Connected Language Performance in Neurotypical and Persons with Aphasia: Use of the Brazilian-Portuguese Story Retell Procedure.

INTRODUCTION: It is important to analyze the micro- and macrostructure of connected language production across languages in neurotypical and impaired speakers such as people with aphasia (PWA). However, the validity, reliability, sensitivity, or specificity of the available Brazilian-Portuguese connected language production batteries remains untested. OBJECTIVE: The purpose of this study was to provide a preliminary assessment of the translated Brazilian-Portuguese Story Retell Procedure (SRP-BP) in PWA and neurotypical control participants (NCPs) and investigate whether the SRP can serve as a measure of overall communication impairment in PWA. METHODS: This cross-sectional study was developed at the Federal University of São Paulo. Seven right-handed PWA and 14 NCPs were recruited. PWA had a single left-hemisphere post-stroke lesion and were without severe aphasia or non-fluent aphasia that might interfere with performing the SRP. The connected language measures calculated from the SRP-BP were the numbers of words, information units, and propositions produced. The data were analyzed with the non-parametric Mann-Whitney test. RESULTS: The NCPs produced significantly more information units and propositions in each of the 12 SRP-BP stories than the PWA group. The same group results were found for the number of words for 11 of the 12 stories, with no statistically significant difference between groups for the Água (Water) story. CONCLUSION: The SRP-BP distinguished the connected language production of PWA from that of NCPs. These results motivate additional psychometric assessment and test development of the SRP-BP in neurotypical, PWA, and other language and cognitively impaired populations.

Reading and listening comprehension in Cantonese-speaking people with right hemisphere versus left hemisphere brain damage.

The problem in language comprehension in people with right hemisphere damage (RHD) is more equivocal than people with left hemisphere damage. This study explores the reading and listening comprehension of Cantonese-speaking individuals with RHD, left hemisphere damage, and neurotypical healthy controls using the Cantonese Computerized Revised Token Test (CRTT-Cantonese) adapted from the English CRTT. Eighteen native Cantonese-speaking individuals with RHD, 32 individuals with left hemisphere damage and aphasia (PWA), and 42 healthy controls participated in this study. All the participants completed the Cantonese Aphasia Battery, Hong Kong Oxford Cognitive Screen, the listening comprehension version of CRTT-Cantonese (CRTT-L-Cantonese), and the reading comprehension version of CRTT-Cantonese (CRTT-R-WF-Cantonese) across different sessions. Linear mixed-effect analysis revealed significant differences among the groups in CRTT-Cantonese tests. However, there were no significant difference between CRTT-L-Cantonese and CRTT-R-WF-Cantonese within the PWA, RHD and healthy control groups. Tukey post-hoc pairwise comparisons showed that PWA scored significantly lower than RHD and healthy control groups (p < 0.0001) in both CRTT-L-Cantonese and CRTT-R-WF-Cantonese, and the RHD group scored significantly lower than healthy control group only on the CRTT-R-WF-Cantonese. The results demonstrate that the CRTT-L-Cantonese and CRTT-R-WF-Cantonese differentiate language comprehension abilities among PWA, RHD and healthy control groups. Although the current findings did not show any diversion between reading and listening comprehension in RHD group, this group showed poorer performance in reading comprehension when compared to healthy controls. The latter findings may support the view that the right hemisphere contributes to reading comprehension in Chinese.

Magnetoencephalographic virtual recording: a novel diagnostic tool for concussion.

OBJECT: Heightened recognition of the prevalence and significance of head injury in sports and in combat veterans has brought increased attention to the physiological and behavioral consequences of concussion. Current clinical practice is in part dependent on patient self-report as the basis for medical decisions and treatment. Magnetoencephalography (MEG) shows promise in the assessment of the pathophysiological derangements in concussion. The authors have developed a novel MEG-based neuroimaging strategy to provide objective, noninvasive, diagnostic information in neurological disorders. In the current study the authors demonstrate a novel task protocol and then assess MEG virtual recordings obtained during task performance as a diagnostic tool for concussion. METHODS: Ten individuals (5 control volunteers and 5 patients with a history of concussion) were enrolled in this pilot study. All participants underwent an MEG evaluation during performance of a language/spatial task. Each individual produced 960 responses to 320 sentence stimuli; 0.3 sec of MEG data from each word presentation and each response were analyzed: the data from each participant were classified using a rule constructed from the data obtained from the other 9 participants. RESULTS: Analysis of response times showed significant differences (p < 10(-4)) between concussed and normal groups, demonstrating the sensitivity of the task. The MEG measures enabled the correct classification of 8 of 10 individuals as concussed versus nonconcussed (p = 0.055). Analysis of single-trial data classified 70% of trials correctly (p < 10(-10)). Concussed patients showed increased activation in the occipitoparietal and temporal regions during evaluation. CONCLUSIONS: These pilot findings are the first evidence of the utility of MEG virtual recording in diagnosing concussion. With further refinements, MEG virtual recordings may represent a noninvasive test to diagnose concussion and monitor its resolution.

Effects of divided attention on swallowing in persons with idiopathic Parkinson's disease.

The purpose of this study was to determine whether attentional resources are involved in swallowing in persons with idiopathic Parkinson's disease, and if so, in which phase(s) of swallowing. The approach involved a dual-task, reaction time (RT) paradigm using ten participants with Parkinson's disease. Single-task baseline measures were obtained for durations of the anticipatory phase and oropharyngeal phase of swallowing and RTs were obtained for nonword auditory stimuli. A dual-task then required participants to swallow 5 ml of water from an 8-oz. cup while listening for a target nonword presented auditorily during the anticipatory or oropharyngeal phase. Target stimuli were randomized across baseline and dual-task trials. Durations of the anticipatory and oropharyngeal phases of swallowing and RTs during baseline and dual-task trials were determined. Results showed a nonsignificant change in speed of completion for both the anticipatory phase and the oropharyngeal phase of swallowing during dual-task trials. However, there was a statistically significant increase in RT during the anticipatory phase during the dual-task condition. RT during the oropharyngeal phase remained unaffected. Given a need for additional research using more complex competing tasks, these data on attention are consistent with earlier claims of an automatic, nonresource-demanding, oropharyngeal swallowing mechanism that is preserved for persons with early-to-mid-stage Parkinson's disease. Clinical implications of these data suggest that disruptive environmental stimuli to individuals with early-to-mid-stage Parkinson's disease may alter feeding but have little effect on the oropharyngeal swallow.

Effects of divided attention on swallowing in healthy participants.

Swallowing impairments are treated mostly behaviorally. It is requisite to understand the relationship of cognition, specifically attention, with swallowing since so many swallowing impairments occur concomitantly with cognitive disorders. This study examined the hypothesis that attentional resources are required during swallowing. The approach involved a dual-task, reaction time (RT) paradigm in ten healthy, nonimpaired participants. Baseline measures were obtained of the duration of the anticipatory phase and of the oropharyngeal phase of swallowing and the RTs to nonword auditory stimuli. A dual-task then required participants to swallow 5 ml of water from an 8-oz. cup while listening for a target nonword presented auditorily during the anticipatory or the oropharyngeal phase. Target stimuli were randomized across baseline and dual-task trials. Duration of the anticipatory phase and of the oropharyngeal phase of swallowing and duration of the RT baseline trial and of the dual-task trial were determined. Results showed a statistically significant increase in speed of the anticipatory phase, relative to the oropharyngeal phase, for swallowing during the dual-task. RTs were slowed for both the anticipatory and the oropharyngeal phase during the dual-task, although neither of these was statistically significant. Clinical implications of these data suggest that disruptive stimuli in the environment to nonimpaired individuals may alter feeding but have little effect on the oropharyngeal swallow.

Need for cognition is associated with the interaction of reward and task-load on effort: A verification and extension study.

Here, we work to provide nuance around the assumption that people will work for rewards. We examine whether individuals' inherent tendency to mobilize cognitive effort (need for cognition, NFC) moderates this effect. We re-analyzed our existing data to verify an effect reported by Sandra and Otto (2018) regarding the association between NFC and reward-induced cognitive effort expenditure, using a more ecological cognitive task design and adding a psychophysiological measure of effort. Specifically, distinct from their short time course visual task-switching paradigm, we used a relatively long course auditory comprehension task paradigm. We found that, consistent with the original study, increased cognitive effort in response to incentive reward depends on individual differences in cognitive motivation (need for cognition). We also found that, to observe consistent phenomena, different indices of effort (behavioral and psychophysiological) need to be considered when evaluating the relationship between the effort expenditure and cognitive motivation. Pupil dilation showed an advantage over reaction time in revealing mental effort mobilized over a prolonged cognitive task. Our results suggest that assessing cognitive motivation when planning a behavior-change program involving reward feedback for positive performance could help to optimize individuals' effort investment.

Development of the English Listening and Reading Computerized Revised Token Test Into Cantonese: Validity, Reliability, and Sensitivity/Specificity in People With Aphasia and Healthy Controls.

Purpose This study reports the psychometric development of the Cantonese versions of the English Computerized Revised Token Test (CRTT) for persons with aphasia (PWAs) and healthy controls (HCs). Method The English CRTT was translated into standard Chinese for the Reading-Word Fade version (CRTT-R-WF-Cantonese) and into formal Cantonese for the Listening version (CRTT-L-Cantonese). Thirty-two adult native Cantonese PWAs and 42 HCs were tested on both versions of CRTT-Cantonese tests and on the Cantonese Aphasia Battery to measure the construct and concurrent validity of CRTT-Cantonese tests. The HCs were retested on both versions of the CRTT-Cantonese tests, whereas the PWAs were randomly assigned for retesting on either version to measure the test-retest reliability. Results A two-way, Group × Modality, repeated-measures analysis of variance revealed significantly lower scores for the PWA group than the HC group for both reading and listening. Other comparisons were not significant. A high and significant correlation was found between the CRTT-R-WF-Cantonese and the CRTT-L-Cantonese in PWAs, and 87% of the PWAs showed nonsignificantly different performance across the CRTT-Cantonese tests based on the Revised Standardized Difference Test. The CRTT-R-WF-Cantonese provided better aphasia diagnostic sensitivity (100%) and specificity (83.30%) values than the CRTT-L-Cantonese. Pearson correlation coefficients revealed significant moderate correlations between the Cantonese Aphasia Battery scores and the CRTT-Cantonese tests in PWAs, supporting adequate concurrent validity. Intraclass correlation coefficient showed high test-retest reliability (between .82 and .96, p < .001) for both CRTT-Cantonese tests for both groups. Conclusions Results support that the validly translated CRTT-R-WF-Cantonese and CRTT-L-Cantonese tests significantly differentiate the reading and listening comprehension of PWAs from HCs and provides acceptable concurrent validity and high test-retest reliability for both tests. Furthermore, favorable PWA versus HC sensitivity and specificity cutoff scores are presented for both CRTT-Cantonese listening and reading tests.

The role of reward and task demand in value-based strategic allocation of auditory comprehension effort.

OBJECTIVES: Listeners who fail to optimize their allocation of effort during auditory comprehension tasks can experience from compromised performance, fatigue and stress, which might result in reduced engagement in social communication activities. Strategically allocating effort based on costs and perceived benefits are commonly observed in the research of effortful physical and visual behaviors. Whether people manage their effort in a similar manner in audition remains unclear. As the listening performance of people with normal hearing often serves as the goal of auditory rehabilitation for people with hearing loss, this study evaluated how strategy-induced effort allocation, challenged by reward and task demand, interactively impacted auditory comprehension in normal hearing adults. DESIGN: A value-based strategic effort allocation paradigm was evaluated in 40 normal-hearing young adults. The paradigm included five levels of reward (motivation) and five levels of task demand (speech rate) that were independently manipulated. Effects of reward and task demand on performance accuracy and pupil dilation (a measure of auditory comprehension effort) were examined. RESULTS: There was a significant interaction effect of reward and task demand on both pupil dilation and comprehension accuracy. At the response stage of speech comprehension processing, pupil dilation significantly decreased as the task demand increased at high reward levels. In contrast, pupil dilation did not vary significantly as a function of task demand at low reward levels. Reward significantly improved performance accuracy at fast and extremely fast rate conditions, but not at the slower rates. CONCLUSIONS: Consistent with previous studies on effort regulation, reward and task demand appear to be associated with auditory comprehension effort allocation in an interactive manner when strategic effort control was required to achieve a reward goal. The young normal-hearing listeners in this study prioritized their effort to relatively easy task items over difficult ones at high levels of reward, suggesting a cost-effective value-based strategic effort allocation. Reward significantly improved task performance in terms of accuracy at difficult listening conditions. These findings support the incorporation of affective factors (e.g., reward) and the utility of the value-based strategic effort allocation paradigm in the experimental setting to understand how clinically relevant factors (such as hearing loss and age) might change strategic auditory comprehension behavior.

Audiological Assessment of Word Recognition Skills in Persons With Aphasia.

PURPOSE: The purpose of this study was to evaluate the ability of persons with aphasia, with and without hearing loss, to complete a commonly used open-set word recognition test that requires a verbal response. Furthermore, phonotactic probabilities and neighborhood densities of word recognition errors were assessed to explore potential underlying linguistic complexities that might differentially influence performance among groups. METHOD: Four groups of adult participants were tested: participants with no brain injury with normal hearing, participants with no brain injury with hearing loss, participants with brain injury with aphasia and normal hearing, and participants with brain injury with aphasia and hearing loss. The Northwestern University Auditory Test No. 6 (NU-6; Tillman & Carhart, 1966) was administered. Those participants who were unable to respond orally (repeating words as heard) were assessed with the Picture Identification Task (Wilson & Antablin, 1980), permitting a picture-pointing response instead. Error patterns from the NU-6 were assessed to determine whether phonotactic probability influenced performance. RESULTS: All participants with no brain injury and 72.7% of the participants with aphasia (24 out of 33) completed the NU-6. Furthermore, all participants who were unable to complete the NU-6 were able to complete the Picture Identification Task. There were significant group differences on NU-6 performance. The 2 groups with normal hearing had significantly higher scores than the 2 groups with hearing loss, but the 2 groups with normal hearing and the 2 groups with hearing loss did not differ from one another, implying that their performance was largely determined by hearing loss rather than by brain injury or aphasia. The neighborhood density, but not phonotactic probabilities, of the participants' errors differed across groups with and without aphasia. CONCLUSIONS: Because the vast majority of the participants with aphasia examined could be tested readily using an instrument such as the NU-6, clinicians should not be reticent to use this test if patients are able to repeat single words, but routine use of alternative tests is encouraged for populations of people with brain injuries.

Auditory performance characteristics of the Computerized Revised Token Test (CRTT).

PURPOSE: To assess the Computerized Revised Token Test (CRTT) performance of individuals with normal hearing under several intensity conditions and under several spectral and temporal perturbation conditions. METHOD: Sixty normal-hearing listeners were randomly assigned to 1 of 3 groups. Group 1 provided performance-intensity information about CRTT performance using uncompressed acoustic stimuli. Groups 2 and 3 completed the CRTT using temporally and spectrally compressed and expanded stimuli. CRTT performance functions were plotted for each group. RESULTS: Group 1 required minimal audibility to perform maximally on this task. As expected, Groups 2 and 3 showed significant differences across subtests, regardless of distortion condition. Mean differences in performance between successive conditions for Group 2 increased beyond 40% time compressed. There was 1 significant difference for the time-expanded condition. There were no differences across frequency compressed and expanded conditions. CONCLUSION: Young listeners require limited signal gain on the CRTT to achieve maximum performance. Time and frequency compression and expansion results were consistent with previous findings with varying types of speech stimuli. The results have implications for administration and interpretation of the CRTT administered to persons from other populations and will help in the development of a normative database for the CRTT.

Update on Didactic and Clinical Education in Fluency Disorders: 2013-2014.

Purpose: This study surveyed didactic and clinical education in fluency disorders at undergraduate and graduate institutions in the United States that provide education in speech-language pathology to determine whether a previously observed reduction in requirements has continued since prior surveys (Yaruss, 1999; Yaruss & Quesal, 2002). Method: The study involved a detailed questionnaire that was sent to 282 communication science and disorders departments. Questions examined didactic and clinical education, as well as faculty knowledge about fluency disorders. Results: Comparisons with prior surveys revealed several findings, including (a) on average, programs have increased academic coursework and incorporated more practical sessions and competency-based testing in the classroom; (b) the number of faculty who possess extensive clinical experience with fluency disorders has decreased; and (c) although an increase in clinical requirements in fluency disorders was detected, the number of programs providing minimal education about fluency disorders remains high. Conclusion: Given an expanding scope of practice, many programs have continued to try to provide adequate education about fluency disorders. Still, direct clinical experiences are limited, and faculty expertise in this area has continued to decrease. To raise students' confidence and competence in fluency disorders, efforts beyond graduate work-or systemic changes in the profession-may be necessary.

Rasch modeling of revised token test performance: validity and sensitivity to change.

The purpose of this research was to examine the validity of the 55-item Revised Token Test (RTT) and to compare traditional and Rasch-based scores in their ability to detect group differences and change over time. The 55-item RTT was administered to 108 left- and right-hemisphere stroke survivors, and the data were submitted to Rasch analysis. Traditional and Rasch-based scores for a subsample of 60 stroke survivors were submitted to analyses of variance with group (left hemisphere with aphasia vs. right hemisphere) and time post onset (3 vs. 6 months post onset) as factors. The 2 scoring methods were compared using an index of relative precision. Forty-eight items demonstrated acceptable model fit. Misfitting items came primarily from Subtest IX. The Rasch model accounted for 71% of the variance in the responses to the remaining items. Intersubtest patterns of item difficulty were well predicted by item content, but unexpected within-subtest differences were found. Both traditional and Rasch person scores demonstrated significant group differences, but only the latter demonstrated statistically significant change over time. Analysis of relative precision, however, failed to confirm a significant difference between the 2 methods. The findings generally support the RTT's validity, but a minority of items appears to respond to a different construct. Also, within-subtest differences in item difficulty suggest the need for further examination of variability in impaired language performance. Finally, the results suggest an equivocal advantage for Rasch scores in detecting change over time.

The effect of speaking rate on serial-order sound-level errors in normal healthy controls and persons with aphasia.

BACKGROUND: Although many speech errors can be generated at either a linguistic or motoric level of production, phonetically well-formed sound-level serial-order errors are generally assumed to result from disruption of phonologic encoding (PE) processes. An influential model of PE (Dell, 1986; Dell, Burger & Svec, 1997) predicts that speaking rate should affect the relative proportion of these serial-order sound errors (anticipations, perseverations, exchanges). These predictions have been extended to, and have special relevance for persons with aphasia (PWA) because of the increased frequency with which speech errors occur and because their localization within the functional linguistic architecture may help in diagnosis and treatment. Supporting evidence regarding the effect of speaking rate on phonological encoding has been provided by studies using young normal language (NL) speakers and computer simulations. Limited data exist for older NL users and no group data exist for PWA. AIMS: This study tested the phonologic encoding properties of Dell's model of speech production (Dell, 1986; Dell,et al., 1997), which predicts that increasing speaking rate affects the relative proportion of serial-order sound errors (i.e., anticipations, perseverations, and exchanges). METHODS & PROCEDURES: The effects of speech rate on the error ratios of anticipation/exchange (AE), anticipation/perseveration (AP) and vocal reaction time (VRT) were examined in 16 normal healthy controls (NHC) and 16 PWA without concomitant motor speech disorders. The participants were recorded performing a phonologically challenging (tongue twister) speech production task at their typical and two faster speaking rates. OUTCOMES & RESULTS: A significant effect of increased rate was obtained for the AP but not the AE ratio. Significant effects of group and rate were obtained for VRT. CONCLUSION: Although the significant effect of rate for the AP ratio provided evidence that changes in speaking rate did affect PE, the results failed to support the model derived predictions regarding the direction of change for error type proportions. The current findings argued for an alternative concept of the role of activation and decay in influencing types of serial-order sound errors. Rather than a slow activation decay rate (Dell, 1986), the results of the current study were more compatible with an alternative explanation of rapid activation decay or slow build-up of residual activation.

A predictive model for diagnosing stroke-related apraxia of speech.

Diagnosis of the speech motor planning/programming disorder, apraxia of speech (AOS), has proven challenging, largely due to its common co-occurrence with the language-based impairment of aphasia. Currently, diagnosis is based on perceptually identifying and rating the severity of several speech features. It is not known whether all, or a subset of the features, are required for a positive diagnosis. The purpose of this study was to assess predictor variables for the presence of AOS after left-hemisphere stroke, with the goal of increasing diagnostic objectivity and efficiency. This population-based case-control study involved a sample of 72 cases, using the outcome measure of expert judgment on presence of AOS and including a large number of independently collected candidate predictors representing behavioral measures of linguistic, cognitive, nonspeech oral motor, and speech motor ability. We constructed a predictive model using multiple imputation to deal with missing data; the Least Absolute Shrinkage and Selection Operator (Lasso) technique for variable selection to define the most relevant predictors, and bootstrapping to check the model stability and quantify the optimism of the developed model. Two measures were sufficient to distinguish between participants with AOS plus aphasia and those with aphasia alone, (1) a measure of speech errors with words of increasing length and (2) a measure of relative vowel duration in three-syllable words with weak-strong stress pattern (e.g., banana, potato). The model has high discriminative ability to distinguish between cases with and without AOS (c-index=0.93) and good agreement between observed and predicted probabilities (calibration slope=0.94). Some caution is warranted, given the relatively small sample specific to left-hemisphere stroke, and the limitations of imputing missing data. These two speech measures are straightforward to collect and analyse, facilitating use in research and clinical settings.

An application of Rasch analysis to the measurement of communicative functioning.

PURPOSE: The purposes of this investigation were to examine the construct dimensionality and range of ability effectively measured by 28 assessment items obtained from 3 different patient-reported scales of communicative functioning, and to provide a demonstration of how the Rasch approach to measurement may contribute to the definition of latent constructs and the development of instruments to measure them. METHOD: Item responses obtained from 421 stroke survivors with and without communication disorders were examined using the Rasch partial credit model. The dimensionality of the item pool was evaluated by (a) examining correlations of Rasch person ability scores obtained separately from each of the 3 scales, (b) iteratively excluding items exceeding mean square model fit criteria, and (c) using principal-components analysis of Rasch model residuals. The range of ability effectively measured by the item pool was examined by comparing item difficulty and category threshold calibrations to the distribution of person ability scores and by plotting the modeled standard error of person ability estimates as a function of person ability level. RESULTS: The results indicate that most assessment items fit a unidimensional measurement model, with the notable exception of items relating to the use of written communication. The results also suggest that the range of ability that could be reliably measured by the current item pool was restricted relative to the range of ability observed in the patient sample. CONCLUSIONS: It is concluded that (a) a mature understanding of communicative functioning as a measurement construct will require further research, (b) patients with stroke-related communication disorders will be better served by the development of instruments measuring a wider range of communicative functioning ability, and (c) the theoretical and methodological tools provided by the Rasch family of measurement models may be productively applied to these efforts.

Intentional and Reactive Inhibition During Spoken-Word Stroop Task Performance in People With Aphasia.

PURPOSE: The integrity of selective attention in people with aphasia (PWA) is currently unknown. Selective attention is essential for everyday communication, and inhibition is an important part of selective attention. This study explored components of inhibition-both intentional and reactive inhibition-during spoken-word production in PWA and in controls who were neurologically healthy (HC). Intentional inhibition is the ability to suppress a response to interference, and reactive inhibition is the delayed reactivation of a previously suppressed item. METHOD: Nineteen PWA and 20 age- and education-matched HC participated in a Stroop spoken-word production task. This task allowed the examination of intentional and reactive inhibition by evoking and comparing interference, facilitation, and negative priming effects in different contexts. RESULTS: Although both groups demonstrated intentional inhibition, PWA demonstrated significantly more interference effects. PWA demonstrated no significant facilitation effects. HC demonstrated significant reverse facilitation effects. Neither group showed significant evidence of reactive inhibition, though both groups showed similar individual variability. CONCLUSIONS: These results underscore the challenge interference presents for PWA during spoken-word production, indicating diminished intentional inhibition. Although reactive inhibition was not different between PWA and HC, PWA showed difficulty integrating and adapting to contextual information during language tasks.

Treatment for Acquired Apraxia of Speech: A Systematic Review of Intervention Research Between 2004 and 2012.

OBJECTIVES: The aim was for the appointed committee of the Academy of Neurological Communication Disorders and Sciences to conduct a systematic review of published intervention studies of acquired apraxia of speech (AOS), updating the previous committee's review article from 2006. METHOD: A systematic search of 11 databases identified 215 articles, with 26 meeting inclusion criteria of (a) stating intention to measure effects of treatment on AOS and (b) data representing treatment effects for at least 1 individual stated to have AOS. RESULTS: All studies involved within-participant experimental designs, with sample sizes of 1 to 44 (median = 1). Confidence in diagnosis was rated high to reasonable in 18 of 26 studies. Most studies (24/26) reported on articulatory-kinematic approaches; 2 applied rhythm/rate control methods. Six studies had sufficient experimental control for Class III rating according to the Clinical Practice Guidelines Process Manual (American Academy of Neurology, 2011), with 15 others satisfying all criteria for Class III except use of independent or objective outcome measurement. CONCLUSIONS: The most important global clinical conclusion from this review is that the weight of evidence supports a strong effect for both articulatory-kinematic and rate/rhythm approaches to AOS treatment. The quantity of work, experimental rigor, and reporting of diagnostic criteria continue to improve and strengthen confidence in the corpus of research.

Reliability and validity of the computerized Revised Token Test: comparison of reading and listening versions in persons with and without aphasia.

PURPOSE: This study assessed the reliability and validity of intermodality associations and differences in persons with aphasia (PWA) and healthy controls (HC) on a computerized listening and 3 reading versions of the Revised Token Test (RTT; McNeil & Prescott, 1978). METHOD: Thirty PWA and 30 HC completed the test versions, including a complete replication. Reading versions varied according to stimulus presentation method: (a) full-sentence presentation, (b) self-paced word-by-word full-sentence construction, and (c) self-paced word-by-word presentation with each word removed with the onset of the next word. Participants also received tests of aphasia and reading severity. RESULTS: The listening version produced higher overall mean scores than each of the reading versions. Differences were small and within 1 standard error of measurement of each version. Overall score test-retest reliability among versions for PWA ranged from r=.89 to r=.97. Correlations between the listening and reading versions ranged from r=.79 to r=.85. All versions correlated highly with aphasia and reading severity. Correlations were generally low for the HC due to restricted variability. Factor analysis yielded a 2-factor solution for PWA and a single-factor for HC. CONCLUSIONS: Intermodality differences were small, and all 4 versions were reliable, concurrently valid, and sensitive to similar linguistic processing difficulties in PWA.

The Burden of Stroke Scale (BOSS) provides valid and reliable score estimates of functioning and well-being in stroke survivors with and without communication disorders.

BACKGROUND AND OBJECTIVE: This study describes the conceptual foundation and psychometric properties of the Burden of Stroke Scale (BOSS), a patient-reported health status assessment designed to quantify the physical, cognitive, and psychological burden of stroke. METHODS: Qualitative research methods were used to develop a 112-item pilot version of the instrument. The pilot version was administered to healthy controls (n=251) and stroke survivors with (n=135) and without (n=146) communication disorders on a single occasion for the purposes of reducing the global item pool, describing the resulting scale properties, examining the dimensionality of the burden of stroke construct, and examining the known-groups validity of the instrument. RESULTS: Sixty-four items were retained, comprising 12 internally consistent and unidimensional scales. Principal components analysis revealed three second-order factors (Physical Activity Limitations, Cognitive Activity Limitations, and Psychological Distress) comprising the Burden of Stroke construct. Comparisons between groups revealed that stroke survivors reported greater activity limitations and psychological distress on all scales relative to controls, and that stroke survivors with communication disorders reported greater activity limitations on swallowing, communication, cognition, and social relations scales relative to non-communicatively disordered stroke survivors. CONCLUSION: These findings support the internal consistency of the BOSS scales, the hypothesized dimensionality of the burden of stroke construct, and the known-groups validity of the instrument.

Simulation of aphasic naming performance in non-brain-damaged adults.

Discussion abounds in the literature as to whether aphasia is a deficit of linguistic competence or linguistic performance and, if it is a performance deficit, what are its precise mechanisms. Considerable evidence suggests that alteration of nonlinguistic factors can affect language performance in aphasia, a finding that raises questions about the modularity of language and the purity of linguistic mechanisms underlying the putative language deficits in persons with aphasia. This study investigated whether temporal stress plus additional cognitive demands placed on non-brain-damaged adults would produce aphasic-like performance on a picture naming task. Two groups of non-brain-damaged participants completed a picture naming task with additional cognitive demands (use of low frequency words and making semantic judgments about the stimuli). A control group performed this task at their own pace, and an experimental group was placed under time constraints. Naming errors were identified and coded by error type. Errors made by individuals with aphasia from a previous study (S. E. Kohn and H. Goodglass, 1985) were recoded with the coding system used in the present study and were then compared with the types of errors produced by the 2 non-brain-damaged groups. Results generally support the hypothesis that the language performance deficits seen in persons with aphasia exist on a continuum with the language performance of non-brain-damaged individuals. Some error type differences between groups warrant further investigation.