Evaluating the Personal Narrative Skills of Monolingual Turkish-Speaking 7- and 10-Year-Old Children with Typical Development through Global TALES: A Pilot Study.

INTRODUCTION: Studies on personal narratives are rare in Turkey and there is no standard protocol for eliciting them. The aim of this small-scale study was to translate the Global TALES Protocol into Turkish, with cultural adaptations, and to present the results regarding its usability for two different age-groups of 7- and 10-year-old school children. We investigated narrative skills in terms of verbal productivity (number of utterances, total number of words), syntactic complexity (mean length of utterance), and semantic diversity (number of different words). In addition, group comparisons were made in terms of the participants' gender and age. METHODS: A total of 20 children, 10 from each age-group (7;0-7;11 and 10;0-10;11) participated in the study. All children were monolingual Turkish-speaking children with typical development. Participants were recruited through personal and/or social networks. All personal narratives were gathered via online connections (Zoom). RESULTS: Descriptive statistics were used to describe the children's performance, and the analysis of group differences was made separately according to age and gender. All children produced narratives in response to the six protocol prompts. In addition, the number of children who did not require the scripted follow-up prompts was higher than those needing a scripted follow-up prompt to produce a response. No statistically significant group differences were found in terms of gender and age on any of the measurements. CONCLUSION: The results from this small-scale investigation showed that the translated version of the Global TALES Protocol was effective in eliciting personal narratives from Turkish-speaking children. We concluded that there is no need to change the directions or give additional guidance or prompts to the children. Future studies with larger samples are needed to confirm these findings.

Comparing the efficiency of speech and language therapy and transcranial magnetic stimulation for treating Broca's aphasia.

OBJECTIVES: Aphasia is an acquired language-cognitive disorder that highly affects an individual's speech, language, and communication skills. Recovery from aphasia requires attentive treatment since it is a long and dynamic process. This study aimed to show interactive benefits of combining classical intervention strategies with new technological approaches and demonstrating their effectiveness. MATERIALS AND METHODS: A total of 40 individuals with Broca's aphasia were included in the study. The participants were divided into Application-1 Speech and Language Therapy, Application-2 Transcranial Magnetic Stimulation, Application-3 (consecutive Transcranial Magnetic Stimulation and Speech and Language Therapy), and Application-4 (Control Group) experimental groups, with 10 participants in each group. RESULTS: Analysis indicated that individuals in the group in which Transcranial Magnetic Stimulation and Speech and Language Therapy were applied consecutively had further increases in speech fluency, repetition, and naming scores from pre-test to post-test (p<0.01). Picture naming and quality-of-life communication scores of individuals in the group in which Speech and Language Therapy was performed increased further from pre-test to post-test (p<0.01). CONCLUSIONS: The results of the study showed a positive effect on language skills, naming scores, and participation in social life of Turkish-speaking aphasic individuals with the Speech and Language Therapy and Transcranial Magnetic Stimulation methods. The use of Transcranial Magnetic Stimulation alone is insufficient in this context. Although Speech and Language Therapy alone is effective in naming ability, Transcranial Magnetic Stimulation in addition to Speech and Language Therapy significantly increases the gain obtained with therapies.

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

The Validity and Reliability of the Language Battery in Comprehensive Aphasia Test-Turkish (CAT-TR).

Aphasia assessment is the initial step of a well-structured language therapy. Therefore, it is reasonable to underline that the assessment tools need to consider the typological and cultural characteristics of the language. A group of international researchers in the Collaboration of Aphasia Trialists have been adapting the Comprehensive Aphasia Test (CAT) into 14 languages spoken in Europe including Turkish. Thus, the aim of this study was to perform the validity and reliability analyses of the Language Battery section of CAT-TR to ensure the assessment of Turkish-speaking people with aphasia (PWA). The test included 21 sub-tests and yielded six modality scores (spoken language comprehension, written language comprehension, repetition, naming, reading, writing). Ninety PWA (Mean AGE = 61.07) and 200 controls (Mean AGE = 54.89) involved in the analyses. The participants were stratified into two education and three age groups. The analyses belonging to content, construct and criterion validity were performed, while the reliability analyses included internal consistency, test-retest and inter-rater reliability. Education influenced all the modality scores of the controls, while age-related differences were significant among all the modality scores except reading. It has to be underlined that Education did not hold any significant effects on the language performance of PWA, whereas those younger than 60 showed statistically better performance in the Spoken and Written Language Comprehension modality scores. The cut-off scores for each modality and Language Battery were presented with high sensitivity and specificity values. Compared to the psychometric characteristics of the adapted versions of CAT and aphasia tests utilized in Turkey, CAT-TR is an appropriate test for the language assessment of Turkish-speaking adults with aphasia.

Turkish Version of the Test Your Memory (TYM-TR) as a Screening Tool in Memory Clinics.

INTRODUCTION: This study compared the Turkish version of Test Your Memory (TYM) MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test) in patients with neurocognitive disorder. METHODS: After a thorough medical workup, patients with a diagnosis of neurocognitive disorder were enrolled. A cross-sectional design was used to compare the TYM results with those of MMSE and CDT. RESULTS: This study was conducted on 100 patients, including 46 males and 54 females, aged 52 to 86. The majority of patients were diagnosed with vascular neurocognitive disorder. The z-score of TYM-TR was significantly lower in the domains of registration, recall, visuospatial, and total score. The same results were achieved when CDT was added to MMSE. The same pattern was observed separately for those who were diagnosed with a mild or major neurocognitive disorder. CONCLUSION: Patients' cognitive deficits might be more evident when measured by the TYM-TR compared to the MMSE.

RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia.

Background: Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. Aim: To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. Outcomes and results: Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. Conclusion: Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).

The influence of proficiency and language combination on bilingual lexical access.

The present study examines the influence of language proficiency and language combination on bilingual lexical access using category fluency in 109 healthy speakers. Participants completed a category fluency task in each of their languages in three main categories (animals, clothing, and food), each with two subcategories, as well as a language use questionnaire assessing their proficiency. Five language combinations were examined (Hindi-English, Kannada-English, Mandarin-English, Spanish-English, and Turkish-English). Multivariate analyses of variance revealed that the average number of correct items named in the category fluency task across the three main categories varied across the different groups only in English and not the other language. Further, results showed that language exposure composite (extracted from the questionnaire using a principal component analysis) significantly affected the average number of items named across the three main categories. Overall, these results demonstrate the effects of particular language combinations on bilingual lexical access and provide important insights into the role of proficiency on access.

Imageability ratings across languages.

Imageability is a psycholinguistic variable that indicates how well a word gives rise to a mental image or sensory experience. Imageability ratings are used extensively in psycholinguistic, neuropsychological, and aphasiological studies. However, little formal knowledge exists about whether and how these ratings are associated between and within languages. Fifteen imageability databases were cross-correlated using nonparametric statistics. Some of these corresponded to unpublished data collected within a European research network-the Collaboration of Aphasia Trialists (COST IS1208). All but four of the correlations were significant. The average strength of the correlations (rho = .68) and the variance explained (R 2 = 46%) were moderate. This implies that factors other than imageability may explain 54% of the results. Imageability ratings often correlate across languages. Different possibly interacting factors may explain the moderate strength and variance explained in the correlations: (1) linguistic and cultural factors; (2) intrinsic differences between the databases; (3) range effects; (4) small numbers of words in each database, equivalent words, and participants; and (5) mean age of the participants. The results suggest that imageability ratings may be used cross-linguistically. However, further understanding of the factors explaining the variance in the correlations will be needed before research and practical recommendations can be made.

Test your memory-Turkish version (TYM-TR): reliability and validity study of a cognitive screening test.

BACKGROUND/AIM: The test your memory (TYM) is reported to be a sensitive cognitive function assessment scale for people with dementia. The aim of the present study was to investigate the reliability and validity of an adapted Turkish version of the TYM (TYM-TR) among Turkish dementia patients. MATERIALS AND METHODS: The TYM-TR was given to 59 patients with dementia aged 60+ and 336 normal controls aged 23-75+. The diagnostic utility of the TYM-TR was compared with that of the mini-mental state examination (MMSE) to validate it. RESULTS: The internal consistency of the TYM-TR was a = 0.85. The test-retest reliability was 0.97 (P < 0.001). The TYM-TR showed a statistically significant correlation with MMSE; r (57) = 0.628 P < 0.001. The TYM-TR distinguished dementia patients from controls (AUC = 0.994). A cut-off point of 34 was optimal for detecting dementia with a sensitivity of 96.61% and a specificity of 96.13% [95% CI (0.981-0.999)]. CONCLUSION: The Turkish version of the TYM was found to have good reliability and validity to distinguish dementia in the Turkish population.

Attitudes of Turkish speech and language therapists toward stuttering.

PURPOSE: The study sought to identify clinical beliefs and attitudes of speech and language therapists (SLTs) in Turkey and to compare them to previous research on SLTs in the USA and UK. METHOD: The Clinician Attitudes Toward Stuttering (CATS) inventory was administered by mail to nearly all-practicing SLTs in Turkey (n=61). RESULTS: Turkish SLTs, whose caseloads contained a substantial number of people who stutter, agreed with CATS items suggesting psychological causes and problems for those who stutter. They strongly believed therapy should focus on parent counseling for preschoolers who stutter as well as adolescents. They were not optimistic about carrying out stuttering therapy nor about the likelihood that children who stutter could be effectively treated. CONCLUSION: Attitudes toward stuttering by clinicians who treat them are important considerations in the conduct and outcomes of stuttering therapy. Additionally, SLTs working with stuttering clients should benefit from professional views and clinical experiences of their colleagues from surveys such as this one. EDUCATIONAL OBJECTIVES: The reader will be able to describe: (a) the components of the CATS, (b) common themes in Turkish speech and language therapists' attitudes toward stuttering, (c) differences between the attitudes of speech and language therapists from Turkey versus the United States and the United Kingdom.

Misconceptions about brain injury in Turkey.

PRIMARY OBJECTIVE: The aim of the study is to provide information about the knowledge and beliefs that people have regarding brain injury and to examine if the misbeliefs of adults in Turkey are similar to the misconceptions previously reported in the US and UK. METHODS AND PROCEDURE: Two hundred and fifty-three respondents answered questions about general brain injury knowledge, coma and unconsciousness, memory deficits and brain injury recovery in a questionnaire. Chi-square analyses revealed significant differences based on age, education and gender. Significant differences were determined between Turkish and US participants and Turkish and UK participants by Student t-test analysis. Findings were compared with those reported by previous researchers from the UK and US who administered the same questionnaire. MAIN OUTCOMES AND RESULTS: A close examination of the survey makes it clear that the percentages for the 'general knowledge on BI' were found to be higher. Participants' levels of accurate information on coma and unconsciousness and memory deficits ranked secondly and thirdly, respectively. The recovery process paled in significance, as it did not feature very highly. CONCLUSIONS: The general public should be informed about the seriousness and pervasiveness of the problems related to consequences of BI before taking decisions concerning language or cognitive therapies for their victims. Healthcare professionals should take roles in advocating reliable publicity primarily by dispelling misconceptions about BI.

Analysis of VOT in Turkish speakers with aphasia.

Studies investigating voicing onset time (VOT) production by speakers with aphasia have shown that nonfluent aphasics show a deficit in the articulatory programming of speech sounds based on the range of VOT values produced by aphasic individuals. If the VOT value lies between the normal range of VOT for the voiced and voiceless categories, then it is a phonetic distortion, thus a phonetic/articulatory deficit. A number of studies in different languages (French, English, Thai, Taiwanese) have investigated VOT in aphasic subjects in which their VOT values have been compared to those of normal speakers. This study investigates the VOT productions of voiced and voiceless stops by Turkish speakers with aphasia. Six patients with different aetiologies but similar language characteristics participated in this study. The results suggest that although Turkish nonfluent aphasics exhibit unimodal distribution of VOT production, the VOT values and ranges show language-specific properties.

The regression hypothesis revisited: evidence from Turkish.

The purpose of the study is first to investigate whether there is a significant difference among three study groups in terms of total content words, total nominal and verbal productions, and total nominal and verbal inflections; and secondly to analyse the most frequent words produced in relation to a picture description task. The underlying assumption is to analyse the tendency towards morpho-syntactic regression among the study groups, namely: a group of aphasics, a group of non-brain damaged adults, and a group of normally developing children still acquiring language. Participants were asked to describe two pictures of situations: one related with 'accidents' and the other with 'hospitals'. No regression was found in the group with aphasia towards the level of children in regard to the total number of nouns and verbs produced, save for the number of nominal inflections. The most frequent nouns were almost similar in the three groups, but qualitatively, the verbs with the highest frequency differed in the children.

Perspectives on public awareness of stroke and aphasia among Turkish patients in a neurology unit.

Recent studies on awareness have drawn attention to the fact that aphasia is a little known disorder to the public, in spite of all the publicity about this frequently occurring neurogenic language disorder. Being a very new concept, studies of awareness are rare in Turkey. This survey study assessed the extent of public awareness of neurological disorders, including aphasia, and information sources to answer questions about such disorders. A survey questionnaire consisting of 22 brief questions divided into three sections of awareness was administered to a convenience sample of 196 adults at a University Hospital in 2004. The results indicated that epilepsy and dementia are "the most well-known", and Multiple Sclerosis (MS) is "the least-known" among the surveyed diseases/disorders. Aphasia awareness was also low. The respondents preferred doctors as the most reliable information source. Speech and language therapists were found to be one of the information sources in advocating publicity as well. Most respondents expected to receive information from the doctors; who, in Turkey, are totally occupied with the physical aspects of health care provision. Neurologists, in collaboration with speech and language therapists, should be in a position to develop educational programmes to increase public awareness.