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Purpose: Many people with aphasia have inadequate language skills for functional communication thereby necessitating well-designed augmentative and alternative communication (AAC) interfaces. Using both a grid and a VSD interface with single word hotspots by neurologically healthy adults, across ages and with different technology experiences, this study examines the utility of these interfaces prior to investigating their use with people with aphasia in future studies., Method: Participants include 18 young adults, 24 older adults with technology experience, and 20 older adults with limited technology experience. The older adult groups were matched for mean age and for sex. Participants described pictures with each interface, and performance was measured based on four dependent variables: (a) the total number of correct information units (CIUs), (b) the percentage of CIUs, (c) CIUs per minute, and (d) preferred interface., Results: There was a significant difference between older adults and the young adult group for the total number of CIUs ( p  < 0.001) and CIUs per minute ( p  < 0.001). Despite the changes in technology experience between the two older groups, there was no significant difference in performance. Additionally, there was no significant difference in performance across the two interfaces in any of the groups., Conclusion: Findings suggest age does impact performance on AAC. However, the difference in technology experience in older adult groups did not affect performance. Furthermore, both interfaces used in the current study were equally beneficial when describing pictures by healthy adults. Implications for RehabilitationAugmentative and alternative communication (AAC) systems involve various interface designs. Consequently, the comparative utility of these interfaces must be examined across populations and communicative functions.Advancement in technology has given rise to numerous high-tech AAC interface designs. However, older adults with acquired language difficulties whose technology experience is limited may become reluctant to use high-tech AAC. Hence, the  influence of technology experience on high-tech AAC performance should be investigated.Prior to examining interfaces with individuals with acquired language difficulties, the current study examined the use of a) grid display and b) visual scene display (VSD) with single word hotspots, by healthy adults of different ages and technology experiences.The study revealed that older adults with limited technology experience were equally competent in using high-tech AAC interfaces, as those with technology experience. Hence, an individual's technology experience should not be considered a deterrent to using high-tech AAC interfaces.Additionally, the study found no differences in performance between the two interfaces, making it essential to consider user's personal preference when adopting AAC interface designs.

Purpose: The absence of culture- and language-specific aphasia assessment in Bangla underscores a critical problem in communication sciences and disorders. Aphasia occurs in ~41% of Bangla-speaking stroke survivors. In the past 40 years, stroke incidence has doubled in low- and middle-income countries, such as Bangladesh and India, where there are ~250 million native Bangla speakers. This study aims to initiate the first step toward identifying an appropriate picture stimulus for the Bangla picture description task (PDT) intended for inclusion in a Bangla aphasia assessment. Researchers have reported the importance of cultural relevance and three visuographic variables of a picture (high-context, color, and photograph vs. black-and-white line drawing) for faster comprehension and comprehensive language production in people with aphasia and neurologically healthy adults., Method: Ninety-six neurologically healthy native Bangla speakers of three age groups (young 19-30, middle age 40-55, and older 65-89 years) were recruited to compare spontaneous language production for four selected culturally related and nonrelated picture stimuli with and without the three visuographic variables. Five linguistic variables were used to analyze the language samples., Results: The results demonstrated a significant (a) picture type effect for moving-average type-token ratio, words per minute (WPM), and mean length of utterance in morphemes (MLU) and (b) age group effect for WPM, MLU, and complexity index., Conclusions: This study suggests that a culturally related high-context color photograph is the optimal choice for the Bangla PDT. This study also indicates reduced fluency, grammatical complexity, and syntactic complexity in healthy Bangla-speaking adults aged 65 years and above., Supplemental Material: https://doi.org/10.23641/asha.22233664.

Purpose: The objective of this study was to explore receptiveness of people with poststroke aphasia to receiving transcranial direct current stimulation (tDCS), including preferences for the treatment setting and schedule of tDCS delivery., Method: An online survey was distributed via e-mail, flyers, social media, and online newsletters to reach people with aphasia. Fisher's exact test examined the relationship of self-reported tDCS receptiveness to demographic, clinical, and other factors., Results: Fifty-seven surveys were returned, and 50 complete surveys were analyzed. Twenty-eight percent of respondents had previously heard of tDCS. Sixty-six percent reported they would receive tDCS if it could help their aphasia, and only 6% reported that they definitely would not. There were statistically significant relationships between being receptive to tDCS and (a) not currently working, (b) being receptive to speech-language therapy, and (c) greater acceptance of potential temporary risks associated with tDCS. Most individuals (73%) who would consider tDCS were equivalently open to receiving it in the clinic or at home, yet the majority (64%) were open to more frequent sessions at home than in the clinic. Most respondents indicated that they would consider having tDCS "forever if it helped" (clinic: 51%; home: 68%)., Conclusions: This is the first study to query individuals with aphasia about their receptiveness to tDCS outside the context of an intervention study. Responses suggest that a large majority of people with poststroke aphasia might be open to receiving tDCS if it can ameliorate their aphasia. Limitations include the small sample size, which does not adequately represent the broader population of people with aphasia, and that the survey did not provide the level of tDCS education crucial to inform shared decision making and person-centered care. However, future work may benefit from considering the practical implications of research designs (e.g., high intensity treatment outside the home) that may not, in application, be widely acceptable to primary stakeholders., Supplemental Material: https://doi.org/10.23641/asha.19611777.

Background: A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black-and-white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP)., Aims: To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black-and-white LD from neurologically healthy native Bangla speakers., Methods & Procedures: A total of 30 participants (mean age = 36.03 years) were recruited based on self-reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black-and-white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM)., Outcomes & Results: Of the four measures, only MLU showed a statistically significant difference between the CP and the black-and-white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM., Conclusions & Implications: This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples. What this paper adds What is already known on the subject There are studies on neurologically healthy individuals as well as on PWA that identified the impact of using different visuographic variables (colour and photograph) separately, which enhanced the picture comprehension and improved performances on associated language production tasks. To our knowledge, no studies have identified the combined impact of these two visuographic variables on spontaneous language production. Therefore, this initial study on neurologically healthy Bangla adults reports the impact of using a CP as a stimulus item for a PDT task to elicit spontaneous language samples. What this paper adds to existing knowledge This study reports that using a culturally appropriate CP for a PDT enhances the grammatical complexity of spontaneous language production of neurologically healthy adults. To our knowledge, this is the first study in Bangla that used the MLU as a measurement variable to analyse adults' spontaneous language production. What are the potential or actual clinical implications of this work? The development of future aphasia assessments should consider incorporating CPs as stimuli for PDTs, which may guide speech-language pathologists to provide accurate diagnoses for aphasia and related language disorders., (© 2020 Royal College of Speech and Language Therapists.)

Background: Efficacy studies have demonstrated the benefit of group conversation therapy for a person with aphasia (PWA). However, a PWA typically participates in individual therapy prior to group therapy. Stimulation therapy (ST) is the most common type of individual aphasia therapy. Ultimately, the outcome of therapy is to enable the PWA to communicate effectively with others, which suggests the need for conversation therapy (CT). Little efficacy data exist to demonstrate the benefit of CT between a PWA and a clinician, in part because no clear treatment outcome measures have been established. More information is needed to identify optimal ways to measure CT outcomes., Aim: To identify ways to measure CT outcomes and to determine if there is a change in linguistic complexity and total talk time during conversation, samples were taken during CT and ST in two PWAs., Methods & Procedures: Seventeen 6-min conversational samples per PWA were analyzed from a prior single-subject AB 1 AB 2 A alternating treatment study with randomized ordering of interventions across participants. Data were analyzed for seven measures of linguistic complexity using Systematic Analysis of Language Transcripts (SALT). Efficiency was measured using correct information units (CIUs) per minute and total talk time., Outcomes & Results: Per cent of complex utterances and propositional density were higher following CT. Four out of seven linguistic measures increased following ST. Total talk time was significantly greater for one PWA during CT compared with ST. No differences were found in CIUs/min across treatment types., Conclusion & Implications: Linguistic complexity and efficiency appear to be conversational treatment outcome measures that are sensitive to change, which researchers might consider using., (© 2016 Royal College of Speech and Language Therapists.)

Background: A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black-and-white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP). Aims: To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black-and-white LD from neurologically healthy native Bangla speakers. Methods & Procedures: A total of 30 participants (mean age = 36.03 years) were recruited based on self-reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black-and-white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM). Outcomes & Results: Of the four measures, only MLU showed a statistically significant difference between the CP and the black-and-white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM. Conclusions & Implications: This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples.

Background: Efficacy studies have demonstrated the benefit of group conversation therapy for a person with aphasia (PWA). However, a PWA typically participates in individual therapy prior to group therapy. Stimulation therapy (ST) is the most common type of individual aphasia therapy. Ultimately, the outcome of therapy is to enable the PWA to communicate effectively with others, which suggests the need for conversation therapy (CT). Little efficacy data exist to demonstrate the benefit of CT between a PWA and a clinician, in part because no clear treatment outcome measures have been established. More information is needed to identify optimal ways to measure CT outcomes. Aim: To identify ways to measure CT outcomes and to determine if there is a change in linguistic complexity and total talk time during conversation, samples were taken during CT and ST in two PWAs. Methods & Procedures: Seventeen 6-min conversational samples per PWA were analyzed from a prior single-subject AB[subscript 1]AB[subscript 2]A alternating treatment study with randomized ordering of interventions across participants. Data were analyzed for seven measures of linguistic complexity using Systematic Analysis of Language Transcripts (SALT). Efficiency was measured using correct information units (CIUs) per minute and total talk time. Outcomes & Results: Per cent of complex utterances and propositional density were higher following CT. Four out of seven linguistic measures increased following ST. Total talk time was significantly greater for one PWA during CT compared with ST. No differences were found in CIUs/min across treatment types. Conclusion & Implications: Linguistic complexity and efficiency appear to be conversational treatment outcome measures that are sensitive to change, which researchers might consider using.

Purpose: There is a pressing need for psychometrically sound naming materials for Spanish/English bilingual adults. To address this need, in this study the authors examined the psychometric properties of An Object and Action Naming Battery (An O&A Battery; Druks & Masterson, 2000) in bilingual speakers. Method: Ninety-one Spanish/English bilinguals named O&A Battery items in English and Spanish. Responses underwent a Rasch analysis. Using correlation and regression analyses, the authors evaluated the effect of psycholinguistic (e.g., imageability) and participant (e.g., proficiency ratings) variables on accuracy. Results: Rasch analysis determined unidimensionality across English and Spanish nouns and verbs and robust item-level psychometric properties, evidence for content validity. Few items did not fit the model, there were no ceiling or floor effects after uninformative and misfit items were removed, and items reflected a range of difficulty. Reliability coefficients were high, and the number of statistically different ability levels provided indices of sensitivity. Regression analyses revealed significant correlations between psycholinguistic variables and accuracy, providing preliminary construct validity. The participant variables that contributed most to accuracy were proficiency ratings and time of language use. Conclusions: Results suggest adequate content and construct validity of O&A items retained in the analysis for Spanish/English bilingual adults and support future efforts to evaluate naming in older bilinguals and persons with bilingual aphasia.

Background: In aphasia research, to improve a study's reliability, the aphasia journals compel their authors to report fidelity. Aphasia researchers are mostly concerned about Type I and Type II errors to maintain the level of confidence. However, the third type (Type III error) can significantly affect the study outcomes and question the research fidelity. Objective: This study explains the methodology of how investigators maintained research fidelity in the context of hiring and training remote data collectors and conducted a multi-site data collection. Methods: The present study used a descriptive analysis design to explicate the three-step process of remote data collection: (1) remotely selecting and training data collectors, (2) remotely supervising data collection and data management, and (3) optimizing and monitoring screening/assessment fidelity. At the initial step, investigators interviewed seven candidates and short-listed four of them, who were trained using a standard training protocol and participated in a mock data collection. For the next two steps, data collectors video-recorded each study session and e-shared the data with the investigator, who watched all the video-recordings and provided necessary feedback with a focus on the screening sections. The screenings were a part of the inclusion-exclusion criteria. Results: Two data collectors (both clinical psychologists) with the highest scores were selected and received final training. One-to-one e-supervision by the investigator resulted in significant improvement in data collectors' performance. Only 4% of the total collected sample size was excluded, and 99 participants' data were analyzed. Conclusion: The present study adds information on maintaining research fidelity for remote data collection, where limited studies exist. [ABSTRACT FROM AUTHOR]

Purpose: We sought to examine interrater reliability in clinical assessment of apraxia of speech (AOS) in individuals with primary progressive aphasia and to identify speech characteristics predictive of AOS diagnosis. Method: Fifty-two individuals with primary progressive aphasia were recorded performing a variety of speech tasks. These recordings were viewed by 2 experienced speechlanguage pathologists, who independently rated them on the presence and severity of AOS as well as 14 associated speech characteristics. We calculated interrater reliability (percent agreement and Cohen’s kappa) for these ratings. For each rater, we used stepwise regression to identify speech characteristics significantly predictive of AOS diagnosis. We used the overlap between raters to create a more parsimonious model, which we evaluated with multiple linear regression. Results: Results yielded high agreement on the presence (90%) and severity of AOS (weighted Cohen’s κ = .834) but lower agreement for specific speech characteristics (weighted Cohen’s κ ranging from .036 to .582). Stepwise regression identified 2 speech characteristics predictive of AOS diagnosis for both raters (articulatory groping and increased errors with increased length/complexity). These alone accounted for ≥ 50% of the variance of AOS severity in the constrained model. Conclusions: Our study adds to a growing body of research that highlights the difficulty in objective clinical characterization of AOS and perceptual characterization of speech features. It further supports the need for consensus diagnostic criteria with standardized testing tools and for the identification and validation of objective markers of AOS. Additionally, these findings underscore the need for a training protocol if diagnostic tools are to be effective when shared beyond the research teams that develop and test them and disseminated to practicing speech-language pathologists, in order to ensure consistent application. [ABSTRACT FROM AUTHOR]

The purpose of this case study was to examine the integrity of cognitive skills, language usage, and language structure components in a patient with corticobasal degeneration (CBD). CBD is a levadopa-nonresponsive, degenerative neurologic movement disorder that is generally accompanied by cognitive (frontal executive dysfunction, dementia) and linguistic (aphasia) disorders. However, no one has reported on social language usage deficits in cases of CBD. The reported frontal executive dysfunction found in CBD led us to expect social language usage deficits in the present case study. Consistent with the literature, the patient demonstrated motor, cognitive (severe apraxia, frontal executive deficits, dementia), and linguistic deficits (aphasia). However she also demonstrated significantly abnormal social language usage previously unreported in the literature. [ABSTRACT FROM AUTHOR]

Objective: To perform a psychometric evaluation of the Functional Outcome Questionnaire for Aphasia (FOQ-A), a 32-item instrument designed to assess the extent to which a person who has had a stroke performs several important functional communication behaviors. Research Design: The FOQ-A was administered to family caregivers of persons with a history of left hemisphere stroke (N = 91) undergoing a comprehensive screening assessment to determine their eligibility for participation in research trials for novel stroke rehabilitation interventions. Results: Statistical analyses provided strong support for the internal consistency reliability and the convergent and discriminant validity of the FOQ-A. An exploratory factor analysis revealed a two-factor solution, Basic Verbal Expression and Conversational Response Skills. Conclusions: The present findings build on earlier evidence indicating that the FOQ-A has good psychometric properties and considerable promise as a measure of functional communication in aphasia rehabilitation. Future research will focus on the test-retest reliability, criterion-oriented validity, and predictive validity of the instrument. [ABSTRACT FROM AUTHOR]