Pilot Results for ECoLoGiC-Tx: A New Conversation-Level Intervention Improving Language in People With Moderate to Severe Aphasia.

PURPOSE: This study reports pilot data for a novel intervention, ECoLoGiC-Tx, delivered to four people with moderate to severe aphasia. ECoLoGiC-Tx addresses language and communication in unstructured, participant-led conversation. The speech-language pathologist (SLP) uses a framework to choose turns that facilitate a social interaction. When communication breakdown occurs, the SLP implements a least-to-most hierarchy to maximize the people with aphasia's (PWA's) independence in self-repair. ECoLoGiC-Tx draws its theoretical underpinnings from conversation analysis and theories of rehabilitation, including principles of complexity, neuroplasticity, and learning. METHOD: Four PWA attended 60-min sessions twice weekly for 10 weeks. Assessment occurred at pretreatment, posttreatment, and 6-week maintenance. Outcomes included established discourse measures for conversation and monologue, tests of language and functional communication, and patient-/family-reported outcome measures (P/FROMs). Discourse samples were collected three times per assessment. Interrater reliability and fidelity for assessment and treatment procedures are reported. RESULTS: Participants presented with Broca's aphasia (one moderate, one severe) or conduction aphasia (one moderate, one severe). Each demonstrated improvements in discourse, test batteries, and P/FROMs. They all demonstrated reduced aphasia severity measured by the Western Aphasia Battery-Revised at posttreatment or maintenance. Change in conversation and monologue was robust for three participants, but was mixed for one person (P1: moderate Broca's aphasia). P/FROMs indicated improvement at posttreatment and maintenance for all participants. Most treatment gains were maintained at 6-week follow-up. CONCLUSIONS: This study provides promising results for ECoLoGiC-Tx to improve language function of people with chronic moderate to severe aphasia. Generalization occurred to tests, functional communication, spontaneous conversation, and structured monologue tasks.

Analyzing Language in the Picnic Scene Picture and in Conversation: The Type of Discourse Sample We Choose Influences Findings in People With Aphasia.

PURPOSE: People with aphasia express that improved conversational discourse is a primary rehabilitation goal. Discourse is usually assessed using monologue, such as a picture description task, but research shows that language in monologue varies from language in everyday conversation. Consequently, we investigated the relationship of language in unstructured conversation and in the picnic scene picture because it is a part of the most often used aphasia battery (Western Aphasia Battery-Revised) and thus is frequently used to inform therapy. Second, because previous research suggests people with severe aphasia may not demonstrate language production variability between types of monologue-level discourse, we evaluated the relationship of severity and the difference in scores between conversation and the picnic scene task. METHOD: Thirty-four people with mild-to-severe aphasia described the picnic scene and provided a conversation sample. We measured language production and communicative success using seven measures with established psychometrics in conversation/monologue. We conducted correlations to answer the research questions. RESULTS: Correlations were moderate and weaker for the measures in the two conditions. A strong negative relationship was demonstrated between aphasia severity and global coherence. All other relationships were moderate and weaker for the remaining measures when correlated with aphasia severity (also negative). CONCLUSIONS: Results are consistent with other studies indicating that language varies in different types of discourse. We conclude that for accurate, meaningful assessment, discourse sampling needs to include the specific type of discourse the individual wishes to address in therapy, because discourse samples and their findings are not interchangeable.

Two-Year Longitudinal Evaluation of Community Aphasia Center Participation on Linguistic, Functional Communication, and Quality of Life Measures Across People With a Range of Aphasia Presentations.

PURPOSE: The purpose of this study was to evaluate potential changes on a hierarchy of language tasks and measures of functional communication and quality of life in a group of people with aphasia (PWA) who attended a community aphasia center for 2 years. A secondary purpose was to determine whether there were any predictors of change. METHOD: Twenty-seven PWA who attended Brooks Rehabilitation Aphasia Center (BRAC) were evaluated on an aphasia battery, confrontation naming, and structured discourse in addition to completing self-reported measures of functional communication and quality of life at three time points: before attending BRAC and after 1 (N = 27) and 2 (N = 20) years of BRAC participation. Twenty-six communication partners who communicated regularly with the PWA completed a questionnaire about their functional communication at the same time points. A mixed linear model was conducted for all dependent variables to determine change over time. Tau-b correlations were conducted between demographic and aphasia-related variables and difference scores for outcome measures that exhibited significant improvements. RESULTS: At 1-year testing, significant improvements were observed on the aphasia battery, object and action naming, and all self- and communication partner-reported measures. At 2-year testing, all improvements were maintained except for the self-reported measure of functional communication. Structured discourse showed increases in average number of words, percentage of meaningful words and utterances, and efficiency of meaningful word production after 2 years. No significant correlations were observed between predictor variables and difference scores. CONCLUSIONS: Participation in aphasia centers can result in significant changes in language, functional communication, and quality of life in people with chronic aphasia. These findings support the importance of aphasia centers in the continuum of care for PWA. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21313689.

Toward Empowering Conversational Agency in Aphasia: Understanding Mechanisms of Topic Initiation in People With and Without Aphasia.

PURPOSE: This study examined topic initiation (TI) in conversations involving people with aphasia (PWA), matched people without aphasia (M-PWoA), and speech-language pathologists who were their conversation partners (SLP-Ps). For each speaker type, we analyzed patterns of distribution of typical mechanisms of TI and patterns of simultaneous use of multiple TI mechanisms. Lastly, we examined associations between use of simultaneous TI mechanisms and communicative success. METHOD: Twenty PWA and 20 M-PWoA each participated in two conversations with SLP-Ps. Conversation samples were analyzed for TI locations and mechanisms, with results tallied for each speaker type following a published typology. A measure of communicative success was applied to TI utterances. Rank-order correlations were conducted to evaluate the patterns of distribution of the TI mechanisms between speaker types and the patterns of multiple mechanism usage between speaker types. Descriptive analysis was conducted to provide additional insight to the TI behaviors of each speaker type and to evaluate the relationship between multiple TI mechanisms and communicative success. RESULTS: All speaker types used cohesion most often to achieve TI. PWA used an abrupt method of TI (noncoherent TI) more often than other speaker types. A single mechanism of TI was used most often by all speaker types, except for SLP-Ps when they were in conversations with PWA. In this case, SLP-Ps most often used two or more layered mechanisms of TI. SLP-Ps also used a highly salient TI mechanism with greater frequency when speaking with PWA than observed between other speaker types. When PWA layered mechanisms of TI, they appeared to be more likely to achieve better communicative success. CONCLUSIONS: Specific, teachable behaviors such as favoring certain TI mechanisms and using multiple TI mechanisms may improve communicative success during TI for PWA. Furthermore, findings suggest that SLP-Ps modify their TI behaviors when speaking to PWA. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.17699423.

Assessing Language in Unstructured Conversation in People With Aphasia: Methods, Psychometric Integrity, Normative Data, and Comparison to a Structured Narrative Task.

Purpose This study evaluated interrater reliability (IRR) and test-retest stability (TRTS) of seven linguistic measures (percent correct information units, relevance, subject-verb-[object], complete utterance, grammaticality, referential cohesion, global coherence), and communicative success in unstructured conversation and in a story narrative monologue (SNM) in persons with aphasia (PWAs) and matched participants without aphasia (M-PWoAs). Furthermore, the relationship of language in unstructured conversation and SNM was investigated for these measures. Methods Twenty PWAs and 20 M-PWoAs participated in two unstructured conversations on different days with different speech-language pathologists trained as social conversation partners. An 8- to 12-min segment of each conversation was analyzed. Additionally, a wordless picture book was used to elicit an SNM sample at each visit. Correlational analyses were conducted to address the primary research questions. Normative range and minimal detectable change data were also calculated for the measures in both conditions. Results IRR and TRTS were moderate to good for parametric measures and moderate to excellent for nonparametric measures for both groups, except for TRTS for referential cohesion for the PWAs in conversation. Furthermore, in PWAs, a strong correlation was demonstrated for three of eight measures across conditions. Moderate or weaker correlations were demonstrated for three of eight measures, and correlations for two of eight measures were not significant. An ancillary finding was no significant differences occurred for sample-to-sample variability between the two conditions for any measure. Conclusions This study replicates previous research demonstrating the feasibility to reliably measure language in unstructured conversation in PWAs. Furthermore, this study provides preliminary evidence that language production varies for some measures between unstructured conversation and SNM, contributing to a literature base that demonstrates language variation between different types of monologue. Thus, these findings suggest that inclusion of the specific types of discourse of interest to the PWA may be important for comprehensive assessment of aphasia. Supplemental Material https://doi.org/10.23641/asha.16569360.

Effects of Verb Network Strengthening Treatment on Sound-Level and Speech Production Errors in Individuals With Aphasia and Acquired Apraxia of Speech.

Purpose This retrospective pilot study investigated whether sound-level and speech production errors decreased in confrontation naming following Verb Network Strengthening Treatment (VNeST) for four participants with acquired apraxia of speech (A-AOS) and aphasia for whom lexical retrieval was previously reported. Specifically, we investigated a potential increase in correct number of syllables per word and posttreatment changes across three domains of speech: segmental production, fluency, and prosody. It was hypothesized that treatment shown to increase lexical retrieval in persons with aphasia and A-AOS could potentially facilitate a reduction in sound-level and speech production errors consistent with dual diagnoses of A-AOS and aphasia. Method Naming responses from four participants with aphasia and A-AOS who previously participated in VNeST studies were investigated for correct number of syllables per word and measures of segmental speech, fluency, and prosody. Results Significant gains in at least one measure of speech production were reported for three of the participants. One participant demonstrated decreased segmental speech errors, two showed significant reduction on syllable segmentation, and two demonstrated a significant reduction on false starts and pauses. Significant gains in production of correct number of syllables were limited to one participant, and one participant did not demonstrate increased accuracy on any measure of speech production. Conclusions While speech production errors consistent with motor speech impairment cannot always be definitively distinguished from the confound of aphasia, two participants produced significantly decreased segmentation of syllables, a characteristic unique to A-AOS. The sound-level and speech production changes recorded may be attributed to a combination of interacting motor and language processes and resource allocation. In addition, specific components of VNeST may have contributed to speech production changes. Future work will focus on a prospective study of effects of language therapy (e.g., VNeST) on measures of speech production with investigation beyond the single-word level.

Measuring Global Coherence in People With Aphasia During Unstructured Conversation.

Purpose Global coherence is an essential macrolinguistic discourse skill that speakers use to formulate discourse to convey meaning with maintenance to a topic. When global coherence is poor, the listener's ability to understand how the discourse makes sense as a whole is diminished. Measures exist to evaluate global coherence in people with aphasia during monologue tasks (e.g., picture description). The aim of the current research is to develop such a measure for unstructured conversation and to explore how global coherence is impacted by aphasia during conversation. A global coherence measure for conversation is required because markedly different cognitive and linguistic demands are made for production of different types of discourse. Thus, a structured monologue measure cannot be used with validity for unstructured conversation. To adequately evaluate global coherence during conversation, a measure specific to the demands of conversation is required. Method We adapted the 4-point Global Coherence Scale (Wright & Capilouto, 2012; Wright et al., 2013), a monologue-level measure of global coherence to conversation, resulting in the 4-point Global Coherence Scale in unstructured conversation (GCSconv). We conducted statistical evaluation of the reliability/stability of the 4-point GCSconv in 18 unstructured conversations held by nine people with aphasia. Utterances with low global coherence scores were classified following a recent methodology to describe how breakdown in these utterances contributed to diminished global coherence (Hazamy & Obermeyer, 2019). Results The 4-point GCSconv demonstrated excellent inter/intrarater reliability and test-retest stability. Nonspecific language and off-topic comments contributed most frequently to lowered global coherence. Conclusions Findings suggest the 4-point GCSconv may be a feasible and reliable measure of global coherence in conversation. This measure adds to a core of emerging reliable discourse measures for conversation. As such, it has potential to inform assessment and treatment of everyday conversation and to investigate the relationship of global coherence in structured monologue and unstructured conversation. Supplemental Material https://doi.org/10.23641/asha.12469187.

Evaluating Change in the Conversation of a Person With Mild Aphasia After Attentive Reading With Constrained Summarization-Written Treatment.

Purpose The purpose of this project was to evaluate the effect of a discourse-level treatment, Attentive Reading with Constrained Summarization-Written (ARCS-W), on conversational discourse. ARCS-W aims to improve spoken and written output by addressing the cognitive-linguistic requirements of discourse production through constrained summarization of novel material. Method This is an experimentally controlled case study with a single participant, Bill. Three conversation samples were collected at pretreatment, and a single conversation was collected 1 month after treatment. The participant completed 24 ARCS-W treatment sessions, and each session included reading and then summarizing a novel current event article following specific constraints (use lexically precise words, stay on topic, use complete sentences) in speaking and writing. Conversation outcomes evaluated the success of each utterance (1-4 scale), grammaticality, and the proportion of utterances with relevant content (relevant utterances). Additionally, behavioral manifestations of word-finding difficulty were evaluated in conversation. Results Bill improved communicative success at the utterance level based on the minimal detectable change. He also demonstrated reductions in behavioral manifestations of lexical retrieval difficulty based on decreases in the percentage of false starts (e.g., t*, t*), mazes (e.g., uh, s*, um), and abandoned utterances. Bill did not increase the proportion of relevant utterances or grammatical utterances in conversation. Conclusions This case study provides preliminary evidence of the potential impact of ARCS-W treatment in conversation. Additionally, the measures implemented to evaluate conversation represent a promising adaptation of a novel methodology to capture change in conversation. Supplemental Material https://doi.org/10.23641/asha.12375053.

"By the Way" How People With Aphasia and Their Communication Partners Initiate New Topics of Conversation.

Purpose The ability to initiate new topics of conversation is a basic skill integral to communicative independence and agency that is susceptible to breakdown in aphasia (Barnes, Candlin, & Ferguson, 2013), yet this discourse skill has received little research attention. Healthy adults (HAs) follow 3 established patterns of structural organization to cue the conversation partner when an utterance is intended to initiate a new topic (Schegloff & Sacks, 1973; Svennevig, 1999). In addition, speakers have the option to use these mechanisms of topic initiation (TI) individually or in conjunction with one another. Occasionally, speakers do not follow these conversational macrostructure expectations, in which case TI occurs abruptly, referred to as a noncoherent TI (NC-TI; Mentis & Prutting, 1991). Understanding how TI is disrupted by aphasia requires foundational knowledge regarding the relative use/combined use of TI mechanisms and NC-TI in HAs and persons with aphasia (PWAs). The purpose of this study is to investigate how PWAs and their conversation partners initiate new topics of conversation and to determine the relationship between the number of TI methods used and communicative success (CS) in persons with mild aphasia (PWA-Mild) and persons with moderate and severe aphasia (PWA-Mod/Sev). Method Six PWA-Mild and 4 PWA-Mod/Sev engaged in 15-min unstructured conversations with different HA partners. Utterances were coded for types of TI used by both partners and were evaluated for CS using a 4-point scale (Leaman & Edmonds, 2019) for PWAs. Results/Implications PWAs used NC-TI with a much greater frequency than HAs who never used NC-TI. The rate of NC-TI was associated with increased severity of aphasia. HAs and PWA-Mild used cohesion most often as the method for TI, while PWA-Mod/Sev used it least often. CS was moderately positively correlated with the number of methods of TI used in PWA-Mod/Sev. However, no such correlation existed for PWA-Mild; this group achieved a high degree of CS on TI utterances, independent of the number of methods of TI used. Findings include the clinical implication suggesting PWA-Mod/Sev may benefit from simultaneous use of TI mechanisms to achieve better CS during conversation. Supplemental Material https://doi.org/10.23641/asha.9765164.

Revisiting the Correct Information Unit: Measuring Informativeness in Unstructured Conversations in People With Aphasia.

Purpose The purpose of this study was to determine whether the correct information unit (CIU) can be reliably applied to unstructured conversational discourse in people with aphasia (PWA). The CIU was developed by Nicholas and Brookshire (1993) to measure word-level informativeness in structured monologue-level discourse and is widely used by clinicians and researchers for this purpose. A case study (Oelschlaeger & Thorne, 1999) investigating the use of the CIU in conversation has suggested potential issues with interrater reliability (IRR), which has discouraged application of the CIU to this discourse context. However, no further research has been conducted to replicate or extend this finding. Given a clinical and research need for reliable linguistic measures appropriate for use in unstructured conversation, revisiting the reliability, stability, and suitability of the CIU is indicated. Method The CIU protocol developed by Nicholas and Brookshire (1993) was modified according to the needs of conversational discourse, resulting in the CIU in conversation (CIUconv) protocol. Two speech-language pathology graduate student research assistants completed training on use of the CIUconv with the 1st author. Sixteen conversations held by 8 PWA (i.e., 2 conversations each) were used as language samples to determine IRR of percent CIU (%CIU) in conversation through use of the CIUconv. Test-retest stability of %CIU as applied per this protocol was then assessed across the 2 conversations collected for each PWA. Results Use of the CIUconv resulted in excellent IRR of %CIU for each research assistant and the 1st author. Likewise, test-retest stability for the measure was excellent. Results were evaluated at both the group and individual levels. Conclusions %CIU demonstrated excellent interrater and test-retest reliability when applied to unstructured conversation using the CIUconv procedure, which was developed to account for expected linguistic characteristics of conversation. These findings suggest that %CIU may be a feasible, reliable measure of informativeness in unstructured conversation in PWA when the CIUconv is used by trained raters.

Conversation in Aphasia Across Communication Partners: Exploring Stability of Microlinguistic Measures and Communicative Success.

Purpose The aim of this study was to determine if people with aphasia demonstrate differences in microlinguistic skills and communicative success in unstructured, nontherapeutic conversations with a home communication partner (Home-P) as compared to a speech-language pathologist communication partner (SLP-P). Method Eight persons with aphasia participated in 2 unstructured, nontherapeutic 15-minute conversations, 1 each with an unfamiliar SLP-P and a Home-P. Utterance-level analysis evaluated communicative success. Two narrow measures of lexical relevance and sentence frame were used to evaluate independent clauses. Two broad lexical and morphosyntactic measures were used to evaluate elliptical and dependent clauses and to evaluate independent clauses for errors beyond lexical relevance and sentence frame (such as phonological and morphosyntactic errors). Utterances were further evaluated for presence of behaviors indicating lexical retrieval difficulty (pauses, repetitions, and false starts) and for referential cohesion. Results No statistical differences occurred for communicative success or for any of the microlinguistic measures between the SLP-P and Home-P conversation conditions. Four measures (2 of lexical retrieval and 1 each of communicative success and grammaticality) showed high correlations across the 2 conversation samples. Individuals showed variation of no more than 10 percentage points between the 2 conversation conditions for 46 of 56 data points. Variation greater than 10 percentage points tended to occur for the measure of referential cohesion and primarily for 1 participant. Conclusions Preliminary findings suggest that these microlinguistic measures and communicative success have potential for reliable comparison across Home-P and SLP-P conversations, with the possible exception of referential cohesion. However, further research is needed with a larger, more diverse sample. These findings suggest future assessment and treatment implications for clinical and research needs. Supplemental Material https://doi.org/10.23641/asha.7616312.

Attentive Reading With Constrained Summarization Adapted to Address Written Discourse in People With Mild Aphasia.

Purpose: The purpose of this study was to examine the preliminary efficacy of Attentive Reading and Constrained Summarization-Written (ARCS-W) in people with mild aphasia. ARCS-W adapts an existing treatment, ARCS (Rogalski & Edmonds, 2008), to address discourse level writing in mild aphasia. ARCS-W focuses on the cognitive and linguistic skills required for discourse production. Method: This study was a within-subject pre-postdesign. Three people with mild aphasia participated. ARCS-W integrates attentive reading or listening with constrained summarization of discourse level material in spoken and written modalities. Outcomes included macro- (main concepts) and microlinguistic (correct information units, complete utterances) discourse measures, confrontation naming, aphasia severity, and functional communication. Results: All 3 participants demonstrated some generalization to untrained spoken and written discourse at the word, sentence, and text levels. Reduced aphasia severity and/or increased functional communication and confrontation naming were also observed in some participants. Conclusions: The findings of this study provide preliminary evidence of the efficacy of ARCS-W to improve spoken and written discourse in mild aphasia. Different generalization patterns suggest different mechanisms of improvement. Further research and replication are required to better understand how ARCS-W can impact discourse abilities.

Evaluation of Language Predictors of Main Concept Production in Spanish/English Bilingual Discourse Using Nicholas and Brookshire Stimuli.

Purpose: A conceptual framework of bilingual aphasia assessment requires an understanding of the variables that influence discourse in bilingual speakers. This study aimed to determine predictors of main concept (MC) production, a measure of discourse completeness, as well as the effect of language dominance on MCs. Method: The Nicholas and Brookshire (1993) picture stimuli were used to elicit English and Spanish discourse in 83 young bilinguals. Participant-reported variables (e.g., proficiency self-ratings) and measured language variables (e.g., correct information units [CIUs] in discourse) were entered into regressions to determine potential MC predictors. A repeated-measures analysis of variance evaluated MCs within and across dominance groups categorized by speaking self-ratings. Results: Measured language variables (number of CIUs, naming accuracy) were most predictive of MCs. The participant-reported variable most associated with MC production was self-rating of speaking proficiency. Spanish- and English-dominant groups produced more MCs in their dominant language; the balanced group produced more English MCs. Between-groups differences were observed. Conclusions: Two measures related to lexical retrieval (CIUs and naming) were most predictive of MC production across languages. Participant ratings of speaking proficiency were also highly correlated to MCs. They also accurately reflected dominance, though balanced bilinguals overestimated their Spanish abilities. Supplemental Material: https://doi.org/10.23641/asha.5708605.

Effect of Verb Network Strengthening Treatment (VNeST) in persons with aphasia: extension and replication of previous findings.

PURPOSE: Verb Network Strengthening Treatment (VNeST) is an aphasia treatment that targets verbs (e.g., measure) and their related thematic roles (e.g., carpenter-lumber). Previous studies reported encouraging results in a number of participants using single-subject design with improvements observed on naming, sentence production, and discourse. The purpose of the current study was to conduct a group analysis evaluating the effect of VNeST on similar outcomes. METHOD: A multiple baseline design across participants was conducted with 11 persons with aphasia due to stroke. Wilcoxon signed-ranks tests were used to evaluate potential improvement from pre- to posttreatment and maintenance. Individual effect sizes were also calculated to evaluate magnitude of change within and across participants. RESULTS: Results showed significant improvement at posttreatment and maintenance on trained and untrained sentence probes and object and action naming. Improvement in the production of sentences not targeted in treatment was nonsignificant at posttreatment assessment but significant at maintenance. Moderate increases in percentage of complete utterances and overall informativeness were observed on discourse. CONCLUSION: The results of this study replicate previous findings and provide evidence that VNeST may promote specific and generalized lexical retrieval abilities and affect basic syntax production in both constrained and discourse production tasks.

Research applications for an Object and Action Naming Battery to assess naming skills in adult Spanish-English bilingual speakers.

Virtually no valid materials are available to evaluate confrontation naming in Spanish-English bilingual adults in the U.S. In a recent study, a large group of young Spanish-English bilingual adults were evaluated on An Object and Action Naming Battery (Edmonds & Donovan in Journal of Speech, Language, and Hearing Research 55:359-381, 2012). Rasch analyses of the responses resulted in evidence for the content and construct validity of the retained items. However, the scope of that study did not allow for extensive examination of individual item characteristics, group analyses of participants, or the provision of testing and scoring materials or raw data, thereby limiting the ability of researchers to administer the test to Spanish-English bilinguals and to score the items with confidence. In this study, we present the in-depth information described above on the basis of further analyses, including (1) online searchable spreadsheets with extensive empirical (e.g., accuracy and name agreeability) and psycholinguistic item statistics; (2) answer sheets and instructions for scoring and interpreting the responses to the Rasch items; (3) tables of alternative correct responses for English and Spanish; (4) ability strata determined for all naming conditions (English and Spanish nouns and verbs); and (5) comparisons of accuracy across proficiency groups (i.e., Spanish dominant, English dominant, and balanced). These data indicate that the Rasch items from An Object and Action Naming Battery are valid and sensitive for the evaluation of naming in young Spanish-English bilingual adults. Additional information based on participant responses for all of the items on the battery can provide researchers with valuable information to aid in stimulus development and response interpretation for experimental studies in this population.

Correlates and cross-linguistic comparisons of informativeness and efficiency on Nicholas and Brookshire discourse stimuli in Spanish/English bilingual adults.

PURPOSE: The purpose of this study was to determine (a) correlates of informativeness and efficiency in discourse and (b) potential cross-linguistic and stimulus type (picture vs. nonpicture) differences in measures of informativeness and efficiency in Spanish/English bilingual adults in the United States. METHOD: Eighty-eight Spanish/English young bilingual adults who self-reported being functional in both languages completed the discourse tasks from Nicholas and Brookshire (1993). Responses were analyzed with an adapted version of the scoring system that is based on correct information units (CIUs), the variable corresponding to informative words. RESULTS: Regression analyses showed that among participant-provided data, self-ratings of proficiency accounted for most of the variance in informativeness over time (CIUs/min), although usage was also important in Spanish. When naming accuracy was added as a variable, verb-naming accuracy superseded all variables as accounting for the most variance in CIUs/min across languages. Overall, participants provided more information more efficiently in English as compared to Spanish. CONCLUSIONS: The results provide preliminary evidence that Nicholas and Brookshire stimuli and scoring procedures may be appropriate for Spanish/English bilinguals and suggest that self-ratings and usage information collected from participants, as well as naming accuracies, may be predictive of informativeness and efficiency in discourse.

Activating situation schemas: the effects of multiple thematic roles on related verbs in a continuous priming paradigm.

Extensive evidence has shown that presentation of a word (target) following a related word (prime) results in faster reaction times compared to unrelated words. Two primes preceding a target have been used to examine the effects of multiple influences on a target. Several studies have observed greater, or additive, priming effects of multiple related primes compared to single related primes. The present study aims to eliminate attentional factors that may have contributed to findings in previous studies that used explicitly presented primes and targets. Thus, a continuous priming paradigm where targets are unknown to participants is used with noun-noun-verb triads filling agent, patient, and action roles in situation schemas (tourist, car, rent). Results replicate priming of single nouns preceding related verbs but do not suggest an additive effect for two nouns versus one. The absence of additive priming suggests that attentional processes may have been a factor in previous research.

Item-level psychometrics and predictors of performance for Spanish/English bilingual speakers on an object and action naming battery.

PURPOSE: There is a pressing need for psychometrically sound naming materials for Spanish/English bilingual adults. To address this need, in this study the authors examined the psychometric properties of An Object and Action Naming Battery (An O&A Battery; Druks & Masterson, 2000) in bilingual speakers. METHOD: Ninety-one Spanish/English bilinguals named O&A Battery items in English and Spanish. Responses underwent a Rasch analysis. Using correlation and regression analyses, the authors evaluated the effect of psycholinguistic (e.g., imageability) and participant (e.g., proficiency ratings) variables on accuracy. RESULTS: Rasch analysis determined unidimensionality across English and Spanish nouns and verbs and robust item-level psychometric properties, evidence for content validity. Few items did not fit the model, there were no ceiling or floor effects after uninformative and misfit items were removed, and items reflected a range of difficulty. Reliability coefficients were high, and the number of statistically different ability levels provided indices of sensitivity. Regression analyses revealed significant correlations between psycholinguistic variables and accuracy, providing preliminary construct validity. The participant variables that contributed most to accuracy were proficiency ratings and time of language use. CONCLUSIONS: Results suggest adequate content and construct validity of O&A items retained in the analysis for Spanish/English bilingual adults and support future efforts to evaluate naming in older bilinguals and persons with bilingual aphasia.

Effect of verb network strengthening treatment in moderate-to-severe aphasia.

PURPOSE: This Phase II treatment study examined the effect of Verb Network Strengthening Treatment (VNeST) on individuals with moderate-to-severe aphasia. Research questions addressed (a) pre- to posttreatment changes and pretreatment to treatment phase changes on probe sentences containing trained verbs (e.g., "The carpenter is measuring the stairs") and semantically related untrained verbs (e.g., "The nurse is weighing the baby"); (b) lexical retrieval changes in single-word naming, sentence, and discourse measures; (c) functional communication by way of proxy and participant report; and (d) error evolution. METHOD: A multiple-baseline approach across participants was used. Effect sizes were calculated for pre- and posttreatment and maintenance probe responses. A C statistic was used to determine changes from the baseline to treatment phases. RESULTS: One participant exhibited improvement on all generalization measures, whereas the other participant exhibited more limited generalization. Both participants showed improvement on the functional communication measure. CONCLUSIONS: As predicted, the participants did not show the same extent of improvement that was observed in participants with more moderate aphasia (Edmonds, Nadeu, & Kiran, 2009). Nonetheless, the findings suggest that VNeST may be appropriate for persons with moderate-to-severe aphasia, especially with a small adaptation to the treatment protocol that will be retained for future iterations of VNeST.

Effect of Verb Network Strengthening Treatment (VNeST) on Lexical Retrieval of Content Words in Sentences in Persons with Aphasia.

BACKGROUND: Verb Network Strengthening Treatment (VNeST) is a semantic treatment that aims to improve lexical retrieval of content words in sentence context by promoting systematic retrieval of verbs (e.g., measure) and their thematic roles (i.e., agent (doer of the action, e.g., carpenter, chef)) and patient (receiver of the action, e.g., lumber, sugar)). VNeST is influenced by Loverso and colleagues (e.g., Loverso, Selinger, and Prescott, 1979), who used "verb as core" treatment to improve sentence production with encouraging results, and McRae and colleagues, who showed that verbs prime typical agents (e.g., pray-nun) and patients (arrest-criminal) (Ferretti, McRae, & Hatherell, 2001) and vice-versa (McRae, Hare, Elman, & Ferretti, 2005). AIMS: There are four specific questions in this study. Does training a set of verbs using VNeST generalize to the ability to produce 1) an agent (carpenter), trained verb (measure), and patient (stairs) in response to novel picture stimuli and 2) an agent (nurse), untrained semantically related verb (weigh), and patient (baby) in response to novel picture stimuli? 3) Are generalization effects maintained?, and 4) Does VNeST generalize to the ability to retrieve nouns and verbs not directly related to treatment items in single word naming, picture description and connected speech tasks? METHODS #ENTITYSTARTX00026; PROCEDURES: Four participants with aphasia participated. Participants received VNeST, which involves retrieval of agent-patient pairs (e.g., chef/sugar, surveyor/land) related to trained verbs (e.g., measure), two times per week. A single subject, repeated probe, multiple baseline experimental design was used. Generalization to sentence production for sentences containing trained verbs and untrained semantically related verbs was tested weekly. OUTCOMES #ENTITYSTARTX00026; RESULTS: Results demonstrated generalization to lexical retrieval of content words in sentences with trained and untrained verbs across participants. Additionally, pre- to post-treatment generalization was observed on single verb and noun naming and lexical retrieval in sentences across a variety of tasks across participants. Generalization to connected speech was observed for 3 of 4 participants. CONCLUSIONS: Though preliminary, these results indicate that VNeST may be effective in promoting generalization from single word naming to connected speech in persons with moderate aphasia. A number of clinical implications related to treatment efficiency are discussed.