[Is oral care for dysphagic patients wasted time? A narrative review on the effects of oral care on pneumonia risk and guidelines for an effective and structured approach]. / Ist die therapeutische Mundpflege bei Dysphagiepatient*innen verschwendete Zeit? Ein narrativer Review zu Effekten der Mundpflege auf die Pneumoniehäufigkeit und Ableitung einer Handlungsempfehlung.

Aspiration pneumonia is a common cause of death in dysphagia patients. In this review, we investigate whether a structured oral care approach can help to reduce pneumonia risk in dysphagic patients. In addition, guidelines for the implementation of oral care on the basis of the analyzed studies are presented. Oral care has positive effects on the risk of pneumonia in dysphagia patients. Oral care should be based on the principles of simplicity, safety, efficiency and effectiveness, universality and economy and it should include all parts of the oral cavity. Effective oral care takes less than five minutes a day. The tactile stimulation prepares the patient for dysphagia therapy and can be considered wisely-invested time.

A systematic review on production and comprehension of linguistic prosody in people with acquired language and communication disorders resulting from unilateral brain lesions.

BACKGROUND: Prosody serves central functions in language processing including linguistic functions (linguistic prosody), like structuring the speech signal. Impairments in production and comprehension of linguistic prosody have been described for persons with unilateral right (RHDP) or left hemisphere damage (LHDP). However, reported results differ with respect to the characteristics and severities of these impairments AIMS: We conducted a systematic literature review focusing on production and comprehension of linguistic prosody at the prosody-syntax interface (i.e., phrase or sentence level) in LHDP and RHDP. METHODS & PROCEDURES: In a systematic literature search we included: (i) empirical studies with (ii) adult RHDP and/or LHDP (iii) investigating production and/or comprehension of linguistic prosody at the (iv) phrase or sentence level (v) reporting quantitative data on prosodic measures. We excluded overview papers; studies involving participants with dysarthria, apraxia of speech, foreign accent syndrome, psychiatric diseases, and/or neurodegenerative diseases; studies focusing primarily on emotional prosody; and on lexical stress / word level; studies of which no full text was available and/or that were published in a language other than English. We searched the databases BIOSIS, MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Cochrane Library, PSYNDEX, PsycINFO and speechBITE, last searched on January 13th 2022.We found 2,631 studies without duplicates. We identified 43 studies which were included into our systematic review. For data extraction and synthesis of results, we grouped studies by (i) modality (production vs. comprehension), (ii) function (syntactic structure vs. information structure), and (iii) by experiment task. For production studies, outcome measures were defined as the productive use of the different prosodic cues (lengthening, pause, f0, amplitude). For comprehension studies, performance measures (accuracy and reaction times) were defined as outcome measures. In accordance with the PRISMA 2020 statement (Page et al., 2021), we conducted a quality check to assess study risk of bias. Our review was pre-registered with PROSPERO (CRD42019120308). OUTCOMES & RESULTS: Of the 43 studies reviewed, 30 studies involved RHDP (n = 309), assessing production in 15 studies and focusing on comprehension of prosody in 16 studies (one study investigated production and comprehension). LHDP (n = 438) were included in 35 studies of which 15 studied production and 21 evaluated comprehension of prosody (one study investigated production and comprehension). Despite the heterogeneity of results in the studies reviewed, our synthesis of results suggests that both LHDP and RHDP show limitations, but no complete impairment, in their production and/or comprehension of linguistic prosody. Prosodic limitations are evident in different areas of processing linguistic prosody, like syntactic disambiguation or the distinction between sentence types. There is a tendency towards more severe limitations in LHDP as compared to RHDP. CONCLUSIONS: We only included published studies into our review and did not perform an assessment of risk of reporting bias as well as systematic certainty assessments of the outcomes. Despite these limitations, we conclude that both groups show deficits in production and comprehension of linguistic prosody, but neither LHDP nor RHDP are completely impaired in their prosodic processing. This suggests that prosody is a relevant communicative resource for LHDP and RHDP worth being addressed in speech-language-therapy.

Individual Differences in Early Disambiguation of Prosodic Grouping.

Prosodic cues help to disambiguate incoming information in spoken language perception. In structurally ambiguous coordinate utterances, such as three-name sequences, the intended grouping is marked by three prosodic cues: F0-range, final lengthening, and pause. To indicate that the first two names are grouped together, speakers typically weaken the durational and tonal cues on the first name whereas they are strengthened on the second name, compared with a structure without internal grouping. The current study uses a gating paradigm to test whether listeners can decide about the internal grouping of a coordinate structure by already exploiting prosodic information on the first name. One hundred ninety-two stimuli were cut into seven parts (gates) and presented to naive participants (n = 45) successively (gate by gate) with increasing length of the utterance and amount of prosodic information. In a two-alternative forced-choice decision task, accuracy was above chance level after the second name. However, more than half of the participants could already reliably detect grouping patterns after the first name. These interindividual differences point toward the existence of different subgroups with diverging prosodic parsing strategies. Furthermore, listeners were sensitive to speaker-specific prosodic patterns. Depending on speaker-specific characteristics and individual parsing capacities, it seems possible-at least for a subgroup of listeners-to make predictions about the underlying grouping structure of coordinated name sequences based on early prosodic cues.

Measuring communication as a core outcome in aphasia trials: Results of the ROMA-2 international core outcome set development meeting.

BACKGROUND: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AIM: To establish consensus on a communication OMI for inclusion in the ROMA COS. METHODS & PROCEDURES: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. OUTCOMES & RESULTS: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living-3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. CONCLUSIONS & IMPLICATIONS: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS: What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.

Production and Comprehension of Prosodic Boundary Marking in Persons With Unilateral Brain Lesions.

PURPOSE: Persons with unilateral brain damage in the right hemisphere (RH) or left hemisphere (LH) show limitations in processing linguistic prosody, with yet inconclusive results on their ability to process prosodically marked structural boundaries for syntactic ambiguity resolution. We aimed at systematically investigating production and comprehension of three prosodic cues (f 0 range, final lengthening, and pause) at structural boundaries in coordinate sequences in participants with right hemisphere brain damage (RHDP) and participants with left hemisphere brain damage (LHDP). METHOD: Twenty RHDP and 15 LHDP participated in our study. Comprehension experiment: Participants and a control group listened to coordinate name sequences with internal grouping by a prosodically marked structural boundary (grouped condition, e.g., "(Gabi und Leni) # und Nina") or without internal grouping (ungrouped condition, e.g., "Gabi und Leni und Nina") and had to identify the target condition. The strength and combinations of prosodic cues in the stimuli were manipulated. Production experiment: Participants were asked to produce coordinate sequences in the two conditions (grouped, ungrouped) in two different tasks: a Reading Aloud and a Repetition experiment. Accuracy of participants' productions was subsequently assessed in a rating study and productions were analyzed with respect to use of prosodic cues. RESULTS: In the Comprehension experiment, RHDP and LHDP had overall lower identification accuracies than unimpaired control participants and LHDP were found to have particular problems with boundary identification when the pause cue was reduced. In production, LHDP and RHDP employed all three prosodic cues for boundary marking, but struggled to clearly mark prosodic boundaries in 28% of all productions. Both groups showed better performance in reading aloud than in repetition. LHDP relied more on using f 0 range and pause duration to prosodically mark structural boundaries, whereas RHDP employed final lengthening more vigorously than LHDP in reading aloud. CONCLUSIONS: We conclude that processing of linguistic prosody is affected in RHDP and LHDP, but not completely impaired. Therefore, prosody can serve as a relevant communicative resource. However, it should also be considered as a target area for assessment and treatment in both groups. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21637505.

Evaluating Models of Gesture and Speech Production for People With Aphasia.

People with aphasia use gestures not only to communicate relevant content but also to compensate for their verbal limitations. The Sketch Model (De Ruiter, 2000) assumes a flexible relationship between gesture and speech with the possibility of a compensatory use of the two modalities. In the successor of the Sketch Model, the AR-Sketch Model (De Ruiter, 2017), the relationship between iconic gestures and speech is no longer assumed to be flexible and compensatory, but instead iconic gestures are assumed to express information that is redundant to speech. In this study, we evaluated the contradictory predictions of the Sketch Model and the AR-Sketch Model using data collected from people with aphasia as well as a group of people without language impairment. We only found compensatory use of gesture in the people with aphasia, whereas the people without language impairments made very little compensatory use of gestures. Hence, the people with aphasia gestured according to the prediction of the Sketch Model, whereas the people without language impairment did not. We conclude that aphasia fundamentally changes the relationship of gesture and speech.

The Production of Gesture and Speech by People With Aphasia: Influence of Communicative Constraints.

Purpose People with aphasia (PWA) use different kinds of gesture spontaneously when they communicate. Although there is evidence that the nature of the communicative task influences the linguistic performance of PWA, so far little is known about the influence of the communicative task on the production of gestures by PWA. We aimed to investigate the influence of varying communicative constraints on the production of gesture and spoken expression by PWA in comparison to persons without language impairment. Method Twenty-six PWA with varying aphasia severities and 26 control participants (CP) without language impairment participated in the study. Spoken expression and gesture production were investigated in 2 different tasks: (a) spontaneous conversation about topics of daily living and (b) a cartoon narration task, that is, retellings of short cartoon clips. The frequencies of words and gestures as well as of different gesture types produced by the participants were analyzed and tested for potential effects of group and task. Results Main results for task effects revealed that PWA and CP used more iconic gestures and pantomimes in the cartoon narration task than in spontaneous conversation. Metaphoric gestures, deictic gestures, number gestures, and emblems were more frequently used in spontaneous conversation than in cartoon narrations by both participant groups. Group effects show that, in both tasks, PWA's gesture-to-word ratios were higher than those for the CP. Furthermore, PWA produced more interactive gestures than the CP in both tasks, as well as more number gestures and pantomimes in spontaneous conversation. Conclusions The current results suggest that PWA use gestures to compensate for their verbal limitations under varying communicative constraints. The properties of the communicative task influence the use of different gesture types in people with and without aphasia. Thus, the influence of communicative constraints needs to be considered when assessing PWA's multimodal communicative abilities.

How Much Information Do People With Aphasia Convey via Gesture?

PURPOSE: People with aphasia (PWA) face significant challenges in verbally expressing their communicative intentions. Different types of gestures are produced spontaneously by PWA, and a potentially compensatory function of these gestures has been discussed. The current study aimed to investigate how much information PWA communicate through 3 types of gesture and the communicative effectiveness of such gestures. METHOD: Listeners without language impairment rated the information content of short video clips taken from PWA in conversation. Listeners were asked to rate communication within a speech-only condition and a gesture + speech condition. RESULTS: The results revealed that the participants' interpretations of the communicative intentions expressed in the clips of PWA were significantly more accurate in the gesture + speech condition for all tested gesture types. CONCLUSION: It was concluded that all 3 gesture types under investigation contributed to the expression of semantic meaning communicated by PWA. Gestures are an important communicative means for PWA and should be regarded as such by their interlocutors. Gestures have been shown to enhance listeners' interpretation of PWA's overall communication.