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Purpose Individuals with primary progressive apraxia of speech (AOS) have AOS in which disruptions in articulation and prosody predominate the speech pattern. Many develop aphasia and/or dysarthria later in the disease course. The aim of this study was to describe the communication limitations in these patients, as measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association's (ASHA) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating. Method Speech and language evaluations were completed for 24 patients with progressive AOS ( n = 7 with isolated AOS; n = 17 with a combination of AOS and aphasia). Descriptive comparisons were utilized to evaluate differences in communication measures among patients with various combinations of MSDs and aphasia. Differences associated with phonetic predominant or prosodic predominant AOS were also examined. Across the entire cohort, correlations were calculated between the participation ratings and other clinical assessment measures. Results The CPIB reflected greater limitations for those with aphasia and AOS compared to isolated AOS, but was not notably different when dysarthria occurred with AOS ( n = 9/24). Across the cohort, there were statistically significant correlations between the CPIB and ASHA FCM-Motor Speech and Language Expression ratings and the MSD severity rating. The CPIB did not correlate with the ASHA FCM-Language Comprehension or other speech-language measures. Conclusions Patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits. The study suggests measures of severity cannot be assumed to correlate with measures of participation restrictions and offers a foundation for further research examining the day-to-day sequela of progressive speech and language disorders. Supplemental Material https://doi.org/10.23641/asha.12743252.

Purpose This study continued Phase I investigation of a modified Phonomotor Treatment (PMT) Program on motor planning in two individuals with apraxia of speech (AOS) and aphasia and, with support from prior work, refined Phase I methodology for treatment intensity and duration, a measure of communicative participation, and the use of effect size benchmarks specific to AOS. Method A single-case experimental design with multiple baselines across behaviors and participants was used to examine acquisition, generalization, and maintenance of treatment effects 8-10 weeks posttreatment. Treatment was distributed 3 days a week, and duration of treatment was specific to each participant (criterion based). Experimental stimuli consisted of target sounds or clusters embedded nonwords and real words, specific to each participants' deficit. Results Findings show improved repetition accuracy for targets in trained nonwords, generalization to targets in untrained nonwords and real words, and maintenance of treatment effects at 10 weeks posttreatment for one participant and more variable outcomes for the other participant. Conclusions Results indicate that a modified version of PMT can promote generalization and maintenance of treatment gains for trained speech targets via a multimodal approach emphasizing repeated exposure and practice. While these results are promising, the frequent co-occurrence of AOS and aphasia warrants a treatment that addresses both motor planning and linguistic deficits. Thus, the application of traditional PMT with participant-specific modifications for AOS embedded into the treatment program may be a more effective approach. Future work will continue to examine and maximize improvements in motor planning, while also treating anomia in aphasia.

Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.

Purpose This study examined the relationship between single word reading, connected text reading, and comprehension in persons with aphasia. Method Thirteen persons with aphasia read orally from the Arizona Battery for Reading and Spelling real-word and nonword lists and the Gray Oral Reading Tests-Fifth Edition. The comprehension questions following each paragraph of the Gray Oral Reading Tests-Fifth Edition were answered and scored. The Reading Comprehension Battery for Aphasia-Second Edition provided a measure of silent reading comprehension. Descriptive statistics and Spearman correlation were used to examine associations among reading measures. Results Persons with aphasia showed associations between single word reading and connected text reading accuracy; however, single word reading ability was not associated with oral or silent reading comprehension. Conclusions Although preliminary, the findings provide support for word-level reading abilities underlying connected text reading accuracy but suggest additional cognitive mechanisms are involved in text-level reading comprehension that are not explained by single word reading alone. The findings indicate clinicians should use caution when inferring comprehension abilities from single word reading performance as reading comprehension abilities are likely best assessed using text-level comprehension assessments.

Speech assessment is an important part of the rehabilitation process for patients with aphasia (PWA). Mandarin speech lucidity features such as articulation, fluency, and tone influence the meaning of the spoken utterance and overall speech clarity. Automatic assessment of these features is important for an efficient assessment of the aphasic speech. Hence, in this paper, a standardized automatic speech lucidity assessment method for Mandarin-speaking aphasic patients using a machine learning based technique is presented. The proposed assessment method adopts the Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE) standard as a guideline. Quadrature based high-resolution time-frequency images with a convolutional neural network (CNN) are utilized to develop a method that can map the relationship between the severity level of aphasic patients' speech and the three speech lucidity features. The results show a linear relationship with statistically significant correlations between the normalized true-class output activations (TCOA) of the CNN model and patients' articulation, fluency, and tone scores, i.e., 0.71 (p < 0.001), 0.60 (p < 0.001) and 0.58 (p < 0.001), respectively. The linearity of the proposed Mandarin aphasic speech assessment method and its significant correlation with the speech severity levels show the efficacy of the method in predicting the severity of impaired Mandarin speech. The outcome of this research envisages assisting speech-language pathologists in Mandarin-speech impairment assessment and promoting early support discharge; hence could alleviate the stress that the healthcare system is currently experiencing in China nationwide. The framework of the proposed Mandarin aphasic speech assessment method can be readily extended to other languages.

Purpose: This study aimed to cross culturally adapt the Protocol for the Exploration of Natural Metalinguistic Skills in Aphasia (MetAphAs), contributing to the future application in the aphasic Chilean population., Method: The sample corresponds to 72 healthy subjects in the region of Valparaíso, between the ages of 50 to 85. The MetAphAs measures natural metalinguistic skills and presents the basic elements on which to base the exploration of the metacognitive dimensions involved in verbal behavior. The validity was ascertained by means of Cronbach's Alpha Coefficient, including the values of each of the 6 sections; the correlations between variables were analyzed by the Pearson coefficient., Results: We observed that 64% of the sample corresponded to the female and 36% to the male gender, with predominant age ranging from 61 to 70 years. We verified adequate correlation between the variables according to the Pearson coefficient, and highly positive values according to Cronbach's Alpha., Conclusion: The use of the protocol is viable, with data demonstrating high reliability. The results evidenced high liability, which encourages the continuation process of its validation with Chilean aphasic population.

Purpose: Aphasia is one of the most common complications after stroke and occurs in 21-38% of the patients during acute period. The present study aimed to investigate the response to speech and language therapy according to artery involvement and lesion location in patients with post-stroke aphasia., Method: The medical records of 107 patients with post-stroke aphasia (mean age, 58.8 ± 14.8 years) who were admitted to a single rehabilitation center for usual care after stroke were reviewed. Location of the ischemic lesion and involved artery was determined assessing the brain MRI of the patients. All the patients received 24 sessions speech and language therapy (3 days a week) as a part of 8-week rehabilitation program. Evaluation of the aphasia was performed with Gülhane Aphasia Test-2 (GAT-2) at baseline and at the end of the rehabilitation program., Results: Baseline GAT-2 scores was significantly worse in patients with middle cerebral artery (MCA) involvement compared to patients with other artery involvements (p = 0.007). While the GAT-2 scores of patients with MCA involvement were improved significantly after speech and language therapy (p < 0.001), the changes in those with anterior cerebral artery (ACA) and posterior cerebral artery (PCA) involvements were not significant (p > 0.05)., Conclusions: The present findings suggested that speech functions might be more affected in ischemic lesion of MCA and response to SLT might be better in patients with MCA involvement., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Besides language deficits, persons with aphasia can present with impairments in executive functions such as cognitive flexibility. Since these impairments can restrict communicative abilities, diagnostics for aphasia should include their assessment. However, tests of executive functions, including symptoms expressed in everyday communication, are lacking for aphasia. Thus, our aim was to fill this gap and study the basic psychometric properties of the novel Cognitive Flexibility in Aphasia Screening. For a pilot evaluation, 26 German patients were examined with tests for language and cognitive flexibility as well as the novel screening. Moreover, 20 non-aphasic persons conducted the latter. We performed a Receiver Operating Characteristic analysis to investigate specificity and sensitivity, and multidimensional scaling to examine similarities between the screening and language/cognitive skills. We found good specificity and sensitivity and showed that the screening is correlated with language skills and verbal cognitive flexibility, revealing promising construct validity and feasibility of the new screening.

Introduction: Verbs and nouns can be selectively impaired, suggesting that they are processed, at least in part, by distinct neural structures. While several tests of object naming are available, tasks involving action verb naming with normative data are lacking. We report the construction and standardization of a new test for the assessment of picture naming of actions., Material and Methods: The test includes 50 stimuli, strictly controlled for several confounding variables. Normative data on 290 Italian subjects pooled across homogenous subgroups for age, sex, and education are reported., Results: Multiple regression analyses revealed that age and education significantly correlated with the subject's score. In particular, increasing age negatively affected performance, while the performance increased with a higher education., Conclusions: In the clinical practice, the availability of equivalent scores will help the comparison with performance in the picture naming of objects. This test allows investigating action naming deficits in aphasic patients, in Parkinson's disease patients and in further neurodegenerative disorders, in which a specific impairment of action verbs is expected, filling a gap in the clinical neuropsychological assessment.

Aphasia shows high incidence in stroke patients and seriously impairs language comprehension, verbal communication, and social activities. Therefore, screening aphasic patients during the acute phase of stroke is crucial for language recovery and rehabilitation. The present study developed a Chinese version of the Language Screening Test (CLAST) and validated it in post-stroke patients.The CLAST was adapted from the Language Screening Test developed by Constance et al to incorporate Chinese cultural and linguistic specificities, and administered to 207 acute stroke patients and 89 stabilized aphasic or non-aphasic patients. Based on the Western Aphasia Battery (WAB) test, its reliability and validity were assessed. A cut-off for the CLAST in Chinese patients was determined by ROC curve analysis.The CLAST comprised 5 subtests and 15 items, including 2 subscores, namely expression (8 points, assessing naming, repetition, and automatic speech) and receptive (7 points maximum, evaluating picture recognition, and verbal instructions) indexes. Analysis of the alternate-form reliability of the questionnaire showed a retest correlation coefficient of 0.945 (P < .001). Intraclass correlation coefficients of three rating teams were >0.98 (P < .001). Internal consistency analysis showed a Cronbach's alpha coefficient of 0.909 (P < .001). The non-aphasia group showed higher scores than the aphasia group (14.2 ± 1.3 vs 10.6 ± 3.8) (P < .01). The questionnaire showed good construct validity by factor analysis. ROC curve analysis showed high sensitivity and specificity for the CLAST, with a cut-off of 13.5.The CLAST is suitable for Chinese post-stroke patients during the acute phase, with high reliability, validity, sensitivity, and specificity.

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.)

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways-(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia., (© 2020 Cognitive Science Society, Inc.)

Background: Minor strokes, defined as NIHSS ≤5 are considered non-disabling, associated with a favourable outcome., Aim: Our aim was to study prevalence and predictors of dysphagia in patients with minor stroke and its impact on functional outcome., Methods: Single centre retrospective study of all minor strokes admitted to Comprehensive Stroke care centre with 1 year completed follow-up were recruited. Clinical and imaging details and follow-up data were extracted from medical records., Results: We had 147 patients with minor stroke, 72.1% men with median age 61 years. 71% presented within 24 h of symptom onset. Most common etiology was lacunar .Median NIHSS at admission was 3(IQR 2). 85 patients had anterior circulation strokes and 34 had chronic infarcts in imaging.19 had significant dysphagia and 10 were discharged with nasogastric feeding tube. Admission NIHSS and white mater changes in imaging were predictive of post stroke dysphagia. Excellent recovery of dysphagia was found within 1 month post stroke in all, except one who required percutaneous gastrostomy. At 3 months 76% had excellent outcome. Presence of dysphagia and diabetes were found to be predictive of short term outcome, independent of admission stroke severity. At 12 months, post stroke dysphagia, female gender and white mater changes in imaging were predictive of unfavourable outcome., Conclusions: Minor strokes are disabling in a small fraction of patients. Over 10% of them can have significant post stroke dysphagia necessitating nasogastric feeding short term. This patient subgroup tend to have less favourable outcome on short and long term follow-up., Competing Interests: Declaration of Competing Interest Authors have no conflicts of interest to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose The objectives of this study are to (a) identify speech-language pathologists' (SLPs') familiarity with transcranial direct current stimulation (tDCS), (b) quantify what SLPs consider necessary tDCS-related improvement in aphasia severity (i.e., tDCS enhancement; desired improvement above and beyond traditional behavioral therapy) to implement this adjuvant therapy for the clinical management of aphasia, and (c) identify concerns that could potentially hinder the clinical adoption of tDCS. Method A brief (14-question) survey was disseminated via e-mail and social media outlets targeting SLPs working with individuals with aphasia. Results Two hundred twenty-one individuals responded, and 155 valid surveys were analyzed. Seventy-one percent of participants reported familiarity with tDCS prior to taking the survey. Clinicians reported a desired mean enhancement of 22.9% additional points on the Western Aphasia Battery-Revised Aphasia Quotient. Importantly, 94.2% of SLPs reported concerns regarding the implementation of tDCS in clinical settings (i.e., safety, cost, administrative approval, reimbursement and training). Conclusions This is the first study to identify SLPs' perspectives regarding the clinical adoption of tDCS. Results suggest the majority of queried SLPs were familiar with tDCS prior to taking the survey. Although SLPs report a desired improvement of approximately 23% additional points on the Western Aphasia Battery-Revised Aphasia Quotient to consider adopting tDCS into practice, many SLPs reported concerns regarding clinical adoption. Responses from the current survey offer important preliminary evidence to begin bridging the research-to-practice gap as it relates to the clinical implementation of tDCS. Relatedly, these results will inform future clinical trials.

Purpose We report on a study that replicates previous treatment studies using Abstract Semantic Associative Network Training (AbSANT), which was developed to help persons with aphasia improve their ability to retrieve abstract words, as well as thematically related concrete words. We hypothesized that previous results would be replicated; that is, when abstract words are trained using this protocol, improvement would be observed for both abstract and concrete words in the same context-category, but when concrete words are trained, no improvement for abstract words would be observed. We then frame the results of this study with the results of previous studies that used AbSANT to provide better evidence for the utility of this therapeutic technique. We also discuss proposed mechanisms of AbSANT. Method Four persons with aphasia completed one phase of concrete word training and one phase of abstract word training using the AbSANT protocol. Effect sizes were calculated for each word type for each phase. Effect sizes for this study are compared with the effect sizes from previous studies. Results As predicted, training abstract words resulted in both direct training and generalization effects, whereas training concrete words resulted in only direct training effects. The reported results are consistent across studies. Furthermore, when the data are compared across studies, there is a distinct pattern of the added benefit of training abstract words using AbSANT. Conclusion Treatment for word retrieval in aphasia is most often aimed at concrete words, despite the usefulness and pervasiveness of abstract words in everyday conversation. We show the utility of AbSANT as a means of improving not only abstract word retrieval but also concrete word retrieval and hope this evidence will help foster its application in clinical practice.

Recovery of stroke-related aphasia can be affected by language therapy in the early and chronic stage. Objectively monitoring therapy-induced neuroplasticity is possible by several measurement techniques including electro- and magneto-encephalography. The obtained event-related potentials (ERPs) and fields (ERFs) provide insights into the neural basis of intact or deficient language processing with milliseconds precision. In this literature review, we highlight the sensitivity of ERPs and ERFs to logopedic interventions by providing an overview of therapy-induced changes in the amplitude, latency and topography of early and mid-to-late components.

Naming treatment outcomes in post-stroke aphasia are variable and the factors underlying this variability are incompletely understood. In this study, 26 patients with chronic aphasia completed a semantic judgment fMRI task before receiving up to 12 weeks of naming treatment. Global (i.e., network-wide) and local (i.e., regional) graph theoretic measures of pre-treatment functional connectivity were analyzed to identify differences between patients who responded most and least favorably to treatment (i.e., responders and nonresponders) and determine if network measures predicted naming improvements. Responders had higher levels of global integration (i.e., average network strength and global efficiency) than nonresponders, and these measures predicted treatment effects after controlling for lesion volume and age. Group differences in local measures were identified in several regions associated with a variety of cognitive functions. These results suggest there is a meaningful and possibly prognostically-informative relationship between patients' functional network properties and their response to naming therapy., (Published by Elsevier Inc.)

Tests and batteries used in the evaluation of language impairments are overly complex and often ineffective (too difficult) in the assessment of post-stroke patients affected by severe aphasia (global aphasia). The present study reports details on the construction and standardization of a new Italian battery of tasks, specifically designed to assess severe lexical disorders in acquired aphasia (Battery for the Assessment of Severe Acquired Lexical Damage in Italian, BASALDI). The battery is composed of a common set of 64 stimuli (concrete nouns), belonging to both living and non-living categories, and consists of four lexical tasks assessing picture naming, repetition, reading aloud, and oral comprehension. The item selection was based on word frequency, word length, and phonological-articulatory complexity, namely the presence of continuant vs. plosive phones, a variable that may interact with word production in case of severe language damage. Standardization (naming agreement) of a new set of 64 colored images and normative data on Italian healthy subjects pooled across homogenous subgroups for age, gender, and education are reported. Finally, for the four tasks, percentile ranks and z-scores were calculated from a pool of 92 left brain-damaged patients affected by aphasia of different types and severity. The battery allows a fine investigation of lexical disorders, being suitable for diagnostic assessment of mild-to-moderate and severe aphasic lexical deficits, detection of changes over time, and possible dissociations between tasks.

The Standard Language Test of Aphasia (SLTA) is the most frequently used comprehensive aphasia rating scale in Japan. Although the SLTA has been verified for reliability, verification for validity is inadequate. The purpose of this study was to examine criterion-related validity of the SLTA. The SLTA was performed on patients who had passed 3months or more after onset of the aphasia-causing disease such as stroke, and the Japanese version of the Western Aphasia Battery (WAB) was subsequently performed. We investigated age, gender, disease, and calculated Spearman's rank correlation coefficient for total score and each item of the SLTA and the WAB. There were 20participants (14males, 6females), with a mean age of 68.5±12.5years. Correlations of the SLTA and the WAB were as follows: SLTA total index score and WAB aphasia quotient; r=0.870 (P<0.001), SLTA Writing factor and WAB (VI) Writing; r=0.852 (P<0.001), SLTA writing instructions and WAB writing instructions; r=0.807 (P<0.001). Many of the correlations of Z-scores between sub-tests were r≥0.7. The SLTA has criteria-related validity and now the aphasia test that has been tested for reliability and validity. (Received July 22, 2019; Accepted March 4, 2020; Published July 1, 2020).

The ictal-interictal continuum represents a diagnostic challenge even for expert neurrophysiologists, often requiring an additional multimodal diagnostic workup to understand its clinical significance. Lateralised rhythmic delta activity (LRDA) is an ictal-interictal continuum pattern that has only recently been investigated and recognised as potentially ictogenic or sometimes even ictal. We describe a patient who presented with acute-onset aphasia, initially suspected of having a stroke; advanced brain imaging with CT-perfusion showed features suggesting regional left temporo-parietal hyperperfusion and an EEG revealed LRDA with fluctuations and intermixed sharp waves in the same areas. Treatment with lacosamide caused both clinical and EEG improvement after a few hours, supporting the hypothesis that the EEG pattern represented an ictal/interictal phenomenon. In the literature, a correlation between metabolic/perfusion imaging and ictal-interictal continuum patterns is described regarding lateralised periodic discharges but less studied for LRDA. In this case, we adopted a multimodal approach, integrating advanced imaging, EEG, clinical features, and response to therapy, to consider the overall clinical presentation as focal NCSE.

Competing Interests: Competing interests: None declared.

Purpose There is a rapid growth of telepractice in both clinical and research settings; however, the literature validating translation of traditional methods of assessments and interventions to valid remote videoconference administrations is limited. This is especially true in the field of speech-language pathology where assessments of language and communication can be easily conducted via remote administration. The aim of this study was to validate videoconference administration of the Western Aphasia Battery-Revised (WAB-R). Method Twenty adults with chronic aphasia completed the assessment both in person and via videoconference with the order counterbalanced across administrations. Specific modifications to select WAB-R subtests were made to accommodate interaction by computer and Internet. Results Results revealed that the two methods of administration were highly correlated and showed no difference in domain scores. Additionally, most participants endorsed being mostly or very satisfied with the videoconference administration. Conclusion These findings suggest that administration of the WAB-R in person and via videoconference may be used interchangeably in this patient population. Modifications and guidelines are provided to ensure reproducibility and access to other clinicians and scientists interested in remote administration of the WAB-R. Supplemental Material https://doi.org/10.23641/asha.11977857.

Purpose The purpose of this article is to revisit the role of augmentative and alternative communication (AAC) in poststroke aphasia rehabilitation. The authors' intent is to provide a viewpoint that expands the use of AAC in poststroke aphasia rehabilitation. Specifically, we seek to clarify the role of AAC in restorative and participation approaches to aphasia rehabilitation while also considering the role of AAC in a comprehensive treatment plan. The authors support their viewpoint with citations from both the historic and contemporary literature on aphasia rehabilitation. Conclusions A thought-provoking viewpoint on the role of AAC in poststroke aphasia rehabilitation is proposed. More specifically, the versatility of AAC strategies is reviewed, with an emphasis on how AAC can be used to empower people with aphasia to fully participate and engage in life activities with increased independence. Moreover, we argue that AAC can be viewed as a dual-purpose tool that can simultaneously serve to drive intersystemic reorganization resulting in some improved language performance-and perhaps restoration of language function-while offering a communication alternative during inevitable anomic events.

Objective: Aphasia is one of the most severe symptoms in stroke patients, affecting one-third of acute stroke patients. We aimed to investigate the prevalence and outcomes of aphasia in patients with acute ischemic stroke (AIS)., Methods: We computed the weighted prevalence of aphasia in AIS patients using the 2003 to 2014 National Inpatient Sample databases. Crude regression model, multivariable regression model, and propensity score matching were used to evaluate the impact of aphasia on the clinical outcomes in AIS patients. We performed the Subpopulation Treatment Effect Pattern Plot (STEPP) analyses in propensity score matching cohort to visually display the effect of interaction between aphasia and age on the clinical outcomes., Results: A total of 16.93% of 4,339,156 AIS patients identified were with aphasia. The proportion of patients with comorbid aphasia increased from 13.34% in 2003 to 21.94% in 2014 (P < .0001). The results of both multivariable regression model and propensity score matching analyses indicated aphasia in AIS as a risk factor for in-hospital deaths. Aphasia was linked to prolonged length of stay (0.66 day, P < .0001) and high hospitalization cost ($971.35, P < .0001). In the STEPP analyses, in-hospital mortality rate increased with age, and the rate was higher in patients with aphasia, but the ratios decreased with an increase in age., Conclusions: Prevalence of comorbid aphasia with AIS is increasing, and it has a significant impact on clinical outcomes. Additionally, aphasia shows a greater impact on survival and medical burden among young patients with AIS., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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 Aphasia research demonstrates increasing interest in the treatment of verb retrieval deficits. This systematically conducted scoping review reports on the level and fidelity of the current evidence for verb treatments; on its effectiveness regarding the production of trained and untrained verbs, functional communication, sentences, and discourse; and on the potential active ingredients. Recommendations to guide clinical decision making and future research are made. Method The computerized database search included studies from January 1980 to September 2018. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to the treatment methods used. Results Thirty-seven studies were accepted into the review, and all but 1 constituted a low level of evidence. Thirty-three studies (89%) described treatment in sufficient detail to allow replication, dosage was poorly reported, and the fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were phonological and semantic cueing in 25 (67.5%) and 20 (54%) studies, respectively. Retrieval of trained verbs improved for 80% of participants, and improvements generalized to untrained verbs for 15% of participants. There was not sufficient detail to evaluate the impact of treatment on sentence production, functional communication, and discourse. Conclusions The evidence for verb treatments is predominantly of a low level. There are encouraging findings in terms of treatments being replicable; however, this is tempered by poor monitoring of treatment fidelity. The quality of verb treatment research would be improved by researchers reaching consensus regarding outcome measures (including generalization to, e.g., sentences and discourse) by manualizing treatment to facilitate implementation and exploring the opinions of participants. Finally, while treatment is largely effective in improving production of trained verbs, lack of generalization to untrained items leads to the recommendation that personally relevant verbs are prioritized.

Purpose: Better understanding of clinical predictors of aphasia outcome is of the utmost importance, in patients' rehabilitation planning, expectation management, and further physiopathology understanding. We aimed to identify clinical predictors of long-term poststroke aphasia's outcome., Methods: We conducted a prospective longitudinal observation study of patients with left-Middle Cerebral Artery stroke with aphasia. Patients were evaluated at baseline, day 7 and 6 months with National Institutes of Health Stroke Scale (NIHSS) and Aphasia Rapid Test Other demographic variables and vascular risk factors were collected. A linear regression was performed to identify best predictors of aphasia at 6 months., Findings: We included 113 patients with a left hemisphere stroke, with 81 reaching the final evaluation. Aphasia Handicap Score at 6 months was predicted by baseline total NIHSS (β = .077, 95%CI = [.026, .127]. P = .004), infarct volume on CT-scan (β = .009, 95%CI = [.003, .015]. P = .003), single word repetition at baseline (β = .188, 95%CI = [.040, .335]. P = .013), and infection during hospitalization (β = .759, 95%CI = [.263, 1.255]. P = .003)., Conclusions: Aphasia's outcome in patients with stroke is predicted by a single word repetition task at baseline. Infection during hospitalization has a negative impact on aphasia's outcome at 6 months., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose of the Review: Although visual and somatosensory disturbances are the most common migraine aura (MA) symptoms, patients can also experience other symptoms during their MA. The aim of this review is to provide an overview of studies that report symptoms of dysphasia and other higher cortical dysfunctions (HCDs) during MA, as well as to determine the frequency of HCDs., Recent Findings: Five studies met the inclusion criteria, corresponding to 697 patients overall. The most frequently reported HCDs were those of the language group (range 10-53%). The occurrence of visual HCDs was noted in 12-40 patients, somatosensory HCDs in 12-20%, and memory disturbances in 10-22% of the patients during MAs. MA is associated with a wide range of neurological symptoms, including symptoms of HCD. A better strategy for investigation of the HCD symptoms is needed to correctly stratify patients thus allowing meaningful studies of aura pathophysiology.

Background and Purpose: Vision, Aphasia, Neglect (VAN) is a large vessel occlusion (LVO) screening tool that was initially tested in a small study where emergency department (ED) nurses were trained to perform VAN assessment on stroke code patients. We aimed to validate the VAN assessment in a larger inpatient dataset., Methods: We utilized a large dataset and used National Institute of Health Stroke Scale (NIHSS) performed by physicians to extrapolate VAN. VAN was compared to NIHSS greater than or equal to 6 and established prehospital LVO screening tools including Rapid Arterial Occlusion Evaluation scale (RACE), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and Cincinnati Pre-hospital Stroke Scale (CPSS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under receiver operating characteristics curve was calculated to estimate the predictive value of LVO., Results: VAN was comparable in sensitivity (79% versus 80%) and NPV (88% versus 87%) to NIHSS greater than or equal to 6. It was superior in specificity (69% versus 57%), PPV (53% versus 46%) and accuracy to NIHSS greater than or equal to 6 (72% versus 64%) with significant receiver operating curve (.74 versus .69, P = .02). VAN also had comparable area under the curve when compared to RACE, FAST-ED, and CPSS however slightly lower accuracy (69%-73%) compared to RACE (76%), FAST-ED (77%), and CPSS (75%). VAN had the highest NPV among all screening assessments (88%)., Conclusions: VAN is a simple screening tool that can identify LVOs with adequate accuracy in hospital setting. Future studies need to be conducted in prehospital setting to validate its utility to detect LVOs in the field., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: Alzheimer's disease (AD) is the most common age-related neurodegenerative disease and leads to dementia. AD is characterized by progressive declines in memory and, as the disease progresses, language dysfunction. Although it has been reported that AD patients show progressive aphasia, no study has examined the relationship between language functions estimated by the Standard Language Test for Aphasia (SLTA) and brain network connectivity in Japanese AD patients. If present, such a relationship would be of particular interest because Japanese speakers are accustomed to mingling ideography and phonography., Methods: 22 Japanese patients with AD who underwent 1.5-tesla MRI scan and SLTA, the scale for speech and reading impairment, participated in this study. We computed brain network connectivity metrics such as degree, betweenness centrality, and clustering coefficient, and estimated their relationships with the subscores of SLTA., Results: There was a significant negative correlation between the score for "reading aloud Kanji words" and the clustering coefficient in the left inferior temporal region, bilateral hippocampal regions, and right parietotemporal region. We also found a significant negative correlation between the score for "auditory comprehension of words" and the clustering coefficient in the left prefrontal region. No significant relationship was found between the other SLTA scores and the network metrics., Conclusions: Our data suggest relationships between reading impairments and regional brain network connectivity in Japanese patients with AD. The brain connectome may provide adjunct biological information that could improve our understanding of reading impairment., (© 2020 S. Karger AG, Basel.)

Language impairment, or aphasia, is a disabling symptom that affects at least one third of individuals after stroke. Some affected individuals will spontaneously recover partial language function. However, despite a growing number of investigations, our understanding of how and why this recovery occurs is very limited. This Review proposes that existing hypotheses about language recovery after stroke can be conceptualized as specific examples of two fundamental principles. The first principle, degeneracy, dictates that different neural networks are able to adapt to perform similar cognitive functions, which would enable the brain to compensate for damage to any individual network. The second principle, variable neuro-displacement, dictates that there is spare capacity within or between neural networks, which, to save energy, is not used under standard levels of performance demand, but can be engaged under certain situations. These two principles are not mutually exclusive and might involve neural networks in both hemispheres. Most existing hypotheses are descriptive and lack a clear mechanistic account or concrete experimental evidence. Therefore, a better neurocomputational, mechanistic understanding of language recovery is required to inform research into new therapeutic interventions.

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.

Background: Though meta-analyses of neuropsychological and social cognitive deficits in behavioral variant frontotemporal dementia (bvFTD) have been conducted, no study has comprehensively characterized and compared the neuropsychological, social cognitive, and olfactory profiles in the behavioral and language variants of FTD., Methods: Our search yielded 470 publications meeting inclusion criteria representing 11 782 FTD patients and 19 451 controls. For each domain, we calculated Hedges' g effect sizes, which represent the mean difference between the patient and control group divided by the pooled standard deviation. The heterogeneity of these effects was assessed with Cochran's Q-statistic using a random-effects model. Meta-regressions were employed to analyze the influence of demographic and disease characteristics., Results: Though semantic variant primary progressive aphasia patients showed the greatest impairment across all task types, the three groups showed similar cognitive effect sizes once contributions from the language subdomain were excluded from analysis. Contrary to expectation, the magnitude of deficits in executive functioning, social cognition and olfaction were comparable between the three subgroups. Among indices, a metric of executive errors distinguished the behavioral variant of FTD from the language phenotypes., Conclusions: These data indicate that social cognitive and traditional executive functioning measures may not capture differences between FTD syndromes. These results have important implications for the interpretation of neuropsychological assessments, particularly when applied to the differential diagnosis of FTD. It is hoped that these findings will guide clinical and research assessments and spur new studies focused on improving the measurement of FTD syndromes.

Background and Purpose: The Vision, Aphasia, and Neglect (VAN) screening tool is a simple bedside test developed to identify patients with large vessel occlusion stroke. In the setting of intracerebral hemorrhage (ICH), there are very few bedside predictors of need for neurosurgical interventions other than age and Glasgow Coma Scale (GCS). We aimed to assess the utility of the VAN screening tool in predicting the need for neurosurgical intervention in patients with ICH., Methods: We accessed sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under receiver operating characteristics curve of VAN for identifying ICH patients who require neurosurgical intervention., Results: Among 228 ICH patients, 176 were VAN positive and 52 were VAN negative. On unadjusted analyses, VAN positive patients had a significantly higher ICH volume, GCS score, and National Institutes of Health Stroke Scale score (P < .001 for all). As compared to VAN negative patients, significantly higher proportion of VAN positive ICH patients (15.4% versus 32.4%) underwent a neurosurgical procedure such as external ventricular drain (EVD) and/or hematoma evacuation with craniotomy or craniectomy. The VAN screening tool had high sensitivity and NPV (100%) in predicting the need for craniectomy or hematoma evacuation, but had lower sensitivity (87.7%) for any neurosurgical procedure, as 15.4% of VAN negative patients received EVD., Conclusions: Our study suggests that VAN screening tool can identify high-risk ICH patients who are more likely to undergo craniotomy or craniectomy but is less sensitive to rule out need for EVD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose : The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary evidence of the measure's psychometric properties. Method : Statements were generated from the: (1) therapeutic alliance literature, (2) qualitative interviews with stakeholders, and (3) Q methodological insights with people with aphasia (PWA) ( n  = 455). A representative sample of statements was identified from the data set ( n  = 57) and reviewed by expert panels (professionals and PWA), culminating in a 42-item clinician and patient version of the aphasia and stroke therapeutic alliance measure (A-STAM). Reliability and validity of both the clinician and patient versions of A-STAM were investigated with 34 Clinician-patient dyads engaging in therapy. Result : Internal consistency and test-retest reliability were excellent for both clinician ( α  = 92; ICC = 0.93) and patient versions of A-STAM ( α  = 0.92; ICC = 0.97). In both versions, scores correlated highly with psychotherapeutic measures of therapeutic alliance, indicative of good construct validity ( r s = 0.75; r s = 0.77). Conclusion : The findings establish the preliminary reliability and validity of A-STAM and support further investigation into the measure's psychometric properties in larger samples.

Purpose: Isolated speech impairment is one of the most challenging clinical manifestations of stroke mimic (SM). We aimed to investigate perfusional and EEG pattern of isolated aphasia to better differentiate between vascular and epileptic etiology in emergency settings., Method: We retrospectively analyzed 481 cases with acute focal neurological symptoms admitted to our Stroke Unit. The patients showing isolated aphasia and confirmed ischemic infarction or SM with seizure etiology on follow-up were included for subsequent analysis of clinical, neuroimaging, and EEG data. We investigated differences in CT Perfusion maps between ROI in the anatomical area compatible with clinical presentation, contralateral ROI and EEG in order to evaluate perfusion and brain oscillatory activity abnormalities., Results: 45 patients presented isolated aphasia as principal neurological symptom: 27 cases due to acute ischemic event, 11 due to seizure SM, while 7 were SM due to other etiologies. Out of 11 SM patients with seizure etiology, significant hyperperfusion on CTP maps (MTT AI%<-10%) and sharp EEG waves were observed in 8 patients, while in 3 patients slight hypoperfusion (MTT AI%<20%) and slow EEG rhythms were detected. 24 out of 27 ischemic stroke patients presented severe hypoperfusion with MTT AI above the stroke threshold (MTT AI > 45%). All ischemic stroke patients presented slower EEG rhythms., Conclusions: The main finding of this study is the identification of different clinical and neuroimaging patterns of isolated aphasia with epileptic or ischemic etiology in emergency settings., (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Purpose : This study aimed to explore family members' experiences and preferences for receiving aphasia information during the early phases of post-stroke care. Method : Sixty-five family members completed an online survey structured according to five phases for caregiver support. The majority of participants were female (73.8%, n  = 48) and spouses/partners (81.5%, n  = 53) to a family member with aphasia. The quantitative data were analysed using descriptive statistics. The qualitative data were analysed using inductive content analysis. Result : Experiences: The majority of family members (≥50%) did not recall receiving aphasia information in four of the five phases and were not completely satisfied with information received in any phase. Preferences: Only three family members (4.6%) reported not wanting aphasia information and this pertained to the first days of care. Family members considered it useful to receive aphasia information in a written modality and via conversations with health professionals across all five phases. Family members identified difficulties obtaining aphasia information, including health professionals providing limited or inadequate information, not being aware of the term aphasia, and difficulties accessing services across care phases. Conclusion : Findings provide insight into how health professionals can better support the information needs of family members living with aphasia.

Purpose : Aphasia group therapy can result in improvements in communication, participation and quality of life (QOL). However, evidence for aphasia group interventions with combined aims across the International Classification of Functioning, Disability and Health (ICF) is limited. TeleGAIN is a holistic aphasia group intervention that can be delivered via telepractice. This study builds on prior pilot work and addresses the need for additional research into the effectiveness of TeleGAIN. The aim of this study was to describe changes in aphasia severity, communication related QOL and participation, for people with chronic aphasia following TeleGAIN. Method : Nineteen participants with aphasia were assessed on a range of outcome measures before and after a twelve-week block of TeleGAIN delivered via web based videoconferencing. Treatment provided opportunities to participate in conversation, engage with others with aphasia and complete functional communication activities. Result : Statistical analyses revealed statistically significant improvements in communication related QOL, increased engagement in communicative activities, and decreased aphasia severity. Conclusion : Results from this study suggest that the online delivery of a multi-purpose group intervention for people with aphasia can result in improved communication, communicative participation, and QOL. It also highlights the potential for intervention provided via telepractice to offer an alternative to face-to-face services.

This case series explores the relationship between verbal memory capacity and sentence comprehension in four patients with aphasia. Two sentence comprehension tasks showed that two patients, P1 and P2, had impaired syntactic comprehension, whereas P3 and P4's sentence comprehension was intact. The memory assessment tasks showed that P1 and P2 had severely impaired short-term memory, whereas P3 and P4 performed within the normal range in the short-term memory tasks. This finding suggests an association between short-term memory deficit and sentence comprehension difficulties. P1 and P3 exhibited impaired comparable working memory deficits, suggesting a dissociation between working memory and sentence comprehension.

Background: Aphasia is a quite common and very disabling symptom following stroke, negatively affecting patient's quality of life. Aim of the study is to evaluate the effectiveness of a rehabilitation training for aphasia that employ a touch-screen tablet using a virtual reality rehabilitation system (VRRS-Tablet)., Material and Methods: Thirty patients with aphasia due to ischemic or hemorrhagic stroke were randomized into either the control or the experimental group and assessed by means of a specific neuropsychological evaluation. The study lasted 6 months and included 2 phases. During the former, the experimental group underwent an experimental linguistic treatment performed using the VRRS-Tablet, while the control group was trained with a traditional linguistic treatment. In the latter, the control groups were delivered to territorial services, while the experimental group was provided with the VRRS-Tablet., Results: The experimental group improves in all the investigated areas, except for writing, while the control group only improves in comprehension, depression, and quality of life., Conclusions: Our study has demonstrated the effectiveness of a home-based telerehabilitation program specific for poststroke aphasia. The use of telerehabilitation by means of VRRS-Tablet could be one of the best solutions to treat aphasic patients after their discharge, promoting continuity of care by monitoring functional outcomes, maintaining preserved abilities, reducing depression, and improving linguistic functions, besides the psychological well-being., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The Aphasia Rapid Test (ART) is a screening questionnaire used for examining language in acute stroke patients. The ART was initially developed and validated in French. The purpose of this study was to assess the inter-rater reliability of Italian ART., Methods: The original version of the ART was translated into Italian. The inter-rater reliability was assessed by two independent neurologists who were blind to each other's ratings in 52 acute post-stroke patients., Results: The 52 patients (28 men, 24 women; mean age 73.73 ± 28.99 years) were included within 1 week of stroke onset (46 ischemic, 6 hemorrhagic), as assessed by clinical examination and confirmed by CT and/or MRI. The mean (± SD) ART value was 9.38 (± 9.26) for rater 1 and 9 (±9.31) for rater 2. The inter-rater agreement was very good, with a coefficient of concordance of 0.99 (95% CI 0.986-0.995; p < 0.0001) and a weighted kappa of 0.878 and a quadratic weighted kappa of 0.983., Conclusions: This study showed that the cross-cultural adaptation of the French version of the ART was successful in an Italian-speaking population.

Objectives: To study the applicability of National Institutes of Health Stroke Scale (NIHSS) in early predicting the prognosis of poststroke dysphagia in an acute ward., Methods: This is an observational retrospective cohort study including adult patients with ischemic stroke. Patients with various factors affecting swallowing were excluded to obtain a representative sample of 165 patients. The main outcome measure was the improvements of oral intake function., Results: The scores of facial palsy (NIHSS item 4) (odds ratio [OR]: 0.484, 95% confidence interval [CI]: 0.279-0.838, P = .0096] and language/aphasia (NIHSS item 9) (OR: 0.562, 95% CI: 0.321-0.982, P = .0430) demonstrated significantly negative effects on the early improvement of dysphagia. Moreover, the improved patients had a 4.14-fold (95% CI: 2.53-11.23, P = .005) increased odds of returning home compared with nonimproved patients., Conclusions: Our findings provide evidence that early improvement of poststroke dysphagia was significantly associated with a favorable discharge destination and NIHSS items of facial palsy and language/aphasia can be used at the onset of stroke to identify dysphagic patients at risk of achieving limited improvement. These findings provide valuable prognostic indicators for clinicians to make a precise outcome prediction at very early stage., (Copyright © 2019 Elsevier Inc. All rights reserved.)

People possess significant knowledge about how real-world events typically unfold. Such event-related semantic memory connects action and object knowledge, is essential for multiple stages of language processing, and may be impaired in neurological conditions like aphasia. However, current assessments are not well designed for measuring this knowledge. This study presents and tests a novel measure of event-related semantic memory. Task-performance data were collected from unimpaired adults across the lifespan and a sample of stroke survivors with aphasia. Individuals with aphasia also completed measures of language processing and action-/object-related semantic memory, to establish the novel measure's convergent validity. Results demonstrate that performance on the event-knowledge measure correlated with action and object semantic-memory measures and was also associated with a broader range of language-processing performance than other semantic-memory measures. These findings suggest that the novel measure can be used to detect the presence and impact of event-knowledge impairments in neurological conditions.

Purpose : The aim of this study was to investigate what speech-language pathologists describe as most important when trying to achieve client-oriented participation during aphasia rehabilitation. Method : A qualitative study including semi-structured focus group interviews with 11 speech-language pathologists. Interviews were analysed with the use of systematic text condensation. Result : Four main themes emerged from the analysis. (1) It is important to take the vulnerability of the client group into account. (2) It is important to address the client's process of realisation by navigating around unrealistic wishes and goals. (3) It is challenging to involve clients when the evidence-base for clinical practice is limited. (4) It is crucial to make therapy meaningful to the client. Conclusion : This study showed that speech-language pathologists perceived prediction of a clinical course in aphasia rehabilitation as challenging due to the vulnerable client group and the perceived need to guide the clients through the rehabilitation process. They talked about how unrealistic client goals, and the lack of a solid evidence-base to guide their clinical practice, made collaborative goal setting and treatment planning challenging. Due to these barriers, the speech-language pathologists struggled to achieve client participation, and thereby aphasia rehabilitation could not be described as fully client-oriented.

Purpose: Intensity of therapy influences outcomes in aphasia treatment, but little is known about optimum dosage across treatment approaches. Improved understanding of the effects of dose could help facilitate clinical decisions that maximise patient outcomes. This study examines learning in individuals with aphasia following exposure to one 60-min dose of computer-delivered script training, with or without a rest break. Method: Twenty participants (6F, 14M; 17 nonfluent, 3 fluent) with chronic aphasia due to left-hemisphere stroke participated. Participants had a mean (SD) age of 56.9 (8.4) years, a mean time post onset of 55.1 (range: 6.4-396.4) months, and a mean (SD) Comprehensive Aphasia Test score of 47.8 (4.0). Participants were exposed to 60 min of training, with or without a rest break, of a three-turn conversational script about either weather or traffic. Treatment was delivered via computer using a virtual clinician that visually modelled speech and guided treatment, promoting treatment fidelity. Oral reading probes for script sentences were administered at baseline (3 times), mid-treatment, immediately post-treatment, and, at various times, up to 2 weeks post-treatment to track script acquisition and maintenance. The study also examined generalisation from a trained script to a conversation with a clinician via a generalisation probe at three time points: baseline, immediately post-treatment, and 2 weeks post-treatment. Result: Following exposure to one dose of script training, participants demonstrated statistically significant improvements in oral reading accuracy and rate of script production on trained probes from baseline to immediately post-treatment and 2 weeks post-treatment. Participants also demonstrated significant change from baseline in generalisation to a conversation with a clinician immediately post-treatment and at 2 weeks post-treatment. Conclusion: Exposure to a single dose of computer-delivered script training may facilitate learning. These results have implications for future research investigating optimal dosage and scheduling parameters.