with aphasia read and listened to passages presented in three synchronised highlighting conditions: sentence highlighting, single word highlighting, and no highlighting. Participants answered comprehension questions, selected most and least preferred conditions, and provided feedback explaining highlighting preferences. OUTCOME & RESULTS: Comprehension accuracy did not vary significantly across presentation conditions, but participants preferred either single word or sentence highlighting over no highlighting. CONCLUSIONS: Neither word nor sentence highlighting benefitted or hindered comprehension by people with aphasia as a group, but individual differences may occur. Clinicians should attend to personal preferences when implementing digital highlighting as a reading support strategy.

Perceptions of people with aphasia about supporting reading with text-to-speech technology: A convergent mixed methods study.

INTRODUCTION: Text-to-speech (TTS) technology is a possible reading support for people with aphasia; however, adoption for functional reading remains rare, and people with aphasia may have limited knowledge about TTS. Given this situation coupled with inherent communication challenges associated with aphasia, the purpose of this convergent mixed methods study was to explore the perceptions of participants about desired features, benefits, and drawbacks of TTS technology after having engaged in one-on-one education and guided practice activities. METHODS: Nineteen adults with chronic aphasia completed a single education and guided practice session followed by close-ended questions and participation in a semi-structured interview to explain preferences, concerns, beliefs, and opinions about potential TTS technology benefits and drawbacks. Three participants had previously used TTS technology for functional reading; all others had some prior exposure but did not use a system for functional purposes. RESULTS: Seventeen of 19 participants expressed TTS technology interest after education and guided practice activities. Participants endorsed selection of a preferred voice, control of speech output rate, and highlighting as priority features. Frequently endorsed benefits were improved comprehension and increased reading independence; some participants believed they would succeed in reading a greater variety of materials, communicate more with others, participate in more reading activities, and/or read faster. The greatest concern was mastering device operation; other concerns related to understanding the voice output, needing another person's help for system use, and matching the speech output rate to a preferred reading rate. CONCLUSIONS: Overall, most participants had positive perceptions about possible benefits afforded by TTS technology. Practitioners need to provide opportunities for people with aphasia to learn about and explore TTS systems to determine whether adoption is desired.