Evaluating circumlocution in naming as a predictor of communicative informativeness and efficiency in discourse.

Background: Discourse analyses yield quantitative measures of functional communication in aphasia. However, they are historically underutilized in clinical settings. Confrontation naming assessments are used widely clinically and have been used to estimate discourse-level production. Such work shows that naming accuracy explains moderately high proportions of variance in measures of discourse, but proportions of variance remain unexplained. We propose that the inclusion of circumlocution productions into predictive models will account for a significant amount more of the variance. Circumlocution productions at the naming-level, while they may not contain the target word, are similar to the content that contributes to discourse informativeness and efficiency. Thus, additionally measuring circumlocution may improve our ability to estimate discourse performance and functional communication. Aim: This study aimed to test whether, after controlling for naming accuracy, the addition of a measure of circumlocution into predictive models of discourse-level informativeness and efficiency would account for a significant amount more of the variance in these discourse-level outcomes. Methods & Procedures: Naming and discourse data from 43 people with poststroke aphasia were analyzed. Naming data were collected using 120 pictured items and discourse data were collected using two picture description prompts. Data scoring and coding yielded measures of naming accuracy, incorrect response type, communicative informativeness, and efficiency. We used robust hierarchical regression to evaluate study predictions. Outcomes & Results: After controlling for naming accuracy, the inclusion of circumlocution into predictive models accounted for a significant amount more of the variance in both informativeness and efficiency. The subsequent inclusion of other response types, such as real word and nonword errors, did not account for a significant amount more of the variance in either outcome. Conclusions: In addition to naming accuracy, the production of circumlocution during naming assessments may correspond with measures of informativeness and efficiency at the discourse-level. Reducing the burden of estimating patients' functional communication will increase our ability to estimate functional communication using tools that are easy to administer and interpret.

Barriers and facilitators to outcome measurement and treatment practices in aphasia rehabilitation in the USA: a mixed methods approach using the Theoretical Domains Framework.

PURPOSE: To identify clinician-perceived barriers and facilitators to the delivery of outcome measurement and evidence-based treatment practices and integration of these practices in aphasia rehabilitation. MATERIALS AND METHODS: Using a convergent mixed methods design, aphasia clinicians (n = 87) across care settings in the United States completed an online survey designed within the Theoretical Domains Framework (TDF). Participants responded to open-ended questions and rated Likert scale statements. Qualitative data were analyzed using content analysis and quantitative data were summarized using descriptive statistics. RESULTS: Factors related to the TDF domain of "environmental context and resources" (priority and productivity demands; characteristics of resources) were cited as primary barriers in 70% of qualitative responses for both outcome and treatment practices and were consistent with Likert rating statements. Facilitators were associated with TDF domains of "memory, attention, decision-making" (decision-making processes), "knowledge" (awareness of evidence) and "social influences" (client and caregiver preferences). CONCLUSIONS: Organizational-level factors and the misalignment of the research evidence with clinical needs are barriers to delivering evidence-based care in aphasia rehabilitation. Theoretically informed strategies such as establishing organizational infrastructure for practice change, developing clinically relevant evidence through research-practice partnerships, and implementing algorithms to support clinical decision-making can address barriers and leverage facilitators.

Rehabilitation research needs to engage clinical partners and consider the healthcare context to provide the field with evidence-based outcome measures and treatment recommendations that meet the needs of the clinical environment.Clinical decision-making tools and algorithms have potential to support systematic, evidence informed care.Future implementation efforts need to test strategies that go beyond knowledge and skills training.Clinicians are optimistic for change in clinical practice within themselves and the profession.

Incorporating Metacognitive Strategy Training Into Semantic Treatment Promotes Restitutive and Substitutive Gains in Naming: A Single-Subject Investigation.

PURPOSE: This study tested the effectiveness of a modified semantic feature analysis (SFA) treatment protocol that incorporated metacognitive strategy training (MST). Regarding its restitutive component, SFA most reliably results in improved word retrieval for treated items and untreated, semantically related items, but evidence of response generalization is often small/inconsistent. Regarding its substitutive component, SFA is thought to facilitate successful communication via habituation of the SFA circumlocution strategy. However, repeated practice with SFA's strategy in the absence of direct MST may not result in independent strategy use and/or generalization. Furthermore, people with aphasia's independent use of the SFA strategy in moments of anomia is presently underreported. To address these limitations, we incorporated MST into SFA and directly measured substitutive outcomes. METHOD: Four people with aphasia participated in 24 treatment sessions of SFA + MST in a single-subject, A-B experimental design with repeated measurements. We measured word retrieval accuracy, strategy use, and explicit strategy knowledge. We calculated effect sizes to measure changes in word retrieval accuracy and strategy use and used visual inspection to assess gains in explicit strategy knowledge from pre- to posttreatment and retention. RESULTS: Participants achieved marginally small to medium effects in word retrieval accuracy for treated; untreated, semantically related; and untreated, semantically unrelated items and marginally small to large effects in independent strategy use. Explicit strategy knowledge was variable. CONCLUSIONS: Across participants, SFA + MST yielded positive changes in word retrieval accuracy or strategy use, or both. Positive changes in word retrieval accuracy were comparable to other SFA studies. Positive changes in strategy use demonstrate preliminary evidence of this treatment's ability to yield restitutive and substitutive gains. Overall, this study offers preliminary evidence of SFA + MST's effectiveness and highlights the importance of directly measuring SFA's substitutive outcomes, which showed that people with aphasia can respond to this treatment in multiple successful ways-not just improved target word production.

'It's been an extraordinary journey': Experience of engagement from the perspectives of people with post-stroke aphasia.

BACKGROUND: Engagement is recognized as an important factor in aphasia treatment response and outcomes, yet gaps remain in our understanding of engagement and practices that promote engagement from the client perspective. AIMS: The purpose of this phenomenological study was to explore how clients with aphasia experience engagement during their inpatient aphasia rehabilitation. METHODS & PROCEDURES: An interpretative phenomenological analysis approach guided the study design and analysis. Data were collected through in-depth interviews with nine clients with aphasia, recruited through purposive sampling, during their inpatient rehabilitation admission. Analysis was completed using a variety of analytic techniques including coding, memoing, triangulation between coders and team discussion. OUTCOMES & RESULTS: The analysis revealed that for clients with aphasia in the acute phrase of recovery, the rehabilitation process resembles travelling on a journey through a foreign land. Successful engagement in the journey was accomplished when one had a therapist who served as a trusted guide and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. CONCLUSIONS & IMPLICATIONS: Engagement is a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. Findings from this work have implications for measuring engagement, training student clinicians to be skilled facilitators in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. WHAT THIS PAPER ADDS: What is already known on the subject Engagement is recognized as an important factor in rehabilitation treatment response and outcomes. Prior literature suggests that the therapist plays a critical role in facilitating engagement within the client-provider relationship. Communication impairments associated with aphasia may negatively impact a client's ability to develop interpersonal connections and participate in the rehabilitation process. There is a dearth of research directly exploring the topic of engagement in aphasia rehabilitation, particularly from the perspective of clients with aphasia. Capturing the client perspective can provide novel insights regarding practices to foster and maintain engagement in aphasia rehabilitation. What this paper adds to existing knowledge This interpretative phenomenological study revealed that for individuals with aphasia in the acute phase of recovery, the rehabilitation process resembles travelling on a sudden and foreign journey. Successful engagement in the journey was accomplished when one had a therapist who served as a 'trusted guide' and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. Through the client experience, engagement is seen as a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. What are the potential or actual clinical implications of this work? The current study highlights the complexity and nuance of engagement within the rehabilitation context, which has implications for measuring engagement, training student clinicians to be skilled in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. It is necessary to recognize that client and provider interactions (and thus engagement) are embedded in and influenced by the broader healthcare system. With this in mind, a patient-centred approach to engagement in aphasia care delivery cannot be achieved through individual efforts only and may require prioritization and action at the systems level. Future work is needed to explore barriers and facilitators to enacting engagement practices, in order to develop and test strategies to support practice change.

Theory-driven treatment modifications: A discussion on meeting the linguistic, cognitive, and psychosocial needs of individual clients with aphasia.

There is a growing body of literature demonstrating that language rehabilitation can improve naming impairments for individuals with aphasia. However, there are challenges applying evidence-based research to clinical practice. Well-controlled clinical studies often consist of homogenous samples and exclude individuals who may confound group-level results. Consequently, the findings may not generalize to the diverse clients serviced by speech-language therapists. Within evidence-based guidelines, clinicians can leverage their experiences and theoretical rationale to adapt interventions to meet the needs of individual clients. However, modifications to evidence-based interventions should not alter aspects of treatment that are necessary to produce change within the treatment target. The current discussion paper uses errorless learning, errorful learning, and retrieval practice for naming in aphasia to model how treatment theories can guide clinicians in making theory-informed modifications to interventions. First, we briefly describe the learning mechanisms hypothesized to underlie errorless learning, errorful learning, and retrieval practice. Next, we identify ways clinicians can provide targeted supports to optimize learning for individual clients. The paper ends with a reflection on how well-defined treatment theories can facilitate the generation of practice-based evidence and clinically relevant decision making.

Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients.

PURPOSE: Increasingly, mechanisms of learning are being considered during aphasia rehabilitation. Well-characterized learning mechanisms can inform "how" interventions should be administered to maximize the acquisition and retention of treatment gains. This systematic scoping review mapped hypothesized mechanisms of action (MoAs) and treatment ingredients in three learning-based approaches targeting naming in aphasia: errorless learning (ELess), errorful learning (EFul), and retrieval practice (RP). The rehabilitation treatment specification system was leveraged to describe available literature and identify knowledge gaps within a unified framework. METHOD: PubMed and CINHAL were searched for studies that compared ELess, EFul, and/or RP for naming in aphasia. Independent reviewers extracted data on proposed MoAs, treatment ingredients, and outcomes. RESULTS: Twelve studies compared ELess and EFul, six studies compared ELess and RP, and one study compared RP and EFul. Hebbian learning, gated Hebbian learning, effortful retrieval, and models of incremental learning via lexical access were proposed as MoAs. To maximize treatment outcomes within theorized MoAs, researchers manipulated study ingredients including cues, scheduling, and feedback. Outcomes in comparative effectiveness studies were examined to identify ingredients that may influence learning. Individual-level variables, such as cognitive and linguistic abilities, may affect treatment response; however, findings were inconsistent across studies. CONCLUSIONS: Significant knowledge gaps were identified and include (a) which MoAs operate during ELess, EFul, and RP; (b) which ingredients are active and engage specific MoAs; and (c) how individual-level variables may drive treatment administration. Theory-driven research can support or refute MoAs and active ingredients enabling clinicians to modify treatments within theoretical frameworks.

Cue responsiveness as a measure of emerging language ability in aphasia.

BACKGROUND: Prior research suggests that initial aphasia severity, lesion size, and lesion location are the most salient factors in predicting recovery outcomes. While these factors provide important prognostic information, information that is individualized and readily available to clinicians is limited. Deficits in naming are common to all aphasia types and are routinely targeted in aphasia assessment and treatment, with cues provided to facilitate lexical retrieval. OBJECTIVES: In this study, we examine aphasia recovery factors that are readily available to clinicians, examining whether a person's ability to improve naming with cues, indicating "stimulability," will be predictive of future word retrieval. METHODS: Ten participants with aphasia following a left-hemisphere stroke participated in initial assessment, seven of whom met criteria for longitudinal assessment. Stroke and early clinical recovery data were collected for all participants. At four timepoints over one year we evaluated longitudinal participants' naming ability and measured the proportion of successful lexical retrieval with the presentation of phonemic, feature, and sentence cues. RESULTS: For all participants, multiple descriptive factors regarding recovery, including lesion information, information from the acute inpatient timeframe, and communication opportunities, were examined. For individuals followed longitudinally, naming stimulability did not consistently predict naming accuracy at the subsequent assessment timepoint. Individuals' attempts at naming emerged as a metric related to future naming performance warranting further evaluation. CONCLUSIONS: Multiple factors related to recovery must be considered when providing prognostic information. Naming stimulability and attempts at naming provide some information regarding future performance, but are not consistently reliable across timepoints.

Using an Implementation Framework to Survey Outcome Measurement and Treatment Practices in Aphasia.

PURPOSE: Best practices in the field of aphasia rehabilitation increasingly acknowledge a whole-person approach that values interventions aimed at reducing impairments, while also recognizing the impact of aphasia on participation and quality of life. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to examine whether current clinical practices along levels of service provision reflect this whole-person, multifaceted approach. METHOD: Speech-language pathologists (SLPs) in the United States who provide intervention to people with aphasia across the continuum of care completed this cross-sectional online survey. Current outcome measurement and treatment practices were evaluated within the Living With Aphasia: Framework for Outcome Measurement via multiple-choice and open-text response questions. Data were analyzed descriptively and using ordinal logistic regression models to compare clinical practices along levels of service provision. RESULTS: Data from 90 SLPs revealed that language and cognitive skills are assessed with equal consistency across clinical settings; however, functional communication, participation, and quality of life domains are prioritized in settings providing care to clients within the community. Psychological well-being is rarely assessed within clinical practice along most of the rehabilitation process and prioritized within the university clinic setting when clients are in the chronic stage of recovery. CONCLUSIONS: Clinical practices related to a multifaceted approach to aphasia intervention are variable across levels of service provision. Further exploration of barriers and facilitators to multifaceted aphasia care along the domains of the CFIR is needed to provide an informed approach to implementing change.

Strategy Development and Feedback Processing During Complex Category Learning.

In this study, 38 young adults participated in a probabilistic A/B prototype category learning task under observational and feedback-based conditions. The study compared learning success (testing accuracy) and strategy use (multi-cue vs. single feature vs. random pattern) between training conditions. The feedback-related negativity (FRN) and P3a event related potentials were measured to explore the relationships between feedback processing and strategy use under a probabilistic paradigm. A greater number of participants were found to utilize an optimal, multi-cue strategy following feedback-based training than observational training, adding to the body of research suggesting that feedback can influence learning approach. There was a significant interaction between training phase and strategy on FRN amplitude. Specifically, participants who used a strategy in which category membership was determined by a single feature (single feature strategy) exhibited a significant decrease in FRN amplitude from early training to late training, perhaps due to reduced utilization of feedback or reduced prediction error. There were no significant main or interaction effects between valence, training phase, or strategy on P3a amplitude. Findings are consistent with prior research suggesting that learners vary in their approach to learning and that training method influences learning. Findings also suggest that measures of feedback processing during probabilistic category learning may reflect changes in feedback utilization and may further illuminate differences among individual learners.

The Application of Lexical Retrieval Training in Tablet-Based Speech-Language Intervention.

In the setting of shortened hospitalization periods, periods of confinement and social isolation, limited resources, and accessibility, technology can be leveraged to enhance opportunities for rehabilitative care (1). In the current manuscript, we focus on the use of tablet-based rehabilitation for individuals with aphasia, a language disorder that frequently arises post-stroke. Aphasia treatment that targets naming through effortful and errorful instances of lexical retrieval, where corrective feedback is generated on every trial, may enhance retention and generalizability of gains (2, 3). This pilot evaluation explored how six individuals with aphasia interacted with a tablet-based therapy application that targeted lexical retrieval. Participants with aphasia either (1) autonomously engaged with the therapy tasks or (2) received systematic encouragement to effortfully retrieve words. Behaviors of response latency and cue use were examined to gain insights into the behavioral patterns of both groups, as well as analyses of task accuracy and outcomes on standardized cognitive-linguistic assessments. Despite some variability, initial observations suggest that participants who received systematic training refrained from using cues to complete tasks and spent longer on each trial, which ultimately co-occurred with increased independent engagement with therapy and improved standardized outcomes. Preliminary results present an alternative means of leveraging technology to implement best-practice recommendations in the context of aphasia telerehabilitation.

Implementing a Standardized Language Evaluation in the Acute Phases of Aphasia: Linking Evidence-Based Practice and Practice-Based Evidence.

The research to practice gap is a significant problem across all disciplines of healthcare. A major challenge associated with the adoption of evidence into routine clinical care is the disconnect between findings that are identified in a controlled research setting, and the needs and challenges of a real-world clinical practice setting. Implementation Science, which is the study of methods to promote research into clinical practice, provides frameworks to promote the translation of findings into practice. To begin to bridge the research-practice gap in assessing recovery in individuals with aphasia in the acute phases of recovery following stroke, clinicians in an acute care hospital and an inpatient rehabilitation hospital followed an implementation science framework to select and implement a standardized language assessment to evaluate early changes in language performance across multiple timepoints. Using a secure online database to track patient data and language metrics, clinically-accessible information was examined to identify predictors of recovery in the acute phases of stroke. We report on the feasibility of implementing such standardized assessments into routine clinical care via measures of adherence. We also report on initial analyses of the data within the database that provide insights into the opportunities to track change. This initiative highlights the feasibility of collecting clinical data using a standardized assessment measure across acute and inpatient rehabilitation care settings. Practice-based evidence may inform future research by contributing pilot data and systematic observations that may lead to the development of empirical studies, which can then feed back into clinical practice.

How Well Do We Use Our Technology? Examining iPad Navigation Skills in Individuals With Aphasia and Older Adults.

Purpose Technology is increasingly being used in rehabilitation, yet exposure and comfort with technology varies across individuals, particularly among older adults. There are limited ways to evaluate comfort with technology or teach people how to use technological devices. The objective of the current study was to develop an iPad task battery and evaluate performance by individuals with aphasia and older adults, further examining whether participants could learn to improve performance with written, verbal, and visual instructions. Method Thirty-two participants completed this study (16 with poststroke aphasia and 16 older adult controls). Participants completed 3 phases of testing: (a) baseline evaluation of performance of an iPad task battery, (b) teaching and practice of unknown tasks, and (c) retention evaluation. Participants were scored on accuracy, speed, and efficiency in each phase. Results were evaluated as a function of demographic and cognitive-linguistic variables. Results Results demonstrate that variability arises in people's abilities to perform tasks on an iPad and that cognitive skills such as executive functions, planning, and visuospatial attention relate to baseline scores of performance. The majority of participants with aphasia showed evidence of retaining information learned in the teaching and practice phase; however, they showed a lower percentage of retained lessons relative to controls. Conclusions Findings support the hypothesis that technology abilities vary among individuals with and without aphasia. Evaluating technology ability and the ability to learn technology is an important component to consider when prescribing tablet-based therapies.

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.

Implementing a Standardized Assessment Battery for Aphasia in Acute Care.

In this article, the implementation of a standardized assessment battery for the evaluation of language in an acute care setting is described. Following an institutional shift to adopt electronic medical records, researchers and clinicians worked together to develop a technology-assisted evaluation of aphasia that would be used to assess all patients admitted to our facility with stroke. The project goal was to devise a clinical process to improve aphasia diagnosis and evaluation while remaining feasible within constraints imposed by the acute care setting and the electronic medical record. Utilizing frameworks from implementation science, the four key phases were: (1) initial considerations of the host setting, (2) creation of a structure for implementation, (3) maintenance of this structure once implementation began, and (4) improvement for future applications. A pilot implementation demonstrated that establishing and executing a minimum standardized assessment for aphasia in acute care is feasible. Retrospective medical record review of 50 aphasia evaluations in the setting of first incidence of left hemisphere stroke affecting the middle cerebral artery (25 preimplementation and 25 postimplementation) revealed that information content of medical notes was more consistent and complete postimplementation than preimplementation. Clinical implications and future directions are discussed.

Evaluating Treatment and Generalization Patterns of Two Theoretically Motivated Sentence Comprehension Therapies.

Purpose: The current study examined treatment outcomes and generalization patterns following 2 sentence comprehension therapies: object manipulation (OM) and sentence-to-picture matching (SPM). Findings were interpreted within the framework of specific deficit and resource reduction accounts, which were extended in order to examine the nature of generalization following treatment of sentence comprehension deficits in aphasia. Method: Forty-eight individuals with aphasia were enrolled in 1 of 8 potential treatment assignments that varied by task (OM, SPM), complexity of trained sentences (complex, simple), and syntactic movement (noun phrase, wh-movement). Comprehension of trained and untrained sentences was probed before and after treatment using stimuli that differed from the treatment stimuli. Results: Linear mixed-model analyses demonstrated that, although both OM and SPM treatments were effective, OM resulted in greater improvement than SPM. Analyses of covariance revealed main effects of complexity in generalization; generalization from complex to simple linguistically related sentences was observed both across task and across movement. Conclusions: Results are consistent with the complexity account of treatment efficacy, as generalization effects were consistently observed from complex to simpler structures. Furthermore, results provide support for resource reduction accounts that suggest that generalization can extend across linguistic boundaries, such as across movement type.

An Examination of Strategy Implementation During Abstract Nonlinguistic Category Learning in Aphasia.

PURPOSE: Our purpose was to study strategy use during nonlinguistic category learning in aphasia. METHOD: Twelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases were calculated. To evaluate strategy use, strategy analyses were conducted over training and testing phases. Participant data were compared with model data that simulated complex multi-cue, single feature, and random pattern strategies. Learning success and strategy use were evaluated within the context of standardized cognitive-linguistic assessments. RESULTS: Categorization accuracy was higher among control participants than among PWA. The majority of control participants implemented suboptimal or optimal multi-cue and single-feature strategies by testing phases of the experiment. In contrast, a large subgroup of PWA implemented random patterns, or no strategy, during both training and testing phases of the experiment. CONCLUSIONS: Person-to-person variability arises not only in category learning ability but also in the strategies implemented to complete category learning tasks. PWA less frequently developed effective strategies during category learning tasks than control participants. Certain PWA may have impairments of strategy development or feedback processing not captured by language and currently probed cognitive abilities.

Nonlinguistic learning in individuals with aphasia: effects of training method and stimulus characteristics.

PURPOSE: The purpose of the current study was to explore nonlinguistic learning ability in individuals with aphasia, examining the impact of stimulus typicality and feedback on success with learning. METHOD: Eighteen individuals with aphasia and 8 nonaphasic controls participated in this study. All participants completed 4 computerized, nonlinguistic category-learning tasks. Learning ability was probed under 2 methods of instruction: feedback-based (FB) and paired-associate (PA). The impact of task complexity on learning ability was also examined, comparing 2 stimulus conditions: typical and atypical. Performance was compared between groups and across conditions. RESULTS: The controls were able to successfully learn categories under all conditions. For the individuals with aphasia, 2 patterns of performance arose: One subgroup of individuals was able to maintain learning across task manipulations and conditions; the other subgroup demonstrated a sensitivity to task complexity, learning successfully only in the typical training conditions. CONCLUSION: Results support the hypothesis that impairments of general learning are present in individuals with aphasia. Some individuals demonstrated the ability to extract category information under complex training conditions; others learned only under conditions that were simplified and that emphasized salient category features. Overall, the typical training condition facilitated learning for all of the participants. Findings have implications for treatment, which are discussed.

Non-linguistic learning and aphasia: evidence from a paired associate and feedback-based task.

Though aphasia is primarily characterized by impairments in the comprehension and/or expression of language, research has shown that patients with aphasia also show deficits in cognitive-linguistic domains such as attention, executive function, concept knowledge and memory. Research in aphasia suggests that cognitive impairments can impact the online construction of language, new verbal learning, and transactional success. In our research, we extend this hypothesis to suggest that general cognitive deficits influence progress with therapy. The aim of our study is to explore learning, a cognitive process that is integral to relearning language, yet underexplored in the field of aphasia rehabilitation. We examine non-linguistic category learning in patients with aphasia (n=19) and in healthy controls (n=12), comparing feedback and non-feedback based instruction. Participants complete two computer-based learning tasks that require them to categorize novel animals based on the percentage of features shared with one of two prototypes. As hypothesized, healthy controls showed successful category learning following both methods of instruction. In contrast, only 60% of our patient population demonstrated successful non-linguistic category learning. Patient performance was not predictable by standardized measures of cognitive ability. Results suggest that general learning is affected in aphasia and is a unique, important factor to consider in the field of aphasia rehabilitation.