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Purpose: Neurogenic speech and language disorders-such as acquired apraxia of speech (AOS) and aphasia with phonemic paraphasia (APP)-are often misdiagnosed due to similarities in clinical presentation. Word syllable duration (WSD)-a measure of average syllable length in multisyllabic words-serves as a proxy for speech rate, which is an important and arguably more objective clinical characteristic of AOS and APP. This study reports stability of WSD over time for speakers with AOS (and aphasia)., Method: Twenty-nine participants with AOS and aphasia (11 women and 18 men, M age = 53.5 years, SD = 13.3) repeated 30 multisyllabic words (of three-, four-, and five-syllable lengths) on three occasions across 4 weeks. WSDs were calculated for each word and then averaged across each list (i.e., word length), as well as across combined lists (i.e., all 30 words) to yield four WSDs for each participant at each time point. Stability over time was calculated using Friedman's test for the group and using Spearman's rho for the individual level. Effects of time and word length were examined using robust mixed-effects linear regression., Results: Friedman's tests and correlations indicated no significant difference in WSDs across sampling occasions for each word length separately or combined. WSD correlated positively with AOS severity and negatively with intelligibility but was not correlated with aphasia severity. Regression analyses confirmed WSD to be stable over time, while WSD calculated from only five tokens (i.e., WSD-5) was less stable over time., Conclusions: Results indicate that WSD can be a stable measure over time, at the individual and group level, providing support for its use in diagnosis and/or as an outcome measure, both clinically and for research. In general, WSD outperformed WSD-5, suggesting that it may be better to calculate WSD from more than five tokens. Stability of WSD in other populations and suitability for differential diagnosis need to be determined. Currently, differentiating disorders by speaking rate, alone, is not recommended., Supplemental Material: https://doi.org/10.23641/asha.25438735.

Purpose: Anomia, or word-finding difficulty, is a prevalent and persistent feature of aphasia, a neurogenic language disorder affecting millions of people in the United States. Anomia assessments are essential for measuring performance and monitoring outcomes in clinical settings. This study aims to evaluate the reliability of response time (RT) annotation based on spectrograms and assess the predictive utility of proxy RTs collected during computerized naming tests., Method: Archival data from 10 people with aphasia were used. Trained research assistants phonemically transcribed participants' responses, and RTs were generated from the onset of picture stimulus to the initial phoneme of the first complete attempt. RTs were measured in two ways: hand-generated RTs (from spectrograms) and proxy RTs (automatically extracted online). Interrater agreement was evaluated based on interclass correlation coefficients and generalizability theory tools including variance partitioning and the φ-coefficient. The predictive utility of proxy RTs was evaluated within a linear mixed-effects framework., Results: RT annotation reliability showed near-perfect agreement across research assistants (φ-coefficient = .93), and the variance accounted for by raters was negligible. Furthermore, proxy RTs significantly and strongly predicted hand-annotated RTs ( R 2 = ~0.82), suggesting their utility as an alternative measure., Conclusions: The study confirms the reliability of RT annotation and demonstrates the predictive utility of proxy RTs in estimating RTs during computerized naming tests. Incorporating proxy RTs can enhance clinical assessments, providing additional information for cognitive measurement. Further research with larger samples and exploring the impact of using proxy RTs in different psychometric models could optimize clinical protocols and improve communication interventions for individuals with aphasia.

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

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

Background: There is a lack of standardized assessment tools for poststroke aphasia in Brazil, particularly bedside screenings for early identification of patients with suspected language disorders. The Language Screening Test (LAST) is a valid and reliable method for screening hospitalized patients following a stroke. This tool was first developed in French and then translated and validated in other languages., Purpose: This study aimed to translate, culturally adapt, and validate the LAST into Brazilian Portuguese., Method: Following a systematic, multistep approach to translation and cultural adaptation of language instruments, this study developed the two parallel versions of the Brazilian Portuguese LAST (pLAST) Versions A and B. The final versions were applied to 70 healthy and 30 poststroke adults across age and educational levels. Subtests of the Boston Diagnostic Aphasia Examination (BDAE) were used to assess the external validity of the pLAST., Results: Findings showed that the two versions (A and B) of the pLAST were equivalent (intraclass correlation coefficient = .91; p < .001). No floor or ceiling effects were observed, and internal validity was excellent (Cronbach's α = .85). Moreover, its external validity against the BDAE was moderate to strong. Test sensitivity and specificity were 0.88 and 1, respectively, and accuracy was 0.96., Conclusion: The Brazilian Portuguese version of the LAST is a valid, simple, easy, and rapid test to screen poststroke aphasia in hospital settings., Supplemental Material: https://doi.org/10.23641/asha.23548911.

Purpose: The objectives of this study were (a) to linguistically and culturally adapt the English bedside version of the Western Aphasia Battery-Revised (Bedside WAB-R) into Moroccan Arabic (MA) and (b) to assess its psychometric properties., Method: The Bedside MA-WAB-R was piloted on a population of 20 participants after a process of linguistic adaptation from English to MA. To verify the psychometric properties of the test, a group of healthy controls ( n = 106) and a group of persons with chronic aphasia ( n = 52) completed the Bedside MA-WAB-R. The test's content validity, construct validity, and the concurrent validity of the aphasia classification system were examined. In addition, the interrater reliability, intrarater reliability, test-retest reliability, and internal consistency of the instrument were evaluated., Results: The results indicated that the Bedside MA-WAB-R overall met standard criteria for excellent psychometric properties, as evinced by high content and construct validity and concurrent validity with independent measures of aphasia diagnosis (speech-language pathologists' impression and lesion location) as well as high internal consistency, inter- and intrarater reliability, and test-retest reliability. The test was also found to have very high sensitivity and specificity for the detection of aphasia, as revealed by the performance of controls. By controlling for age and educational level effects, specific cutoff values were determined to optimize the aphasia diagnosis., Conclusions: The Bedside MA-WAB-R is the first standardized quick aphasia assessment tool with associated psychometric properties for clinical use with an MA-speaking population, particularly within the 26- to 58-year age range. It meets standard criteria for a valid and reliable measure than can have a variety of clinical and research applications.

Purpose: During motor speech examinations for suspected apraxia of speech (AOS), clients are routinely asked to repeat words several times sequentially. The purpose of this study was to understand the task in terms of the relationship among consecutive attempts. We asked to what extent phonemic accuracy changes across trials and whether the change is predicted by AOS diagnosis and sound production severity., Method: One hundred thirty-three participants were assigned to four diagnostic groups based on quantitative metrics (aphasia plus AOS, aphasia-only, and aphasia with two borderline speech profiles). Each participant produced four multisyllabic words 5 times consecutively. These productions were audio-recorded and transcribed phonetically and then summarized as the proportion of target phonemes that was produced accurately. Nonparametric statistics were used to analyze percent change in accuracy from the first to the last production based on diagnostic group and a broad measure of speech sound accuracy., Results: Accuracy on the repeated words deteriorated across trials for all groups, showing reduced accuracy from the first to the last repetition for 62% of participants. Although diagnostic groups differed on the broad measure of speech sound accuracy, severity classification based on this measure did not determine degree of deterioration on the repeated words task., Discussion: Responding to a request to say multisyllabic words 5 times sequentially is challenging for people with aphasia with and without AOS, and as such, performance is prone to errors even with mild impairment. For most, the task does not encourage self-correction. Instead, it promotes errors, regardless of diagnosis, and is, therefore, useful for screening purposes.

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: The aim of this study was to advance the use of structured, monologic discourse analysis by validating an automated scoring procedure for core lexicon (CoreLex) using transcripts., Method: Forty-nine transcripts from persons with aphasia and 48 transcripts from persons with no brain injury were retrieved from the AphasiaBank database. Five structured monologic discourse tasks were scored manually by trained scorers and via automation using a newly developed CLAN command based upon previously published lists for CoreLex. Point-to-point (or word-by-word) accuracy and reliability of the two methods were calculated. Scoring discrepancies were examined to identify errors. Time estimates for each method were calculated to determine if automated scoring improved efficiency., Results: Intraclass correlation coefficients for the tasks ranged from .998 to .978, indicating excellent intermethod reliability. Automated scoring using CLAN represented a significant time savings for an experienced CLAN user and for inexperienced CLAN users following step-by-step instructions., Conclusions: Automated scoring of CoreLex is a valid and reliable alternative to the current gold standard of manually scoring CoreLex from transcribed monologic discourse samples. The downstream time saving of this automated analysis may allow for more efficient and broader utilization of this discourse measure in aphasia research. To further encourage the use of this method, go to https://aphasia.talkbank.org/discourse/CoreLexicon/ for materials and the step-by-step instructions utilized in this project., Supplemental Material: https://doi.org/10.23641/asha.20399304.

Purpose: Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency., Method: In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic., Results: Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments., Conclusions: This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets., Supplemental Material: https://doi.org/10.23641/asha.19326419.

Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail. Conclusions The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database. Supplemental Material https://doi.org/10.23641/asha.166395100.

Purpose Depression assessment is challenging in persons with aphasia given their language impairment. Studies have used both self-report scales and by-proxy measures of depression in persons with aphasia. However, the validity of these measures has been called into question. The aim of this study was to conduct a preliminary investigation into aspects of validity of the community version of the Stroke Aphasia Depression Questionnaire (SADQ-10) and the Center for Epidemiological Studies Depression Scale-Revised (CESD-R). Method Twenty-four participants with chronic aphasia completed the CESD-R, the Patient-Reported Outcomes Measurement Information System Global Mental Health scale (PROMIS GMH), and the Dynamic Visual Assessment of Mood Scales (D-VAMS) while their caregivers completed the SADQ-10. Internal consistency of the CESD-R and the SADQ-10 and the convergent validity of the CESD-R, SADQ-10, PROMIS GMH, and D-VAMS were examined. Results The SADQ-10 and the CESD-R were internally consistent. The CESD-R was moderately correlated with the SADQ-10, PROMIS GMH, and D-VAMS. However, the SADQ-10 was not correlated with the PROMIS GMH and D-VAMS. Conclusions We suggest both the CESD-R and the SADQ-10 be used together to screen for depression in persons with aphasia. Further studies with larger sample sizes need to be conducted to establish validity of other depression screening instruments in person with aphasia.

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.

Purpose The purpose of this study was to compare the utility of two automated indices of lexical diversity, the Moving-Average Type-Token Ratio (MATTR) and the Word Information Measure (WIM), in predicting aphasia diagnosis and responding to differences in severity and aphasia subtype. Method Transcripts of a single discourse task were analyzed for 478 speakers, 225 of whom had aphasia per an aphasia battery. We calculated the MATTR and the WIM for each participant. We compared the group means among speakers with aphasia, neurotypical controls, and left-hemisphere stroke survivors with mild aphasia not detected by an aphasia battery. We examined whether each measure distinguished levels of aphasia severity and subtypes of aphasia. We used each measure to classify aphasia versus neurotypical control and compared the areas under the curve. Results The WIM and the MATTR differentiated among people with aphasia, neurotypical controls, and people with mild aphasia. Both measures demonstrated moderately high predictive accuracy in classifying aphasia. The WIM demonstrated greater sensitivity to aphasia severity and subtype compared to the MATTR. Conclusions The WIM and the MATTR are promising measures that quantify lexical diversity in different and complementary ways. The WIM may be more useful for quantifying the effect of treatment or disease progression, whereas the MATTR may be more useful for discriminating discourse produced by people with very mild aphasia from discourse produced by neurotypical controls. Further validation is required.

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 Many communication disorders result in speech sound errors that listeners perceive as phonemic errors. Unfortunately, manual methods for calculating phonemic error frequency are prohibitively time consuming to use in large-scale research and busy clinical settings. The purpose of this study was to validate an automated analysis based on a string metric-the unweighted Levenshtein edit distance-to express phonemic error frequency after left hemisphere stroke. Method Audio-recorded speech samples from 65 speakers who repeated single words after a clinician were transcribed phonetically. By comparing these transcriptions to the target, we calculated the percent segments with a combination of phonemic substitutions, additions, and omissions and derived the phonemic edit distance ratio, which theoretically corresponds to percent segments with these phonemic errors. Results Convergent validity between the manually calculated error frequency and the automated edit distance ratio was excellent, as demonstrated by nearly perfect correlations and negligible mean differences. The results were replicated across 2 speech samples and 2 computation applications. Conclusions The phonemic edit distance ratio is well suited to estimate phonemic error rate and proves itself for immediate application to research and clinical practice. It can be calculated from any paired strings of transcription symbols and requires no additional steps, algorithms, or judgment concerning alignment between target and production. We recommend it as a valid, simple, and efficient substitute for manual calculation of error frequency.

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 Group conversation treatment has the potential to improve communication and reduce social isolation for people with aphasia. This project examined how 2 conflicting hypotheses-treatment dosage and group dynamics-affect treatment outcomes. Method Forty-eight participants with chronic aphasia were randomly assigned to either a dyad, a large group, or a delayed control group. Conversation group treatment was provided for an hour, twice per week, for 10 weeks. Individual goals were developed by each participant and addressed in the context of thematically oriented conversation treatment. Standardized testing across language domains was completed pretreatment (Time 1), posttreatment (Time 2), at a 6-week maintenance point (Time 3), and at 11-month follow-up for the experimental groups. Results Treatment groups showed greater changes on standardized measures than the control group posttreatment. Dyads showed the most changes on measures of language impairment, whereas changes on the self-reported functional communication measure (Aphasia Communication Outcome Measure) and connected speech task only showed significant changes in the large group. Conclusions This randomized controlled trial on conversation treatment indicated that both treatment groups-but not the delayed control group-showed significant changes on standardized tests. Hence, conversation treatment is associated with changes in measures of language impairment and quality of life. Dyads showed the most changes on measures of language impairment, whereas changes on the functional communication measure (Aphasia Communication Outcome Measure) and discourse production only showed significant changes in the large group. Thus, group size may be associated with effects on different types of outcome measures.

Purpose: The purpose of this study is to compare the outcomes of the manually coded Northwestern Narrative Language Analysis (NNLA) system, which was developed for characterizing agrammatic production patterns, and the automated Computerized Language Analysis (CLAN) system, which has recently been adopted to analyze speech samples of individuals with aphasia (a) for reliability purposes to ascertain whether they yield similar results and (b) to evaluate CLAN for its ability to automatically identify language variables important for detailing agrammatic production patterns., Method: The same set of Cinderella narrative samples from 8 participants with a clinical diagnosis of agrammatic aphasia and 10 cognitively healthy control participants were transcribed and coded using NNLA and CLAN. Both coding systems were utilized to quantify and characterize speech production patterns across several microsyntactic levels: utterance, sentence, lexical, morphological, and verb argument structure levels. Agreement between the 2 coding systems was computed for variables coded by both., Results: Comparison of the 2 systems revealed high agreement for most, but not all, lexical-level and morphological-level variables. However, NNLA elucidated utterance-level, sentence-level, and verb argument structure-level impairments, important for assessment and treatment of agrammatism, which are not automatically coded by CLAN., Conclusions: CLAN automatically and reliably codes most lexical and morphological variables but does not automatically quantify variables important for detailing production deficits in agrammatic aphasia, although conventions for manually coding some of these variables in Codes for the Human Analysis of Transcripts are possible. Suggestions for combining automated programs and manual coding to capture these variables or revising CLAN to automate coding of these variables are discussed.

Purpose: Apraxia of speech (AOS) is a consequence of stroke that frequently co-occurs with aphasia. Its study is limited by difficulties with its perceptual evaluation and dissociation from co-occurring impairments. This study examined the classification accuracy of several acoustic measures for the differential diagnosis of AOS in a sample of stroke survivors., Method: Fifty-seven individuals were included (mean age = 60.8 ± 10.4 years; 21 women, 36 men; mean months poststroke = 54.7 ± 46). Participants were grouped on the basis of speech/language testing as follows: AOS-Aphasia (n = 20), Aphasia Only (n = 24), and Stroke Control (n = 13). Normalized Pairwise Variability Index, proportion of distortion errors, voice onset time variability, and amplitude envelope modulation spectrum variables were obtained from connected speech samples. Measures were analyzed for group differences and entered into a linear discriminant analysis to predict diagnostic classification., Results: Out-of-sample classification accuracy of all measures was over 90%. The envelope modulation spectrum variables had the greatest impact on classification when all measures were analyzed together., Conclusions: This study contributes to efforts to identify objective acoustic measures that can facilitate the differential diagnosis of AOS. Results suggest that further study of these measures is warranted to determine the best predictors of AOS diagnosis., Supplemental Materials: https://doi.org/10.23641/asha.5611309.

Purpose: Language comprehension in people with aphasia (PWA) is frequently evaluated using multiple-choice displays: PWA are asked to choose the image that best corresponds to the verbal stimulus in a display. When a nontarget image is selected, comprehension failure is assumed. However, stimulus-driven factors unrelated to linguistic comprehension may influence performance. In this study we explore the influence of physical image characteristics of multiple-choice image displays on visual attention allocation by PWA., Method: Eye fixations of 41 PWA were recorded while they viewed 40 multiple-choice image sets presented with and without verbal stimuli. Within each display, 3 images (majority images) were the same and 1 (singleton image) differed in terms of 1 image characteristic. The mean proportion of fixation duration (PFD) allocated across majority images was compared against the PFD allocated to singleton images., Results: PWA allocated significantly greater PFD to the singleton than to the majority images in both nonverbal and verbal conditions. Those with greater severity of comprehension deficits allocated greater PFD to nontarget singleton images in the verbal condition., Conclusion: When using tasks that rely on multiple-choice displays and verbal stimuli, one cannot assume that verbal stimuli will override the effect of visual-stimulus characteristics.

Purpose: This study evaluates how proposition density can differentiate between persons with aphasia (PWA) and individuals in a control group, as well as among subtypes of aphasia, on the basis of procedural discourse and personal narratives collected from large samples of participants., Method: Participants were 195 PWA and 168 individuals in a control group from the AphasiaBank database. PWA represented 6 aphasia types on the basis of the Western Aphasia Battery-Revised (Kertesz, 2006). Narrative samples were stroke stories for PWA and illness or injury stories for individuals in the control group. Procedural samples were from the peanut-butter-and-jelly-sandwich task. Language samples were transcribed using Codes for the Human Analysis of Transcripts (MacWhinney, 2000) and analyzed using Computerized Language Analysis (MacWhinney, 2000), which automatically computes proposition density (PD) using rules developed for automatic PD measurement by the Computerized Propositional Idea Density Rater program (Brown, Snodgrass, & Covington, 2007; Covington, 2007)., Results: Participants in the control group scored significantly higher than PWA on both tasks. PD scores were significantly different among the aphasia types for both tasks. Pairwise comparisons for both discourse tasks revealed that PD scores for the Broca's group were significantly lower than those for all groups except Transcortical Motor. No significant quadratic or linear association between PD and severity was found., Conclusion: Proposition density is differentially sensitive to aphasia type and most clearly differentiates individuals with Broca's aphasia from the other groups.

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: This study examined the test-retest stability of select word-retrieval measures in the discourses of people with aphasia who completed a 5-stimulus discourse task., Method: Discourse samples across 3 sessions from 12 individuals with aphasia were analyzed for the stability of measures of informativeness, efficiency, main concepts, noun and verb retrieval, word-finding difficulty, and lexical diversity. Values for correlation coefficients and the minimal detectable change score were used to assess stability for research and clinical decision making., Results: Measures stable enough to use in group research studies included the number of words; the number of correct information units (CIUs); the number of accurate-complete, accurate-incomplete, and absent main concepts; the percentage of T-units that had word-finding behaviors of any kind; the percentage of T-units that contained empty words; and a lexical diversity measure. Words per minute, CIUs per minute, and the percentage of T-units that contained time fillers or delays were sufficiently stable to use when making clinical decisions about an individual., Conclusion: Although several of the measures demonstrated acceptable stability for group research studies, relatively few were sufficiently stable for making clinical decisions about individuals on the basis of a single administration.

Purpose: We explored the reliability and validity of 2 quantitative approaches to document presence and severity of speech properties associated with apraxia of speech (AOS)., Method: A motor speech evaluation was administered to 39 individuals with aphasia. Audio-recordings of the evaluation were presented to 3 experienced clinicians to determine AOS diagnosis and to rate severity of 11 speech dimensions. Additionally, research assistants coded 11 operationalized metrics of articulation, fluency, and prosody in the same speech samples and in recordings from 20 neurologically healthy participants., Results: Agreement among the 3 clinicians was limited for both AOS diagnosis and perceptual scaling, but inter-observer reliability for the operationalized metrics was strong. The relationships between most operationalized metrics and mean severity ratings for corresponding perceptual dimensions were moderately strong and statistically significant. Both perceptual scaling and operationalized quantification approaches were sensitive to the presence or absence of AOS., Conclusions: Perceptual scaling and operationalized metrics are promising quantification techniques that can help establish diagnostic transparency for AOS. However, because satisfactory reliability cannot be assumed for scaling techniques, effective training and calibration procedures should be implemented. Operationalized metrics show strong potential for enhancing diagnostic objectivity and sensitivity.

Purpose: To explore whether individuals with aphasia exhibit differences in the M350, an electrophysiological marker of lexical activation, compared with healthy controls., Method: Seven people with aphasia, 9 age-matched controls, and 10 younger controls completed an auditory lexical decision task while cortical activity was recorded with magnetoencephalography. There were 2 stimulus conditions of interest: identity primed (i.e., a word preceded by itself) and semantic primed (i.e., a word preceded by a semantically related word). Latency and amplitude of the M350 response as well as reaction time were measured., Results: Consistent with the age-matched control group, the group with aphasia showed both identity and semantic priming behaviorally. In contrast to the control groups, the group with aphasia did not show either semantic or identity priming of the M350 response. This group also demonstrated longer M350 latencies than either control group. Furthermore, within this group, M350 latency was positively correlated with a measure of semantic impairment., Conclusions: These findings highlight the usefulness of temporally sensitive measures when studying aphasia and demonstrate that the latency of electrophysiological markers is of interest in this population. In particular, increased M350 latency appears to be indicative of a semantic processing impairment.

Purpose: The purpose of this study was to develop a short form of the Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 2001) for individuals with aphasia and compare it with 2 existing short forms originally analyzed with responses from people with dementia and neurologically healthy adults., Method: Development of the new BNT-Aphasia Short Form and analysis of the other 2 forms were completed with archival data from 100 individuals with aphasia. The authors developed the BNT-Aphasia Short Form using items from the original 60-item instrument based on item response theory. Rasch analysis was computed on the short forms developed by Graves, Bezeau, Fogarty, and Blair (2004) and by Mack, Freed, Williams, and Henderson (1992)., Results: Analysis of the Graves et al. (2004) short form resulted in the smallest range of item difficulty and the largest floor effect compared with the Mack et al. (1992) short form and the BNT-Aphasia short form. The BNT-Aphasia Short Form showed an increase in information in the middle of the scale relative to both the Graves et al. and the Mack et al. forms., Conclusions: The new short form demonstrates good psychometric properties when used with individuals with aphasia. However, the Mack et al. form proved to be as psychometrically sound as the BNT-Aphasia Short Form and is also appropriate for individuals with aphasia.

Purpose: The 1st aim of this study was to further establish the external validity of the main concept (MC) analysis by examining its relationship with the Cantonese Linguistic Communication Measure (CLCM; Kong, 2006; Kong & Law, 2004)-an established quantitative system for narrative production-and the Cantonese version of the Western Aphasia Battery (CAB; Yiu, 1992). The 2nd purpose of the study was to evaluate how well the MC analysis reflects the stability of discourse production among chronic Cantonese speakers with aphasia., Method: Sixteen participants with aphasia were evaluated on the MC analysis, CAB, and CLCM in the summer of 2008 and were subsequently reassessed in the summer of 2009. They encompassed a range of aphasia severity (with an Aphasia Quotient ranging between 30.2/100 and 94.8/100 at the time of the 1st evaluation)., Results: Significant associations were found between the MC measures and the corresponding CLCM indices and CAB performance scores that were relevant to the presence, accuracy, and completeness of content in oral narratives. Moreover, the MC analysis was found to yield comparable scores for chronic speakers on 2 occasions 1 year apart., Conclusion: The present study has further established the external validity of MC analysis in Cantonese. Future investigations involving more speakers with aphasia will allow adequate description of its psychometric properties.

Purpose: The typicality treatment approach on improving naming was investigated within 2 inanimate categories (furniture and clothing) using a single-subject experimental design across participants and behaviors in 5 patients with aphasia., Method: Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, whereas generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants., Results: Results indicated that 2 out of 4 patients trained on naming of atypical examples demonstrated generalization to naming untrained typical examples. One patient showed trends toward generalization but did not achieve criterion. Furthermore, all 4 patients trained on typical examples demonstrated no generalized naming to untrained atypical examples within the category. Also, analysis of errors indicated an evolution of errors as a result of treatment, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias., Conclusion: These results extend our previous findings (S. Kiran & C. K. Thompson, 2003a) to patients with nonfluent aphasia and to inanimate categories such as furniture and clothing. Additionally, the results provide support for the claim that training atypical examples is a more efficient method of facilitating generalization to untrained items within a category than training typical examples (S. Kiran, 2007).

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.

Reported speech, wherein one quotes or paraphrases the speech of another, has been studied extensively as a set of linguistic and discourse practices. Researchers agree that reported speech is pervasive, found across languages, and used in diverse contexts. However, to date, there have been no studies of the use of reported speech among individuals with aphasia. Grounded in an interactional sociolinguistic perspective, the study presented here documents and analyzes the use of reported speech by 7 adults with mild to moderately severe aphasia and their routine communication partners. Each of the 7 pairs was videotaped in 4 everyday activities at home or around the community, yielding over 27 hr of conversational interaction for analysis. A coding scheme was developed that identified 5 types of explicitly marked reported speech: direct, indirect, projected, indexed, and undecided. Analysis of the data documented reported speech as a common discourse practice used successfully by the individuals with aphasia and their communication partners. All participants produced reported speech at least once, and across all observations the target pairs produced 400 reported speech episodes (RSEs), 149 by individuals with aphasia and 251 by their communication partners. For all participants, direct and indirect forms were the most prevalent (70% of RSEs). Situated discourse analysis of specific episodes of reported speech used by 3 of the pairs provides detailed portraits of the diverse interactional, referential, social, and discourse functions of reported speech and explores ways that the pairs used reported speech to successfully frame talk despite their ongoing management of aphasia.

Using story retelling as an index of language ability, it is difficult to disambiguate comprehension and memory deficits. Collecting data on the serial position effect (SPE), however, illuminates the memory component. This study examined the SPE of the percentage of information units (%IU) produced in the connected speech samples of adults with aphasia and age-matched, non-brain-injured (NBI) participants. The NBI participants produced significantly more direct and alternate IUs than participants with aphasia. Significant age and gender differences were found in subsamples of the NBI controls, with younger and female participants generating significantly more direct IUs than male and older NBI participants. Alternate IU productions did not generate an SPE from any group. There was a significant linear increase from the initial (primacy) to the final (recency) portion of the recalled alternate IUs for both the NBI group and the group of participants with aphasia. Results provide evidence that individuals with aphasia recall discourse length information using similar memory functions as the nonimpaired population, though at a reduced level of efficiency or quantity. A quadratic model is suggested for the recall of information directly recalled from discourse-length language material.

Narratives were elicited in two story tasks, retelling and generation, from two groups of adults, 55 with closed head injury (CHI) and 47 non-brain-injured (NBI), recruited from rehabilitation facilities in three northeastern states. Participants were classified, on the basis of their socioeconomic status (SES), as professional, skilled worker, or unskilled worker. Narratives were analyzed using five discourse measures at the levels of sentence production, intersentential cohesion, and story grammar. Discourse performance was then compared across groups, tasks, and SES levels. Discourse performance of the CHI group was also compared with their scores from the Wisconsin Card Sorting Test, a measure of executive functioning. Results indicated that two discourse measures distinguished the groups. The CHI participants produced significantly fewer words per T-unit and fewer T-units within episode structure than did the NBI group, which was attributed to difficulties with content organization. Performance on all five discourse measures differed for the story retelling versus the story generation tasks for both CHI and NBI groups. All participants produced longer and more grammatically complex T-units in the story generation task than in story retelling. However, cohesive adequacy and story grammar were better in the story retelling task than in the story generation task. It was therefore concluded that story generation was a more challenging task than story retelling for both groups. The only significant difference noted for SES involved the measure of intersentential cohesion. The unskilled workers demonstrated poorer cohesive adequacy than either the skilled workers or professionals, regardless of group or story task. Finally, modest correlations were noted between the discourse performance of the CHI group and scores from the Wisconsin Card Sorting Test in both story tasks.

The purpose of this study was to investigate the presence and nature of spoken language deficits in Huntington's (HD) and Parkinson's (PD) diseases. Specifically, the study examined whether (a) the spoken language abilities of patients with HD or PD differ from those of age-matched control participants with no brain damage, (b) HD and PD are associated with similar spoken language profiles, and (c) the spoken language abilities of patients with HD or PD are related to the severity of their motor speech deficits, cognitive impairments, or both. All participants completed picture description tasks and a battery of cognitive and motor speech tests. Syntactic, quantitative, and informativeness measures of spoken language were analyzed. In terms of syntax, patients with HD produced shorter utterances, a smaller proportion of grammatical utterances, a larger proportion of simple sentences, and fewer embeddings per utterance than their non-brain-damaged peers. The HD group also produced utterances that were shorter and syntactically simpler than those of the PD group, despite similar performances on the cognitive and motor speech tests. The only syntactic difference between the PD group and their control group was that patients with PD produced a smaller proportion of grammatical sentences. Although the patient and control participants tended to produce similar amounts of verbal output, less of what the patients said was considered informative. Correlations between language measures and test battery results suggested that the spoken language abilities of patients with HD or PD are related to a variety of neuropsychological and motor speech changes. The implications of these findings for the clinical management of HD and PD are discussed.

Normal comprehension skill is linked with the proficiency of a suppression mechanism, which functions to dampen mental activation that becomes irrelevant or inappropriate to a final interpretation. This study investigated suppression and discourse comprehension in adults with right brain damage (RBD). To index suppression function, 40 adults with RBD and 40 without brain damage listened to sentence stimuli that biased the meaning of a sentence-final lexical ambiguity (e.g., SPADE), then judged whether a probe word (e.g., CARDS) fit the overall sentence meaning. Probes represented the contextually inappropriate meanings of the ambiguities and were presented in two conditions: 175 ms and 1000 ms post-stimulus. The same probes were used with unambiguous comparison stimuli. Probe judgment response times indicated that only the group without brain damage suppressed inappropriate interpretations over time. In a multiple regression analysis, suppression function added significantly to predicting performance on a general measure of narrative discourse comprehension for participants with RBD. The discussion addresses how suppression deficits may account more broadly for comprehension difficulties after RBD; it also considers several unresolved issues concerning the suppression construct and the suppression deficit hypothesis.

The Correct Information Unit (CIU) analysis for measuring the communicative informativeness and efficiency of connected speech (Nicholas & Brookshire, 1993) was applied to the naturally occurring conversation of a person with moderate aphasia. Results indicated that, in this instance, reliable CIU measures could not be obtained. Intrarater reliability for CIU and %CIU was low, reaching only 72%, and interrater reliability was never greater than 63%. However, reliability of word counts was good. Post hoc analysis of rater disagreements in application of the CIU analysis revealed that the majority (72%) resulted from insufficiencies in the scoring rules that were originally designed to measure single speaker connected discourse. Two descriptive categories of disagreements were identified: interpretations of informativeness and absence of rules. The remaining 28% of disagreements were attributable to human error in the application of scoring rules. Comparison of findings with previous research and implications for future research are discussed.

We examined the effects of group communication treatment on linguistic and communicative performance in adults with chronic aphasia. Participants were randomly assigned to two treatment and two deferred treatment groups. Groups were balanced for age, education level, and initial aphasia severity. Twenty-four participants completed the 4-month treatment trial. While in the treatment condition, all participants received 5 hours of group communication treatment weekly, provided by a speech-language pathologist. The focus of treatment included increasing initiation of conversation and exchanging information using whatever communicative means possible. While awaiting group communication treatment, participants in the deferred treatment groups engaged in such activities as support, performance, or movement groups in order to control for the effects of social contact. Linguistic and communicative measures were administered to all participants at entry, after 2 and 4 months of treatment, and following 4 to 6 weeks of no treatment. In addition, participants in the deferred treatment groups received an additional administration of all measures just before their treatment trial. Results revealed that participants receiving group communication treatment had significantly higher scores on communicative and linguistic measures than participants not receiving treatment. In addition, significant increases were revealed after 2 months of treatment and after 4 months of treatment. No significant decline in performance occurred at time of follow-up.

An extensive search of aphasia-treatment literature yielded 55 reports of clinical outcomes satisfying the essential criteria for inclusion in a meta-analysis. The results confirmed those of an earlier meta-analysis in demonstrating the utility of aphasia treatments, generally considered, for bringing about desirable clinical outcomes. Beyond the general case, the new findings address clinical utility in finer detail than was previously possible. Effects of treatment for aphasia are synthesized and assessed for each of four important dimensions: amount of treatment, type of treatment, severity of aphasia, and type of aphasia.

The spoken language of individuals with mild aphasia and age-matched control subjects was studied under conditions of isolation, focused attention, and divided attention. A picture-description task was completed alone and in competition with a tone-discrimination task. Regardless of condition, individuals with aphasia performed more poorly on most morphosyntactic, lexical, and pragmatic measures of spoken language than control subjects. Increasing condition complexity resulted in little quantitative or qualitative change in the spoken language of the control group. In contrast, the individuals with aphasia showed dual-task interference; as they shifted from isolation to divided-attention conditions, they produced fewer syntactically complete and complex utterances, fewer words, and poorer word-finding accuracy. In pragmatic terms, their communication was considered less successful and less efficient. These results suggest that decrements of attentional capacity or its allocation may negatively affect the quantity and quality of the spoken language of individuals with mild aphasia.

The results of two studies of sentence comprehension in aphasic patients using sentence-picture matching tests are presented. In the first study, 52 aphasic patients were tested on 10 sentence types. Analysis of the number of correct responses per sentence type showed effects of syntactic complexity and number of propositions. Factor analysis yielded first factors that accounted for two-thirds of the variance in performance to which all sentence types contributed. Clustering analysis yielded groups of patients whose performances progressively deteriorated and in which performance was more affected by sentence types that were harder for the group overall. These results were very similar to those previously obtained using an enactment task. In the second study, 17 aphasic patients were tested on the same 10 sentence types using both sentence-picture matching and enactment tasks. Correlational analyses showed that performance on the two tests was significantly correlated across both subjects and sentences. The results provide data relevant to the determinants of the complexity of a sentence in auditory comprehension.