Which blueberries are better value? The development and validation of the functional numeracy assessment for adults with aphasia.

BACKGROUND: People with aphasia (PWA) can experience functional numeracy difficulties, that is, problems understanding or using numbers in everyday life, which can have numerous negative impacts on their daily lives. There is growing interest in designing functional numeracy interventions for PWA; however, there are limited suitable assessments available to monitor the impact of these interventions. Existing functional numeracy assessments lack breadth and are not designed to be accessible for PWA, potentially confounding their performance. Additionally, they do not include real-life demands, such as time pressure, which may affect their ecological validity. Thus, there is a crucial need for a new assessment to facilitate further research of PWA's functional numeracy. AIMS: To develop, validate and pilot a wide-ranging, aphasia-friendly functional numeracy assessment to investigate how functional numeracy is impacted by aphasia severity and time pressure demands, and to explore predictors of PWA's functional numeracy. METHODS & PROCEDURES: To develop the Functional Numeracy Assessment (FNA), 38 items inspired by the General Health Numeracy Test (GHNT) and Excellence Gateway were adapted for suitability for PWA and entered in a computerized psychometric-style test. The final 23 items (FNA23) were selected based on 213 neurotypical controls' performance, and controlled for difficulty, response modality and required numeracy skills. Aphasia-friendly adaptations of the GHNT and Subjective Numeracy Scale were used to examine the FNA23's concurrent validity. Internal consistency reliability and interrater reliability (for spoken responses) were also examined. A novel Time Pressure Task was created by slight adaptation of seven FNA23 questions to explore the effects of time pressure on functional numeracy performance. A total of 20 PWA and 102 controls completed all measures on an online testing platform. OUTCOMES & RESULTS: The FNA23 demonstrated acceptable internal consistency reliability (KR-20 = 0.81) and perfect interrater reliability (for spoken responses). FNA23 and GHNT scores were positively associated, suggesting satisfactory concurrent validity. PWA demonstrated poorer functional numeracy than controls and took longer to complete assessments, indicating that aphasia impacts functional numeracy. Time pressure did not significantly impact performance. PWA demonstrated a wide range of functional numeracy abilities, with some performing similarly to controls. CONCLUSIONS & IMPLICATIONS: The FNA23 is a wide-ranging, valid and reliable assessment which, with further development, will be a useful tool to identify and monitor PWA's functional numeracy difficulties in research and clinical practice. Considering PWA's widespread functional numeracy difficulties evidenced by this study, all PWA would likely benefit from routine evaluation for functional numeracy difficulties as part of their neurorehabilitation journeys. WHAT THIS PAPER ADDS: What is already known on this subject Few studies have investigated functional numeracy difficulties in PWA. No published functional numeracy assessments exist that have been specifically designed to be accessible for PWA. What this paper adds to existing knowledge The newly developed FNA23 is a valid and reliable tool to extensively assess PWA's functional numeracy. This study confirmed previous findings of widespread functional numeracy difficulties in PWA that are related to their aphasia severity. What are the potential or actual clinical implications of this work? The FNA23 can be used to assess PWA's functional numeracy to inform areas of strengths and difficulties to target in intervention, and to monitor progress towards achieving intervention objectives. All PWA should be routinely evaluated for functional numeracy difficulties.

Training flexibility in fixed expressions in non-fluent aphasia: A case series report.

BACKGROUND: Many speakers with non-fluent aphasia (NFA) are able to produce some well-formed word combinations such as 'I like it' or 'I don't know', although they may not use variations such as 'He likes it' or 'I don't know that person'. This suggests that these utterances represent fixed forms. AIMS: This case series investigation explored the impact of a novel intervention aimed at enhancing the connected speech of individuals with NFA. The intervention, motivated by usage-based principles, involved filling open slots in semi-fixed sentence frames. METHODS & PROCEDURES: Five participants with NFA completed a 6-week intervention programme. The intervention trained participants to insert a range of different lexical items into the open slots of high-frequency phrases such as 'I like it' to enable more productive sentences (e.g., 'they like flowers'). The outcomes and acceptability were examined: The primary outcome measure focused on changes in connected narrative, and the availability of trained constructions (e.g., 'I like it') was explored through a story completion test. Two baseline measures of behaviour were taken prior to intervention, and outcomes assessed immediately after intervention and at a 6-week maintenance assessment. OUTCOME & RESULTS: A pre-/post-treatment comparison of connected speech measures showed evidence of enhanced connected speech for two of the five participants (P2 and P5). An analysis of story completion test scores revealed positive change for two participants (P1 and P2). Findings were mixed with regard to baseline stability of outcome measures and post-intervention stability of language changes. The intervention was acceptable to all participants. CONCLUSION & IMPLICATIONS: While this pilot study yielded promising findings with regard to the intervention's acceptability and increased connected speech for some participants, the findings were mixed across the sample of five participants. This research helps inform hypotheses and selection criteria for future studies. WHAT THIS PAPER ADDS: What is already known on the subject Despite difficulties producing grammatically correct sentences, many speakers with aphasia are able to produce well-formed utterances, often representing familiar expressions such as 'I don't know' and 'I like it'. In usage-based Construction Grammar (CxG) theories, familiar utterances are assumed to be processed as one unit and are therefore more resilient to brain damage. CxG assumes that residual utterances such as 'I like it' map onto more abstract sentence frames (e.g., '[REFERENT] like-TENSE [THING]'). What this paper adds to existing knowledge Sentence therapy, informed by CxG principles, is novel in aphasiology, and usage-based interventions need to be evaluated with regard to their impact on language processing at the connected speech level. This case series report explores the acceptability and outcomes of a usage-based sentence therapy. We also introduce and explore the value of an automated, frequency-based analysis tool for evaluating connected speech outcomes in aphasia therapy. What are the potential or actual clinical implications of this work? The findings inform further development of usage-based aphasia interventions targeting word combinations.

'What's cooking?' A comparison of an activity-oriented and a table-top programme of therapy on the language performance of people with aphasia.

BACKGROUND: Many people with aphasia have word-finding difficulties, with some showing particular difficulties with verbs. Picture-naming therapy is often used to improve naming, but gains are usually limited to therapy items and do not transfer to conversation. Therapy where words are produced in sentences and in real-life activities may be more effective. AIMS: The current pilot study investigated whether an activity-oriented therapy approach would be accepted and viable if implemented in a community setting, and whether communicating whilst cooking was more beneficial than using paper-based activities. If successful, it would be expected that verb production would improve in structured and unstructured tasks in both naming and narrative tasks. METHODS & PROCEDURES: The study employed a case-series repeated-measures design, with testing of treated and control items. Seven adults with anomia participated, although only five completed the full programme. Participants were divided into two groups and each group completed both treatments, but in different orders. Each treatment was employed for six 2-h sessions over a 3-week period. OUTCOMES & RESULTS: Naming of both treated and untreated verbs showed a statistically significant improvement following both treatments and this continued into the maintenance phase. There was a numerical but not statistically significant gain in the variety of verbs used in spoken narratives. Participants predominantly chose positive terms to describe their experience of the programme, but did not prefer one therapy over the other. CONCLUSIONS & IMPLICATIONS: Preliminary findings suggest that an activity-oriented therapy approach, whether it involves carrying out tasks or paper-based activities, can result in clinically meaningful improvements for people with chronic aphasia. Further research using a randomized control trial is required to determine whether cooking therapy alone is effective.

'All the better for not seeing you': effects of communicative context on the speech of an individual with acquired communication difficulties.

UNLABELLED: Evidence shows that speakers adjust their speech depending on the demands of the listener. However, it is unclear whether people with acquired communication disorders can and do make similar adaptations. This study investigated the impact of different conversational settings on the intelligibility of a speaker with acquired communication difficulties. Twenty-eight assessors listened to recordings of the speaker reading aloud 40 words and 32 sentences to a listener who was either face-to-face or unseen. The speaker's ability to convey information was measured by the accuracy of assessors' orthographic transcriptions of the words and sentences. Assessors' scores were significantly higher in the unseen condition for the single word task particularly if they had heard the face-to-face condition first. Scores for the sentence task were significantly higher in the second presentation regardless of the condition. The results from this study suggest that therapy conducted in situations where the client is not able to see their conversation partner may encourage them to perform at a higher level and increase the clarity of their speech. LEARNING OUTCOMES: Readers will be able to describe: (1) the range of conversational adjustments made by speakers without communication difficulties; (2) differences between these tasks in offering contextual information to the listener; and (3) the potential for using challenging communicative situations to improve the performance of adults with communication disorders.

A comparison of computerized and paper-based language tests with adults with aphasia.

PURPOSE: This study investigated whether computers are a useful tool in the assessment of people with aphasia (PWA). Computerized and traditionally administered versions of tasks were compared to determine whether (a) the scores were equivalent, (b) the administration was comparable, (c) variables such as age affected performance, and (d) the participants' perceptions of the computerized and traditionally administered versions of the tasks were similar. METHOD: Fifteen PWA were assessed on 2 language tasks-sentence-picture matching and grammaticality judgment-in 3 conditions: computer only, computer with the clinician present, and traditional. The participants also completed questionnaires rating aspects of each condition. RESULTS: Scores from the traditionally administered tasks were highly correlated with those from the computerized tasks, but scores from the computerized tasks were significantly lower. There was no significant difference in the time taken between the conditions. Whereas some individuals felt comfortable with the computer, overall, participants preferred the traditional assessment method or when another person was in the room. No factors were identified that predicted participants' relative performance in the computer condition. CONCLUSION: The results suggest that PWA can be assessed using computerized versions of tasks, but that caution should be exercised when comparing scores to those collected using traditional methods, including norms. The variation in participants' opinions regarding computerized tasks suggests that this method might be more suitable for some participants than others.

Accent identification by adults with aphasia.

The UK is a diverse society where individuals regularly interact with speakers with different accents. Whilst there is a growing body of research on the impact of speaker accent on comprehension in people with aphasia, there is none which explores their ability to identify accents. This study investigated the ability of this group to identify the geographical origins of a speaker. Age-matched participants with and without aphasia listened to 120 audio recordings of five speakers each of six accents, reading aloud four sentences each. Listeners were asked to make a forced-choice decision about the geographical origin of the speaker. Adults with aphasia were significantly less accurate than control participants at identifying accents but both groups made the same pattern of errors. Adults with aphasia who are able to identify a new speaker as being from a particular place may draw on this information to help them "tune in" to the accent.

Accent on communication: the impact of regional and foreign accent on comprehension in adults with aphasia.

PURPOSE: This study explored whether an unfamiliar non-native accent, differing in both segmental and prosodic features was more difficult for individuals with aphasia to understand than an unfamiliar native accent, which differed in segmental features only. METHOD: Comprehension, which was determined by accuracy judgments on true/false sentences, and speed of response were assessed in the following three conditions: a familiar Southern Standard British English (SSBE) accent, an unfamiliar native Grimsby accent, and an unfamiliar non-native Chinese accent. Thirty-four English speaking adults (17 people with and 17 people without aphasia) served as listeners for this study. RESULTS: All listeners made significantly more errors in the unfamiliar non-native accent, although this difficulty was more marked for those with aphasia. While there was no affect of speaker accent on the response times of listeners with aphasia, listeners without aphasia were significantly slower with the unfamiliar non-native accent. CONCLUSION: The results indicate that non-native accented speech affects comprehension even on simple tasks in ideal listening conditions. The findings suggest that speaker accent, especially accents varying in both segmental and prosodic features, can be a barrier to successful interactions between non-native accented speakers and native listeners, particularly those with aphasia.

Investigating the impact of unfamiliar speaker accent on auditory comprehension in adults with aphasia.

BACKGROUND: In an increasingly multicultural society, all individuals are likely to come into contact with speakers with unfamiliar accents. Recent figures suggest that such accent variation may be particularly apparent within the healthcare workforce. Research on accent variation has demonstrated that an unfamiliar speaker accent can affect listener comprehension, but the impact of speaker accent on the comprehension skills of listeners with neurological impairment has not been widely explored. AIMS: To investigate the effect of an unfamiliar accent on the sentence comprehension of individuals with aphasia following stroke. METHODS & PROCEDURES: The impact of two different accents (south-east England and Nigerian) on accuracy and response time for 16 individuals with aphasia and 16 healthy control subjects was measured. Participants were presented with a computerized sentence-to-picture matching task and their accuracy and response times were recorded. OUTCOMES & RESULTS: Results showed that individuals with aphasia made significantly more errors in comprehension of sentences spoken in an unfamiliar accent than in a familiar accent, a finding that was not demonstrated by the control group when outliers were excluded. Individuals with aphasia were slower overall; however, response times did not show significant effects of speaker accent for either group. CONCLUSIONS & IMPLICATIONS: The impact of speaker accent should be considered in the rehabilitation of individuals with aphasia following stroke. Clinical implications include the possibility of underestimating an individual's language abilities on assessment, and the potential errors in comprehension that may occur.

Knowledge is BLISS: an investigation into the transparency of BLISS symbol strings directed by a person with aphasia.

BACKGROUND: Since his stroke 15 years ago, Tony O'Donnell has worked with BLISS, a symbolic, graphical language. BLISS has been used with a variety of clinical populations, including people with severe aphasia. O'Donnell found his adapted version of BLISS was meaningful to him when spoken and written English was not. The present study is part of a larger project that investigated the validity and generality of O'Donnell's belief that his adapted system would be useful for people with severe aphasia. AIMS: The first aim was to investigate whether people without aphasia and without training could match the adapted version of BLISS to pictures. The second aim was to conduct collaborative research involving researchers with and without aphasia and to explore their experiences. METHODS & PROCEDURES: The performance of 55 undergraduate students was investigated on two forced-choice matching tasks: (1) matching three pictures and three BLISS strings; and (2) selecting one of two BLISS strings to match to a picture. A semi-structured interview was conducted to obtain the researchers' perceptions of the research process. OUTCOMES & RESULTS: The participants' performance across tasks showed that individuals without aphasia can match BLISS strings without training. However, there was considerable individual variation and only some participants scored significantly above chance on both tasks. The interview revealed that although this study took longer to complete, there were many positive aspects of working collaboratively. All the researchers gained personally and professionally from their involvement. Of particular interest was the realization that the researcher with aphasia had a greater ability to plan, problem solve and develop ideas than was initially thought. CONCLUSIONS AND IMPLICATIONS: Individuals without aphasia are able to match symbol strings to pictures without teaching. Further research is required to establish whether people with aphasia can similarly match the adapted version of BLISS to pictures. This study provides further evidence that people with aphasia can engage productively in the research process, even when experimental methodologies are employed.

'Helping or something': perceptions of students with aphasia and tutors in further education.

BACKGROUND: Every year, 10 000 people of working age in the UK have a stroke. Although half of all cases occur in those over 75 years of age, stroke affects more than 1000 people under the age of 30 years. The effects of stroke are far reaching and many people will find that they are unable to return to their previous lives. For some, a way to improve their situation is through further or higher education. Despite the increasing opportunities for people with disabilities to participate in further education, comparatively few studies have looked at this route for people who have had strokes. This study attempts to explore these issues. AIMS: This study investigated the experiences, views and expectations of two students with aphasia involved in further education, and those of their tutors. The study aimed to identify factors that acted as enablers and barriers in accessing education. METHODS & PROCEDURES: Two women with aphasia who had enrolled on further education courses following their strokes and their respective tutors contributed to this study. Questionnaires and semi-structured interviews were used to collect the data. Qualitative research methods were then used to reveal issues important to the participants in the teaching and learning dyad. OUTCOMES & RESULTS: Analysis of the interviews revealed that a core problem identified by all parties was access to learning support. The two underlying issues that were important for the students with aphasia were tutors' awareness of needs and problems with explaining their needs. For the tutors, awareness of the students' needs was most important. The perceptions of the students and the tutors of the educational experience were not the same. CONCLUSIONS: The disparities identified in the participants' accounts suggest that both parties need to be more aware of the roles and responsibilities if individuals with disability are to have equal opportunities in further education.

Writing with voice: an investigation of the use of a voice recognition system as a writing aid for a man with aphasia.

BACKGROUND: People with aphasia may experience difficulties that prevent them from demonstrating in writing what they know and can produce orally. Voice recognition systems that allow the user to speak into a microphone and see their words appear on a computer screen have the potential to assist written communication. AIM: This study investigated whether a man with fluent aphasia could learn to use Dragon NaturallySpeaking to write. METHODS & PROCEDURES: A single case study of a man with acquired writing difficulties is reported. A detailed account is provided of the stages involved in teaching him to use the software. The therapy tasks carried out to develop his functional use of the system are then described. Outcomes included the percentage of words accurately recognized by the system over time, the quantitative and qualitative changes in written texts produced with and without the use of the speech-recognition system, and the functional benefits the man described. OUTCOMES & RESULTS: The treatment programme was successful and resulted in a marked improvement in the subject's written work. It also had effects in the functional life domain as the subject could use writing for communication purposes. CONCLUSIONS: The results suggest that the technology might benefit others with acquired writing difficulties.