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This study investigated the effects of two associative learning tasks on aphasic subjects' labeling of novel symbols. It was designed to determine if aphasic subjects need to develop their own associations for word-symbols pairs (personalized cueing) to obtain the long-term labeling benefits observed in prior research or if comparable results are obtained when "ready-made" associations are used during training (provided cueing). The results showed that the two cueing techniques were equal in their ability to elicit correct responses from the subjects. The results also demonstrated the long-term effectiveness of both cueing procedures on the subjects' labeling accuracy up to 30 days after training was discontinued.

The contribution of a visual source of contextual information to speech perception was measured in 12 listeners with aphasia. The three experimental conditions were: Visual-Only (referential gesture), Auditory-Only (computer-edited speech), and Audio-Visual. In a two-alternative, forced-choice task, subjects indicated which picture had been requested. The stimuli were first validated with listeners without brain damage. The listeners with aphasia were subgrouped as having high or low language comprehension based on standardized test scores. Results showed a significantly larger contribution of gestural information to the responses of the lower-comprehension subgroup. The contribution of gesture was significantly correlated with the amount of ambiguity experienced with the auditory-only information. These results show that as the auditory information becomes more ambiguous, individuals with impaired language comprehension deficits make greater use of the visual information. The results support clinical observations that speech information received without visual context is perceived differently than when received with visual context.

The effect of speech sample size on the test-retest stability of two measures of connected speech--words per minute (WPM) and percent of words that are correct information units (Percent CIUs)--was evaluated. A standard set of 10 stimuli was used to elicit connected speech from 20 non-brain-damaged adults and 20 adults with aphasia. Each subject's responses to the 10 stimuli were transcribed and scored for WPM and Percent CIUs. Then each subject's responses to the 10 stimuli were randomly divided to produce smaller speech samples representing his or her responses to 1, 2, 3, 4, 5, and 7 stimuli. The test-retest stability of the WPM and Percent CIUs measures was then evaluated for each of the smaller sample sizes and for the complete 10-stimulus sample. For both groups, the test-retest stability of the two measures increased as sample size increased, with the greatest increases occurring as samples increased in size from those representing 1 stimulus to those representing 4 or 5 stimuli, with smaller increases in stability thereafter. In general, these results suggest that the best balance between high test-retest stability and the time and effort required to transcribe and score speech samples can be achieved with samples representing 4 or 5 stimuli (an average of 300 to 400 words for aphasic subjects), although this will vary across individuals.

This study examines the effect of emotional content on the verbal pragmatic aspects of discourse production in right-brain-damaged (RBD), left-brain-damaged (LBD), and normal control (NC) right-handed adults. Subject groups were matched for gender, age, education, and occupation; brain-damaged groups did not differ on months post CVA onset and lesion location. Subjects were screened to ensure that they demonstrated adequate cognitive and visual perceptual skills to participate in the study. Pictorial stimuli were used to elicit discourse that contained emotional and nonemotional (procedural, visuospatial) content. Trained raters evaluated each discourse for appropriateness on seven verbal pragmatic features (e.g., conciseness, quantity, relevancy). Across all three conditions, the brain-damaged groups were impaired relative to NCs. In the nonemotional conditions, LBDs were particularly impaired in pragmatics, whereas in the emotional condition, RBDs demonstrated pragmatic deficits. Emotional content appeared to facilitate pragmatic performance among LBD aphasics and to suppress pragmatic performance among RBDs.

Twelve aphasic and 12 non-brain-damaged adult males described the speech elicitation pictures from the Boston Diagnostic Aphasia Examination (BDAE), the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA), the Western Aphasia Battery (WAB), and six pictures representing male-biased or female-biased daily-life situations. For each speech sample we calculated number of words, words per minute, number of correct information units, percentage of words that were correct information units, and percentage of correct information units that were nouns or adjectives (amount of enumeration or naming). The WAB picture elicited more enumeration than the BDAE or MTDDA pictures, and information was produced at a slower rate in response to the WAB picture than the other two pictures. These differences were statistically significant and appear to be clinically important. Gender bias had statistically significant effects on two measures. Male-biased pictures elicited significantly more words and significantly more correct information units than female-biased pictures. However, these differences were small and do not appear to be clinically important. Two of the five measures (words per minute and percentage of words that were correct information units) differentiated non-brain-damaged speakers from aphasic speakers. The magnitude of these differences suggests that these measures provide clinically important information about the problems aphasic adults may have when they produce narrative discourse.

This note suggests some changes in variable selection and operationalization for research on prognosis in adult neurologic communicative disorders. The issues raised are relevant to both broad prognostic questions concerning extent of recovery, and focused questions regarding candidacy and treatment efficacy.

This study investigated the isometric force and static position control of the upper lip, lower lip, tongue, jaw, and finger in four subject groups (normal control, apraxia of speech, conduction aphasia, and ataxic dysarthria) at two force and displacement levels. Results from both the force and position tasks suggested that the apraxic and dysarthric groups tended to produce significantly greater instability than the normal group, although the pattern of instability across articulators was not systematic within or across the force and position experiments for subjects within or between groups. The conduction aphasic group produced force and position stability that typically was not significantly different from any of the remaining three groups, suggesting that their force and position stability as indexed in the present study fell somewhere between that of the normal group and the apraxic and dysarthric groups. It is suggested that other analyses of force and position control, such as descriptive accounts of the trial-by-trial time histories, might shed additional light on the speech and orofacial sensorimotor control deficits in persons with apraxia, dysarthria, and conduction aphasia.

Fourteen measures of empty speech during a picture description task were examined in four subject groups--patients with Alzheimer's dementia, Wernicke's aphasias, anomic aphasias, and normal controls--to discover if these groups could be distinguished on the basis of their discourse. Patients with Alzheimer's dementia were distinguished from patients with Wernicke's aphasia by producing more empty phrases and conjunctions, whereas patients with Wernicke's aphasia produced more neologisms, and verbal and literal paraphasias. The demented patients shared many empty speech characteristics with patients with anomic aphasia. Naming deficits, as measured by confrontation naming tasks, did not correlate with empty discourse production. Our findings may be useful clinically for distinguishing these different patient groups.

Aphasic and nonaphasic subjects participated in a sentence verification task in which they were asked to judge whether spoken sentences correctly described pictures presented with the sentences. True active and true passive sentences were presented, as well as, false active and passive sentences in which agents and objects were reversed. In addition, false active sentences in which either the subject, verb, or object did not match the picture were presented. Subjects' response accuracy and reaction times were recorded. Passive sentences were more difficult than active sentences for both groups of subjects, and false sentences were verified more quickly than true sentences for both groups. Both groups appeared to be processing sentences for meaning as they were received, rather than waiting for the entire sentence before beginning to process it for meaning. In general, performance of aphasic subjects resembled that of nonaphasic subjects, except that aphasic subjects consistently took longer to verify sentence meaning than nonaphasic subjects.

Fourteen mildly aphasic and 14 normal speakers responded to an oral verbal fluency task for five different semantic categories. Retrieved words were scored within each 15-s time interval of a 60-s task as highly representative (i.e., having a high frequency of occurrence in a previous normative study), moderately representative (i.e., having a moderate frequency of occurrence), or highly unrepresentative (i.e., having a low frequency of occurrence). Both speaker groups were affected similarly by category type, and both retrieved words according to prior data-based notions of semantic categorical organization. The two groups differed with respect to the interaction between time intervals and representativeness levels. The different verbal fluency performance of the aphasic subjects was related to both the temporal occurrence of a word within a 60-s response interval and to its representativeness level (prototypicality) within a particular semantic category.

Two simple exploratory statistical techniques, stem and leaf displays and box plots, are described and applied to the analysis of Western Aphasia Battery Cortical Quotient scores for 111 acute stroke patients. A stem and leaf display highlights the shape of a distribution of data and is useful for quickly ordering and displaying data in the form of a frequency distribution; box plots focus special attention on the tails of a distribution and are valuable for summarizing, analyzing, and comparing group data. These methods were used to determine an internal Cortical Quotient cutoff score to distinguish between normal and cognitively impaired patients. The utility of this Cortical Quotient cutoff score and the relevance of these statistical techniques to other research in communicative disorders are discussed.

Thirty-five aphasic subjects who were 1 year or longer post onset of brain injury were given a battery of reading tests which was composed of recognition and oral reading tests for letters, words, sentences, and paragraphs, and comprehension tests for sentences and paragraphs. Results indicated a residual reading disorder or alexia in all subjects, with comprehension tests producing the highest error rate, oral reading tests second, and then recognition tests. Reading ability was found to be related to overall language skill, level of education, and oral reading ability. Results are discussed in light of current theories of reading and future research needs.

Studies in child language have shown that contrastive stress appears to be an early developing device to mark the topic-comment distinction, and thus is important for the acquisition of pragmatic knowledge. This study examined the use of contrastive stress by autistic children with mean-length-of-utterance (MLU) scores between 1.9 and 4.1 morphemes. Normal and aphasic subjects at similar MLU levels served as contrast groups. The contrastive stress task required that the subjects verbally assess the counterfactual nature of a presupposition in a yes-no question. Toy manipulation was used to elicit the desired responses in a play situation. Listener judgment served as the basis for analyzing results. Although all subject groups were able to perform the task, differences were seen in the number of correct responses and the patterns of stress misassignment .

Adult aphasics completed a sentence evaluation and revision task to test some aspects of their linguistic competence. Grammatical and ungrammatical sentences served as the stimuli. Ungrammatical sentences were characterized by violations of syntactic or semantic structure, or both. Aphasics evaluated correctly the grammaticality of most stimulus sentences. Incorrect evaluations were associated with sentences characterized by violations of syntactic structure. Aphasics' revisions of sentences that they judged to be ungrammatical were in the direction of appropriate grammatical structures. Omission of morphological endings was the most frequent sentence revision error. Aphasics' errors on both tasks could be accounted for by performance deficits such as inattentiveness to syntactic detail, auditory perceptual impairments, and inefficient lexical retrieval. These findings lend support to the argument that aphasia is best characterized as a performance rather than competence disruption.

A dichotic listening test, composed at 30 CVC-word pairs, was administered to 20 adults with aphasia and 20 normal adults. The subjects with aphasia were selected for inclusion in one of four experimental groups which differed according to intitial severity of aphasia and time post onset. All experimental subjects were given a diagnostic language test within the first four weeks following aphasia onset and again at the time of dichotic testing. Difference scores provided a quantitative estimate of language improvement. Data analysis revealed a strong left-ear preference (-0.363) for the experimental subjects which differed significantly from a right-ear preference (+0.290) obtained from the normal control subjects. Further, initial severity of aphasia was found to be a significant variable, capable of influencing the magnitude of ear preference. Multiple regression and partial correlational methods revealed significant, positive relationships between the magnitude of ear preference and initial severity of aphasia and between the former and the magnitude of language improvement. Time post aphasia onset was not shown to be a significant variable. The theoretical and potential clinical relevance of the results are discussed.

To determine the effects of arranging test tasks by order of difficulty, two test forms were administered to each of 20 patients with aphasia. The two test forms were split halves of the Porch Index of Communicative Ability. One of the test forms, Form EH, was presented to each patient with the subtests arranged for the individual subject in an order from easy to hard. The other test form, Form HE, was administered to each subject in the hard-to-easy order. There was no significant difference between the performance of the subjects on the Form EH and their performance on Form HE.

A descriptive taxonomy, the pragmatic protocol, was developed for this study. The protocol consists of 30 pragmatic parameters of language. The purpose of the study was to test the utility of the tool to evaluate a range of pragmatic aspects of language in a sample of conversational speech from subjects in six groups. Among the disordered subjects, four distinct profiles emerged that separated the diagnostic groups. Individual differences in the way pragmatic deficits were distributed within a diagnostic category were also identified. The authors stress that the assessment of pragmatics should encompass a range of parameters that includes aspects of linguistic structure as well as those aspects of communication that have to do with principles governing language use. We offer our data as an early look at the way in which pragmatic deficits stratify across disordered populations.

Information is presented regarding the Reading Comprehension Battery for Aphasia (RCBA). The results of reliability and validity measures show the test to be psychometrically adequate. Multidimensional and plus-minus methods of scoring the test are equally effective, but plus-minus scoring appears to be more efficient. Order of subtest difficulty is consistent for the entire subject group and does not vary significantly for fluent and nonfluent aphasics. Finally, both auditory comprehension and overall severity of aphasia correlate significantly with reading comprehension.

It has been claimed that the Porch Index of Communicative Ability (PICA), through its multidimensional scoring system, corrects for lacks in other tests for aphasia. Specifically, the PICA is said to specify the details of the response and indicate the nature of the response; detect and describe small changes in the patient's responses; indicate the patient's level of communicative ability; and eliminate the subjectivity and bias present in descriptive methods of scoring. It is argued here that the PICA does none of these things and that the multidimensional scoring system as applied in the PICA is invalid.

The reliability and validity characteristics of the Western Aphasia Battery (WAB) are described. High internal consistency measures and high test-retest reliability argue for stability of the test both because its parts contribute to the composite index and because of its temporal reliability. Inter- and intrajudge reliability are both very high, suggesting consistent scoring within and between scorers. The WAB satisfies face- and content-validity criteria. Results from the WAB and the Neurosensory Center Comprehensive Examination for Aphasia (NCCEA) highly correlate, indicating good construct validity. WAB AQ scores and Raven's Coloured Progressive Matrices scores significantly correlate, suggesting that the language portions of the WAB are not totally independent from nonverbal functioning. WAB AQ scores reliably differentiate between aphasic and control groups, with only a small overlap for high functioning anomic aphasic subjects.

A German version of the Sklar Aphasia Scale (SAS) was administered to groups of fluent aphasics, nonfluent aphasics, and three control groups (brain-damaged patients without aphasia, schizophrenics, and normal subjects). The SAS discriminated fluent and nonfluent aphasics from schizophrenic brain-damaged, and normal control subjects with a high level of confidence; 91.8% of the aphasic and 81.5% of the brain-damaged patients without aphasia were correctly classified. However, the SAS did not discriminate between fluent and nonfluent aphasics. A factor analysis, which also included the subtests of the Token Test and eight other variables, showed the SAS and the Token Test to load mainly on the same general factor, which represents the severity of language disorders or the impairment of those left-hemisphere functions that might be basic to language. Subtests II and IV of the SAS also had loadings on a memory factor, but none of the subtests had variance on the third factor which represented the sensory-motor or fluency/nonfluencey dimension.

The performance of individuals with mild and moderate Alzheimer's disease (AD), normal age-matched elderly individuals, and stroke patients with fluent and nonfluent aphasia were compared on a group of neuropsychological tasks. The unique performance profiles associated with each subject group are discussed, and the best tasks for intergroup differentiation specified. Whereas the tasks employed were efficacious for discriminating early- and middle-stage AD patients from normal subjects and aphasic stroke patients, and early- from middle-stage AD patients, they were not efficacious for subtyping aphasia patients according to fluency. Generally, memory measures were best for intergroup differentiation.

This study determined (1) the types of word retrieval behaviors employed by aphasic adults in conversation and (2) the degree to which identified behaviors were successful in prompting production of intended words. Five retrieval behaviors--delay, semantic association, phonetic association, description, and generalization--were identified. It was possible to organize the retrieval behaviors of 18 aphasic subjects in a hierarchical order of efficiency. Use of a particular behavior and the success with which it facilitated production of an intended word appeared strongly related to severity of aphasia. Findings again bring to focus the significance of the associational processes to the problem of word retrieval in aphasia.

This study investigated the practicality of developing short forms of the Porch Index of Communicative Ability (PICA). Stepwise regression procedures were performed using data from 222 complete administrations of the PICA to determine the accuracy of prediction of overall scores on the basis of data from either fewer subtests or fewer items. Results indicated that the PICA is highly redundant and that it may be possible to develop useful shorter forms of it.

The language skills of 11 aphasic patients were assessed through the use of the PICA. Spuses's understanding of the aphasic partner's language deficits was measured by rating the aphasic spouse on the Functional Communication Profile. Results indicate that spouses of aphasic patients view the patient's communication to be less impaired than it actually is. Implications for the counseling role of the speech pathologist in language therapy are discussed.

Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western Aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.

A pantomime recognition test was developed to study the extent of impairment of pantomime recognition and the relationship between pantomime recognition and verbal deficits in asphasics. This test requires no verbal instructions to the subject and only a simple pointing response. A description and rationale for the test are presented. This new test and three tests of verbal abilities (Verbal Recognition Test, Naming Test, and the Porch Index of Communicative Ability) were administered to four groups of subjects: aphasics, right-hemisphere damaged, subcortically damaged, and normals. Results indicate (1) greater impairment of pantomime recognition ability in aphasics than the other groups of subjects and (2) high correlations between impairment of pantomime recognition and impairment of verbal abilities in aphasics. Our findings are consistent with previous clinical reports and experimental data showing that aphasics commonly demonstrate impairment in gesture and pantomime. We conclude that aphasia is best understood as a general impairment of symbolic communication that includes nonverbal as well as verbal deficits.

Twenty-seven schizophrenic patients free of any known neurologic deficit were tested with an aphasia test battery. The objective of the research was to derive a profile of schizophrenic language performance to permit its comparison with the profiles characteristic of aphasia, apraxia of speech, generalized intellectual impairment, and confused language. Results indicate that schizophrenic patients exhibit a profile of language performance distinctive from those found in aphasia, apraxia of speech, confusion, or generalized intellectual impairment and demonstrate that the disruption of language in schizophrenia is not aphasic in nature.

Administration of the Western Aphasia Battery (WAB) yields a total score termed the Aphasia Quotient (AQ), which is said to reflect the severity of the spoken language deficit in aphasia. This score is a weighted composite of performance on 10 separate WAB subtests. Based on data from 100 patients, all 10 subtests were found to correlate highly with each other and with the AQ, but the score from one subtest, Information Content, was the best predictor of the AQ. Time postonset had no influence on the relationships among the subtests or between the 10 subtests and the AQ. These findings are useful in understanding the Western Aphasia Battery and in interpreting the Aphasia Quotient.