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Purpose: Individuals with aphasia identify discourse-level communication (i.e., language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, are poorly understood, and vary greatly among individuals with aphasia. In response, this study consisted of a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis (SFA) clinical trials. Aim 1 evaluated changes in theoretically motivated discourse outcomes representing lexical-semantic processing, lexical diversity, grammatical complexity, and discourse informativeness. Aim 2 explored the potential moderating role of nonlanguage cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes., Method: This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for n = 60 (Aim 1) and a subset n = 44 (Aim 2). Outcome measures included lexical-semantic processing (% semantic errors), lexical diversity (moving average type-token ratio), grammatical complexity (mean utterance length), and discourse informativeness (% correct information units). Bayesian generalized mixed-effects models were used to examine changes across four study time points: enrollment, entry, exit, and 1-month follow-up., Results: The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after SFA when measured using standard, general-topic discourse stimuli. There was weak and inconsistent evidence that nonlanguage cognitive factors may play a role in moderating treatment response., Conclusions: These findings indicate a clear need to pair theoretically informed treatments designed to facilitate generalization to discourse with intentional measurement paradigms designed to capture it. Furthermore, there is a clear need to examine how established treatments, restorative or compensatory, can better facilitate generalization to discourse-level communication. These priorities are critical for meaningfully improving everyday communication and reducing the profound communication and psychosocial consequences of aphasia., Supplemental Material: https://doi.org/10.23641/asha.26524081.

Language users rely on both linguistic and conceptual processing abilities to efficiently comprehend or produce language. According to the principle of rational adaptation, the degree to which a cognitive system relies on one process vs. another can change under different conditions or disease states with the goal of optimizing behavior. In this study, we investigated rational adaptation in reliance on linguistic versus conceptual processing in aphasia, an acquired disorder of language. In individuals living with aphasia, verb-retrieval impairments are a pervasive deficit that negatively impacts communicative function. As such, we examined evidence of adaptation in verb production, using parallel measures to index impairment in two of verb naming's critical subcomponents: conceptual and linguistic processing. These component processes were evaluated using a standardized assessment battery designed to contrast non-linguistic (picture input) and linguistic (word input) tasks of conceptual action knowledge. The results indicate that non-linguistic conceptual action processing can be impaired in people with aphasia and contributes to verb-retrieval impairments. Furthermore, relatively unimpaired conceptual action processing can ameliorate the influence of linguistic processing deficits on verb-retrieval impairments. These findings are consistent with rational adaptation accounts, indicating that conceptual processing plays a key role in language function and can be leveraged in rehabilitation to improve verb retrieval in adults with chronic aphasia., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Clear operational definitions of constructs are necessary to ensure that research findings are meaningful and interpretable. In the field of aphasiology, aphasia is often defined to the effect of "aphasia is an acquired language disorder often due to brain injury that affects expressive and receptive language." To contribute to our understanding of the construct of aphasia, we conducted a content analysis of six diagnostic aphasia tests: the Minnesota Test for the Differential Diagnosis of Aphasia, the Porch Index of Communicative Ability, the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, the Comprehensive Aphasia Test, and the Quick Aphasia Battery. These chosen tests have historical prominence, with several in regular clinical and research use today. We hypothesized that the content of the aphasia tests should be very similar since they all purport to identify and characterize (if present) aphasia, with recognition that there may be some subtle differences in test content stemming in large part to epistemological differences in the test makers' views of aphasia. Instead, we found predominantly weak Jaccard indices, a similarity correlation coefficient, between test targets. Only five test targets were found in all six aphasia tests: auditory comprehension of words and sentences, repetition of words, confrontation naming of nouns, and reading comprehension of words. The qualitative and quantitative results suggest that the content across aphasia tests may be more disparate than expected. We conclude by discussing the implication of our results for the field, including the importance of updating, if necessary, the operational definition of aphasia through conversation with a broad audience of interested and affected people., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: Small- N studies are the dominant study design supporting evidence-based interventions in communication science and disorders, including treatments for aphasia and related disorders. However, there is little guidance for conducting reproducible analyses or selecting appropriate effect sizes in small- N studies, which has implications for scientific review, rigor, and replication. This tutorial aims to (a) demonstrate how to conduct reproducible analyses using effect sizes common to research in aphasia and related disorders and (b) provide a conceptual discussion to improve the reader's understanding of these effect sizes., Method: We provide a tutorial on reproducible analyses of small- N designs in the statistical programming language R using published data from Wambaugh et al. (2017). In addition, we discuss the strengths, weaknesses, reporting requirements, and impact of experimental design decisions on effect sizes common to this body of research., Results: Reproducible code demonstrates implementation and comparison of within-case standardized mean difference, proportion of maximal gain, tau-U, and frequentist and Bayesian mixed-effects models. Data, code, and an interactive web application are available as a resource for researchers, clinicians, and students., Conclusions: Pursuing reproducible research is key to promoting transparency in small- N treatment research. Researchers and clinicians must understand the properties of common effect size measures to make informed decisions in order to select ideal effect size measures and act as informed consumers of small- N studies. Together, a commitment to reproducibility and a keen understanding of effect sizes can improve the scientific rigor and synthesis of the evidence supporting clinical services in aphasiology and in communication sciences and disorders more broadly. Supplemental Material and Open Science Form: https://doi.org/10.23641/asha.21699476.

Purpose: To empirically assign severity levels (e.g., mild, moderate) to four relatively new patient-reported outcome measures (PROMs) for adults with acquired cognitive/language disorders. They include the Communicative Participation Item Bank, the Aphasia Communication Outcome Measure, and Neuro-QoL's item banks of Cognitive Function (v2.0) and Ability to Participate in Social Roles and Activities (v1.0)., Method: We conducted 17 focus groups that comprised 22 adults with an acquired cognitive/language disorder from stroke, Parkinson's disease, or traumatic brain injury; 30 care partners of an adult with an acquired cognitive/language disorder; and 42 speech-language pathologists who had experience assessing/treating individuals with those and other cognitive/language disorders. In a small, moderated focus-group format, participants completed "PROM-bookmarking" procedures: They discussed hypothetical vignettes based on PROM item responses about people with cognitive/language disorders and had to reach consensus regarding whether their symptoms/function should be categorized as within normal limits or mild, moderate, or severe challenges., Results: There was generally good agreement among the stakeholder groups about how to classify vignettes, particularly when they reflected very high or low functioning. People with aphasia described a larger range of functional communication challenges as "mild" compared to other stakeholder types. Based on a consensus across groups, we present severity levels for specific score ranges for each PROM., Conclusion: Standardized, stakeholder-informed severity levels that aid interpretation of PROM scores can help clinicians and researchers derive better clinical meaning from those scores, for example, by identifying important clinical windows of opportunity and assessing when symptoms have returned to a "normal" range., (© 2022. The Author(s).)

Purpose: Item response theory (IRT) is a modern psychometric framework with several advantageous properties as compared with classical test theory. IRT has been successfully used to model performance on anomia tests in individuals with aphasia; however, all efforts to date have focused on noun production accuracy. The purpose of this study is to evaluate whether the Verb Naming Test (VNT), a prominent test of action naming, can be successfully modeled under IRT and evaluate its reliability., Method: We used responses on the VNT from 107 individuals with chronic aphasia from AphasiaBank. Unidimensionality and local independence, two assumptions prerequisite to IRT modeling, were evaluated using factor analysis and Yen's Q 3 statistic (Yen, 1984), respectively. The assumption of equal discrimination among test items was evaluated statistically via nested model comparisons and practically by using correlations of resulting IRT-derived scores. Finally, internal consistency, marginal and empirical reliability, and conditional reliability were evaluated., Results: The VNT was found to be sufficiently unidimensional with the majority of item pairs demonstrating adequate local independence. An IRT model in which item discriminations are constrained to be equal demonstrated fit equivalent to a model in which unique discrimination parameters were estimated for each item. All forms of reliability were strong across the majority of IRT ability estimates., Conclusions: Modeling the VNT using IRT is feasible, yielding ability estimates that are both informative and reliable. Future efforts are needed to quantify the validity of the VNT under IRT and determine the extent to which it measures the same construct as other anomia tests., Supplemental Material: https://doi.org/10.23641/asha.22329235.

Purpose: The purpose of this study was to evaluate whether a short-form computerized adaptive testing (CAT) version of the Philadelphia Naming Test (PNT) provides error profiles and model-based estimates of semantic and phonological processing that agree with the full test., Method: Twenty-four persons with aphasia took the PNT-CAT and the full version of the PNT (hereinafter referred to as the "full PNT") at least 2 weeks apart. The PNT-CAT proceeded in two stages: (a) the PNT-CAT30, in which 30 items were selected to match the evolving ability estimate with the goal of producing a 50% error rate, and (b) the PNT-CAT60, in which an additional 30 items were selected to produce a 75% error rate. Agreement was evaluated in terms of the root-mean-square deviation of the response-type proportions and, for individual response types, in terms of agreement coefficients and bias. We also evaluated agreement and bias for estimates of semantic and phonological processing derived from the semantic-phonological interactive two-step model (SP model) of word production., Results: The results suggested that agreement was poorest for semantic, formal, mixed, and unrelated errors, all of which were underestimated by the short forms. Better agreement was observed for correct and nonword responses. SP model weights estimated by the short forms demonstrated no substantial bias but generally inadequate agreement with the full PNT, which itself showed acceptable test-retest reliability for SP model weights and all response types except for formal errors., Discussion: Results suggest that the PNT-CAT30 and the PNT-CAT60 are generally inadequate for generating naming error profiles or model-derived estimates of semantic and phonological processing ability. Post hoc analyses suggested that increasing the number of stimuli available in the CAT item bank may improve the utility of adaptive short forms for generating error profiles, but the underlying theory also suggests that there are limitations to this approach based on a unidimensional measurement model., Supplemental Material: https://doi.org/10.23641/asha.22320814.

Purpose: Specifying the active ingredients in aphasia interventions can inform treatment theory and improve clinical implementation. This secondary analysis examined three practice-related predictors of treatment response in semantic feature verification (SFV) treatment. We hypothesized that (a) successful feature verification practice would be associated with naming outcomes if SFV operates similarly to standard feature generation semantic feature analysis and (b) successful retrieval practice would be associated with naming outcomes for treated, but not semantically related, untreated words if SFV operates via a retrieval practice-oriented lexical activation mechanism., Method: Item-level data from nine participants with poststroke aphasia who received SFV treatment reported in the work of Evans, Cavanaugh, Quique, et al. (2021) were analyzed using Bayesian generalized linear mixed-effects models. Models evaluated whether performance on three treatment components (facilitated retrieval, feature verification, and effortful retrieval) moderated treatment response for treated and semantically related, untreated words., Results: There was no evidence for or against a relationship between successful feature verification practice and treatment response. In contrast, there was a robust relationship between the two retrieval practice components and treatment response for treated words only., Discussion: Findings were consistent with the second hypothesis: Retrieval practice, but not feature verification practice, appears to be a practice-related predictor of treatment response in SFV. However, treatment components are likely interdependent, and feature verification may still be an active ingredient in SFV. Further research is needed to evaluate the causal role of treatment components on treatment outcomes in aphasia.

The Rehabilitation Treatment Specification System (RTSS) was developed as a systematic way to describe rehabilitation treatments for the purpose of both research and practice. The RTSS groups treatments by type and describes them by 3 elements: the treatment (1) ingredients and (2) the mechanisms of action that yield changes in the (3) target behavior. Adopting the RTSS has the potential to improve consistency in research, allowing for better cross-study comparisons to strengthen the body of research supporting various treatments. Because it is still early in its development, the RTSS has not yet been widely implemented across different rehabilitation disciplines. In particular, aphasia recovery is one area of rehabilitation that could benefit from a unifying framework. Accordingly, this article is part of a series where we illustrate how the RTSS can be applied to aphasia treatment and research. This article more specifically focuses on examining the neurobiological mechanisms of action associated with experimental aphasia therapies, including brain stimulation and pharmacologic intervention, as well as more traditional behavioral therapy. Key elements of the RTSS are described, and 4 example studies are used to illustrate how the RTSS can be implemented. The benefits of a unifying framework for the future of aphasia treatment research and practice are discussed., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate articles in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose This meta-analysis synthesizes published studies using "treatment of underlying forms" (TUF) for sentence-level deficits in people with aphasia (PWA). The study aims were to examine group-level evidence for TUF efficacy, to characterize the effects of treatment-related variables (sentence structural family and complexity; treatment dose) in relation to the Complexity Account of Treatment Efficacy (CATE) hypothesis, and to examine the effects of person-level variables (aphasia severity, sentence comprehension impairment, and time postonset of aphasia) on TUF response. Method Data from 13 single-subject, multiple-baseline TUF studies, including 46 PWA, were analyzed. Bayesian generalized linear mixed-effects interrupted time series models were used to assess the effect of treatment-related variables on probe accuracy during baseline and treatment. The moderating influence of person-level variables on TUF response was also investigated. Results The results provide group-level evidence for TUF efficacy demonstrating increased probe accuracy during treatment compared with baseline phases. Greater amounts of TUF were associated with larger increases in accuracy, with greater gains for treated than untreated sentences. The findings revealed generalization effects for sentences that were of the same family but less complex than treated sentences. Aphasia severity may moderate TUF response, with people with milder aphasia demonstrating greater gains compared with people with more severe aphasia. Sentence comprehension performance did not moderate TUF response. Greater time postonset of aphasia was associated with smaller improvements for treated sentences but not for untreated sentences. Conclusions Our results provide generalizable group-level evidence of TUF efficacy. Treatment and generalization responses were consistent with the CATE hypothesis. Model results also identified person-level moderators of TUF (aphasia severity, time postonset of aphasia) and preliminary estimates of the effects of varying amounts of TUF for treated and untreated sentences. Taken together, these findings add to the TUF evidence and may guide future TUF treatment-candidate selection. Supplemental Material https://doi.org/10.23641/asha.16828630.

Metacognitive strategy training shows promise for reducing disability following stroke, but previous trials have excluded people with aphasia. Considering the high incidence of poststroke aphasia, it is important to determine whether people with aphasia can benefit from strategy training. The purpose of this study was to determine the feasibility of an adapted strategy training protocol for people with aphasia. We recruited 16 adults with mild-moderate aphasia from inpatient stroke rehabilitation. We examined recruitment and retention, intervention delivery and fidelity, participant engagement and communication, participant strategy mastery, and change in disability. Therapists demonstrated good fidelity to intervention elements. Participants demonstrated good engagement and fair communication. The sample achieved a mean Functional Independence Measure change of 21.8 ( SD = 16.2, Cohen's d = .95), similar to matched controls without aphasia from previous trials. An adapted strategy training protocol appears feasible for people with aphasia in inpatient stroke rehabilitation. Future studies should examine the efficacy of this approach in larger samples.

Purpose The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed-accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV). Method Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of "pass" responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed. Results Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of "pass" responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency. Conclusions BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy. Supplemental Material https://doi.org/10.23641/asha.14935812.

The Aphasia Communication Outcome Measure (ACOM) is a patient-reported measure of communicative functioning developed for persons with stroke-induced aphasia. It was motivated by the desire to include the perspective of persons with aphasia in the measurement of treatment outcomes and to apply newly accessible psychometric tools to improve the quality and usefulness of available outcome measures for aphasia. The ACOM was developed within an item response theory framework, and the validity of the score estimates it provides is supported by evidence based on its content, internal structure, relationships with other variables, stability over time, and responsiveness to treatment. This article summarizes the background and motivation for the ACOM, the steps in its initial development, evidence supporting its validity as a measure of patient-reported communication functioning, and current recommendations for interpreting change scores., Competing Interests: P.J.D. and W.D.H. report Grants from the Veterans Affairs Rehabilitation Research and Development Service, during the conduct of the study. W.D.H. reports consulting fees from the University of Delaware and a speaking fee from Twin Cities Speech-Language Pathologists associated with the work., (Thieme. All rights reserved.)

Anomia assessment is a fundamental component of clinical practice and research inquiries involving individuals with aphasia, and confrontation naming tasks are among the most commonly used tools for quantifying anomia severity. While currently available confrontation naming tests possess many ideal properties, they are ultimately limited by the overarching psychometric framework they were developed within. Here, we discuss the challenges inherent to confrontation naming tests and present a modern alternative to test development called item response theory (IRT). Key concepts of IRT approaches are reviewed in relation to their relevance to aphasiology, highlighting the ability of IRT to create flexible and efficient tests that yield precise measurements of anomia severity. Empirical evidence from our research group on the application of IRT methods to a commonly used confrontation naming test is discussed, along with future avenues for test development., Competing Interests: W.D.H. reports grants from Portland State University, during the conduct of the study., (Thieme. All rights reserved.)

Background: Current neurocognitive models of language function have been primarily built from evidence regarding object naming, and their hypothesized white-matter circuit mechanisms tend to be coarse grained. Methods: In this cross-sectional, observational study, we used novel correlational tractography to assess the white-matter circuit mechanism behind verb retrieval , measured through action picture-naming performance in adults with chronic aphasia. Results: The analysis identified tracts implicated in current neurocognitive dual-stream models of language function, including the left inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and arcuate fasciculus. However, the majority of tracts associated with verb retrieval were not ones included in dual-stream models of language function. Instead, they were projection pathways that connect frontal and parietal cortices to subcortical regions associated with motor functions, including the left corticothalamic pathway, frontopontine tract, parietopontine tract, corticostriatal pathway, and corticospinal tract. Conclusions: These results highlight that corticosubcortical projection pathways implicated in motor functions may be importantly related to language function. This finding is consistent with grounded accounts of cognition and may furthermore inform neurocognitive models. Impact statement This study suggests that in addition to traditional dual-stream language fiber tracts, the integrity of projection pathways that connect frontal and parietal cortices to subcortical motor regions may be critically associated with verb-retrieval impairments in adults with aphasia. This finding challenges neurological models of language function.

Purpose Semantic feature analysis (SFA) is a naming treatment found to improve naming performance for both treated and semantically related untreated words in aphasia. A crucial treatment component is the requirement that patients generate semantic features of treated items. This article examined the role feature generation plays in treatment response to SFA in several ways: It attempted to replicate preliminary findings from Gravier et al. (2018), which found feature generation predicted treatment-related gains for both trained and untrained words. It examined whether feature diversity or the number of features generated in specific categories differentially affected SFA treatment outcomes. Method SFA was administered to 44 participants with chronic aphasia daily for 4 weeks. Treatment was administered to multiple lists sequentially in a multiple-baseline design. Participant-generated features were captured during treatment and coded in terms of feature category, total average number of features generated per trial, and total number of unique features generated per item. Item-level naming accuracy was analyzed using logistic mixed-effects regression models. Results Producing more participant-generated features was found to improve treatment response for trained but not untrained items in SFA, in contrast to Gravier et al. (2018). There was no effect of participant-generated feature diversity or any differential effect of feature category on SFA treatment outcomes. Conclusions Patient-generated features remain a key predictor of direct training effects and overall treatment response in SFA. Aphasia severity was also a significant predictor of treatment outcomes. Future work should focus on identifying potential nonresponders to therapy and explore treatment modifications to improve treatment outcomes for these individuals. Supplemental Material https://doi.org/10.23641/asha.12462596.

The information theoretic principle of rational adaptation predicts that individuals with aphasia adapt to their language impairments by relying more heavily on comparatively unimpaired non-linguistic knowledge to communicate. This prediction was examined by assessing the extent to which adults with chronic aphasia due to left-hemisphere stroke rely more on conceptual rather than lexical information during verb retrieval, as compared to age-matched neurotypical controls. A primed verb naming task examined the degree of facilitation each participant group received from either conceptual event-related or lexical collocate cues, compared to unrelated baseline cues. The results provide evidence that adults with aphasia received amplified facilitation from conceptual cues compared to controls, whereas healthy controls received greater facilitation from lexical cues. This indicates that adaptation to alternative and relatively unimpaired information may facilitate successful word retrieval in aphasia. Implications for models of rational adaptation and clinical neurorehabilitation are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dresang, Warren, Hula and Dickey.)

While current dual-steam neurocognitive models of language function have coalesced around the view that distinct neuroanatomical networks subserve semantic and phonological processing, respectively, the specific white matter components of these networks remain a matter of debate. To inform this debate, we investigated relationships between structural white matter connectivity and word production in a cross-sectional study of 42 participants with aphasia due to unilateral left hemisphere stroke. Specifically, we reconstructed a local connectome matrix for each participant from diffusion spectrum imaging data and regressed these matrices on indices of semantic and phonological ability derived from their responses to a picture-naming test and a computational model of word production. These connectometry analyses indicated that both dorsally located (arcuate fasciculus) and ventrally located (inferior frontal-occipital, uncinate, and middle longitudinal fasciculi) tracts were associated with semantic ability, while associations with phonological ability were more dorsally situated, including the arcuate and middle longitudinal fasciculi. Associations with limbic pathways including the posterior cingulum bundle and the fornix were also found. All analyses controlled for total lesion volume and all results showing positive associations obtained false discovery rates < 0.05. These results challenge dual-stream accounts that deny a role for the arcuate fasciculus in semantic processing, and for ventral-stream pathways in language production. They also illuminate limbic contributions to both semantic and phonological processing for word production., (Published by Oxford University Press on behalf of the Guarantors of Brain 2020. This work is written by US Government employees and is in the public domain in the US.)

Purpose Aphasia is a language disorder caused by acquired brain injury, which generally involves difficulty naming objects. Naming ability is assessed by measuring picture naming, and models of naming performance have mostly focused on accuracy and excluded valuable response time (RT) information. Previous approaches have therefore ignored the issue of processing efficiency, defined here in terms of optimal RT cutoff, that is, the shortest deadline at which individual people with aphasia produce their best possible naming accuracy performance. The goals of this study were therefore to (a) develop a novel model of aphasia picture naming that could accurately account for RT distributions across response types; (b) use this model to estimate the optimal RT cutoff for individual people with aphasia; and (c) explore the relationships between optimal RT cutoff, accuracy, naming ability, and aphasia severity. Method A total of 4,021 naming trials across 10 people with aphasia were scored for accuracy and RT onset. Data were fit using a novel ex-Gaussian multinomial RT model, which was then used to characterize individual optimal RT cutoffs. Results Overall, the model fitted the empirical data well and provided reliable individual estimates of optimal RT cutoff in picture naming. Optimal cutoffs ranged between approximately 5 and 10 s, which has important implications for assessment and treatment. There was no direct relationship between aphasia severity, naming RT, and optimal RT cutoff. Conclusion The multinomial ex-Gaussian modeling approach appears to be a promising and straightforward way to estimate optimal RT cutoffs in picture naming in aphasia. Limitations and future directions are discussed.

Purpose The patient's perspective of their health is a core component of evidence-based practice (EBP) and person-centered care. Patient-reported outcomes (PROs), captured with PRO measures (PROMs), are the main way of formally soliciting and measuring the patient's perspective. Currently, however, PROs play a relatively small role in mainstream speech-language pathology practice. The purpose of this article is to raise important questions about how PROs could be applied to EBP in speech-language pathology for individuals with communication disorders and to propose preliminary approaches to address some of these questions. Method Based on a narrative review of the literature, this article introduces relevant terminology and broadly describes PRO applications in other health care fields. The article also raises questions related to PRO-informed clinical practice in speech-language pathology. To address some of these questions, the article explores previous research to provide suggestions for clinical administration, interpretation, and future research. Conclusion More routine measurement of subjective health constructs via PROMs-for example, constructs such as effort, participation, self-efficacy, and psychosocial functioning-may improve EBP. More routine use of PROMs could significantly expand the information that is available to clinicians about individual clients and add to the evidence base for the profession of speech-language pathology. However, careful consideration and more research are needed on how to capture and interpret PROs from individuals with cognitive and language disorders.

Purpose The aim of this study was to examine the effects of dose frequency, an aspect of treatment intensity, on articulation outcomes of sound production treatment (SPT). Method Twelve speakers with apraxia of speech and aphasia received SPT administered with an intense dose frequency and a nonintense/traditional dose frequency (SPT-T). Each participant received both treatment intensities in the context of multiple baseline designs across behaviors. SPT-Intense was provided for 3 hourly sessions per day/3 days per week; and SPT-T for 1 hour-long session per day/3 days per week. Twenty-seven treatment sessions were completed with each phase of treatment. Articulation accuracy was measured in probes of production of treated and untreated words. Results All participants achieved improved articulation of treated words with both intensities; there were no notable differences in magnitude of improvement associated with dose frequency. Positive response generalization to untrained words was found in 21 of 24 treatment applications; the cases of negligible response generalization occurred with SPT-T words. Conclusions Dose frequency (and corresponding total intervention duration) did not appear to impact treatment response for treated items. Disparate response generalization findings for 3 participants in the current study may relate to participant characteristics such as apraxia of speech severity and/or stimuli factors.

Purpose The purpose of this study was to verify the equivalence of 2 alternate test forms with nonoverlapping content generated by an item response theory (IRT)-based computer-adaptive test (CAT). The Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996)was utilized as an item bank in a prospective, independent sample of persons with aphasia. Method Two alternate CAT short forms of the PNT were administered to a sample of 25 persons with aphasia who were at least 6 months postonset and received no treatment for 2 weeks before or during the study. The 1st session included administration of a 30-item PNT-CAT, and the 2nd session, conducted approximately 2 weeks later, included a variable-length PNT-CAT that excluded items administered in the 1st session and terminated when the modeled precision of the ability estimate was equal to or greater than the value obtained in the 1st session. The ability estimates were analyzed in a Bayesian framework. Results The 2 test versions correlated highly ( r = .89) and obtained means and standard deviations that were not credibly different from one another. The correlation and error variance between the 2 test versions were well predicted by the IRT measurement model. Discussion The results suggest that IRT-based CAT alternate forms may be productively used in the assessment of anomia. IRT methods offer advantages for the efficient and sensitive measurement of change over time. Future work should consider the potential impact of differential item functioning due to person factors and intervention-specific effects, as well as expanding the item bank to maximize the clinical utility of the test. Supplemental Material https://doi.org/10.23641/asha.11368040.

Purpose This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined. Method Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics. Results There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia. Conclusion Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process. Supplemental Material https://doi.org/10.23641/asha.9701690.

Purpose of Review: Aphasia is often characterized in terms of subtype and severity, yet these constructs have limited explanatory power, because aphasia is inherently multifactorial both in its neural substrates and in its symptomatology. The purpose of this review is to survey current and emerging multivariate approaches to understanding aphasia., Recent Findings: Techniques such as factor analysis and principal component analysis have been used to define latent underlying factors that can account for performance on batteries of speech and language tests, and for characteristics of spontaneous speech production. Multivariate lesion-symptom mapping has been shown to outperform univariate approaches to lesion-symptom mapping for identifying brain regions where damage is associated with specific speech and language deficits. It is increasingly clear that structural damage results in functional changes in wider neural networks, which mediate speech and language outcomes. Multivariate statistical approaches are essential for understanding the complex relationships between the neural substrates of aphasia, and resultant profiles of speech and language function.

Purpose In this study, we investigated the agreement between the 175-item Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996 ) and a 30-item computer adaptive PNT (PNT-CAT; Fergadiotis, Kellough, & Hula, 2015 ; Hula, Kellough, & Fergadiotis, 2015 ) created using item response theory (IRT) methods. Method The full PNT and the PNT-CAT were administered to 47 participants with aphasia in counterbalanced order. Latent trait-naming ability estimates for the 2 PNT versions were analyzed in a Bayesian framework, and the agreement between them was evaluated using correlation and measures of constant, variable, and total error. We also evaluated the extent to which individual pairwise differences were credibly greater than 0 and whether the IRT measurement model provided an adequate indication of the precision of individual score estimates. Results The agreement between the PNT and the PNT-CAT was strong, as indicated by high correlation ( r = .95, 95% CI [.92, .97]), negligible bias, and low variable and total error. The number of statistically robust pairwise score differences did not credibly exceed the Type I error rate, and the precision of individual score estimates was reasonably well predicted by the IRT model. Discussion The strong agreement between the full PNT and the PNT-CAT suggests that the latter is a suitable measurement of anomia in group studies. The relatively robust estimates of score precision also suggest that the PNT-CAT can be useful for the clinical assessment of anomia in individual cases. Finally, the IRT methods used to construct the PNT-CAT provide a framework for additional development to further reduce measurement error. Supplemental Material https://doi.org/10.23641/asha.8202176.

Purpose After stroke, how well do people with aphasia (PWA) adapt to the altered functioning of their language system? When completing a language-dependent task, how well do PWA balance speed and accuracy when the goal is to respond both as quickly and accurately as possible? The current work investigates adaptation theory ( Kolk & Heeschen, 1990 ) in the context of speed-accuracy trade-offs in a lexical decision task. PWA were predicted to set less beneficial speed-accuracy trade-offs than matched controls, and at least some PWA were predicted to present with adaptation deficits, with impaired accuracy or response times attributable to speed-accuracy trade-offs. Method The study used the diffusion model ( Ratcliff, 1978 ), a computational model of response time for simple 2-choice tasks. Parameters of the model can be used to distinguish basic processing efficiency from the overall level of caution in setting response thresholds and were used here to characterize speed-accuracy trade-offs in 20 PWA and matched controls during a lexical decision task. Results Models showed that PWA and matched control groups did not differ overall in how they set response thresholds for speed-accuracy trade-offs. However, case series analyses showed that 40% of the PWA group displayed the predicted adaptation deficits, with impaired accuracy or response time performance directly attributable to overly cautious or overly incautious response thresholds. Conclusions Maladaptive speed-accuracy trade-offs appear to be present in some PWA during lexical decision, leading to adaptation deficits in performance. These adaptation deficits are potentially treatable, and clinical implications and next steps for translational research are discussed.

Background: Item response theory (IRT; Lord & Novick, 1968) is a psychometric framework that can be used to model the likelihood that an individual will respond correctly to an item. Using archival data (Mirman et al., 2010), Fergadiotis, Kellough, and Hula (2015) estimated difficulty parameters for the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996) using the 1-parameter logistic IRT model. Although the use of IRT in test development is advantageous, its reliance on sample sizes exceeding 200 participants make it difficult to implement in aphasiology. Therefore, alternate means of estimating the item difficulty of confrontation naming test items warrant investigation. In a preliminary study aimed at automatic item calibration, Swiderski, Fergadiotis, and Hula (2016) regressed the difficulty parameters from the PNT on word length, age of acquisition (Kuperman et al., 2012), lexical frequency as quantified by the Log10CD index (Brysbaert & New, 2009), and naming latency (Székely et al., 2003). Although this model successfully explained a substantial proportion of variance in the PNT difficulty parameters, a substantial proportion (20%) of the response time data were missing. Further, only 39% of the picture stimuli from Székely and colleagues (2003) were identical to those on the PNT. Given that the IRT sample size requirements limit traditional calibration approaches in aphasiology and that the initial attempts in predicting IRT difficulty parameters in our pilot study were based on incomplete response time data this study has two specific aims., Aims: To estimate naming latencies for the 175 items on the PNT, and assess the utility of psycholinguistic variables and naming latencies for predicting item difficulty., Methods and Procedures: Using a speeded picture naming task we estimated mean naming latencies for the 175 items of the Philadelphia Naming test in 44 cognitively healthy adults. We then re-estimated the model reported by Swiderski et al (2016) with the new naming latency data., Results: The predictor variables described above accounted for a substantial proportion of the variance in the item difficulty parameters ( Adj. R 2 = .692)., Conclusions: In this study we demonstrated that word length, age of acquisition, lexical frequency, and naming latency from neurotypical young adults usefully predict picture naming item difficulty in people with aphasia. These variables are readily available or easily obtained and the regression model reported may be useful for estimating confrontation naming item difficulty without the need for collection of response data from large samples of people with aphasia.

The human inferior longitudinal fasciculus (ILF) is a ventral, temporo-occipital association tract. Though described in early neuroanatomical works, its existence was later questioned. Application of in vivo tractography to the neuroanatomical study of the ILF has generally confirmed its existence, however, consensus is lacking regarding its subdivision, laterality and connectivity. Further, there is a paucity of detailed neuroanatomic data pertaining to the exact anatomy of the ILF. Generalized Q-Sampling imaging (GQI) is a non-tensor tractographic modality permitting high resolution imaging of white-matter structures. As it is a non-tensor modality, it permits visualization of crossing fibers and accurate delineation of close-proximity fiber-systems. We applied deterministic GQI tractography to data from 30 healthy subjects and a large-volume, averaged diffusion atlas, to delineate ILF anatomy. Post-mortem white matter dissection was also carried out in three cadaveric specimens for further validation. The ILF was found in all 60 hemispheres. At its occipital extremity, ILF fascicles demonstrated a bifurcated, ventral-dorsal morphological termination pattern, which we used to further subdivide the bundle for detailed analysis. These divisions were consistent across the subject set and within the atlas. We applied quantitative techniques to study connectivity strength of the ILF at its anterior and posterior extremities. Overall, both morphological divisions, and the un-separated ILF, demonstrated strong leftward-lateralized connectivity patterns. Leftward-lateralization was also found for ILF volumes across the subject set. Due to connective and volumetric leftward-dominance and ventral location, we postulate the ILFs role in the semantic system. Further, our results are in agreement with functional and lesion-based postulations pertaining to the ILFs role in facial recognition.

Purpose: This investigation was designed to examine the effects of treatment intensity (i.e., dose frequency) on the outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech., Method: Five men with chronic apraxia of speech and aphasia received both intense SPT (3 hr per day/3 days per week) and nonintense/traditional SPT (SPT-T; 1 hr per day/3 days per week) in the context of single-case experimental designs. Each treatment was applied separately to a designated set of experimental words with 1 treatment applied at a time. Twenty-seven treatment sessions were conducted with each phase of treatment. Accuracy of articulation of target sounds within treated and untreated experimental words was measured during the course of the investigation., Results: All participants demonstrated improved articulation with both treatment intensities. Better maintenance of gains for treated items was found with SPT-T for 2 participants as measured at an 8-week posttreatment retention probe. Superior maintenance of increased accuracy of production of untreated items was also observed with SPT-T for all participants., Conclusion: A less intense (distributed) application of SPT facilitated better maintenance of improved articulatory accuracy for untreated items, and in some cases treated items, than intense SPT., Supplemental Materials: https://doi.org/10.23641/asha.5734053.

Purpose: This study investigated the predictive value of practice-related variables-number of treatment trials delivered, total treatment time, average number of trials per hour, and average number of participant-generated features per trial-in response to semantic feature analysis (SFA) treatment., Method: SFA was administered to 17 participants with chronic aphasia daily for 4 weeks. Individualized treatment and semantically related probe lists were generated from items that participants were unable to name consistently during baseline testing. Treatment was administered to each list sequentially in a multiple-baseline design. Naming accuracy for treated and untreated items was obtained at study entry, exit, and 1-month follow-up., Results: Item-level naming accuracy was analyzed using logistic mixed-effect regression models. The average number of features generated per trial positively predicted naming accuracy for both treated and untreated items, at exit and follow-up. In contrast, total treatment time and average trials per hour did not significantly predict treatment response. The predictive effect of number of treatment trials on naming accuracy trended toward significance at exit, although this relationship held for treated items only., Conclusions: These results suggest that the number of patient-generated features may be more strongly associated with SFA-related naming outcomes, particularly generalization and maintenance, than other practice-related variables., Supplemental Materials: https://doi.org/10.23641/asha.5734113.

Purpose: The inferior fronto-occipital fasciculus (IFOF) and uncinate fasciculus (UF) are major fronto-capsular white matter pathways. IFOF connects frontal areas of the brain to parieto-occipital areas. UF connects ventral frontal areas to anterior temporal areas. Both fascicles are thought to subserve higher language and emotion roles. Controversy pertaining to their connectivity and subdivision persists in the literature, however., Methods: High-definition fiber tractography (HDFT) is a non-tensor tractographic method using diffusion spectrum imaging data. Its major advantage over tensor-based tractography is its ability to trace crossing fiber pathways. We used HDFT to investigate subdivisions and cortical connectivity of IFOF and UF in 30 single subjects and in an atlas comprising averaged data from 842 individuals. A per-subject aligned, atlas-based approach was employed to seed fiber tracts and to study cortical terminations., Results: For IFOF, we observed a tripartite arrangement corresponding to ventrolateral, ventromedial, and dorsomedial frontal origins. IFOF volume was not significantly lateralized to either hemisphere. UF fibers arose from ventromedial and ventrolateral frontal areas on the left and from ventromedial frontal areas on the right. UF volume was significantly lateralized to the left hemisphere. The data from the averaged atlas was largely in concordance with subject-specific findings. IFOF connected to parietal, occipital, but not temporal, areas. UF connected predominantly to temporal poles., Conclusion: Both IFOF and UF possess subdivided arrangements according to their frontal origin. Our connectivity results indicate the multifunctional involvement of IFOF and UF in language tasks. We discuss our findings in context of the tractographic literature.

Purpose: In this study, we investigated the fit of the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996) to an item-response-theory measurement model, estimated the precision of the resulting scores and item parameters, and provided a theoretical rationale for the interpretation of PNT overall scores by relating explanatory variables to item difficulty. This article describes the statistical model underlying the computer adaptive PNT presented in a companion article (Hula, Kellough, & Fergadiotis, 2015)., Method: Using archival data, we evaluated the fit of the PNT to 1- and 2-parameter logistic models and examined the precision of the resulting parameter estimates. We regressed the item difficulty estimates on three predictor variables: word length, age of acquisition, and contextual diversity., Results: The 2-parameter logistic model demonstrated marginally better fit, but the fit of the 1-parameter logistic model was adequate. Precision was excellent for both person ability and item difficulty estimates. Word length, age of acquisition, and contextual diversity all independently contributed to variance in item difficulty., Conclusions: Item-response-theory methods can be productively used to analyze and quantify anomia severity in aphasia. Regression of item difficulty on lexical variables supported the validity of the PNT and interpretation of anomia severity scores in the context of current word-finding models.

Purpose: The purpose of this study was to develop a computerized adaptive test (CAT) version of the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996), to reduce test length while maximizing measurement precision. This article is a direct extension of a companion article (Fergadiotis, Kellough, & Hula, 2015), in which we fitted the PNT to a 1-parameter logistic item-response-theory model and examined the validity and precision of the resulting item parameter and ability score estimates., Method: Using archival data collected from participants with aphasia, we simulated two PNT-CAT versions and two previously published static PNT short forms, and compared the resulting ability score estimates to estimates obtained from the full 175-item PNT. We used a jackknife procedure to maintain independence of the samples used for item estimation and CAT simulation., Results: The PNT-CAT recovered full PNT scores with equal or better accuracy than the static short forms. Measurement precision was also greater for the PNT-CAT than the static short forms, though comparison of adaptive and static nonoverlapping alternate forms showed minimal differences between the two approaches., Conclusion: These results suggest that CAT assessment of naming in aphasia has the potential to reduce test burden while maximizing the accuracy and precision of score estimates.

Purpose: The purpose of this study is to investigate the structure and measurement properties of the Aphasia Communication Outcome Measure (ACOM), a patient-reported outcome measure of communicative functioning for persons with aphasia., Method: Three hundred twenty-nine participants with aphasia responded to 177 items asking about communicative functioning. The data were analyzed using a categorical item factor analysis approach. Validity of ACOM scores on the basis of their convergence with performance-based, clinician-reported, and surrogate-reported assessments of communication was also assessed., Results: Fifty-nine items that obtained adequate fit to a modified bifactor measurement model and functioned similarly across several demographic and clinical subgroupings were identified. The factor model estimates were transformed to item response theory graded response model parameters, and the resulting score estimates showed good precision and moderately strong convergence with other measures of communicative ability and functioning. A free software application for administration and scoring of the ACOM item bank is available from the first author., Conclusions: The ACOM provides reliable measurement of patient-reported communicative functioning in aphasia. The results supported the validity of ACOM scores insofar as (a) factor analyses provided support for a coherent measurement model, (b) items functioned similarly across demographic and clinical subgroups, and (c) scores showed good convergence with measures of related constructs.

Purpose: The purpose of this article is to describe the rationale, clinical processes, and outcomes of an intensive comprehensive aphasia program (ICAP)., Method: Seventy-three community-dwelling adults with aphasia completed a residentially based ICAP. Participants received 5 hr of daily 1:1 evidence-based cognitive-linguistically oriented aphasia therapy, supplemented with weekly socially oriented and therapeutic group activities over a 23-day treatment course. Standardized measures of aphasia severity and communicative functioning were obtained at baseline, program entry, program exit, and follow-up. Results were analyzed using a Bayesian latent growth curve model with 2 factors representing (a) the initial level and (b) change over time, respectively, for each outcome measure., Results: Model parameter estimates showed reliable improvement on all outcome measures between the initial and final assessments. Improvement during the treatment interval was greater than change observed across the baseline interval, and gains were maintained at follow-up on all measures., Conclusions: The rationale, clinical processes, and outcomes of a residentially based ICAP have been described. ICAPs differ with respect to treatments delivered, dosing parameters, and outcomes measured. Specifying the defining components of complex interventions, establishing their feasibility, and describing their outcomes are necessary to guide the development of controlled clinical trials.

Research into intensive comprehensive aphasia programs (ICAPs) has yet to show that this service delivery model is efficacious, effective, has cost utility, or can be broadly implemented. This article describes a phased research approach to the study of ICAPs and sets out a research agenda that considers not only the specific issues surrounding ICAPs, but also the phase of the research. Current ICAP research is in the early phases, with dosing and outcome measurement as prime considerations as well as refinement of the best treatment protocol. Later phases of ICAP research are outlined, and the need for larger scale collaborative funded research is recognized. The need for more rapid translation into practice is also acknowledged, and the use of hybrid models of phased research is encouraged within the ICAP research agenda.

Purpose: To evaluate the dimensionality and measurement invariance of the aphasia communication outcome measure (ACOM), a self- and surrogate-reported measure of communicative functioning in aphasia., Methods: Responses to a large pool of items describing communication activities were collected from 133 community-dwelling persons with aphasia of ≥ 1 month post-onset and their associated surrogate respondents. These responses were evaluated using confirmatory and exploratory factor analysis. Chi-square difference tests of nested factor models were used to evaluate patient-surrogate measurement invariance and the equality of factor score means and variances. Association and agreement between self- and surrogate reports were examined using correlation and scatterplots of pairwise patient-surrogate differences., Results: Three single-factor scales (Talking, Comprehension, and Writing) approximating patient-surrogate measurement invariance were identified. The variance of patient-reported scores on the Talking and Writing scales was higher than surrogate-reported variances on these scales. Correlations between self- and surrogate reports were moderate-to-strong, but there were significant disagreements in a substantial number of individual cases., Conclusions: Despite minimal bias and relatively strong association, surrogate reports of communicative functioning in aphasia are not reliable substitutes for self-reports by persons with aphasia. Furthermore, although measurement invariance is necessary for direct comparison of self- and surrogate reports, the costs of obtaining invariance in terms of scale reliability and content validity may be substantial. Development of non-invariant self- and surrogate report scales may be preferable for some applications.

Purpose: The purpose of this study was to identify the most appropriate item response theory (IRT) measurement model for aphasia tests requiring 2-choice responses and to determine whether small samples are adequate for estimating such models., Method: Pyramids and Palm Trees (Howard & Patterson, 1992) test data that had been collected from individuals with aphasia were analyzed, and the resulting item and person estimates were used to develop simulated test data for 3 sample size conditions. The simulated data were analyzed using a standard 1-parameter logistic (1-PL) model and 3 models that accounted for the influence of guessing: augmented 1-PL and 2-PL models and a 3-PL model. The model estimates obtained from the simulated data were compared to their known true values., Results: With small and medium sample sizes, an augmented 1-PL model was the most accurate at recovering the known item and person parameters; however, no model performed well at any sample size. Follow-up simulations confirmed that the large influence of guessing and the extreme easiness of the items contributed substantially to the poor estimation of item difficulty and person ability., Conclusion: Incorporating the assumption of guessing into IRT models improves parameter estimation accuracy, even for small samples. However, caution should be exercised in interpreting scores obtained from easy 2-choice tests, regardless of whether IRT modeling or percentage correct scoring is used.

Purpose: To present a primarily conceptual introduction to item response theory (IRT) and Rasch models for speech-language pathologists (SLPs)., Method: This tutorial introduces SLPs to basic concepts and terminology related to IRT as well as the most common IRT models. The article then continues with an overview of how instruments are developed using IRT and some basic principles of adaptive testing., Conclusion: IRT is a set of statistical methods that are increasingly used for developing instruments in speech-language pathology. While IRT is not new, its application in speech-language pathology to date has been relatively limited in scope. Several new IRT-based instruments are currently emerging. IRT differs from traditional methods for test development, typically referred to as classical test theory (CTT), in several theoretical and practical ways. Administration, scoring, and interpretation of IRT instruments are different from methods used for most traditional CTT instruments. SLPs will need to understand the basic concepts of IRT instruments to use these tools in their clinical and research work. This article provides an introduction to IRT concepts drawing on examples from speech-language pathology.

Objectives: To examine the dimensionality of scales for measuring patient-reported cognitive and communicative functioning in a sample of stroke survivors and to evaluate the consequences for measurement of treating them as a single, undifferentiated construct., Design: Secondary analysis of existing cross-sectional data., Setting: Data were collected in outpatient rehabilitation clinics and in the community., Participants: Unilateral stroke survivors (N=316) 3 months or more postonset referred for participation in research., Interventions: Not applicable., Main Outcome Measures: The Burden of Stroke Scale cognition and communication domain scales were evaluated by using confirmatory factor analysis, Rasch analysis, and tests of differential item functioning (DIF). To evaluate the impact of multidimensionality on the measurement of individual patients, separately estimated cognition and communication scores were compared. Combined and separately estimated scores were also examined for responsiveness to group differences in the presence of cognitive and communicative impairment., Results: Factor analysis and Rasch model fit analyses equivocally supported the unidimensionality of the item pool. DIF analyses between participants with right versus left hemisphere stroke suggested multidimensionality. Scaling cognition and communication items separately resulted in different person scores for a significant number of patients and greater responsiveness to group differences., Conclusions: Patient-reported scales assessing communication along with more general cognitive activities may possess an internal structure that is inconsistent with a unidimensional measurement model with potential negative consequences for measurement., (Published by Elsevier Inc.)

Aphasia has traditionally been viewed as a loss or impairment of language. However, evidence is presented suggesting that language mechanisms are fundamentally preserved and that aphasic language behaviors are instead due to impairments of cognitive processes supporting their construction. These processes may be understood as a linguistically specialized attentional system that is vulnerable to competition from other processing domains. We present two models of attention that focus on competition for central processing and discuss findings from dual-task studies of normal and aphasic performance. First, competing language and nonlanguage tasks appear to share limited-capacity, parallel processing resources. Second, aphasic individuals demonstrate slowed central processing that could be due to a reduction in processing capacity or ability to allocate that capacity. Third, the attention models discussed bear a coherent relationship to current models of language processing. Clinical implications of a cognitive processing account of aphasia are also considered.

Purpose: In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005., Method: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles., Conclusion: Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

Objectives: To examine the reliability, validity, and responsiveness of the Burden of Stroke Scale (BOSS)., Study Design: A prospective cohort of stroke survivors were assessed at 3 (T1, T2), 6 (T3), and 12 (T4) months post onset (MPO) of stroke. Test-retest reliability was evaluated by calculating intra-class correlation coefficients (ICCs) between T1 and T2 scale scores. Convergent validity was evaluated by calculating Pearson product moment correlation coefficients between T1 BOSS, Stroke Impact Scale and MOS SF-36 scale scores assessing similar health concepts. Responsiveness was evaluated using a repeated measures ANOVA and the linear trend test in the full study sample and by calculating standardized response means (SRM) and a probability of change statistic, p between T1, T3, and T4 scale scores in participants demonstrating change on external criteria., Results: ICCs ranged from 0.78 to 0.94. Pearson coefficients ranged from -0.57 to -0.86. Moderate to high responsiveness estimates were obtained for 9 of 12 subscales with SRM (p) values ranging from .497 (.690) to 1.161 (.877). Composite scale SRM (p) values ranged from .661 (.746) to 1.192 (.883)., Conclusions: The BOSS provided valid and reliable score estimates that were responsive to positive changes in functioning and well-being during the first year of recovery from stroke.

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.

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.

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.