Metacognitive accuracy predicts self-reported quality of life following traumatic brain injury.

OBJECTIVE: Metacognition and quality of life (QoL) are both adversely affected by traumatic brain injury (TBI), but the relation between them is not fully understood. As such, the purpose of this study was to determine the degree to which metacognitive accuracy predicts QoL in individuals with TBI. METHODS: Eighteen participants with moderate-to-severe TBI completed a stimulus-response task requiring the discrimination of emotions depicted in pictures of faces and then provided a retrospective confidence judgment after each response. Metacognitive accuracy was calculated using participants' response accuracy and confidence judgment accuracy. Participants also completed the Quality of Life After Brain Injury (QOLIBRI) questionnaire to assess QoL in various areas of functioning. RESULTS: Performance of a linear regression analysis revealed that higher metacognitive accuracy significantly predicted lower overall QoL. Additionally, higher metacognitive accuracy significantly predicted lower QoL related to cognition and physical limitations. CONCLUSION: The study results provide evidence of an inverse relation between metacognitive performance and QoL following TBI. Metacognitive changes associated with TBI and their relation to QoL have several clinical implications for TBI rehabilitation.

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.

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.

Speech and Language Characteristics of Neurologically Healthy Adults When Describing the Modern Cookie Theft Picture: Mixing the New With the Old.

PURPOSE: The Modern Cookie Theft picture has recently become available. This study's purpose was to compare (a) speech and language production by neurologically healthy adults (NHAs) given a generic instruction to describe the picture versus instruction to describe it as if talking with someone who was blind and (b) production during the first 90 s versus full samples. METHOD: One hundred NHAs minus five outliers formed two participant groups. Each group heard either the original or modified task instruction. Transcriptions of resulting descriptions were analyzed regarding duration, word and T-unit productivity, content units (CUs), and main concepts (MCs) both in full and 90-s samples. Identified CUs and MCs were compared with existing lists from previous research. RESULTS: Significantly longer samples and greater verbosity occurred with the modified versus original instruction even when limiting time to a 90 s maximum. With the modified instruction, CUs included 119 and 138 terms for truncated and full samples, respectively; participants mentioned 98 and 104 CUs, respectively, given the original instruction. MCs expressed were 18 and 19 for truncated and full samples, respectively, given the modified instruction; with the original instruction, this dropped to 11 and 12 MCs for truncated and full samples, respectively. Within samples, CU and MC repetitions were greater given modified rather than original instruction. CONCLUSIONS: Normative productivity and content generation data are critical for guiding diagnostic efforts and treatment planning. Benefits and detriments associated with differing productivity and content redundancy secondary to varying instructions and analysis time frames are discussed.

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.

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.

Implementing Team-Based Post-Stroke Telerehabilitation: A Case Example.

Access to extensive, interdisciplinary rehabilitation following stroke is necessary to optimize recovery. Telerehabilitation is an appropriate model for delivering these services. However, given its relatively recent increase in popularity as a service delivery model, researchers have yet to explore the feasibility of interprofessional coordination and collaboration as a guiding framework for telerehabilitation and the effects of team-based remote service delivery on recovery of body functions and activities. This case example reports the development, implementation, and progression of a post-acute treatment program delivered via telerehabilitation to a woman with left hemorrhagic stroke. As is typical, therapy time alone afforded insufficient practice to exploit neuroplasticity and ensure maintenance and generalization of improved functioning; hence, the team worked collaboratively to encourage interdisciplinary activities outside scheduled treatment sessions. Standardized and informal assessments administered at the start and conclusion of treatment confirmed improved functioning as did the client's progress toward independent living and return to work. Implications for telerehabilitation practices are discussed.

Perceptions About Writing by Adults With Moderate or Severe Traumatic Brain Injury.

PURPOSE: Writing challenges can cause ongoing distress and limit resumption of pre-injury activities following traumatic brain injury (TBI); however, little TBI research or clinical practice addresses written communication. Understanding the writing perceptions and experiences of adults engaged in intensive, inpatient rehabilitation following hospital discharge for TBI is an initial step in addressing this situation. METHOD: Transcendental phenomenology served to structure this qualitative research. Six adults between 2 and 6 months post-TBI participated in a common experience of writing about a personal memorable event. Standardized test scores and symptom ratings provided descriptive information about participants. Additionally, participants completed the Neurobehavioral Symptom Inventory and NASA Task Load Index and engaged in semistructured interviews to describe writing perceptions and experiences. RESULTS: Data analysis revealed themes and subthemes about writing perceptions, challenges, and support strategies. Participants varied in their perceptions of post-injury writing changes. Test results revealed areas of challenge for all participants, but only half reported awareness of writing changes. Those aware of changes differed from other participants regarding word retrieval, memory, and concentration as well as overall effort expended, frustration, and performance quality. Although all participants relied on writing supports, only one had adjusted multiple writing strategies following injury. CONCLUSIONS: Some adults with TBI are aware of writing changes while receiving posthospital, inpatient rehabilitation services, but others deny such changes. This differs from reports concerning later recovery stages, perhaps because few functional writing opportunities arise during rehabilitation. Application of compensatory strategies specific to post-injury writing challenges is unlikely while awareness remains limited.

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.

Informal Written Language Analysis Methods: Case Examples of Adults With Traumatic Brain Injury.

PURPOSE: Written expression challenges following traumatic brain injury (TBI) in adults have received little clinical attention but can substantially affect quality of life and the success of reintegration efforts. Assessment tools and procedures are lacking despite the likelihood of post-TBI problems with microstructure (e.g., productivity, spelling accuracy) and macrostructure (e.g., topic adherence, organization) aspects of written language. The lack of standardized procedures forces reliance on informal methods to determine writing strengths and challenges. METHOD: A combination of assessment procedures allowed for evaluation of the productivity and efficiency, adherence to writing conventions (e.g., spelling, sentence structure, punctuation), and macrostructure organization (e.g., story grammar, topic adherence) of written narratives collected from five adults with TBI. RESULTS: Use of multiple assessment methods revealed disparate writing challenges across the five case examples. The differing writing profiles underscore the necessity of evaluating multiple aspects of written narratives. CONCLUSIONS: The described analysis methods can help clinicians determine areas of strength and challenge in written work generated by adults with TBI. Examination of multiple aspects of writing is key to garnering a comprehensive appraisal of post-TBI writing.

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.

Case Managers' Perceptions About Synchronous Telerehabilitation versus Clinic-based Physical Therapy Services for People with Spinal Cord Injury.

People with spinal cord injury (SCI) require extensive rehabilitation to maximize independence and quality of life. Much of this treatment occurs on an outpatient basis through telerehabilitation or clinic-based services. Synchronous telerehabilitation has become increasingly common in recent years, but many professionals remain reluctant to suggest it when clinic-based services are available. This survey study explored case managers' perceptions regarding advantages and disadvantages of synchronous telerehabilitation versus clinic-based physical therapy services for people with SCI. Respondents were 89 case managers responsible for service provision coordination. Results showed a significant preference for clinic-based rather than telerehabilitation physical therapy services. Relative experience with the two service delivery models significantly affected perceptions. Only facilitating travel convenience differed significantly as a reason for recommending one service delivery method over the other. The incongruity between perceptions about synchronous telerehabilitation and existing literature about its cost, convenience, and efficacy suggests a need for additional education.

Effect of Text-to-Speech Rate on Reading Comprehension by Adults With Aphasia.

Purpose Accessing auditory and written material simultaneously benefits people with aphasia; however, the extent of benefit as well as people's preferences and experiences may vary given different auditory presentation rates. This study's purpose was to determine how 3 text-to-speech rates affect comprehension when adults with aphasia access newspaper articles through combined modalities. Secondary aims included exploring time spent reviewing written texts after speech output cessation, rate preference, preference consistency, and participant rationales for preferences. Method Twenty-five adults with aphasia read and listened to passages presented at slow (113 words per minute [wpm]), medium (154 wpm), and fast (200 wpm) rates. Participants answered comprehension questions, selected most and least preferred rates following the 1st and 3rd experimental sessions and after receiving performance feedback, and explained rate preferences and reading and listening strategies. Results Comprehension accuracy did not vary significantly across presentation rates, but reviewing time after cessation of auditory content did. Visual data inspection revealed that, in particular, participants with substantial extra reviewing time took longer given fast than medium or slow presentation. Regardless of exposure amount or receipt of performance feedback, participants most preferred the medium rate and least preferred the fast rate; rationales centered on reading and listening synchronization, benefits to comprehension, and perceived normality of speaking rate. Conclusion As a group, people with aphasia most preferred and were most efficient given a text-to-speech rate around 150 wpm when processing dual modality content; individual differences existed, however, and mandate attention to personal preferences and processing strengths.

Post-acute rehabilitation effects on functional outcome and discharge disposition of people with severe traumatic brain injury.

Objective: This study's purpose was to document the effect of post-acute rehabilitation on functional independence of adults with moderate or severe traumatic brain injury (TBI). Methods: Retrospective analysis of admission and discharge scores on the Northwick Park Dependency Score (NPDS) and Mayo-Portland Adaptability Inventory - Fourth Edition (MPAI-4) as well as discharge disposition was performed for 271 adults admitted to post-acute rehabilitation between 2012 and 2017. Results: Discharge disposition was home for 83.39% of cases. Home discharge cases admitted to rehabilitation significantly sooner after injury than supported living discharge cases. Also, home discharge cases achieved significantly better NPDS and MPAI-4 scores both at admission and discharge than supported discharge cases. Analyses split by program duration revealed cases with ≤90 day stays were closer to injury upon admission and had significantly better admission and discharge NPDS and MPAI-4 scores than those with longer stays. Although NPDS and MPAI-4 change scores for home versus supported living discharge did not differ significantly, change scores for home discharge cases with ≤90-day programs were significantly smaller than those with >90-day programs. Conclusion: Findings support the notion that providing intensive post-acute rehabilitation may increase the functional independence of people with moderate or severe TBI.

Alexia and Agraphia Intervention Following Traumatic Brain Injury: A Single Case Study.

Purpose This case study documents the effectiveness of a multicomponent intervention for an adolescent with acquired alexia and agraphia following severe traumatic brain injury. Method Initial testing revealed severe central alexia and surface agraphia with concomitant anomic aphasia. Intervention components included sight word drills, modified Multiple Oral Reading (MOR) procedures, functional reading tasks, and modified Copy and Recall Treatment. Intervention spanned 2 months with sessions 5 days per week. Data collection and analysis involved monitoring sight word decoding, reading speed and decoding errors during MOR, and spelling accuracy of Copy and Recall Treatment words. Follow-up testing occurred at intervention conclusion. Results Sight word mastery for 315 words progressed from 66.35% to 100% over 5 weeks and was maintained thereafter. MOR materials progressed from Grade 1 to Grade 5. Initial reading speed was 31 words per minute with errors on 15% of words. At program completion, reading speed was 47 words per minute with 7% decoding errors despite increased difficulty of reading material. The participant demonstrated initial mastery of 15 spelling lists containing 15 words each and sustained mastery (2 additional consecutive weeks of 100% accuracy) of 8 lists. Follow-up assessment revealed improvements consistent with 3-4 grade levels but persistent impairment relative to premorbid functioning. Conclusion The multicomponent program was effective in promoting substantial improvement, although surface alexia and agraphia persisted after 2 months of treatment. The case provides an example of the type and extent of progress possible given minimal initial recovery but systematic intervention within the context of intensive postacute rehabilitation.

Effects of Written, Auditory, and Combined Modalities on Comprehension by People With Aphasia.

Background People with aphasia experience reading challenges affecting participation in daily activities. Researchers have found combined auditory and written presentation modalities help people with aphasia comprehend contrived sentences and narratives, but less is known about the effects of combined modalities on functional, expository text comprehension. Aims This study's purpose was to examine comprehension accuracy, reviewing time, and modality preference of people with aphasia when presented with edited newspaper articles in written only, auditory only, and combined written and auditory modalities. Method and Procedure Twenty-eight adults with chronic aphasia read and/or listened to 36 passages. Following each passage, participants answered comprehension questions. Then, they ranked the modalities in accordance with preference and provided a rationale for their ranking. Outcomes and Results Comprehension accuracy was significantly better in the combined than auditory-only condition and in the written-only than auditory-only condition; the difference between combined and written-only conditions was not significant. Reviewing time differed significantly among conditions with the written-only condition taking longest and the auditory-only condition taking shortest. Most participants preferred the combined condition. Conclusions Access to combined modalities helps people with aphasia comprehend expository passages such as those found in newspapers better than auditory-only presentation. Furthermore, combined presentation decreases reviewing time from that needed for unsupported reading without compromising comprehension accuracy. Given that most participants preferred combined modality presentation, providing simultaneous auditory and written access to content through text-to-speech technology is a viable strategy when aphasia results in persistent reading challenges.

Comprehension of Single Versus Combined Modality Information by People With Aphasia.

Purpose Every adult with aphasia displays a unique constellation of language comprehension skills and varies in the benefit derived from different content presentation formats. For many, multiple modality presentation enhances comprehension. This study's purpose was to determine the comprehension benefits for people with mild, moderate, and severe aphasia when hearing, reading, or simultaneously hearing and reading single sentences. Method Twenty-seven adults with aphasia performed a repeated-measures experiment across 3 conditions. Participants read and/or listened to sentence stimuli and selected from 4 images the 1 matching the sentence. Participants also indicated condition preference. Results Participants demonstrated significantly greatest accuracy during simultaneous written and auditory stimulus presentation. Performance patterns varied within aphasia severity groups. Individuals with mild and moderate aphasia demonstrated minimal performance differences across conditions, and people with severe aphasia were significantly more accurate in the combined modality than the written-only modality. Overall, participants required the longest response time in the written-only condition; however, participants were most efficient with auditory content. Condition preferences did not always mirror accuracy; however, the majority reported a preference for combined content presentation. Conclusions Results suggest some people with aphasia may benefit from combined auditory and written modalities to enhance comprehension efforts.