Search

Following a traumatic brain injury (TBI), people frequently have difficulty understanding nonliteral language, including irony and indirect requests. Despite the handicap that these disorders can represent in daily life, they are rarely treated clinically, and remediation studies are scarce. The present study thus aimed to evaluate the effectiveness of an explicit metapragmatic therapy targeting nonliteral language comprehension and taking into account cognitive processes likely to underlie this comprehension (i.e., contextual processing, theory of mind, and executive functions). This study was registered on the ClinicalTrials.gov system (ID: NCT04708561) before participant recruitment. Two adults with severe TBI took part in the study. An ABA design with multiple baselines was used to assess the evolution of treated and non-treated written literal and nonliteral story comprehension, as well as ecological tasks and tasks assessing the cognitive processes of interest (theory of mind and executive functions). An interview was also conducted at the end of treatment to assess participant satisfaction. Therapy resulted in significant improvement in treated items, with one-month maintenance of gains and generalisation to untreated items in both participants. The generalisation to a working memory task was also observed in one participant. Finally, participant satisfaction with the treatment was high. Our study demonstrated for the first time the potential of a therapy targeting irony and indirect request comprehension in TBI individuals. Clinically, it offers concrete therapeutic avenues and fills a critical gap in the TBI population's evidence for the remediation of nonliteral language comprehension. [ABSTRACT FROM AUTHOR]

Background: Whilst reading difficulties are a common feature of aphasia, there has been limited consideration of the impact of these difficulties on how people with aphasia experience reading in their everyday lives. Previous studies, using semi-structured interviews, have highlighted the need to consider reading from the perspective of the individual due to the complexity of factors influencing reading and individual variation in practices and preferences. These studies have contributed to our understanding of the individual's perspective but have been restricted to people with less severe aphasia and some expressive ability. We need tools to facilitate understanding the personal perspective of people across the severity range that are feasible within a clinical setting. Aims: The aim of this study was to investigate people with aphasia's perception of their current reading ability and activities and feelings about reading using a questionnaire. The validity, reliability, and clinical usefulness and acceptability of the questionnaire were considered. Methods & Procedures: The questionnaire was developed through an iterative process, involving a review of literature, integration of findings from an interview study, direct consultation with people with aphasia, pilot testing, and review. The questionnaire comprised four sections: A) Current reading, B) Thoughts and feelings about reading, C) Reading activities, and D) Reading strategies. Eighty-one participants completed the questionnaire during a study of reading in people with aphasia. Following completion of data collection, tester feedback was considered and the psychometric properties of the questionnaire in relation to aspects of validity and reliability were analysed. Outcomes & Results: Perception of reading ability, feelings about reading and reading activity varied considerably across participants, with not all individuals reporting difficulties. There was increased perceived difficulty as the length of text increased. Participants highlighted that they were unhappy with their speed of reading. The most common strategies used to support reading were re-reading, slowing down, and reducing distractions. The iterative process resulted in a 29 item questionnaire which had appropriate face validity, construct validity and test re-test reliability and was clinically appropriate and feasible. Conclusions: The study provides additional evidence about the individual variability in reading in people with aphasia, emphasising the importance of considering personal perception alongside formal assessments of reading comprehension. The questionnaire provides a practical and reliable measure of a person's perception of reading post-stroke and has potential as a patient-centred tool, contributing to goal setting and outcome measurement. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of written healthcare information in improving an individual's health status, patients may not be able to sufficiently utilize available resources because of a disparity between the accessibility of online written materials and patients' ability to process that information. For individuals with impairments in written language comprehension, such as persons with aphasia, this disparity may be magnified. It is crucial that written health resources be cognitively accessible, accurate, and understandable for persons with aphasia. Aims: The aims of this study were to: (1) objectively measure the accessibility of current written educational materials for persons with aphasia and (2) examine the relationship between levels of readability, validity, and user-friendliness of materials accessed. Methods & Procedures: Aphasia-related webpages likely to be accessed during an Internet search were retrieved and analysed. These webpages were determined by selecting the first 10 search results generated from entering the terms: "aphasia", "aphasia treatment", and "aphasia help", into Google, Bing, and Yahoo. This method resulted in 30 website resources per search engine. For each webpage, readability was evaluated using the following readability formulae: Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level (F-K), Simple Measure of Gobbledygook, and FORCAST. Additionally, validity and user-friendliness were evaluated for each webpage using the following measures: Site, Publisher, Audience, Timeliness (SPAT) and Suitability Assessment of Materials (SAM), respectively. Outcomes & Results: A significant disparity was found between the desired and current level of readability, validity, and user-friendliness of the written information provided within the top search results related to aphasia. Based on the readability formulae output the average reading grade level of 10th grade was well above the average 5th grade reading level recommended for written materials. A third of the websites were unacceptable using the SPAT's quality standards and overall user-friendliness was deemed poor with an average SAM score of 27.4 out of 52 total points. No relationship was found between the validity or user-friendliness of websites and their readability. Conclusions: These data clearly demonstrate inadequacies in written web-based information about aphasia across several measures and provide insight into how the presentation of this information can be improved to facilitate useful information dissemination. Highlighting these disparities is important for promoting increased consideration and improvement in the usefulness and accessibility of healthcare information for persons with aphasia. [ABSTRACT FROM AUTHOR]

Background: Gestures can provide an excellent natural alternative to verbal communication in people with aphasia (PWA). However, despite numerous studies focusing on gesture production in aphasia, it is still a matter of debate whether the gesture system remains intact after language impairment and how PWA use gestures to improve communication. A likely source for the contradicting results is that many studies were conducted on individual cases or in heterogeneous groups of individuals with additional cognitive deficits such as conceptual impairment and comorbid conditions such as limb apraxia. Aims: The goal of the current study was to evaluate the integrity and function of gestures in PWA in light of cognitive theories of language-gesture relationship. Since all such theories presuppose the integrity of the conceptual system, and the absence of comorbid conditions that selectively impair gesturing (i.e., limb apraxia), our sample was selected to fulfill these assumptions. Methods & Procedures: We examined gesture production in eight PWA with preserved auditory comprehension, no comorbidities, and various degrees of expressive deficit, as well as 11 age- and education-matched controls, while they described events in 20 normed video clips. Both speech and gesture data were coded for quantitative measures of informativeness, and gestures were grouped into several functional categories (matching, complementary, compensatory, social cueing, and facilitating lexical retrieval) based on correspondence to the accompanying speech. Using rigorous group analyses, individual-case analyses, and analyses of individual differences, we provide converging evidence for the integrity and type of function(s) served by gesturing in PWA. Outcomes & Results: Our results indicate that the gesture system can remain functional even when language production is severely impaired. Our PWA heavily relied on iconic gestures to compensate for their language impairment, and the degree of such compensation was correlated with the extent of language impairment. In addition, we found evidence that producing iconic gestures was related to higher success rates in resolving lexical retrieval difficulties. Conclusions: When comprehension and comorbidities are controlled for, impairment of language and gesture systems is dissociable. In PWA with good comprehension, gesturing can provide an excellent means to both compensate for the impaired language and act as a retrieval cue. Implications for cognitive theories of language-gesture relationship and therapy are discussed. [ABSTRACT FROM AUTHOR]

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA. Aims: This paper presents an analysis of the use ofoh-prefacing by some PWA during therapeutic supported conversations with SLTs. Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs. Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g.,oh right) versus those that continue the conversation, merely claiming understanding (e.g.,right). This use ofoh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treatoh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former. Conclusions: At least some PWA useoh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereasoh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff. [ABSTRACT FROM AUTHOR]