Developing consensus-based clinical competencies to guide stroke clinicians in the implementation of psychological care in aphasia rehabilitation.

Background People with aphasia experience depression and anxiety associated with negative outcomes across a range of time post-stroke. Stroke clinicians are well-positioned to facilitate low-intensity psychotherapeutic interventions after aphasia (e.g. mood screening, behavioural activation, problem-solving therapy, relaxation therapy); however, they self-report a lack of knowledge, skills and confidence to do so. The Theoretical Domains Framework (TDF) provides a lens through which to view and target clinician behaviours and training needs in this area of practice. The aim of this study was to develop and gain consensus on items for a rating scale of clinical competencies in facilitating individual-based, low-intensity psychotherapeutic interventions for people with aphasia. Methods An e-Delphi methodology using focus groups and survey rounds was used to gain consensus on clinical competencies considered important. Results Eight stroke clinicians (speech pathologists and psychologists), two people with aphasia and three family members participated in one of four focus groups. Four themes were derived from the data: (1) Communication support, (2) Assessment and therapy structure, (3) Interpersonal skills, and (4) Needs of the significant other (family or friend). Themes informed an initial list of 23 self-rated and observer-rated competency items. Following two rounds of e-Delphi surveys, 11 stroke clinicians (six speech pathologists and five psychologists) reached consensus (80-100%) for 19 competencies. Conclusions The Psychological Care in Aphasia Rehabilitation Competency scale offers a preliminary list of items to guide and train clinicians to implement low-intensity psychotherapeutic interventions for people with aphasia.

Meta-analysis and systematic review of the relationship between sex and the risk or incidence of poststroke aphasia and its types.

OBJECTIVE: To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice. DATA SOURCES: Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023. STUDY SELECTION: Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex. DATA EXTRACTION: Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded. DATA SYNTHESIS: 36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05). CONCLUSIONS: There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.

The non-paretic-hand-to-opposite-ear test: A simple test to detect aphasia and neglect and an indicator of large anterior vessel occlusion in patients with suspected acute stroke.

INTRODUCTION: Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke. METHODS: In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated. RESULTS: The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO. CONCLUSION: The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed.

[Features of aphasic disorders in patients with acute cerebrovascular disorder in the posterior cerebral artery basin]. / Osobennosti afaticheskikh rasstroistv u patsientov s ostrym narusheniem mozgovogo krovoobrashcheniya v basseine zadnei mozgovoi arterii.

Aphasia is a systemic disorder of formed speech that develops as a result of local brain lesions. Most aphasias are characterized by damage to secondary cortical fields, which in turn are responsible for the performance of the functions of gnosis and praxis, which explains the variability in the manifestations of speech disorders in patients with acute cerebrovascular accidents. However, it is necessary in each case to diagnose the central pathological mechanism, which underlies the development of the entire syndrome and determines the entire clinical picture. The most important task of a speech therapist-aphasiologist is to qualify the defect, namely to isolate the mechanism and analyze the syndrome in order to select individual methods of corrective restoration. This article presents a case of a patient with an ischemic stroke in the left posterior cerebral artery with the development of amnestic aphasia in combination with alexia without agraphia.

Turkish validity and reliability study on the quick aphasia battery.

INTRODUCTION: The quick aphasia battery (QAB), which assesses all areas of language in detail and quickly, was developed in English. It has been shown to be suitable for bedside patients. There is a need for a Turkish bedside test that allows for a comprehensive yet rapid assessment of stroke patients in terms of aphasia. The aim of this study was to create a Turkish version of QAB (QAB-TR) and to determine its validity and reliability in Turkish-speaking patients after a stroke. MATERIALS AND METHODS: The study was conducted with 188 people aged 41-88 years. Of these, 37 (19.7%) had aphasia (12 chronic, 25 acute), 53 (28.2%) were acute stroke patients without aphasia, and 98 (52.1%) were healthy controls. Internal consistency and criterion validity, test-retest reliability, and inter-rater reliability of the QAB-TR were performed. The language assessment test for aphasia was used for criterion validity. For the inter-rater reliability of the test, two different speech language therapists (SLP) administered the QAB-TR. For test-retest reliability, 2 weeks later, the same SLP who filled out the QAB-TR the first time was administered the test again. To test the validity of the test, correlations between the items and subsections were determined. Receiver operating characteristic (ROC) analysis was performed to examine the sensitivity and selectivity of the QAB-TR score, and a cut-off value was determined to distinguish patients with aphasia. RESULTS: The inter-rater Krippendorff's alpha value of the QAB-TR total was 0.6754. There was no statistically significant difference (p > .05) between the first and second QAB-TR total scores. The correlation analysis between the QAB-TR subsection scores and the total QAB-TR score (0.244-0.897) revealed statistically significant relationships. The area under the ROC curve was statistically significant and was found to be 0.853 (95% confidence interval: 0.799-0.906). The cut-off point for the QAB score to discriminate between patients with aphasia and those without aphasia was found to be 8.825, with 0.767 sensitivity and 0.765 selectivity (1-0.235). CONCLUSION: All the study results show that QAB-TR has internal consistency, criterion validity, test-retest reliability, and inter-rater reliability. It can be administered in as little as 15 min and provides information about the multidimensional linguistic profiles of individuals. QAB-TR can be used for both clinical and study purposes as a language battery that allows for the measurement of the strengths and weaknesses of Turkish-speaking individuals who have suffered a stroke in basic language areas in acute and chronic periods. It can be easily administered at the bedside for individuals who have just suffered an acute stroke and can facilitate early assessment of individuals in terms of aphasia and early initiation of therapy, if necessary.

Discourse Task Type-Specific Linguistic Characteristics in Anomic Aphasia and Healthy Controls: Evidence From Mandarin-Chinese AphasiaBank.

PURPOSE: This study was designed to examine the hypothesis that discourse task types influence language performance in Mandarin Chinese-speaking people and to reveal the discourse task-specific linguistic properties of persons with anomic aphasia compared to neurotypical controls. METHOD: Language samples from persons with aphasia (n = 31) and age- and education-matched controls (n = 31) across four discourse tasks (sequential-picture description, single-picture description, story narrative, and procedural discourse) were collected from Mandarin AphasiaBank. Task-specific distributions of parts of speech were analyzed using mosaic plots. The main effects of tasks in each group and the between-group differences within each task for several typical linguistic variables were evaluated, including the mean length of utterance, tokens, moving-average type-token ratio, words per minute, propositional density, noun-verb ratio, noun percentage, and verb percentage. RESULTS: The results revealed an impact of discourse tasks on most language variables in both groups. In the healthy controls, story narratives yielded the highest total words and lowest verb percentage. In the aphasia group, procedural discourse elicited the fewest total words and densest expressions, whereas their single-picture descriptions had the highest noun-verb ratio. For all tasks, the aphasia group performed worse than the control group in the mean length of utterance, tokens, moving-average type-token ratio, and words per minute. For noun-verb ratio, noun percentage, and verb percentage, only one task (i.e., single-picture description) showed significant between-group differences. CONCLUSION: The selection of discourse tasks should be addressed in assessments and interventions for Mandarin Chinese-speaking individuals with aphasia to obtain more accurate and feasible outcomes.

[Transcranial direct current stimulation to enhance training effectiveness in chronic poststroke aphasia-A challenge for recruiting participants]. / Transkranielle Gleichstromstimulation zur Verbesserung der Trainingseffektivität bei chronischer Aphasie nach Schlaganfall ­ wie gelingt die Studienrekrutierung Betroffener?

INTRODUCTION/BACKGROUND: DC_TRAIN_APHASIA is an ongoing multicenter, randomized controlled trial, conducted since November 2019 under the lead of the University Medicine Greifswald (ClinicalTrials.gov Identifier: NCT03930121). The study seeks to determine whether adjuvant transcranial direct current stimulation (tDCS) can increase the effectiveness of a 3­week treatment with intensive speech-language therapy in chronic post-stroke aphasia. MATERIAL AND METHOD: Until the end of 2024, a total of 130 patients are to be included in Germany. Recruitment has been a challenge throughout the study and substantial efforts went into devising innovative recruiting approaches. Standard recruitment strategies were used, such as directly approaching people with aphasia in clinical settings, inpatient and outpatient language rehabilitation facilities, and patient support and advocacy groups, alongside more innovative techniques including radio commercials, dissemination of study information via national television and social media platforms. PROVISIONAL RESULTS: Up until now, 110 patients have been included into the study. The largest short-term response was achieved via television and radio. The largest long-term response was obtained through recruitment via logopaedic and neurological facilities, patient support groups, and social media. Participants served as "testimonials", expressing that they were satisfied with the therapy and the tDCS application. DISCUSSION: The multicenter study DC_TRAIN_APHASIA aims to provide evidence on tDCS as an adjuvant application to increase the effect size of intensive speech-language therapy in chronic post-stroke aphasia. The present review may guide future studies in recruiting samples that involve people with impaired communicative abilities.

Generalization in Aphasia Treatment: A Tutorial for Speech-Language Pathologists.

PURPOSE: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24714399.

Reading for Meaning: The Influence of Reader Characteristics on Paragraph Understanding in Aphasia.

PURPOSE: The study improves our understanding of the reading comprehension difficulties seen in people with aphasia. It investigates the influence of reader characteristics, including personal demographic variables, and linguistic and wider cognitive skills, on text comprehension. METHOD: Seventy-five people with aphasia and 87 neurologically typical readers completed a test of paragraph comprehension. People with aphasia also completed background tests of language, attention, recognition memory, and executive functions. The influence of demographic variables (age, gender, and level of education) was analyzed separately in the group of people with aphasia and the typical readers using analyses of variance. In the people with aphasia, the relationship between paragraph comprehension and the language and cognitive tests was explored using correlational analyses. RESULTS: In the typical readers, there was a significant effect of gender and level of education and a significant three-way interaction. For the people with aphasia, there were no significant effects of demographic variables. Significant positive correlations were found between performance on paragraph comprehension and each of the language tests and with tests of auditory attention, executive functions, and recognition memory for words. CONCLUSIONS: In people with aphasia, the effects of demographic variables were overshadowed by the effect of their language difficulties. The association seen across language measures reflects the shared semantic representations across single-word, sentence, and text levels, across modalities. The study emphasizes the importance of attention, executive functions, and short-term memory in the comprehension of and memory for what we read. The contribution of both language difficulties and wider cognitive skills needs to be considered when planning intervention. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24695451.

"I Could Not Talk . . . She Did Everything . . . She's Now My Sister": People With Aphasia's Perspectives on Friends Who Stuck Around.

PURPOSE: Aphasia may decrease the capacity to develop and maintain friendships. The aim of this study was to better understand the perspectives of people with aphasia on why some friendship bonds remain strong and some do not. Furthermore, we wanted to explore how age and aphasia severity shape views on friendship. METHOD: We interviewed 27 people with aphasia about their experiences of friendship before and after the onset of aphasia. We then used framework analysis and reflexive thematic analysis to interpret the interview data. RESULTS: From the interviews, we created four major themes concerning how friend relationships had been impacted by aphasia: (a) Not all bonds have the same chance of surviving the onset of aphasia; (b) people with aphasia's closest friends took active steps to keep relationships strong; (c) if friends knew some basic information about aphasia, bonds would stay stronger; (d) positive affective aspects of friendship play an important role in keeping bonds strong. We also noted differences in friendship experiences that appeared to be influenced by age and aphasia severity of participants. CONCLUSIONS: Interview data provided actionable ideas including focusing on friends who are likely to be responsive to help with maintaining the friendship, providing them with strategies to keep the friendship active and communication meaningful, and acknowledging the positive impact that this will have on the friend recovering from aphasia. More research is needed to develop programs that empower people with aphasia to maintain their friendships. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24688671.

The Communication Success Screener: A Preliminary Investigation of Perceived Communicative Success Across Modalities, Environments, and Demands.

PURPOSE: Behavioral intervention targeting speech, language, and communication concerns is an established therapeutic approach for patients with communication concerns across a range of acquired neurogenic disorders. The multidimensional factors that contribute to a person's self-identified communication challenges and strengths in their daily communication needs must be considered to provide functional and person-centered care. While assessments grounded in clinician observation or client self-report exist, there is a direct need for a screening tool that comprehensively evaluates the roles of modality (verbal, text, gesture) and environment (in-person, virtual) on self-reported success across communicative demands. In this study, we describe a preliminary approach to monitoring the progression of receptive and expressive communication skills in people with chronic poststroke aphasia in the context of communication practices of the 21st century, culminating in the development and exploratory implementation of a novel clinical instrument: the Communication Success Screener (COMSS). METHOD: Thirty-three participants with aphasia due to stroke were recruited to complete and evaluate the COMSS via an online survey. Quantitative responses and open-ended participant feedback were collected to validate and propose adaptations to the COMSS. Group-level analyses and case presentations were used to highlight COMSS features and outcomes. RESULTS: Participant responses to the COMSS questionnaire suggest that this screening tool creates differentiated communicative success profiles based on self-report. Participant feedback also indicated that the COMSS appropriately evaluates self-reported success across modalities of verbal, text, and gesture in the context of in-person and virtual environments. CONCLUSIONS: The communication concerns experienced by people with aphasia are often heterogeneous and vary as a function of their daily activities of living, preferred language modalities, and environmental supports. We present preliminary feasibility analyses of the COMSS as a potential tool to support the monitoring of functional change by evaluating self-reported communicative success across form, modality, environment, and task demand. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24521044.

Variations in Eye-Gaze Behaviors Evident When Five Adults With Aphasia-Based Alexia Read Multisentence Passages.

PURPOSE: The problems that people with aphasia encounter when reading passages are poorly understood. This study's purpose was in-depth examination of eye-gaze behaviors exhibited by five people with aphasia-based alexia. METHOD: Five adults with aphasia-based alexia and five neurotypical adults (NAs) read paragraphs while having their eye movements recorded. Acquired data included descriptive characterization of overall eye-gaze behaviors and determination of the (a) percent of fixated words, (b) average fixation duration, (c) average initial and total summed fixation durations of processing attempts on individual words, and (d) effects of word length and frequency on fixation durations. Careful examination of these data allowed examination of consistencies and discrepancies among people with aphasia and supported speculation about underlying deficits. RESULTS: Case participants exhibited unique fixation behaviors in comparison to one another and to neurotypical adults. Case participants' total reading time, percent of fixated words, average fixation duration, and average initial and total summed fixation durations on passage words exceeded those of neurotypical adults. Four of five exhibited positive word length and negative word frequency correlations with fixation durations. CONCLUSIONS: People with aphasia display eye-gaze behaviors unique to them and differing from those of NAs when reading texts. Better understanding of the connection between specific eye-gaze behaviors and problems decoding words, linking them with lexical-semantic information, and constructing meaning from written content is necessary to further progress in developing effective assessment tools and treatments.

AI-Generated Images for Speech Pathology-An Exploratory Application to Aphasia Assessment and Intervention Materials.

PURPOSE: Images are a core component of aphasia assessment and intervention that require significant resources to produce or source. Text-to-image generation is an Artificial Intelligence (AI) technology that has recently made significant advances and could be a source of low-cost, highly customizable images. The aim of this study was to explore the potential of AI image generation for use in aphasia by examining its efficiency and cost during generation of typical images. METHOD: Two hundred targets (80 nouns, 80 verbs, and 40 sentences) were selected at random from existing aphasia assessments and treatment software. A widely known image generator, DALL-E 2, was given text prompts for each target. The success rate, number of prompts required, and costs were summarized across target categories (noun/verb/sentence) and compared to frequency and imageability. RESULTS: Of 200 targets, 189 (94.5%) successfully conveyed the key concept. The process took a mean of 2.3 min per target at a cost of $0.31 in U.S. dollars each. However, there were aesthetic flaws in many successful images that could impact their utility. Noun images were generated with the highest efficiency and accuracy, followed by verbs, while sentences were more challenging, particularly those with unusual scenes. Patterns of flaws and errors in image generation are discussed. CONCLUSION: The ability to rapidly generate low-cost, high-quality images using AI is likely to be a major contribution to aphasia assessment and treatment going forward, particularly as advances in this technology continue.

Aphasia associated with non-traumatic subarachnoid haemorrhage: a systematic review.

PURPOSE: Individuals with non-traumatic subarachnoid haemorrhage (SAH) are often excluded from studies of stroke populations due to differing pathophysiology and treatment pathways. Thus, aphasia presentation in the non-traumatic SAH population is potentially under-represented within existing research evidence. MATERIALS AND METHODS: Five databases were systematically searched with terms related to "aphasia" and "subarachnoid haemorrhage." Studies were included if aphasia was attributed to non-traumatic SAH or its associated complications, and where at least one language assessment measure used determined the presence or absence of aphasia. Study quality was evaluated using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Following deduplication, 2726 articles were identified for title and abstract screening. Full text screening for 162 articles occurred, with 18 articles selected for inclusion. Aphasia incidence ranged from 5 to 24%, and was influenced by assessment measure, timing of assessment, subgroup studied, and classifications of aphasia. Many studies excluded participants with poorer clinical outcome, intracerebral complications, or severe aphasia. Few studies used comprehensive language assessment measures to examine across language domains. CONCLUSIONS: Aphasia presentation is highly heterogenous following non-traumatic SAH. Future research using comprehensive language assessments at multiple time points post onset is required to better understand aphasia presentation and management needs for this population.

Aphasia screening and/or assessment should be routinely performed for all individuals following non-traumatic subarachnoid haemorrhage (SAH).Comprehensive assessment across all language domains is required to ascertain the nature and extent of aphasia.Co-occurring cognitive deficits are likely in the SAH population.

Online Aphasia Groups: Navigating Issues of Voice and Identity.

PURPOSE: Participation in aphasia groups is associated with increased communication, reduced feelings of social isolation, and increased quality of life. Despite the growing popularity of online aphasia groups, little is known about how to manage conversation in this format. We examined online aphasia book club sessions to examine how the facilitator supported group members' participation in conversation. METHOD: Interactional sociolinguistic discourse analysis was used to analyze the behaviors and actions of the facilitator and group members. Qualitative data for this study were drawn from four recorded online aphasia book club sessions held through a university's free aphasia clinic on the Zoom web-conferencing platform. RESULTS: Sociolinguistic discourse analysis revealed strategic facilitator behaviors that served to (a) give members with varying levels of verbal language abilities voice, (b) foreground or background aspects of voice, and (c) minimize her own voice to promote interactional symmetry between herself and group members. CONCLUSIONS: Identity formed the backdrop for facilitators' actions when leading online groups, guiding decisions about who got to talk, when, for how long, through what modality, and about what topics. A better understanding of the interactions that occur online, such as how to develop and protect the identities of group members, could equip facilitators with the tools necessary for facilitating positive, engaging aphasia therapy groups online.

Nonlinguistic Cognitive Functions of Mandarin Speakers With Poststroke Aphasia.

PURPOSE: The purpose of this study was to examine the cognitive functions of Mandarin speakers with poststroke aphasia and to investigate the relationship between nonlinguistic cognitive deficits and the severity of aphasia. METHOD: Twenty-three adults with aphasia resulting from left-hemispheric stroke and 23 adults matched for age and educational level completed a series of six nonlinguistic cognitive tests measuring nonverbal intelligence, short-term memory, visual selective attention, visual alternating attention, auditory selective attention, and auditory alternating attention. A standardized aphasia assessment (Concise Chinese Aphasia Test [CCAT]) was also conducted to evaluate the severity of aphasia. Data analyses examined cognitive functions by comparing task performance of the two groups and examining the relationship between scores on the cognitive tasks and aphasia severity based on a hierarchical regression analysis. RESULTS: The aphasia group scored significantly lower than the control group on all nonlinguistic cognitive tasks with large effect sizes (d = 0.95 ~ 1.54). Significant associations between different nonlinguistic cognitive tasks and CCAT subtests were observed. Results from the hierarchical regression analysis showed that auditory alternating attention was the only factor that significantly predicted aphasia severity based on CCAT overall scores after age and education level were taken into account. CONCLUSIONS: The findings align with prior research observing deficits in nonlinguistic cognition in individuals with aphasia. Implications for clinical practice and future research are discussed.

Correct Information Unit Analysis in Different Discourse Tasks Among Persons With Anomic Aphasia Based on Mandarin AphasiaBank.

PURPOSE: This study aimed to explore how well persons with anomic aphasia communicate information during discourse regarding quantity, quality, and efficiency compared to neurotypical controls, to investigate the influence of discourse tasks on informativeness and efficiency and to examine impact factors like aphasia severity and cognitive ability. METHOD: Language samples of four discourse tasks from 31 persons with anomic aphasia and 31 neurotypical controls were collected from Mandarin AphasiaBank. Correct information unit (CIU) analysis measures including the total number of CIUs, percentage of CIUs, CIUs per minute, and words per minute were calculated. Group differences and the effects of discourse tasks on informativeness and efficiency were investigated. Correlations of CIU analysis measures with aphasia severity and cognitive ability were examined. RESULTS: Persons with anomic aphasia showed lower efficiency in conveying information than controls. They underperformed controls on all CIU analysis measures when executing story narrative tasks. Discourse tasks influenced the informativeness and efficiency of both groups. Neurotypical controls delivered the greatest quantity of information most efficiently when narrating stories. Persons with anomic aphasia exhibited reduced quantity of information during procedural discourse and displayed superior information quality in sequential-picture descriptions. Discourse information may be impacted by aphasia severity and cognitive ability, with varying effects depending on the task. CONCLUSIONS: Persons with anomic aphasia are inefficient in communicating discourse messages and perform poorly on all measures in story narratives. When measuring discourse information, the effects of discourse tasks and factors like aphasia severity and cognitive ability should be considered.

[Neurodynamic speech disorders in the acute ischemic stroke]. / Neirodinamicheskie narusheniya rechi v ostrom periode ishemicheskogo insul'ta.

OBJECTIVE: To identify the features of the clinical picture and evaluate the dynamics of regression of neurodynamic speech disorders in comparison with cortical aphasia in patients with ischemic stroke (IS) in the carotid system. MATERIAL AND METHODS: We examined 268 patients with a median age of 59 (54; 70) years in the acute period of IS in the dominant hemisphere with the presence of cortical aphasia or neurodynamic speech disorders. The degree of speech recovery was characterized by an increase in the score on the Speech Questionnaire (ΔSQ) from 1 to 21 days after the development of IS. The patients were divided into group 1 (n=148) with a low level of recovery (ΔSQ≤6) and group 2 (n=120) with a high level (ΔSQ >6). RESULTS: Of the 268 patients, cortical aphasia was detected in 171 (63.8%) patients, and neurodynamic speech disorders characterized by significant variability of symptoms over the course of hours and days were detected in 97 (36.2%) patients. In patients with cortical aphasia, the majority of patients (63.2%) were classified into group 1, and among patients with neurodynamic speech disorders - into group 2 (58.8%), which showed the stability of the regression dynamics of speech disorders (p=0.001). In patients with cortical lesions the impressive side of speech suffered more often - in this group patients with sensorimotor aphasia predominate. In the case of neurodynamic speech disorders, motor and sensorimotor disorders are observed with approximately the same frequency (p=0.002). CONCLUSION: In comparison with cortical aphasias, the sensory component of speech suffers to a lesser extent in neurodynamic speech disorders. Neurodynamic speech disorders generally recover faster and more fully.

Automating Intended Target Identification for Paraphasias in Discourse Using a Large Language Model.

PURPOSE: To date, there are no automated tools for the identification and fine-grained classification of paraphasias within discourse, the production of which is the hallmark characteristic of most people with aphasia (PWA). In this work, we fine-tune a large language model (LLM) to automatically predict paraphasia targets in Cinderella story retellings. METHOD: Data consisted of 332 Cinderella story retellings containing 2,489 paraphasias from PWA, for which research assistants identified their intended targets. We supplemented these training data with 256 sessions from control participants, to which we added 2,415 synthetic paraphasias. We conducted four experiments using different training data configurations to fine-tune the LLM to automatically "fill in the blank" of the paraphasia with a predicted target, given the context of the rest of the story retelling. We tested the experiments' predictions against our human-identified targets and stratified our results by ambiguity of the targets and clinical factors. RESULTS: The model trained on controls and PWA achieved 50.7% accuracy at exactly matching the human-identified target. Fine-tuning on PWA data, with or without controls, led to comparable performance. The model performed better on targets with less human ambiguity and on paraphasias from participants with fluent or less severe aphasia. CONCLUSIONS: We were able to automatically identify the intended target of paraphasias in discourse using just the surrounding language about half of the time. These findings take us a step closer to automatic aphasic discourse analysis. In future work, we will incorporate phonological information from the paraphasia to further improve predictive utility. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24463543.