Using a digital spelling aid to improve writing in persons with post-stroke aphasia: An intervention study.

BACKGROUND: Intervention studies aimed to improve the written production of single words by persons with aphasia have yielded promising results and there is growing interest in interventions targeting text writing. The development of technical writing aids offers opportunities for persons with aphasia, and studies have shown that using them can have a positive impact on written output. AIMS: The aim was to investigate what impact training to use a computerised spell checker had on text writing in persons with aphasia. METHODS & PROCEDURES: The study had a multiple-baseline single-case experimental design replicated across six male Swedish participants with mild-to-moderate post-stroke aphasia. The participants received training twice a week during 8 weeks, learning how to use the spell checker. At baseline and before every session, the participants wrote two texts which were logged in a keystroke-logging tool. Dependent variables were continuously measured in the texts, and the participants performed tests of language function and answered questionnaires on reading and writing habits and health-related quality of life before and after the intervention. The participants were also interviewed about how they had experienced the training. The results were evaluated on individual and group level. RESULTS: The study showed that systematic individual training involving a spell checker was experienced as positive by the participants and that they all described their writing ability in more positive terms after the intervention. Evaluation showed statistically significant improvements on group level for the dependent variables of spelling accuracy, rated syntax, writing speed and proportion of unedited text during text writing when using the spell checker. The intervention also had a generalising effect on writing speed and editing during text writing without the spell checker and on spelling accuracy in a dictation test. The participants who had the greatest spelling problems were the ones who showed the most progress, but participants with only minor writing difficulties at baseline also improved. CONCLUSIONS & IMPLICATIONS: The study shows that a digital spelling aid constitutes effective support for people with aphasia and may also affect levels other than spelling. The training had a generalising positive effect on text writing and spelling in a test. Although writing difficulties is a persisting symptom in aphasia, it can be supported and improved through use of digital spelling aids. Hence, treatment of writing ability should always be included in the rehabilitation of people with aphasia. WHAT THIS PAPER ADDS: What is already known on this subject Use of a technical writing aid can have a positive impact on the written output of persons with aphasia. Using a digital spell checker may improve spelling as well as other levels of writing, but it has not been investigated using a keystroke-logging tool in combination with language-test scores and results from questionnaires. What this paper adds to existing knowledge Through analyses on both individual and group level, this study shows that a digital spelling aid constitutes effective support for people with aphasia and also affects levels other than spelling. The training had a generalising positive effect on text writing and spelling in a test. What are the potential or actual clinical implications of this work? Digital spelling support, which is a relatively simple and inexpensive technology, can support and improve text writing in persons with post-stroke aphasia.

Aphasia and spelling to dictation: Analysis of spelling errors and editing.

INTRODUCTION: Spelling difficulty is a common symptom of aphasia and can entail editing difficulties. Previous research has shown that extensive editing is related to a lower production rate in text writing for persons with aphasia, yet editing difficulty is not commonly examined. It is not known if editing difficulty is related to reading and writing skills or to aspects of the word. AIMS: To analyse spelling and editing processes as well as errors in a dictation task performed by Swedish-speaking adults with post-stroke aphasia. Furthermore, the study aimed to identify any relationships between spelling and editing difficulties and characteristics of individual words. Finally, relationships between successful edits and reading and phonological ability were investigated and specific editing strategies or behaviours identified. Correlation analyses were performed between measures of spelling and editing and word frequency and length as well as participants' scores on tests of reading, phonological spelling and phonological decoding. METHODS & PROCEDURES: A total of 16 Swedish speaking participants with post-stroke aphasia wrote a word-dictation task in a keystroke logging program and were tested for phonological spelling, phonological decoding and reading ability. Spelling errors were categorized and analysed. OUTCOMES & RESULTS: The most common error type was omission of letter(s) and there was evidence of aphasia-specific writing errors. Both spelling and editing difficulty were related to word frequency and word length. Successful editing was related to participants' scores on the phonological spelling task, but not to phonological decoding or reading ability. Specific editing strategies could be identified, and some strategies were individual, while others were more commonly used. CONCLUSIONS & IMPLICATIONS: Word length and word frequency should be taken into consideration in spelling tests for persons with aphasia, and the presence of editing difficulty should be taken into account when assessing spelling difficulties. Treatment for writing difficulties in aphasia should include training in successful editing strategies and individual fitting of digital writing aids. What this paper adds What is already known on the subject Post-stroke aphasia often causes writing and spelling difficulties. Spelling difficulties may entail editing difficulties, in turn causing extensive and/or unsuccessful editing. Extensive editing is known to impede productivity in text writing. Still, editing behaviour, abilities relating to editing or what features of a word that causes editing difficulty has not been investigated for persons with aphasia. What this paper adds to existing knowledge This study adds an in-depth analysis of spelling ability, spelling errors and editing behaviour for persons with aphasia, using keystroke logging and a single-word dictation task. Results showed that both features of the target word (frequency and word length) and the individual abilities of the person with aphasia (score on a phonological spelling task) related to spelling and editing difficulty, editing behaviour and successful editing. Specific editing strategies were analysed and described. What are the potential or actual clinical implications of this work? Word length and word frequency should be taken into consideration when testing single-word spelling for persons with aphasia. When assessing spelling difficulties, both correctness of spelling as well as the presence and nature of any editing difficulties should be taken into account and treatment for writing difficulties in should include training in successful editing strategies. The fitting of digital writing aids for persons with aphasia should be individual, since many of the editing strategies used were individual.

Writing fluency in patients with low-grade glioma before and after surgery.

BACKGROUND: Low-grade glioma (LGG) is a type of brain tumour often situated in or near areas involved in language, sensory or motor functions. Depending on localization and tumour characteristics, language or cognitive impairments due to tumour growth and/or surgical resection are obvious risks. One task that may be at risk is writing, both because it requires intact language and memory function and because it is a very complex and cognitively demanding task. The most commonly reported language deficit in LGG patients is oral lexical-retrieval difficulties, and poor lexical retrieval would be expected to affect writing fluency. AIMS: To explore whether writing fluency is affected in LGG patients before and after surgery and whether it is related to performance on tasks of oral lexical retrieval. METHODS & PROCEDURES: Twenty consecutive patients with presumed LGG wrote a narrative and performed a copy task before undergoing surgery and at 3-month follow-up using keystroke-logging software. The same tasks were performed by a reference group (N = 31). The patients were also tested using the Boston Naming Test (BNT) and word-fluency tests before and after surgery. Writing fluency was compared between the patients and the reference group, and between the patients before and after surgery. Relationships between performance on tests of oral lexical retrieval and writing fluency were investigated both before and after surgery. OUTCOME & RESULTS: Different aspects of writing fluency were affected in the LGG patients both before and after surgery. However, when controlling for the effect of typing speed, the LGG group differed significantly from the reference group only in the proportion of pauses within words. After surgery, a significant decline was seen in production rate and typing speed in the narrative task, and a significant increase was seen in pauses before words. Strong positive relationships were found between oral lexical retrieval and writing fluency both before and after surgery. CONCLUSIONS & IMPLICATIONS: Although aspects of writing fluency were affected both before and after surgery, the results indicate that typing speed is an important factor behind the pre-surgery differences. However, the decline in overall productivity and the increase in pauses before words after surgery could be related to a lexical deficit. This is supported by the finding that oral lexical-retrieval scores were strongly correlated with writing fluency. However, further exploration is needed to identify the language and cognitive abilities affecting writing processes in LGG patients.

Timed written picture naming in 14 European languages.

We describe the Multilanguage Written Picture Naming Dataset. This gives trial-level data and time and agreement norms for written naming of the 260 pictures of everyday objects that compose the colorized Snodgrass and Vanderwart picture set (Rossion & Pourtois in Perception, 33, 217-236, 2004). Adult participants gave keyboarded responses in their first language under controlled experimental conditions (N = 1,274, with subsamples responding in Bulgarian, Dutch, English, Finnish, French, German, Greek, Icelandic, Italian, Norwegian, Portuguese, Russian, Spanish, and Swedish). We measured the time to initiate a response (RT) and interkeypress intervals, and calculated measures of name and spelling agreement. There was a tendency across all languages for quicker RTs to pictures with higher familiarity, image agreement, and name frequency, and with higher name agreement. Effects of spelling agreement and effects on output rates after writing onset were present in some, but not all, languages. Written naming therefore shows name retrieval effects that are similar to those found in speech, but our findings suggest the need for cross-language comparisons as we seek to understand the orthographic retrieval and/or assembly processes that are specific to written output.

The text telephone as an empowering technology in the daily lives of deaf people-A qualitative study.

Text-telephone technology (TTY) has been used for communication between deaf people since 1964. There is a gap in the scientific knowledge about the influence this may have had especially in relation to effective participation in society as well as the feeling of capability, confidence and collective meaningfulness. The aim of the present paper is, first, to disentangle the different aspects of TTY as an empowering artifact; and, second, to explore the role of TTY in their lives. To provide a framework for the empirical analysis, the paper draws on Empowerment Theory: personal control, a proactive approach to life, and a critical awareness of one's socio-political environment. Twenty-four people aged 16-64 with Swedish Sign Language (SSL) as their first language were interviewed. The findings indicate that the introduction of the TTY was of great importance for self-esteem, equality and independence. The findings show that feelings of empowerment are closely linked to language use and contextually driven, and it is in interaction between deaf and hearing that such feelings arise (or not). The results indicate the need for further research into Deaf people's use of other means of interacting, using modern technique for example in social digital media and interactive platforms.

Reading during the composition of multi-sentence texts: an eye-movement study.

Writers composing multi-sentence texts have immediate access to a visual representation of what they have written. Little is known about the detail of writers' eye movements within this text during production. We describe two experiments in which competent adult writers' eye movements were tracked while performing short expository writing tasks. These are contrasted with conditions in which participants read and evaluated researcher-provided texts. Writers spent a mean of around 13 % of their time looking back into their text. Initiation of these look-back sequences was strongly predicted by linguistically important boundaries in their ongoing production (e.g., writers were much more likely to look back immediately prior to starting a new sentence). 36 % of look-back sequences were associated with sustained reading and the remainder with less patterned forward and backward saccades between words ("hopping"). Fixation and gaze durations and the presence of word-length effects suggested lexical processing of fixated words in both reading and hopping sequences. Word frequency effects were not present when writers read their own text. Findings demonstrate the technical possibility and potential value of examining writers' fixations within their just-written text. We suggest that these fixations do not serve solely, or even primarily, in monitoring for error, but play an important role in planning ongoing production.

Children's perception of their synthetically corrected speech production.

We explore children's perception of their own speech - in its online form, in its recorded form, and in synthetically modified forms. Children with phonological disorder (PD) and children with typical speech and language development (TD) performed tasks of evaluating accuracy of the different types of speech stimuli, either immediately after having produced the utterance or after a delay. In addition, they performed a task designed to assess their ability to detect synthetic modification. Both groups showed high performance in tasks involving evaluation of other children's speech, whereas in tasks of evaluating one's own speech, the children with PD were less accurate than their TD peers. The children with PD were less sensitive to misproductions in immediate conjunction with their production of an utterance, and more accurate after a delay. Within-category modification often passed undetected, indicating a satisfactory quality of the generated speech. Potential clinical benefits of using corrective re-synthesis are discussed.

Aphasia and text writing.

BACKGROUND: Good writing skills are needed in almost every aspect of life today, and there is a growing interest in research into acquired writing difficulties. Most of the findings reported so far, however, are based on words produced in isolation. The present study deals with the production of entire texts. AIMS: The aim was to characterize written narratives produced by a group of participants with aphasia. METHODS & PROCEDURES: Eight persons aged 28-63 years with aphasia took part in the study. They were compared with a reference group consisting of ten participants aged 21-30 years. All participants were asked to write a personal narrative titled 'I have never been so afraid' and to perform a picture-based story-generation task called the 'Frog Story'. The texts were written on a computer. OUTCOME & RESULTS: The group could be divided into participants with low, moderate, and high general performance, respectively. The texts written by the participants in the group with moderate and high writing performance had comparatively good narrative structure despite indications of difficulties on other linguistic levels. CONCLUSIONS & IMPLICATIONS: Aphasia appeared to influence text writing on different linguistic levels. The impact on overall structure and coherence was in line with earlier findings from the analysis of spoken and written discourse and the implication of this is that the written modality should also be included in language rehabilitation.

A comparison between written and spoken narratives in aphasia.

The aim of the present study was to explore how a personal narrative told by a group of eight persons with aphasia differed between written and spoken language, and to compare this with findings from 10 participants in a reference group. The stories were analysed through holistic assessments made by 60 participants without experience of aphasia and through measurement of lexical and syntactic variables. The findings showed that the participants with aphasia generally received lower ratings than the reference group, but also that stories written by participants with aphasia were rated as easier to understand, more interesting, and more coherent than the group's spoken stories. Regression analysis showed that syntax could predict several of the rated variables for the stories told by the participants with aphasia. Results point to the need to include writing training in language rehabilitation in order to increase the ability for persons with aphasia to participate in communicative situations in everyday life.

Combined eyetracking and keystroke-logging methods for studying cognitive processes in text production.

Writers typically spend a certain proportion of time looking back over the text that they have written. This is likely to serve a number of different functions, which are currently poorly understood. In this article, we present two systems, ScriptLog+ TimeLine and EyeWrite, that adopt different and complementary approaches to exploring this activity by collecting and analyzing combined eye movement and keystroke data from writers composing extended texts. ScriptLog+ TimeLine is a system that is based on an existing keystroke-logging program and uses heuristic, pattern-matching methods to identify reading episodes within eye movement data. EyeWrite is an integrated editor and analysis system that permits identification of the words that the writer fixates and their location within the developing text. We demonstrate how the methods instantiated within these systems can be used to make sense of the large amount of data generated by eyetracking and keystroke logging in order to inform understanding of the cognitive processes that underlie written text production.

Process and product in writing--a methodological contribution to the assessment of written narratives in 8-12-year-old Swedish children using ScriptLog.

Twenty-seven children, with typical language development (TLD), 8-10 years old and 10-12 years old, were assessed with keystroke-logging in order to investigate their narrative writing. Measures of the writing process and the written product were used. One purpose was to explore how children produce written narratives in on-line production, and to relate the writing process to the written product. The results showed that those children who produced the final text faster, also wrote stories that comprised of more words. In the group of older children, children with better narrative ability used less pause time than those with worse ability, and the girls were faster writers than the boys. We believe that keystroke-logging gives valuable information for the assessment of young children's writing and that it is a potentially valid assessment tool for children from about 10 years of age.

Aphasia and the process of revision in writing a text.

Most of the previous research on aphasia and writing ability concentrates on the production of words in isolation. The purpose of the current study was to examine the process of producing written texts by clients with aphasia. By using keystroke logging, it was possible to analyse the participants' ongoing work during text writing. Results showed that the participants with aphasia composed their texts in what may be described as a linear way. Edits concerning syntax or text structure were almost absent in the subjects' data, but they spent much time and effort on revising smaller units of text, that is, letters and words, possibly as a result of changing their minds or not being able to realize their intentions. However, these changes did not always result in correctly written words in the final text. The findings are discussed in relation to current writing theories.